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Tag: European Society of Cardiology

  • Weight loss drug helps heart failure patients with obesity.

    Weight loss drug helps heart failure patients with obesity.

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    Newswise — Amsterdam, Netherlands – 25 Aug 2023: Semaglutide improves heart failure-related symptoms and physical function and results in greater weight loss compared with placebo in patients with heart failure with preserved ejection fraction (HFpEF) and obesity, according to late breaking research presented in a Hot Line session today at ESC Congress 2023.1

    Approximately half of patients with heart failure in the community have HFpEF.2 Most patients with HFpEF are overweight or obese, and growing evidence suggests that obesity and excess adiposity are not simply comorbidities, but may play a pivotal role in the development and progression of HFpEF.3 Patients with obesity-related HFpEF have an especially high burden of debilitating symptoms (shortness of breath, exertional intolerance, swelling/oedema) and physical limitations, which collectively result in a poor quality of life.4,5 Few treatment options are available, and there are no approved therapies specifically targeting the obesity phenotype of HFpEF.

    Semaglutide is a potent glucagon-like-peptide-1 receptor agonist which has previously been shown to produce substantial weight loss in people with overweight and obesity.6 The STEP-HFpEF trial tested the hypothesis that treatment with semaglutide can significantly improve symptoms, physical limitations and exercise function, in addition to weight loss, in patients with HFpEF and obesity.7

    STEP-HFpEF was a randomised, double-blind, placebo-controlled trial conducted at 96 sites in 13 countries in Asia, Europe, North America and South America. The trial included patients with HFpEF (left ventricular ejection fraction ≥45%), body mass index (BMI) ≥30 kg/m2, heart failure symptoms and functional limitations (New York Heart Association functional class II–IV and Kansas City Cardiomyopathy Questionnaire Clinical Summary Score [KCCQ-CSS] <90 points).

    Participants were randomly assigned in a 1:1 ratio to once-weekly subcutaneous semaglutide 2.4 mg or placebo for 52 weeks. The trial had two primary endpoints: change from baseline to week 52 in 1) KCCQ-CSS, a gold standard measure of heart failure-related symptoms and physical limitations; and 2) body weight. Confirmatory secondary endpoints included change in 6-minute walk distance (6MWD – a validated measure of exercise function); a hierarchical composite endpoint of death, heart failure events and change in KCCQ-CSS and 6MWD; and change in C-reactive protein (CRP – a measure of inflammation).

    The trial included 529 patients. The median age was 69 years and 56.1% were women. The median body weight and BMI at baseline were 105.1 kg and 37.0 kg/m2, respectively. At baseline, patients had a substantial degree of heart failure-related symptoms, physical limitations and poor exercise tolerance: 66.2% were NYHA class II and 33.8% were NYHA class III–IV; the median KCCQ-CSS was 58.9 points; and the median 6MWD was 320 meters.

    The trial met both primary endpoints and all confirmatory secondary endpoints. The mean change in KCCQ-CSS from baseline to week 52 was 16.6 points with semaglutide versus 8.7 points with placebo (estimated treatment difference [ETD]: 7.8 points, 95% confidence interval [CI] 4.8 to 10.9; p<0.001). The mean change in body weight from baseline to week 52 was -13.3% with semaglutide versus -2.6% with placebo (ETD: -10.7%, 95% CI -11.9% to -9.4%; p<0.001).

    Regarding secondary endpoints, the mean change in 6MWD was 21.5 meters for semaglutide versus 1.2 meters for placebo (ETD: 20.3 meters, 95% CI 8.6 to 32.1; p<0.001). For the hierarchical composite endpoint, semaglutide produced more wins than placebo (win ratio 1.72, 95% CI 1.37 to 2.15; p<0.001). The mean change in CRP was -43.5% and -7.3% with semaglutide and placebo, respectively (estimated treatment ratio 0.61, 95% CI 0.51 to 0.72; p<0.001).

