Spotlight on cardiology
The European Society of Cardiology Congress – a key get-together in the cardiovascular world – took place in tragic circumstances in Barcelona this year, just days after the August terrorist attack which killed at least 16 people and left many others injured. While the organisers issued a strong statement of sympathy and solidarity, there was no stopping the Congress which is set to be one of the most important in years, with a number of large trials reporting results.
One of the potential game-changers is the CANTOS trial, involving over 10,000 people with prior myocardial infarction. The trial is testing canakinumab, a monoclonal antibody which targets an inflammatory pathway, for the prevention of major adverse cardiac events. Preliminary results, announced at ESC 2017 and simultaneously published in the New England Journal of Medicine, showed that the drug reduced events by 15% compared with placebo.
Cantos provides long-awaited evidence to bolster the so-called “inflammatory hypothesis” in heart disease. The potential downsides of the treatment are the high cost of the immunotherapy and the fact that it increased the risk of fatal infections.
Another key trial reporting at ESC 2017 is COMPASS, which shows that the novel anticoagulant (NOAC) rivaroxaban plus aspirin improves outcomes in stable cardiovascular disease.
The trial, which randomised over 27,000 patients to various combinations of treatments, found that the addition of rivaroxaban to aspirin reduced the likelihood of myocardial infarction, stroke or cardiovascular death by 24%, improving overall survival by 18%.
Addition of the NOAC did increase the risk of GI bleeding, but not for fatal or cerebral bleeding. Analysis showed that with 23 months of treatment in 1000 patients, the addition of rivaroxaban to aspirin would prevent 13 infarctions or strokes and seven deaths from any cause, at a cost of 12 major bleeds, most of which would be easily treatable.
Here are some other highlights from the congress:
- Japanese researchers found that poor sleep is significantly associated with ischaemic heart disease and stroke, in an observational study of 13,000 patients.
- Swedish researchers found that in contrast to major guideline recommendations, giving antiplatelet therapy to STEMI patients in the ambulance on the way to the hospital was no better than waiting for in-hospital treatment.
- A Swiss team found a reduction in the gender gap in mortality from heart attack. Younger women had been shown to be more likely to die from MI than men of a similar age in previous studies, but that gap has narrowed over the past 20 years.
- A substudy of the PRECISION trial looked at the effect of various NSAIDs on blood pressure. Ibuprofen was associated with a significant increase in systolic blood pressure, while celecoxib was not.
- Apixaban lowers stroke risk in atrial fibrillation patients undergoing cardioversion, according to late-breaking results from the EMANATE trial.
- A 14-year study has found that statins lower the risk of both breast cancer and overall mortality. The huge study involved over a million people.
- And finally, married patients with heart disease are more likely to survive than those who are single or widowed, a large study from the ACALM Study Unit has found.
For more information on these and other studies, click here.
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