Cardiovascular Disease: Top Papers in 2022

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Apixaban May be the Safer DOAC in Afib, Suggests First Large Comparative Analysis

In patients with atrial fibrillation (AF), use of the factor Xa inhibitor apixaban was associated with up to a 28% lower risk of gastrointestinal (GI) bleeding when compared with the 3 other now-popular direct oral anticoagulants (DOACs) dabigatran, edoxaban, and rivaroxaban.

The finding comes from a large-scale multinational cohort study including more than 500 000 new users of the medications that also found the 4 agents associated with similar rates of ischemic stroke, systemic embolism, and all cause mortality.

FDA Approves Mavacamten, First-in-Class Treatment for Obstructive Hypertrophic Cardiomyopathy

The US Food and Drug Administration (FDA) on April 28, 2022, approved mavacamten for treatment of adults with symptomatic obstructive hypertrophic cardiomyopathy (obstructive HCM).

The first-in-class allosteric and reversible inhibitor selective for cardiac myosin specifically targets the underlying pathophysiology of the genetic disorder and is associated with improvement in functional capacity and symptoms. The FDA previously granted breakthrough therapy designation to mavacamten.

USPSTF Finalizes Recommendations for Use of Aspirin in Primary CVD Prevention

In its final recommendation on initiating aspirin for primary prevention of CVD or stroke the USPSTF issued a grade C recommendation for use of low-dose aspirin in adults aged 40-59 years who have a ≥10% 10-year CVD risk. Evidence for a net benefit of the therapy in this age group is small, the recommendation states, and the decision to initiate therapy should be individualized.

Persons who are not at increased risk for bleeding and who are willing to take the aspirin daily are more likely to benefit. In adults aged ≥60 years, the final recommendation is against initiation of low-dose aspirin for primary CVD prevention, to which the group assigned a grade D.

New AHA Statement on NAFLD and Cardiovascular Risk: A Guideline Topline

The progressive increase in incidence of NAFLD is largely and proportionally driven by steadily rising rates of obesity, metabolic syndrome, and T2D, according to a new scientific statement from the American Heart Association. Global prevalence may exceed 35% in the next decade, AHA predicts.

NAFLD has the potential to progress nonalcoholic steatohepatitis (NASH), cirrhosis, and hepatocellular carcinoma and it is now a well-known risk factor for atherosclerotic cardiovasuclar disease, the leading cause of death in patients with hepatic steatosis.

DASH Diet May Prevent Nearly 27 000 US CVD Events in Patients with Stage 1 Hypertension, Reveals New Simulation

Adoption of the Dietary Approaches to Stop Hypertension (DASH) diet may have the greatest impact for US patients with stage 1 hypertension (HTN) compared to other nonpharmacologic interventions, according to new research.

Findings from the simulation study showed adopting the DASH diet would prevent an estimated 16 000 CVD events among men and 11 000 among women with untreated stage 1 HTN. The DASH dietary plan was one of several nonpharmacologic lifestyle interventions analyzed in the study for its impact on elevated blood pressure (BP).

Regular Use of Acetaminophen May Significantly Increase Hypertension and CV Risk

Adults with hypertension who regularly take 4g of acetaminophen daily risk an increase in SBP of approximately 5 mm Hg—a rise with meaningful long-term implications for CV disease, according to authors of the PATH-BP trial.

Their findings call in to question the routine recommendation of acetaminophen as a safe alternative to nonsteroidal NSAIDs for common chronic painful conditions and particularly in persons with hypertension. The implications are significant given that acetaminophen is the most widely used over-the-counter and prescription analgesic worldwide, the authors write.

Treatment Gap: In Patients with ASCVD, Low Use of Statins, High-intensity Statins Persists

In a study of more than 600 000 patients with ASCVD, nearly half were not being treated with a statin and less than one-quarter had a prescription fill for a high-intensity statin, according to findings published in the journal JACC.

The authors also report that among the patients much less likely to receive guideline-recommended statins were younger individuals (<45 years), women, and those with noncoronary atherosclerosis (peripheral arterial and cerebrovascular disease). Study authors note it is one of the largest recent analyses of US statin prescribing habits.