    In terms of exploratory endpoints, the change in NTproBNP at 52 weeks was -20.9% and -5.3% for semaglutide versus placebo (estimated treatment ratio 0.84, 95% CI 0.71 to 0.98). One patient in the semaglutide group and 12 in the placebo group experienced an adjudicated event of heart failure hospitalisation or urgent visit (hazard ratio 0.08, 95% CI 0.00 to 0.42). Serious adverse events were reported in 35 (13.3%) and 71 (26.7%) participants with semaglutide and placebo, respectively (p<0.001).

    Principal investigator Dr. Mikhail Kosiborod of Saint Luke’s Mid America Heart Institute, Kansas City, US said: “In patients with HFpEF and obesity, treatment with semaglutide 2.4 mg produced large improvements in symptoms, physical limitations and exercise function, reduced inflammation, and resulted in greater weight loss and fewer serious adverse events as compared with placebo. To our knowledge, this is the first trial of a pharmacologic agent to specifically target obesity as a treatment strategy for HFpEF, and the magnitude of the benefits we observed is the largest seen with any agent in HFpEF. This will likely have a significant impact on clinical practice, especially since there is a dearth of efficacious therapies in this vulnerable patient group. We believe that these findings should also change the nature of the conversation about the role of obesity in HFpEF, as the STEP-HFpEF results clearly indicate that obesity is not simply a comorbidity in patients with HFpEF but a root cause and a target for therapeutic intervention.”

     

    References and notes

    1STEP-HFpEF will be discussed during Hot Line 1 on Friday 25 August at 11:15 to 12:15 CEST in room Amsterdam.

    2Dunlay SM, Roger VL, Redfield MM. Epidemiology of heart failure with preserved ejection fraction. Nat Rev Cardiol. 2017;14:591–602.

    3Borlaug BA, Jensen MD, Kitzman DW, et al. Obesity and heart failure with preserved ejection fraction: new insights and pathophysiological targets. Cardiovasc Res. 2023;118:3434-3450.

    4Reddy YNV, Lewis GD, Shah SJ, et al. Characterization of the obese phenotype of heart failure with preserved ejection fraction: a RELAX trial ancillary study. Mayo Clin Proc. 2019;94:1199–

    1209.

    5Reddy YNV, Rikhi A, Obokata M, et al. Quality of life in heart failure with preserved ejection fraction: importance of obesity, functional capacity, and physical inactivity. Eur J Heart Fail. 2020;22:1009–1018.

    6 Wilding JPH, Batterham RL, Calanna S, et al. Once-weekly semaglutide in adults with overweight or obesity. N Engl J Med. 2021;384:989-1002.

    7Kosiborod MN, Abildstrøm SZ, Borlaug BA, et al. Design and baseline characteristics of STEP-HFpEF program evaluating semaglutide in patients With obesity HFpEF phenotype. JACC Heart Fail. 2023;S2213-1779(23)00245-7.

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  • Study challenges advice to limit high-fat dairy in global diet

    Study challenges advice to limit high-fat dairy in global diet

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    Newswise — Sophia Antipolis, 7 July 2023:  Unprocessed red meat and whole grains can be included or left out of a healthy diet, according to a study conducted in 80 countries across all inhabited continents and published today in European Heart Journal, a journal of the European Society of Cardiology (ESC).1 Diets emphasising fruit, vegetables, dairy (mainly whole-fat), nuts, legumes and fish were linked with a lower risk of cardiovascular disease (CVD) and premature death in all world regions. The addition of unprocessed red meat or whole grains had little impact on outcomes.

    “Low-fat foods have taken centre stage with the public, food industry and policymakers, with nutrition labels focused on reducing fat and saturated fat,” said study author Dr. Andrew Mente of the Population Health Research Institute, McMaster University, Hamilton, Canada. “Our findings suggest that the priority should be increasing protective foods such as nuts (often avoided as too energy dense), fish and dairy, rather than restricting dairy (especially whole-fat) to very low amounts. Our results show that up to two servings a day of dairy, mainly whole-fat, can be included in a healthy diet. This is in keeping with modern nutrition science showing that dairy, particularly whole-fat, may protect against high blood pressure and metabolic syndrome.”

