Sek Kathiresan, MD after Novo Nordisk’s weight loss drug Wegovy was shown to cut CV events by 20%.

——————-

First time reading Cardiac Wire? Sign up here.

Cardiology Pharmaceuticals

Wegovy Cuts Weight and Cardiovascular Events

The hottest medication in the world got even hotter this week after Novo Nordisk revealed that its weight loss drug Wegovy (semaglutide) also reduces major cardiac event risks by 20% – a revelation that could change how GLP-1s are used, perceived, and reimbursed.

Novo Nordisk’s double-blinded SELECT trial gave either semaglutide (2.4 mg weekly) or a placebo to 17,604 non-diabetic obese adults with cardiovascular disease (≥45yrs, mean BMI 33, 41 countries, 800 sites) in addition to standard of care. 

Over a 5-year follow up period, the semaglutide group…

• Had a 20% lower risk of major cardiovascular events
• Achieved reductions in cardiovascular death, heart attacks, and stroke
• Showed that semaglutide was safe and well-tolerated, matching previous trials

Although the complete study hasn’t been released, these topline results were widely viewed as among the most significant from a preventative cardiology trial in recent memory. They also sparked a frenzy on CardioTwitter, and widespread coverage across cardiology and mainstream news sites, while driving a massive 14% surge in Novo Nordisk’s stock price in a single day. 

And for good reason. If semaglutide and other GLP-1s are proven to truly slash CV events by a fifth it could…

• Improve the cardiovascular health of an untold number of GLP-1 users
• Prompt the FDA to approve semaglutide for CV risk reduction
• Pressure Medicare and commercial payors to finally cover weight loss drugs
• Reverse critical narratives around weight loss medications
• Solidify cardiology’s role in weight and cardiometabolic care
• Further expand the (already massive) value of the weight loss segment

On a more scientific note, SELECT also prompted some interesting discussions regarding what’s driving semaglutide’s CV event reductions (e.g. directly from weight loss, cardiometabolic improvements, vascular improvements, all of the above). Further understanding of these mechanisms might lead to new CVD treatments.

The Takeaway

Although many cardiologists weren’t surprised that GLP-1 users would also have better cardiovascular outcomes, the SELECT trial’s 20% MACE reductions seemed to leave nearly everyone astounded. 

Considering that there were 135,000 new semaglutide prescriptions in the United States in May 2023 (without payor coverage or CVD evidence), GLP-1s’ long term population health impact might prove to be more astounding than any of us imagined.

Creating A Novice Heart Failure Screening Pathway

We hear a lot about AI’s potential to expand echocardiography to far more users and clinical settings, and a study using Us2.ai’s AI-automated echo analysis and reporting solution showed that echo’s AI-driven expansion might go far beyond what many of us had in mind.

Cleerly Revealed What Other CAD Tests Couldn’t

“I could have had a heart attack.” Florida-based registered nurse, Sharon Bruno BSN, RN, had a zero CAC Score and no known heart disease symptoms, but she learned through Cleerly’s AI-enabled CCTA analysis that she actually had moderate plaque burden. See how Sharon’s proactive detection allowed her to make lifestyle changes early enough to reduce her CVD risks.

The Wire

• Expanding Troponin to Chronic CAD: A JACC study highlighted the potential to expand troponin testing to patients with chronic heart disease. In the prospective study of 3,888 patients with stable angina, troponin levels were twice as high (6.7 vs. 3.3 ng/L) among patients who had heart attacks or died from cardiovascular causes during a 2.4-year follow-up period. 

• Geisinger & Bodyport’s HF Pilot: Geisinger launched a remote heart failure management pilot program that uses Bodyport’s Cardiac Scale to monitor HF patients’ fluid levels and catch signs of worsening heart failure. Geisinger will initially provide smart scales to 200 HF patients, who will use the scale for 20 seconds daily in their homes. Health system HF case managers can access this data using the Bodyport platform or via alerts with urgent cases, allowing them to proactively intervene and avoid hospitalizations.

• Statins’ Age Advantage: Older patients might see greater LDL-C reductions from low-to-moderate intensity statins than younger patients. In a study of almost 83k statin-takers, participants who were over age 75 saw greater LDL-C reductions than participants who were under 50 years old, both when taking 20 mg simvastatin (39% vs. 33.8%) and 20 mg atorvastatin (44.2% vs. 40.2%).

• RA’s Aortic Stenosis Risks: A new study in JAMA Internal Medicine suggests that patients with rheumatoid arthritis (RA) have higher aortic stenosis risks. Among 73k patients with RA and 639k without, patients with rheumatoid arthritis had greater risks of aortic stenosis, aortic valve intervention, and AS-related death (adjusted hazard ratios: 1.48, 1.34, 1.26). The authors noted that more analysis is needed given the study’s low representation of female participants (only 12.3%) and the fact that RA is more common in women.

