Top 6 Highlights from 2023 ACC Meeting

March 4^th saw the kickoff of the American College of Cardiology’s Annual Meeting in New Orleans. For three days, leading clinicians and organizations presented thought-provoking research in the world of cardiology. The Family Heart Foundation presented our research in a scientific poster during the sessions. Highlights from the event include:

Chief Medical Officer for the Family Heart Foundation, Dr. Mary McGowan, presented a poster based on an analysis of 38 million high risk Americans in the Family Heart Database^TM.

The results: Key findings of the study reveal:

1. Only 27.8% of high-risk patients ever reached medical guideline-recommended LDL-cholesterol levels
2. People who did reach recommended LDL-cholesterol levels only kept their LDL at that level for less than 6 months at a time, on average
3. 79.5% of clinicians never prescribed combination cholesterol-lowering medications though the guidelines provide direction and rational for doing so
4. Only 2.2% of high-risk patients received combination cholesterol-lowering medications

What this means: There is a glaring gap in American healthcare when it comes to LDL-cholesterol management. Research shows that lower LDL for longer is better, but over two-thirds of Americans aren’t reaching their LDL safe zone. That’s a large majority of Americans walking around in danger, and they don’t know it.

Dr. Steven Nissen from the Cleveland Clinic presented the much-anticipated results of Esperion’s CLEAR Outcomes trial for bempedoic acid. This 4 year study looked at cardiovascular outcomes for patients with or at risk for atherosclerotic cardiovascular disease (ASCVD) who are unable to tolerate statins and who either took bempedoic acid or placebo.

This global study included nearly 14,000 patients, and the standing room only audience applauded when Dr. Nissen announced that 48% of them were women. It was a poignant moment proving we’ve come a long way in balancing the gender scales in cardiovascular research (we still have further to go!).

The results: The study showed that bempedoic acid lowered LDL-cholesterol by 21% and cut the relative risk of major cardiovascular events by 13-15%, including relative risk of a heart attack by 23%.

What this means: This is the first outcomes trial for bempedoic acid and shows that bempedoic acid not only lowers LDL, but also reduces the risk for cardiovascular events. This study is also the first outcomes trial ever in statin intolerant patients. Results were very positive for this population who need non-statin treatment options.

Bempedoic acid is currently FDA approved. It’s available for people with ASCVD and for those with FH who are on maximally tolerated statins. For those with documented statin-associated side effects, “maximally tolerated” can be no statin at all. Esperion will apply to the FDA for an expanded indication for cardiovascular risk reduction based on these outcomes.

On the final morning of the conference, Dr. Christie Ballantyne presented Phase 2 results of a clinical trial on the safety and efficacy of Merck’s oral PCSK9 inhibitor, MK-0616.

The results: The study revealed promising numbers for those who were on MK-0616. It lowered LDL-cholesterol by up to 61% and eighty percent of patients on the lowest dose of MK-0616 achieved their guideline-recommended LDL levels, while nearly 91% of those on the highest dose brought their LDL to the safe zone.

What this means: This means we may also have an oral PCSK9 inhibitor on the horizon. It’s important that people with high LDL-cholesterol have options to lower their LDL since we know it’s an important risk factor for cardiovascular disease.

In August of 2022, Amgen released results of their FOURIER-OLE (Further cardiovascular Outcomes Research with PCSK9 Inhibition in Subjects with Elevated – Risk-Open Label Extension) study. It essentially said that lower LDL for longer reduces the risk of heart attack, stroke, and cardiovascular-related death. This weekend, Amgen presented data on the impact of earlier versus later initiation of its PCSK9 inhibitor, evolocumab, on total cardiovascular events.

The results: Over the duration of 5 or more years, those who started taking evolocumab earlier had 19% fewer total cardiovascular events compared to those who started taking it later.

What this means: Don’t wait! With LDL-cholesterol, lower for longer is really better when it comes to preventing heart attacks, strokes, heart procedures, and death from cardiovascular disease.

One commenter remarked this study was very “timely” as many clinicians are seeing patients adopting this dietary lifestyle. Data from the UK Biobank looked at 305 patients who self-reported a diet that is more than 45% fats and no more than 25% carbohydrates and compared them with people who reported being on a standard diet.

The results: After an average of 11.8 years, those who were on the low-carb high-fat (LCHF) diet had higher levels of LDL-cholesterol. Plus, 9.8% of those who followed the LCHF diet had a new cardiac event in that time, while only 4.3% of those who reported a standard diet had a new cardiac event in that same time.

What this means: This study had significant limitations, but this initial look at the effects of a keto diet shows an increased risk of cardiovascular events, including heart attack, stroke, or coronary revascularization.

The longest line at ACC2023 was for the lipoprotein(a), also known as Lp(a), testing.  Over the 3 days of the conference more than 1,000 people had their Lp(a) tested!

What this means: There is clearly an interest in Lp(a) screening in every part of the health care industry – a great sign in the lead up to March 24, Lp(a) Awareness Day! Hopefully this means more of the healthcare professionals who attended the meeting will screen more of their own patients! Do you know your Lp(a)?