MGH’s Pradeep Natarajan, MD after tirzepatide kept 94% of prediabetic patients from progressing to diabetes.

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Preventive Cardiology

Tirzepatide’s Prediabetes and Hypertension Impact

It looks like we might be able to add prediabetes and hypertension to the growing list of conditions that Eli Lilly’s “weight loss drug” tirzepatide is able to treat, after new analysis of the SURMOUNT-1 trial showed significant reductions in blood pressure and diabetes progression.

• Tizepatide (aka Mounjaro and Zepbound) is often referred to as a GLP-1, but uniquely activates both GIP and GLP-1 hormone receptors.
• Tirzepatide has already gained FDA approval for type 2 diabetes and obesity, while achieving greater weight loss than Novo Nordisk’s semaglutide.

Although tirzepatide is already widely used to treat diabetes, analysis of 1,032 obese or overweight prediabetics in the SURMOUNT-1 trial showed a whopping 94% lower risk of progressing to type 2 diabetes with tirzepatide through 176 weeks. 

• During the subsequent 17-week off-treatment period, the patients began to regain weight and showed some increases in type 2 diabetes progression, resulting in a 88% diabetes risk reduction after the off-period.

A separate analysis of the SURMOUNT-1 trial’s first 72 weeks showed that tirzepatide led to lasting blood pressure control among 2,539 non-diabetic overweight/obese adults, leading to 6.8 mm Hg systolic and 4.2 mm Hg diastolic net reductions (mostly occurring in first 24 weeks).

• By the end of the trial, 58% of tirzepatide-takers had normal BP versus 35.2% of placebo-takers.
• Notably, weight loss drove around 70% of the blood pressure reductions.

Although Lilly might not specifically seek approvals for hypertension or prediabetes, these studies add to the growing body of evidence that tirzepatide’s impact goes far beyond weight loss and diabetes.

• Lilly is already seeking tirzepatide’s FDA approval as a sleep apnea treatment, and recently released data showing that it slashes heart failure events and significantly reduces patients’ MASH severity.

That’s a lot of future possibilities for a drug that generated $4.35B in the second quarter alone – despite supply constraints, limited payor coverage, and fierce competition from Novo Nordisk’s semaglutide.

The Takeaway

Tirzepatide was already one of the hottest drugs in the world, and these studies suggest that weight loss and diabetes care could prove to be just one part of its massive impact, especially when you consider that 98 million American adults are prediabetic and 120 million have high blood pressure.

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. 

A Solution for Your Entire Cardiology Service Line

The pace of change in healthcare can be dizzying, creating new and more complex challenges for cardiology departments to overcome. See how Merge Cardio and Merge Hemo can turn those challenges into opportunities for greater workflow efficiency and improved care.

Us2.ai’s Next Gen AI

Us2.ai recently scored FDA clearance for Us2.v2, the newest version of its flagship software featuring 45 automated echocardiography parameters, including strain analysis. See how the new version automates echo exams and improves cardiovascular disease detection.

The Wire

• Home HF Test Breakthrough: Colorado State researchers are developing a quick, portable, and low-cost saliva test that might expand access to home heart failure screening. The electrochemical biosensor test measures Galectin-3 and S100A7 biomarkers, revealing signs of heart failure in 15 minutes, and carrying a production cost of just $3. This combination of advantages could make regular home HF testing possible.

• AISAP Echo AI Cleared: Israeli AI startup AISAP received FDA clearance for its CARDIO echo AI software. CARDIO is designed to help clinicians with basic ultrasound scanning skills diagnose up to 90% of the most common structural and functional cardiac parameters at patients’ bedsides. The cloud-based platform combines four CADx modules for valvular pathologies and eight cardiac measurements, using that output to generate echo analyses, interpretations, and reports. Earlier this year AISAP raised $13M in seed funding.

