5 things to look for at AHA.18

With the American Heart Association’s 2018 Scientific Sessions set for Nov. 10-12 in Chicago, two co-chairs of the programming committee previewed the themes of the meeting, its most anticipated clinical trials and the two new guidelines that will be unveiled.

Here are five things to look for at AHA.18, according to Eric Peterson, MD, and Don Lloyd Jones, MD, ScM:

1.  New cholesterol guidelines

Jones, one of the coauthors of the guidelines, said the new document should help clinicians better decide who should receive PCSK9 inhibitors and inform the general process for patient selection in lipid-lowering therapies.

Both of these areas have seen considerable research and interest since the last guidelines update in 2013, which is why Jones singled them out.

“I think the major changes in the treatment of cholesterol certainly involve the FDA approval of two new agents—the PCSK9 inhibitors—and not surprisingly we spent a lot of time in the guidelines about what is the appropriate use of those medications that have been shown to reduce event rates further even in individuals that are well-treated with statins, achieving very low LDL cholesterol levels, but at pretty significant cost,” said Jones, MD, ScM, the chair of the department of preventive medicine at Northwestern University. “So, I think you can look for specific recommendations on when and in whom one should use PCSK9 inhibitors. … I think the clear recommendations will be helpful to clinicians.”

Jones said clinicians have grappled with finding the best risk assessment tools to help with patient selection for statins and other cholesterol-lowering medications. He hopes the new guidelines can help in the regard, too.

“I think you’ll see some pretty significant advances in terms of how we think about patients and who might be appropriate for using statin therapy and who might be appropriate for withholding statin therapy because it’s unlikely they’d benefit from it,” he said.

2. Late-breaking science

There are six late-breaking science sessions with four to five studies each, covering cardiovascular care from primary prevention to heart failure. A few potential highlights are listed below:

  • REDUCE-IT will have its primary results reported. The trial's top-line results indicated the potential of icosapent ethyl (Vascepa) to further reduce cardiovascular events by 25 percent in statin-treated adults.
  • VITAL will explore whether vitamin D and Omega-3 fatty acid supplementation is effective in the primary prevention of cardiovascular disease and cancer. The Omega-3 result will be interesting to look at in comparison to REDUCE-IT, as REDUCE-IT is using a more purified form of a fish-derived substance—and a higher dose—in an attempt to lower lipids and reduce cardiovascular events.
  • TRED-HF may add insight on if and when it’s safe to take a patient off pharmacological therapy after recovery from dilated cardiomyopathy.
  • TiCAB is a double-blind, randomized study comparing ticagrelor therapy with aspirin in patients undergoing coronary artery bypass grafting (CABG).

3. Social determinants of health

Considering he works in the Chicago area and the scientific sessions are in the city, Jones used an example of two local neighborhoods to pitch an AHA.18 session on the social determinants of health. He said there is a 16-year difference in life expectancy between residents of the Garfield Park neighborhood (69 years old) and people who live a few miles away downtown in the Loop (85 years old).

“There are many, many reasons for why that might be and this session is going to explore exactly what those are,” said Jones, referring to the Nov. 10 session titled, “Zip Codes are More Important than Genetic Codes.”

“Digging into the social determinants of health, these are the conditions and the environments in which we are born, in which we live, we learn, we work, we play, we worship and we age—and all those different conditions can affect a huge range of our health, our functioning, our quality of life and certainly our cardiovascular outcomes. Cardiovascular disease in this case drives much of that 16-year difference in these two neighborhoods in Chicago, so this session I think is going to be a very exciting deep dive on the importance of place and not just DNA.”

A separate session will look into the long-term impact of stress from being in a violent environment and the effect that can have on the cardiovascular system.

4. Physical activity guidelines

HHS is set to release its second edition of physical activity guidelines for Americans on Nov. 12, a decade after releasing the initial guidelines.

Since 2008, Jones said, more information has become available regarding the adequate intensity and duration of exercise, as well as the importance of resistance training in addition to aerobic workouts. He expects the updated guidelines to incorporate that recent research into actionable suggestions.

“Especially in recent years there’s been particular interest in the intensity of exercise and whether a 10-minute burst of exercise can be potentially as beneficial as a 30-minute more moderate walk, and I think there are data that are available that the guideline writers will have (to make) specific recommendations that can help to guide people in their selection of the types, the intensity and the frequency of their physical activity,” he said.

5. New format

The event is being trimmed down from its usual four-day format to a three-day affair, with sessions beginning at 7:15 a.m. each day and running into the evening.

“The meeting was long and it was a challenge in this day and age for people to get off that much work as well as to try to get through how much was being delivered at these meetings, said Peterson, MD, the executive director of the Duke Clinical Research Institute in Durham, North Carolina. “They’re going to be long days … but we think for both the presenters as well as the attendees, this new format is going to be quite lively, exciting and consistent with where displays of scientific meetings should be going in the future.”

Peterson also said the meeting organizers made an effort to add more audience engagement to the sessions, rather than each presentation seeming more like a lecture. Most rooms will enable audience members to pose questions via cell phone to presenters, moderators and panelists.

“Much less of somebody just standing up and delivering slides, much more opportunities for the actual audience to give their impressions for what science is being delivered as well as to engage directly with the speaker,” Peterson said.