Weill-Cornell’s Louis J. Aronne, MD on pemvidutid users trimming an average of 4 inches from their waistline in under six months.

Pharmaceuticals

Pemvidutide’s Weight Loss and CVD Evidence

The weight loss drug arena might have another contender on the way, as interim Phase 2 results from the MOMENTUM trial show that Altimmune’s pemvidutide drove significant weight loss and improved key cardiovascular metrics.

• Pemvidutide is an investigational peptide-based GLP-1/glucagon dual receptor agonist  for the treatment of obesity and and non-alcoholic steatohepatitis (NASH)
• Pemvidutide’s unique dual activation approach is believed to mimic the complementary effects of diet (via GLP-1) and exercise (via glucagon) on weight loss

Twenty four-week data from 160 patients detailed by Medscape showed that different doses of pemvidutide (1.2 mg, 1.8 mg, or 2.4 mg) led to promising weight and cardiovascular improvements. 

That’s especially (and logically) true for patients taking the maximum 2.4 mg pemvidutide dose: 

• Weight loss = -10.7% vs. -1% w/ placebo
• Patients who lost ≥5% of their body weight = -66.7% vs. -25% w/ placebo
• Patients who lost ≥10% of their body weight = ~50%
• Waist circumference = -10.2 cm
• Total cholesterol = -16.5%
• Triglyceride levels = -25%
• Systolic blood pressure =  -5.5 mm Hg
• Diastolic blood pressure = -1.8 mm Hg

Similar to other weight loss drugs, pemvidutide led to increased adverse GI events, including four patients reporting severe vomiting in the 2.4 mg group and one patient in the 1.8 mg group. 

• The researchers and pemvidutide-watchers are likely paying special attention to drug tolerance, noting previous challenges with study participants dropping out due in part to adverse events.

The MOMENTUM trial (48-weeks, 320 participants, 30 sites) is one of the few obesity drug studies not focused on patients who also have diabetes, noting that because pemvidutide has a neutral impact on glucose, it’s specifically intended for treating obesity and nonalcoholic steatohepatitis (not T2D).

This might be precursor to a future trend toward weight loss drug specialization, as GLP-1s like semaglutide and tirzepatide potentially become positioned as ideal for the 20%-25% of obese patients with diabetes, while GLP-1/glucagon agonists like pemvidutide could be targeted at obese patients with fatty liver disease or hyperlipidemia. 

• The good news for Cardiac Wire readers is all of these drugs appear to have a positive impact on key cardiovascular metrics, and potentially on CV events.

The Takeaway

Although we’re still a few months away from seeing final results from the MOMENTUM trial, these are solid weight loss and cardiometabolic improvements for just 24 weeks, and pemvidutide’s “twincretin” approach seems promising – especially for non-diabetic patients.

HeartFlow’s FFRCT’s Nationwide Improvements

What happens when HeartFlow’s FFRCT Analysis is adopted nationwide? See how the NHS’ nationwide implementation of HeartFlow’s FFRCT solution led to significant reductions in cardiovascular and all-cause mortality, plus solid efficiency gains.

Accurately Measuring Heart Rate Variability

Heart rate variability measurement and analysis involves two critical elements – the ability to accurately discern the R wave in noisy environments, and using the correct analysis method for a given application. Check out how Monebo’s Kinetic HRV ECG Algorithm excels at both of these essential tasks.

The Wire

• ECG AI Afib Screening: Cedars-Sinai researchers used an ECG AI algorithm to accurately identify which patients – from a geographically and ethnically diverse cohort – would have Afib within 31 days. After training with 12-lead ECG sinus rhythm data from two large VA networks, the researchers tested the model using data from four other VA networks and Cedars-Sinai, detecting patients who would experience Afib with 0.86 and 0.93 AUROCs. The researchers suggested that similar models could be used for proactive Afib screening in people not yet showing symptoms.

• Shockwave C2+: Shockwave Medical introduced its Shockwave C2+ Coronary Intravascular Lithotripsy (IVL) catheter, highlighting its ability to provide 50% more pulses per catheter than its current Shockwave C2 catheter. The enhanced C2+ catheter will debut at TCT this week and launch in the US in November, leveraging its pulse upgrade to improve treatment of complex calcium.

• Kaiser Reaches Strike-Ending Agreement: Kaiser Permanente reached a “tentative agreement” with the unions representing 75k KP employees, pausing the largest healthcare strike in US history. If finalized, the new contract would secure an across-the-board 21% wage increase over four years, plus additional provisions to improve training practices and protect workers from outsourcing. Kaiser and the unions are meeting this week to lock in an agreement, which could end nearly seven months of negotiations and avoid the possibility of a longer 10-day strike.

• Excellent SAVR Outcomes: A retrospective real-world study found low-risk patients have excellent outcomes with surgical aortic valve replacement (SAVR). Among 42.6K patients (mean age 74.3) treated for severe aortic stenosis between 2011-2019, the rates of death from any cause were low at one year (2.6%), five years (7.1%) and eight years (12.4%). Younger age, lower predicted risk of morality, and higher LVEF were each associated with better outcomes.

