Purpose of the Review
This review highlights selected cardiovascular disease (CVD) prevention studies presented at the 2019 American Heart Association (AHA) Scientific Sessions.
Several important cardiovascular prevention studies were presented at the 2019 AHA Scientific Sessions. Results from the Colchicine Cardiovascular Outcomes Trial (COLCOT) showed that low-dose colchicine reduces the risk of recurrent CVD events among patients with recent myocardial infarction. A prospective analysis from the UK Biobank cohort demonstrated that the increased CVD risk associated with clonal hematopoiesis of indeterminate potential is mitigated by a common disruptive mutation in the IL6R gene that suppresses the pro-inflammatory IL-1β/IL-6 pathway. The Treat Stroke to Target trial demonstrated that reducing low-density lipoprotein cholesterol to <70 mg/dL among patients with ischemic stroke or transient ischemic attack reduces the risk of recurrent CVD events as compared with a higher LDL-C target of 90–110 mg/dL. A secondary analysis focusing on American participants enrolled in the Reduction of Cardiovascular Events with Icosapent Ethyl-Intervention Trial (REDUCE-IT) showed that these patients receive a similar benefit in terms of cardiovascular risk reduction with icosapent ethyl as compared with the entire trial population. A post hoc analysis of the Further Cardiovascular Outcomes Research with PCSK9 Inhibition in Subjects with Elevated Risk (FOURIER) trial demonstrated that a genetic risk score comprising 27 single-nucleotide polymorphisms is associated with cardiovascular risk among patients with established atherosclerotic CVD and patients with high genetic risk receive a relatively higher benefit from evolocumab use. Similar results were observed with alirocumab use in a post hoc analysis of the ODYSSEY OUTCOMES trial where a genome-wide polygenic risk score comprising 6.5 million DNA variants was used.
These studies presented at 2019 AHA Scientific Sessions will help guide our approach to preventing CVD.
This is a preview of subscription content, log in to check access.
Buy single article
Instant unlimited access to the full article PDF.
Price includes VAT for USA
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
This is the net price. Taxes to be calculated in checkout.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
Al Rifai M, Jia X, Al-Mallah MH, Miedema MD, Martin SS, Virani SS. Major Randomized Clinical Trials in Cardiovascular Disease Prevention Presented at the 2019 American College of Cardiology Annual Scientific Session. Curr Atheroscler Rep. 2019;21(8):31.
Jia X, Al Rifai M, Gluckman TJ, Birnbaum Y, Virani SS. Highlights from Selected Cardiovascular Disease Prevention Studies Presented at the 2019 European Society of Cardiology Congress. Curr Atheroscler Rep. 2019;21(12):46.
Libby P. Inflammation in atherosclerosis. Arterioscler Thromb Vasc Biol. 2012;32(9):2045–51.
•• Ridker PM, Everett BM, Thuren T, et al. Antiinflammatory therapy with canakinumab for atherosclerotic disease. N Engl J Med. 2017;377(12):1119–31 The landmark Canakinumab Antiinflammatory Thrombosis Outcome Study (CANTOS) trial showed that Canakinumab, a fully human monoclonal antibody targeting interleukin-1β, reduces the risk of recurrent cardiovascular events among patients with previous myocardial infarction and a high-sensitivity C-reactive protein level of ≥2 mg/L.
Ridker PM, Everett BM, Pradhan A, et al. Low-dose methotrexate for the prevention of atherosclerotic events. N Engl J Med. 2019;380(8):752–62.
Nidorf SM, Eikelboom JW, Budgeon CA, Thompson PL. Low-dose colchicine for secondary prevention of cardiovascular disease. J Am Coll Cardiol. 2013;61(4):404–10.
Tardif JC, Kouz S, Waters DD, et al. Efficacy and safety of low-dose colchicine after myocardial infarction. N Engl J Med. 2019.
Libby P, Sidlow R, Lin AE, et al. Clonal hematopoiesis: crossroads of aging, cardiovascular disease, and cancer: JACC Review Topic of the Week. J Am Coll Cardiol. 2019;74(4):567–77.
Khetarpal SA, Qamar A, Bick AG, et al. Clonal hematopoiesis of indeterminate potential reshapes age-related CVD: JACC Review Topic of the Week. J Am Coll Cardiol. 2019;74(4):578–86.
•• Jaiswal S, Natarajan P, Silver AJ, et al. Clonal hematopoiesis and risk of atherosclerotic cardiovascular disease. N Engl J Med. 2017;377(2):111–21 This seminal report established the association of clonal hematopoiesis of indeterminate potential (CHIP) with atherosclerotic cardiovascular disease.
Fuster JJ, MacLauchlan S, Zuriaga MA, et al. Clonal hematopoiesis associated with TET2 deficiency accelerates atherosclerosis development in mice. Science. 2017;355(6327):842–7.
Sano S, Oshima K, Wang Y, et al. Tet2-mediated clonal hematopoiesis accelerates heart failure through a mechanism involving the IL-1beta/NLRP3 inflammasome. J Am Coll Cardiol. 2018;71(8):875–86.
Interleukin-6 Receptor Mendelian Randomization Analysis C, Swerdlow DI, Holmes MV. et alThe interleukin-6 receptor as a target for prevention of coronary heart disease: a mendelian randomization analysis. Lancet. 2012;379(9822):1214–24.
