At this weekend's American Heart Association (AHA) meeting, intensive blood pressure (BP) lowering and other mainstays in cardiovascular medicine have a lot to prove, as do innovations related to GLP-1 receptor agonists and artificial intelligence (AI).
AHA's main scientific sessions run from Saturday, Nov. 7 to Monday, Nov. 9, with expanded programming starting on Friday, Nov. 6. The meeting will be held in person in Chicago and with livestreaming of select sessions.
Featured among the first AHA late-breakers will be Saturday's OPTIMAL-Stroke and OPTIMAL-Diabetes, two separate trials of intensive BP control that are expected to fill major gaps left by the landmark SPRINT trial from over 10 years ago.
While both OPTIMAL studies tested a systolic BP target of <120 mmHg for the purpose of cardiovascular protection in people starting at 130-180 mmHg, the former sought ischemic stroke survivors in particular, and the latter higher-risk individuals with type 2 diabetes, both important patient groups excluded from the SPRINT trial that had contributed to the national redefining of hypertension in 2017.
Meanwhile, another cornerstone -- albeit controversial -- cardiovascular therapy has a major hurdle in STREAM, a Saturday afternoon late-breaker. This randomized noninferiority trial is larger than the prior SITE/SAGA and will provide more important evidence on whether statin users, older adults without cardiovascular disease, are put at risk if they discontinue the therapy.
Also in the hot seat is the familiar concept of an early invasive strategy of coronary stenting or bypass surgery in patients with stable ischemic heart disease. Years after the neutral reports of ISCHEMIA, ISCHEMIA-CKD, and COURAGE, these landmark trials have the opportunity to show whether the story changes with longer follow-up during a Saturday morning featured science session at AHA.
Drugs in development also feature heavily in the scientific program.
Among the most important stories will be whether there is still a path forward for inflammation- and lipoprotein(a)-lowering for cardiovascular benefit. In fact, the ZEUS cardiovascular outcomes report for the interleukin-6 blocker ziltivekimab and the Lp(a)HORIZON trial of lipoprotein(a)-lowering pelacarsen -- both with disappointing topline results publicly available for months now -- were chosen for the opening late-breaking trial session at AHA.
In electrophysiology, highlights include Sunday presentations of the OptimPacing trial of left bundle branch pacing versus right ventricular pacing for atrioventricular block, and the SUPERIOR trial of sacubitril/valsartan (Entresto) for preventing recurrent atrial fibrillation after catheter ablation in patients with hypertension.
Monday morning then brings the placebo-controlled ATTAIN-OSA late-breaking trial on using the GLP-1 receptor agonist orforglipron (Foundayo) in people with obstructive sleep apnea and obesity or overweight.
As for a more accessible way to check for left ventricular systolic function, smartwatches with AI-enabled ECGs present an innovative approach and are the subject of the WATCH-LV trial in AHA's closing late-breaking science session on Monday.
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