    The study examined the relationships between a new diet score and health outcomes in a global population. A healthy diet score was created based on six foods that have each been linked with longevity. The PURE diet included 2-3 servings of fruit per day, 2-3 servings of vegetables per day, 3-4 servings of legumes per week, 7 servings of nuts per week, 2-3 servings of fish per week, and 14 servings of dairy products (mainly whole fat but not including butter or whipped cream) per week. A score of 1 (healthy) was assigned for intake above the median in the group and a score of 0 (unhealthy) for intake at or below the median, for a total of 0 to 6. Dr. Mente explained: “Participants in the top 50% of the population – an achievable level – on each of the six food components attained the maximum diet score of six.”

    Associations of the score with mortality, myocardial infarction, stroke and total CVD (including fatal CVD and non-fatal myocardial infarction, stroke and heart failure) were tested in the PURE study which included 147,642 people from the general population in 21 countries. The analyses were adjusted for factors that could influence the relationships such as age, sex, waist-to-hip ratio, education level, income, urban or rural location, physical activity, smoking status, diabetes, use of statins or high blood pressure medications, and total energy intake.

    The average diet score was 2.95. During a median follow-up of 9.3 years, there were 15,707 deaths and 40,764 cardiovascular events. Compared with the least healthy diet (score of 1 or less), the healthiest diet (score of 5 or more) was linked with a 30% lower risk of death, 18% lower likelihood of CVD, 14% lower risk of myocardial infarction and 19% lower risk of stroke. Associations between the healthy diet score and outcomes were confirmed in five independent studies including a total of 96,955 patients with CVD in 70 countries.

    Dr. Mente said: “This was by far the most diverse study of nutrition and health outcomes in the world and the only one with sufficient representation from high-, middle- and low-income countries. The connection between the PURE diet and health outcomes was found in generally healthy people, patients with CVD, patients with diabetes, and across economies.”

    “The associations were strongest in areas with the poorest quality diet, including South Asia, China and Africa, where calorie intake was low and dominated by refined carbohydrates. This suggests that a large proportion of deaths and CVD in adults around the world may be due to undernutrition, that is, low intakes of energy and protective foods, rather than overnutrition. This challenges current beliefs,” said Professor Salim Yusuf, senior author and principal investigator of PURE.

    In an accompanying editorial, Dr. Dariush Mozaffarian of the Friedman School of Nutrition Science and Policy, Tufts University, Boston, US stated: “The new results in PURE, in combination with prior reports, call for a re-evaluation of unrelenting guidelines to avoid whole-fat dairy products. Investigations such as the one by Mente and colleagues remind us of the continuing and devastating rise in diet-related chronic diseases globally, and of the power of protective foods to help address these burdens. It is time for national nutrition guidelines, private sector innovations, government tax policy and agricultural incentives, food procurement policies, labelling and other regulatory priorities, and food-based healthcare interventions to catch up to the science. Millions of lives depend on it.”

     

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  • Short Bursts of Vigorous Activity Linked with Increased Longevity

    Short Bursts of Vigorous Activity Linked with Increased Longevity

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    Newswise — Sophia Antipolis, 28 October 2022:  Two minute bursts of vigorous activity totalling 15 minutes a week are associated with a reduced risk of death, according to research published today in European Heart Journal, a journal of the European Society of Cardiology (ESC).1

    “The results indicate that accumulating vigorous activity in short bouts across the week can help us live longer,” said study author Dr. Matthew N. Ahmadi of the University of Sydney, Australia. “Given that lack of time is the most commonly reported barrier to regular physical activity, accruing small amounts sporadically during the day may be a particularly attractive option for busy people.”

    A second study, also published today in EHJ, found that for a given amount of physical activity, increasing the intensity was associated with a reduced likelihood of cardiovascular disease.2 “Our study shows that it’s not just the amount of activity, but also the intensity, that is important for cardiovascular health,” said study author Dr. Paddy C. Dempsey of the University of Leicester and University of Cambridge, UK, and the Baker Heart and Diabetes Institute, Melbourne, Australia.