• Olpasiran Makes Waves: In the OCEAN(a)-DOSE trial, 276 participants who took Amgen’s Olpasiran every 12 weeks and then discontinued the medication after roughly 7 doses, saw sustained Lp(a) reductions of 40-50% with doses of 75 mg or more. At 96 weeks, Lp(a) was still down by 27.9% for the 75 mg dose and by 36.4% for the 225 mg dose, all with no new safety issues.

• MitraClip’s Bad Press: Abbott’s MitraClip is having a bad summer, which started with a KFF report highlighting the implant’s “contentious path through the FDA” and subsequent adverse events, recalls, lawsuits, and conflicting study results. A few weeks later KFF once again targeted MitraClip, using it as an example of devices that are recalled but remain in clinical use. Although KFF’s MitraClip reports were largely ignored by mainstream media at first, that’s changed in recent weeks, including a PBS segment focused on MitraClip’s “contentious” FDA path and a CBS story focused on its recalls.

• An ImPRESSive Test for Hypercoagulability: A new tool called the Platelet Reactivity ExpreSsion Score (PRESS) could help identify people with a hyperreactive platelet phenotype, which is linked to higher cardiovascular risk. In patients with peripheral artery disease, those with hyperreactive platelets had more than double the risk of a cardiovascular event within 30 days (37.2% vs. 15.3%. PRESS also accurately detected the hyperactive phenotype in people with PAD (AUC=0.81).

• Windtree’s Headwinds: Despite a recent $12.9M capital infusion, cardiovascular drug startup Windtree Therapeutics faces financial uncertainty, as its remaining $1.8M won’t be enough to support it over the next year. While it works on strategic alternatives, Windtree will continue trials investigating its istaroxime steroidal drug, including a Phase 2 extension trial for blood pressure, and a Phase 3 heart failure trial performed by its Asia-Pacific partner Lee’s Pharmaceutical.

• How Spironolactone Helps: Results from the MAGMA trial suggest that the mineralocorticoid receptor antagonist spironolactone’s cardiovascular benefits are due to its reduction of aortic wall volume, regression of LV mass, and changes to native T1. In 79 patients with high-risk type 2 diabetes and moderate-to-severe CKD, thoracic wall volume changed by 0.87% in participants taking spironolactone versus 7.1% for placebo, while LV mass size was reduced by 5.8g among spironolactone-takers compared to an increase of 3.1g with placebo. 

• Chest Compression Recall: The FDA issued a Class I recall on Defibtech’s RMU-2000 ARM XR Chest Compression Device due to reports of the motor stopping, causing it to fail during CPR. Linked to one injury and one death, the malfunction reportedly poses serious safety risks, including potential patient death. The FDA advises removing affected devices from use or sale to prevent further incidents.

• Honing Cardiac CT Protocols: Radiologists and cardiologists are lucky to have a variety of CT-based cardiac imaging tools at their disposal, but what works best for ruling out coronary artery disease? In a study in Radiology, researchers preferred a sequential approach in which CCTA and CT-FFR were used for initial evaluation and CT perfusion was reserved for hemodynamically relevant stenosis. In 105 patients, the sequential CCTA+CT-FFR with CT perfusion protocol had higher specificity than CCTA and CT-FFR alone (88% vs. 77%), while sensitivity was comparable (88% vs. 90%).

• BayCare Teams Up With Cadence: FL-based BayCare is teaming up with chronic condition management startup Cadence to implement a remote monitoring program for seniors with hypertension, congestive heart failure, and type 2 diabetes. The program shares real-time vitals such as weight, blood pressure, heart rate, and glucose levels with BayCare clinicians and Cadence’s care team, enabling proactive medication optimization, lifestyle guidance, and intervention if any metrics are out of range.

• SVB Mid-Year Investment Report: SVB’s mid-year healthcare investment report echoed the sentiment of other recent updates: digital health funding is a tale of two startup classes. While Series A digital health startups collected $1.7B across 109 rounds in the first half – with median valuations swelling 16% to $44 million – Series B and C companies closed much smaller sums in extension rounds designed to hold them over until next year when they might be able to raise at higher valuations. Over 28% of H1 healthcare investments were down or flat rounds, the highest total since 2019.

