Watch for these Studies at AHA Scientific Sessions

NOVEMBER 11, 2016
Kevin Campbell, MD
cardiology, heart, stem cells, heart failure, NSAIDS, cardiomyopathy, American Heart Association, AHA 2016As we prepare for this year’s annual meeting of the American Heart Association in New Orleans, several interesting studies will be on everyone’s mind.

This year’s AHA Scientific Sessions promises to be another great event. Although I am not able to attend the AHA sessions in person this year, I will be actively participating in the science and discussions with my colleagues via social media.

Look to the hashtag #AHA2016 to follow and participate in the conversation. This should be a great event where we can exchange ideas and information in order to learn how we can better treat our patients and improve outcomes.  There will be a lot of great science presented. Here are a few trials that have piqued my interest:
 
1.     PRECISION—Is there a difference in cardiac outcomes in patients who use non selective NSAIDs  vs. COX2 inhibitors? In this trial, patients with osteoarthritis or rheumatoid arthritis with or at risk for coronary artery disease were recruited in an effort to determine if there was a difference in overall benefit between celecoxib (COX2 Inhibitor) or non-selective NSAIDS (ibuprofen or naproxyn). The primary outcome of the trial is the first occurrence of cardiovascular death (including hemorrhagic death), non-fatal myocardial infarction, or non-fatal stroke. The researchers have designated the primary hypothesis to be that celecoxib is non inferior to non-selective NSAIDs. Secondary outcomes include significant GI events and patient reported arthritic pain. This particular trial is very large and has been ongoing since 2006 and should provide some insight into the controversy surrounding the use of COX-2 inhibitors in patients with CAD. In the past, there has been some evidence to suggest that celecoxib has negative cardiac effects and that naproxsyn may have positive effects—this trial may help clarify these previous data.

2.     HOPE-3 –looking at the effect of cholesterol and blood pressure therapy on cognition.  In the Heart Outcomes Prevention Evaluation-3 trial, nearly 13,000 patients were studied. In this particular analysis, investigators will present data on how the use of antihypertensive agents and cholesterol lowering agents may affect brain function. Many cardiologists are pushing lipid levels lower and lower and are also working for even stricter blood pressure control in order to mitigate risk for cardiovascular events. In the past there have been some concerns raised about the long-term cognitive effects in patients who are aggressively treated for both blood pressure and cholesterol. This study is very large and well designed and will provide insight that will help guide just how aggressively we may treat these conditions in at-risk patients going forward. 

3.     German Aortic Valve Registry—compares patients with severe AS undergoing either TAVR or surgical valve—has over 100,000 patients. In this trial, researchers will report on the one-year outcomes of intermediate surgical risk patients with aortic stenosis. There has been some recent data presented at the American College of Cardiology meetings this spring from SAPIEN-3 suggesting that TAVR may be superior to traditional aortic valve replacement surgery. Now we will hear from another large registry and see if these results remain consistent. This area of valvular heart disease is a hot topic and many cardiologists will be very interested in how these results pan out.  Will TAVR become the standard of care when it comes to dealing with intermediate-risk valve cases?

4.     Multisense Trial—Using ICD diagnostics to ultimately develop algorithms that can pick up on worsening CHF before clinically apparent. In the Multisense registry, the primary objectives of this study were to determine how ambulatory sensor measurements change with worsening heart failure, and to develop multisensor detection algorithms. While no hypothesis testing was performed, this registry may provide important data for future studies. It may help heart failure researchers determine better ways to manage CHF and prevent hospital admissions. Diagnostics of interest in this registry included thoracic impedence, physiologic response to activity and respiration. If we can develop better technologies that allow us to get an idea of our patient’s day to day CHF status, it is likely that we can prevent hospital admissions and reduce morbidity and mortality in patients with cardiomyopathies.

There are certain to be many other important trials presented—I have just highlighted a few. More importantly, many of these presentations may actually change the way we practice medicine as cardiovascular professionals. As always, the American Heart Association meetings will once again be met with great enthusiasm and interest from all of us who care for patients on a daily basis. Colleagues will reconnect both in person and through social media and ideas and research will be shared. It is my hope that each and every one of us is able to come away with a renewed commitment to provide the very best care with the newest and best evaluated therapies for our patients. 

Editor's Note: Kevin Campbell, MD, is Assistant Professor of Medicine, Division of Cardiology, University of North Carolina. He is a frequent guest commentator for several major news networks and has a social media following as "Dr. Kevin." He is a contributor to MDMag.com.


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