    Both studies included adults aged 40 to 69 years from the UK Biobank. Participants wore an activity tracker on their wrist for seven consecutive days. This is an objective way to measure motion, and particularly sporadic activity of different intensities during the day.

    The first study enrolled 71,893 adults without cardiovascular disease or cancer. The median age was 62.5 years and 56% were women. The investigators measured the total amount of weekly vigorous activity and the frequency of bouts lasting two minutes or less. Participants were followed for an average of 6.9 years. The investigators analysed the associations of volume and frequency of vigorous activity with death (all-cause, cardiovascular disease and cancer) and incidence of cardiovascular disease and cancer after excluding events occurring in the first year.

    The risk of all five adverse outcomes reduced as the volume and frequency of vigorous activity increased, with benefits seen even with small amounts. For example, participants with no vigorous activity had a 4% risk of dying within five years. Risk was halved to 2% with less than 10 minutes of weekly vigorous activity, and fell to 1% with 60 minutes or more.

    Compared with just two minutes of vigorous activity per week, 15 minutes was associated with an 18% lower risk of death and a 15% lower likelihood of cardiovascular disease, while 12 minutes was associated with a 17% reduced risk of cancer. Further gains were observed with greater amounts of vigorous activity. For instance, approximately 53 minutes a week was associated with a 36% lower risk of death from any cause.

    Regarding frequency, accumulating short bouts (up to two minutes) of vigorous activity on average four times a day was associated with a 27% lower risk of death. But health benefits were observed at even lower frequencies: 10 short bouts a week was associated with 16% and 17% lower risks of cardiovascular disease and cancer, respectively.

    The second study included 88,412 adults free of cardiovascular disease. The average age was 62 years and 58% were women. The investigators estimated the volume and intensity of physical activity, then analysed their associations with incident cardiovascular disease (ischaemic heart disease or cerebrovascular disease). Participants were followed for a median 6.8 years.

    The researchers found that both higher amounts and greater intensity were associated with lower rates of incident cardiovascular disease. Increasing the intensity led to greater reductions in cardiovascular disease for the same volume of exercise. For example, the rate of cardiovascular disease was 14% lower when moderate-to-vigorous activity accounted for 20% rather than 10% of activity, the equivalent of converting a 14 minute stroll into a brisk seven minute walk.

    Dr. Dempsey said: “Our results suggest that increasing the total volume of physical activity is not the only way to reduce the likelihood of developing cardiovascular disease. Raising the intensity was also particularly important, while increasing both was optimal. This indicates that boosting the intensity of activities you already do is good for heart health. For example, picking up the pace on your daily walk to the bus stop or completing household chores more quickly.”

    ENDS

     

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    Funding: Please see the papers.

    Disclosures: Please see the papers.

    Notes

    References

    1Ahmadi MN, Clare PJ, Katzmarzyk PT, et al. Vigorous physical activity, incident heart disease, and cancer: how little is enough? Eur Heart J. 2022. doi:10.1093/eurheartj/ehac572.

    Link will go live on publication:

    https://academic.oup.com/eurheartj/article-lookup/doi/10.1093/eurheartj/ehac572

    2Dempsey PC, Rowlands AV, Strain T, et al. Physical activity volume, intensity and incident cardiovascular disease. Eur Heart J. 2022. doi:10.1093/eurheartj/ehac613.

    Link will go live on publication:

    https://academic.oup.com/eurheartj/article-lookup/doi/10.1093/eurheartj/ehac613

    Joint editorial:

    Matthews CE, Saint-Maurice PF. The hare and the tortoise: physical activity intensity and scientific translation. Eur Heart J. 2022. doi:10.1093/eurheartj/ehac626.

    Link will go live on publication:

    https://academic.oup.com/eurheartj/article-lookup/doi/10.1093/eurheartj/ehac626

    About the European Society of Cardiology

    The European Society of Cardiology brings together health care professionals from more than 150 countries, working to advance cardiovascular medicine and help people lead longer, healthier lives.

    About European Heart Journal

    European Heart Journal (EHJ) is the flagship journal of the European Society of Cardiology. It is the world’s leading publication in general cardiology. Please acknowledge the journal as a source in any articles.

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