• Two Sides to Lodoco: Teva Pharmaceuticals and Tiofarma are crying foul over Agepha Pharma’s move to reformulate colchicine as the CVD drug Lodoco – allegedly allowing Agepha to market it with higher prices than the companies’ generic colchicine gout meds. However, others view this as an oversimplified argument. Agepha proactively met with the investigators who discovered colchicine’s CVD benefits in 2013 and acquired all intellectual property in 2014, before spending the last 10 years establishing Lodoco as the first anti-inflammatory CVD treatment.

• LBBAP’s Repolarization Advantage: Left bundle branch area pacing (LBBAP) may have an edge over conventional BiV-epi for cardiac resynchronization repolarization. In a small study of 10 patients, LBBAP achieved significant reductions in epicardial LV repolarization time (94.9 vs. 125 ms) and LV RT dispersion (29.4 vs. 40.8) compared to BiV-epi. Another new pacing method called biventricular endocardial pacing (BiV-endo) performed similarly to BiV-epi.

• Boston Scientific’s POLARx Approval: Boston Scientific’s announced the FDA approval of its POLARx Cryoablation System for treating paroxysmal AFib, bringing the innovative system to the US after being used with 25k patients globally. The system’s new POLARx FIT catheter notably supports two balloon sizes (28 & 31mm), allowing physicians to adjust and expand during procedures without disruptive device changes, while treating a wider range of pulmonary vein anatomies.

• E-gaming Cardiac Arrests Uncommon: Mayo Clinic researchers found that electronic gaming rarely causes life-threatening reactions in patients with genetic heart diseases, despite anecdotal reports of sudden cardiac arrest. In a study of 3,370 patients with genetic heart diseases, 1,079 (32%) had an event before their diagnosis, five of which (0.5%) were linked to e-gaming. After diagnosis and treatment, 431 experienced a cardiovascular event, only one of which was linked to e-gaming (0.2%).

• Viz HCM’s De Novo Clearance: AI-based care coordination company Viz.ai landed FDA de novo clearance for its Viz HCM solution, which analyzes routine 12-lead ECG recordings to identify patients with undiagnosed hypertrophic cardiomyopathy and then notifies cardiologists. Viz.ai developed Viz HCM with support from Bristol Myers Squibb (maker of the only obstructive HCM treatment), and both companies seem optimistic about the solution’s potential to identify the hundreds of thousands of Americans living with undiagnosed HCM.

• Longer LTL’s HF Risks: A JAMA Cardiology study discovered that longer leukocyte telomere length (LTL) is associated with improved cardiovascular structure and function, and potentially lower heart failure risks. Among 40k participants, people with longer LTL had a higher left ventricular mass, larger ventricle sizes and stroke volumes, and a lower risk of heart failure (hazard ratio: 0.86). The authors proposed exploring LTL’s role in cardiac remodeling, which could lead to new HF risk stratification approaches and therapeutic targets.

• Eli Lilly’s Blockbuster Q2: Eli Lilly’s been firing on all cylinders, with shares climbing over 15% after Mounjaro helped drive an 85% increase in Q2 profit. Lilly’s $8.3B second quarter revenue included $668M from Jardiance (diabetes / heart failure), $927M from Verzenio (breast cancer), and $979M from Mounjaro, up from just $16M in Q2 2022 despite still only having FDA approval for diabetes. Mounjaro was submitted for weight loss approval just last month, and Lilly still has a new $4B facility under works to ramp up mass production by 2027.

Making the Leap to Outsource Post-Processing

Interested in how to outsource cardiac image post-processing, but not sure where to start? PIA walks you through how to assess and compare vendors, understand pricing models and payment options, and outline your requirements to identify vendors who meet your clinical needs. 

Experience the Future of Learning: Medtronic Academy 2.0 is Here!

Unlock your ultimate destination for structural heart medical education with the newly redesigned Medtronic Academy 2.0. Gain access to expert-led courses, webinars, and a wealth of resources to stay ahead in cardiovascular care. Visit now!

The Resource Wire

• Aggregating multisource cardiology data is a worthy mission, but it’s often thwarted by confusion and complexity. This Change Healthcare article with Dr. Jennifer Hall, chief of data science at the American Heart Association, outlines best practices to help you overcome your cardiology data challenges and start leveraging deeper insights.

• HeartFlow’s new RoadMap Analysis solution allows CT readers to accurately, efficiently, and consistently identify stenoses in the coronary arteries. See how RoadMap Analysis’ visual and quantitative insights into the narrowing of all major coronary arteries helps readers evaluate coronary CT angiograms before determining the need for an FFRCT.=

• Noise and artifacts can make automated ECG analysis less reliable than what’s required for the exacting standards of cardiac safety trials. Monebo’s Kinetic Intervals ECG Algorithm provides precise interval measurements between any two points on the ECG waveform, allowing clinicians to utilize data they can trust.