AI Algorithms in Cardiology: Navigating the Path from Research to Practice

Join Tempus on Tuesday, September 24 for an in-depth webinar exploring the transformative power of cardiology AI algorithms. Learn from leading experts, including Cedars Sinai’s Dr. David Ouyang and Tempus’ senior cardiology team Dr. Brandon Fornwalt and Dr. John Pfeifer, about how cardiology AI algorithms are unlocking new possibilities for diagnosis, treatment, and patient outcomes. Secure your spot now to be part of this pivotal discussion.

TeraRecon’s Structural Heart Enhancements

Detecting and addressing mitral valve and LAA conditions can be challenging. Check out TeraRecon’s Structural Heart white paper and discover how improving workflow and pretreatment planning can streamline these processes and potentially improve patient outcomes.

Join the Cardiovascular Revolution

See how Optum enterprise imaging can prepare you for the future of imaging with industry-leading structured reporting, single-database architecture, AI and cloud-native design.

The Resource Wire

• HeartFlow FFRCT Avoids Invasive Cath: Despite being conscious about his heart health, 60-year old Mike Gartman suddenly experienced classic symptoms of CAD. See how Mike’s HeartFlow FFRCT Analysis results allowed him to avoid the invasive procedure altogether and gain peace of mind about his disease.

• Forging the Future of Cardiovascular Care: Cardiology is changing, and for the better. Get a view into Lee Health Heart Institute’s medical director Richard Chazal, MD’s vision for a new era in cardiology, driven by imaging, AI and personalized medicine.

• The Post-Acute Stroke Game Changer: See how Viz Connect solution can optimize your post-acute stroke pathway. The Viz.ai solution allows the cardiology team to promptly receive Neurology referrals to evaluate patients with suspected AFib for cardiac monitoring and reduce their risk of secondary stroke.

• 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!

• Catch up on 2024’s Cardiology Coffee Breaks: Join GE HealthCare on a journey to bridge the gaps to connected cardiovascular care with this season’s Cardiology Coffee Breaks. In the time it takes you to finish your coffee, these Coffee Breaks demonstrate how GE’s integrated solutions empower healthcare organizations to provide precision care, achieve operational efficiency, and enhance patient satisfaction. 

• A New Era of Precision and Efficiency: Ready to enhance your cardiovascular imaging precision and efficiency? See how Circle Cardiovascular Imaging’s new cvi42 6.1 platform is bringing CT and MR imaging under a single platform.

• Reducing ECG Background Noise: Monebo’s Kinitec Rhythms ECG Algorithm separates true ECG signals from background noise, leading to more accurate diagnoses and improved operator efficiency. See for yourself how the algorithm measured up to a gold standard.

• Taking AI from Idea to the Clinic: There are few areas of healthcare with more innovation than artificial intelligence, but most of those solutions never make it past being published in a medical journal – providing no additional value to medical care or the solutions’ developers. In this Cardiac Wire Show, Bunkerhill Health CEO Nishith Khandwala discusses Bunkerhill’s unique approach to solving this problem and the impact they are having in cardiology and beyond.

The Industry Wire

1. 10 CIOs share their most unique tech.
2. World’s oldest living person dies at 117.
3. Two VA hospital execs ‘immediately transferred’ amid care delay probe.
4. Doc involved with Matthew Perry’s death reopens Calabasas clinic.
5. What will Harris mean for Health Care? – Not much.
6. AdventHealth takes over St. Luke’s in North Carolina.
7. California hospital told dead woman’s family she checked out of hospital.
8. Providence children’s hospital opens school for long-term patients.
9. Another suit filed against FDA over lab-developed test rule.
10. MGB’s ‘tip of the spear’ for boosting access.