Bick AG, Pirruccello JP, Griffin GK, et al. Genetic IL-6 signaling deficiency attenuates cardiovascular risk in clonal hematopoiesis. Circulation. 2019.
Amarenco P, Bogousslavsky J, Callahan A 3rd, et al. High-dose atorvastatin after stroke or transient ischemic attack. N Engl J Med. 2006;355(6):549–59.
Kernan WN, Ovbiagele B, Black HR, et al. Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2014;45(7):2160–236.
Grundy SM, Stone NJ, Bailey AL, et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2019;73(24):3168–209.
Amarenco P, Kim JS, Labreuche J, et al. A comparison of two LDL cholesterol targets after ischemic stroke. N Engl J Med. 2019.
•• Bhatt DL, Steg PG, Miller M, et al. Cardiovascular risk reduction with icosapent ethyl for hypertriglyceridemia. N Engl J Med. 2019;380(1):11–22 The landmark Reduction of Cardiovascular Events with Icosapent Ethyl–Intervention Trial (REDUCE-IT) trial showed that icosapent ethyl therapy decreases the risk of cardiovascular events in high-risk primary and secondary prevention settings in patients with triglyceride level of 150 to 499 mg/dL and low-density lipoprotein cholesterol level of 41 to 100 mg/dL.
Bhatt DL, Miller M, Brinton EA, et al. REDUCE-IT USA: results from the 3146 patients randomized in the United States. Circulation. 2019.
Jia X, Kohli P, Virani SS. Omega-3 fatty acid and cardiovascular outcomes: insights from recent clinical trials. Curr Atheroscler Rep. 2019;21(1):1.
Jia X, Akeroyd JM, Nasir K, et al. Eligibility and cost for icosapent ethyl based on the REDUCE-IT Trial. Circulation. 2019;139(10):1341–3.
Additive therapies for cardiovascular disease: effectiveness and value. Final evidence report [https://icerreview.org/wpcontent/uploads/2019/02/ICER_CVD_Final_Evidence_Report_101719.pdf] Accessed: November 20, 2019.
Sabatine MS, Giugliano RP, Keech AC, et al. Evolocumab and clinical outcomes in patients with cardiovascular disease. N Engl J Med. 2017;376(18):1713–22.
Schwartz GG, Steg PG, Szarek M, et al. Alirocumab and cardiovascular outcomes after acute coronary syndrome. N Engl J Med. 2018;379(22):2097–107.
• Navarese EP, Robinson JG, Kowalewski M, et al. Association between baseline LDL-C level and total and cardiovascular mortality after LDL-C lowering: a systematic review and meta-analysis. JAMA. 2018;319(15):1566–79 This meta-analysis of 34 clinical trials showed that more intensive low-density lipoprotein cholesterol lowering compared with less intensive lowering is associated with a greater reduction in risk of total and cardiovascular mortality and the greatest benefit from low-density lipoprotein cholesterol lowering therapy may be seen in patients with higher baseline levels.
Khan SU, Riaz H, Rahman H, et al. Association of baseline LDL-C with total and cardiovascular mortality in patients using proprotein convertase subtilisin-kexin type 9 inhibitors: a systematic review and meta-analysis. J Clin Lipidol. 2019;13(4):538–49.
Sugrue LP, Desikan RS. What are polygenic scores and why are they important? JAMA. 2019;321(18):1820–1.
Marston NA, Kamanu FK, Nordio F, et al. Predicting benefit from evolocumab therapy in patients with atherosclerotic disease using a genetic risk score: results from the FOURIER Trial. Circulation. 2019.
Mega JL, Stitziel NO, Smith JG, et al. Genetic risk, coronary heart disease events, and the clinical benefit of statin therapy: an analysis of primary and secondary prevention trials. Lancet. 2015;385(9984):2264–71.
Khera AV, Chaffin M, Aragam KG, et al. Genome-wide polygenic scores for common diseases identify individuals with risk equivalent to monogenic mutations. Nat Genet. 2018;50(9):1219–24.
Damask A, Steg PG, Schwartz GG, et al. Patients with high genome-wide polygenic risk scores for coronary artery disease may receive greater clinical benefit from alirocumab treatment in the ODYSSEY OUTCOMES trial. Circulation. 2019.
Conflict of Interest
A.M., D.M., M.G., L.S.S., and R.S.B. each declare that they have no conflict of interest. S.S.V. reports research support from the Department of Veterans Affairs, the World Heart Federation, and the Tahir and Jooma Family; honorarium from the American College of Cardiology (Associate Editor for Innovations, acc.org); and membership with the Steering Committee of the Patient and Provider Assessment of Lipid Management (PALM) registry at the Duke Clinical Research Institute (no financial remuneration).
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
This article is part of Topical Collection on Reviews and New Research Implications
About this article
Cite this article
Mehta, A., Mahtta, D., Gulati, M. et al. Cardiovascular Disease Prevention in Focus: Highlights from the 2019 American Heart Association Scientific Sessions. Curr Atheroscler Rep 22, 3 (2020). https://doi.org/10.1007/s11883-020-0822-6
- Cardiovascular disease
- Proprotein convertase subtilisin/kexin type 9 inhibitors
- Icosapent ethyl