• First Dog Open-Heart Surgery: The University of Florida’s College of Veterinary Medicine performed the first open-heart surgery on a dog in the US, successfully performing a 7-hour surgical mitral valve repair procedure on George, a 12-year-old miniature poodle. After a week in the ICU and nearly two months of recovery, the good boy is now taking two 45-minute walks a day and is expected to make a full recovery within three months.

• Complete PCI Similar to Staged: The randomized MULTISTARS AMI study found that immediate multivessel PCI was noninferior to staged multivessel PCI among hemodynamically stable patients with STEMI and multivessel coronary artery disease. The study’s primary composite endpoint event (all-cause death, nonfatal MI, stroke, unplanned ischemia-driven PCI or HF hospitalization) occurred in 35 of 418 patients (8.5%) who had multivessel PCI versus 68 of 422 (16.3%) with staged PCI (P<0.001 noninferiority, P<0.001 superiority).

• CureMetrix’s BAC AI Cleared: The FDA cleared CureMetrix’s cmAngio application for calculating breast arterial calcification (BAC) in mammograms. Studies have linked BAC to cardiovascular disease, so the clearance could allow screening for both cancer and CVD from a single mammogram. CureMetrix didn’t make any cardiovascular claims in its press release, other than to say that it helps radiologists identify BAC as an “underreported incidental finding” that should be reported. CureMetrix joins a growing number of mammo AI companies exploring BAC detection, including iCAD and Volpara.

• PET MPI Guides Revascularization: A JACC study shows the promise of using the change in LVEF stress, assessed with Rb-82 PET myocardial perfusion imaging (MPI), for early referral to revascularization. In the study of 14,649 consecutive patients undergoing PET MPI, an LVEF-R (stress LVEF – rest LVEF) of ≤0 identified patients with no known CAD who had a survival benefit from 90-day revascularization (P=-0.005). A corresponding JACC editorial called for randomized controlled trials to establish PET MPI’s role in guiding treatment.

• Walgreens & CRF’s VHD Research: Walgreens and the Cardiovascular Research Foundation are teaming up to drive patient participation in the PREVUE-VALVE study, a population-based clinical trial that aims to quantify the prevalence of valvular heart disease (VHD) among older Americans and pave the way for new VHD therapies and diagnostic tools. The announcement highlighted Walgreens’ ability to drive diverse nationwide participation, noting that historical VHD data has been derived from cohorts with little racial and ethnic diversity.

• How to Safely Increase HF Meds: A post-hoc analysis of the STRONG-HF trial shed more light on how to safely up-titrate medications in acute HF. In the new analysis of 542 patients on rapid up-titration, almost 58% had at least one of the study’s safety indicators (e.g. lower SBP, potassium and eGFR) used to guide treatment and therefore received slightly lower doses (-11%). These patients had lower quality of life but with no significant increases in HF readmissions or death.

• Healthcare Exodus Continues: The healthcare worker exodus continued throughout last year, according to the latest data from Definitive Healthcare. Over 145k providers left the industry between 2021 and 2022, with physicians accounting for almost half of all departures followed by nurse practitioners with 35k exits. Definitive reaches the logical conclusion that providers leaving in droves doesn’t help care quality or lead to fewer medical errors, and recommends that healthcare orgs mitigate the impacts of the staffing shortage by consolidating operations or investing in telehealth.

Incidental CAC Predicts Long-Term Risks

What if you could identify which of your asymptomatic patients have high risks of future cardiac events? Stanford-led researchers used Bunkerhill Health’s Incidental CAC algorithm to do just that, finding that patients with ≥100 incidental CAC scores had a 24% 10-year risk of developing ASCVD and far higher risks of major adverse events.

Elevate Your Imaging Skills: Don’t miss Dr. Nicolo Piazza’s exclusive master class series

Gain in-depth knowledge of fluoroscopic anatomy and cutting-edge imaging techniques with renowned expert, Dr. Nicolo Piazza. This five-session master class is happening now through November. Register now!

The Resource Wire

• How can AI help physicians “see” beyond conventional lipid profiles? Tune in to this on-demand webinar showcasing how Cleerly’s AI-QCT solution complements conventional approaches to evaluating heart disease risk factors, and improves coronary artery disease diagnosis and heart attack risk assessments.

• Ready to enhance your cardiovascular CT services with automated CT-FFR integration? Tune-in to Keya Medical and Precision Image Analysis’s SCCT webinar and learn from industry experts how to solve the challenges of scaling CT-FFR services and overcome the complexity of CT-FFR implementation.

• Looking to optimize your cardiovascular imaging services, but don’t know what to measure? Check out this Change Healthcare report for insights on how to track and evaluate your cardiovascular imaging performance, assess quality, and enhance operational efficiency. Read the full article now and start measuring what matters!

• See how Us2.ai’s echo AI solution improved heart failure screening in the NHS, reducing echo waiting times from 12 months to under 6 weeks.