President of the AHA, Kieth Churchwell, M.D.

Cardiovascular Disease

Cardiovascular Disease and Deaths On the Rise

Another year, another AHA report reasserting heart disease’s dominance as the number one killer in the United States, and the latest data shows that this trend is still gaining momentum.

• Every year, the AHA reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors.
• In 2010, the AHA released a 2020 goal to improve the CV health of all Americans by 20%, while reducing CVD and stroke deaths by 20%.

Four years after that goal’s due date, the burden of CVD in the U.S. is at an all time high, with 942k cardiovascular disease-related deaths in 2022, up by 10k from 2021.

• Nearly half of all Americans over 20 (48.6% as of 2020) have some form of CVD (comprising CHD, HF, stroke, and hypertension).
• Excluding hypertension (CHD, HF, and stroke only), just 9.9% of U.S. adults have CVD.

What’s causing this high CVD prevalence? While there’s no one answer for a specific patient group, the AHA’s biggest CVD risk culprits should be pretty familiar – obesity, smoking/tobacco use, and sedentary behavior.

• From 2017 to 2020, adult obesity prevalence in the U.S. was 41.8%, while obesity-related CV deaths tripled from 1999 to 2020 (2.2 to 6.6 deaths per 100k people).
• Sedentary behavior is also on the rise in America, with self-reported daily sitting times increasing from 332 min/day in 2007 to 351 min/day in 2017.
• The percentage of U.S. adult smokers is now down to 11.5% (it was 51% of men in 1965), although smokers still face a nearly three-fold higher all-cause mortality risk (HR: 2.80).

However, there’s light at the end of the cardiovascular tunnel thanks to advancements in drugs like GLP-1s and new cholesterol controls, which mean heart disease isn’t a death sentence like it used to be.

The Takeaway

The AHA’s latest report reads more like a public health problem than a cardiology one, suggesting that prevention could have a greater impact than any drug, device, or treatment.

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The Wire

• Roche’s Lp(a) Molarity Test: Roche scored FDA 510(k) clearance for its Tina-quant Lipoprotein (a) Gen.2 Molarity assay, making it the first test of its kind available in the U.S. for measuring lipoprotein (a) in nanomoles per liter. Lp(a) often varies in sizes and has no defined molecular weight, which means Roche’s molarity-based test allows lab professionals and clinicians to know the number of Lp(a) particles in a blood sample.

• PCD-CT vs. EID-CT: Recent study results suggest photon-counting detector–CT could be better at diagnosing obstructive CAD than conventional energy-integrating detector–CT. Researchers retrospectively compared 7.8k patients who underwent CCTA using either PCD-CT or EID-CT and found that PCD-CT led to fewer subsequent invasive coronary angiographies (9.9% vs 13.1%) with better specificity (98.0% vs 93.0%), positive predictive value (83.3% vs 63.0%), and diagnostic accuracy (97.2% vs 92.8%). PCD-CT patients referred for ICA were also more likely to undergo revascularization.

• You Are What You Eat: Can eating too much fat turn your hands yellow? One man did exactly that by adopting an extremely high fat diet allegedly consisting of “6 to 9 lb of cheese, sticks of butter, and additional fat incorporated into his daily hamburgers.” The Florida man decided to see a doctor when yellowish cholesterol deposits (xanthelasma) appeared on his palms, soles, and elbows. Blood tests found his cholesterol levels exceeded 1000 mg/dL, although he reported “weight loss, increased energy, and improved mental clarity.”

• Risky Asymptomatic Amyloids: Asymptomatic ATTR cardiac amyloid infiltration might be part of a more severe spectrum of disease than previously thought. A cohort study of 485 patients with asymptomatic ATTR cardiac amyloid infiltration found that those with grade 2 or 3 cardiac uptake had greater rates of disease progression and a 5-fold higher risk of cardiovascular death (HR: 5.30) compared with those with grade 1 uptake. Based on the results, researchers recommend disease-modifying treatment even for asymptomatic patients with grade 2 or 3 uptake.

• LIBerate-HoFH Results: Adding strong evidence for its LDL-C lowering therapy, LIB Therapeutics published the results of its Phase 3 LIBerate-HoFH study that compared its PCSK9 inhibitor, lerodalcibep, to monoclonal antibody, evolocumab (Amgen’s Repatha), for treating homozygous familial hypercholesterolemia. Among 66 randomized patients, lerodalcibep and evolocumab had similar mean monthly LDL-C reductions (-9.1% & -10.8%), despite varying LDL-C responses from patient to patient.

• AVS’ Series B: Amplitude Vascular Systems secured $36M in Series B funding to support its Pulse Intravascular Lithotripsy device’s peripheral vascular commercial launch in the U.S. and support future coronary/carotid IDE trials. Although long dominated by Shockwave, the IVL segment seems to be heating up, following a $19M round by FastWave and Boston Scientific’s acquisition of Bolt Medical. 

• A Heart-Shaped Box: Ncardia launched its Ncyte Heart in a Box 3D cardiac microtissue model designed to support cardiovascular research by mimicking cardiac cells. The Ncyte Heart in a Box system is derived from human-induced pluripotent stem cells and provides three cardiac cell types: ventricular cardiomyocytes, endothelial cells, and cardiac fibroblasts. These high-purity cellular components can be used to help study heart development, disease progression, and how cells interact in a cardiac environment. 

• MedStar’s First TTVR: In two separate procedures, cardiac experts at MedStar Union Memorial Hospital performed Maryland’s first transcatheter tricuspid valve replacements (TTVR) to treat tricuspid regurgitation. Both patients were in their 80’s and received the Evoque (Edwards Lifesciences) valve via a catheter, preventing the need for conventional open-heart surgery. The procedure’s success is good news for the estimated 1.6M people in the U.S. with TR, many of whom suffer from complications that prevent traditional open heart implantation. 

• Aspirin for PTS? New results from the ARIVA Trial suggest adding aspirin to rivaroxaban therapy for patients with post-thrombotic syndrome might not help prevent venous stent thrombosis. Researchers randomized 169 patients to receive either aspirin plus rivaroxaban or rivaroxaban alone for six months and found that adding aspirin only slightly improved patency rates (94.8% vs. 92.4%). Despite the slight improvement in blood vessel openness, patients did not report any difference in quality of life or other outcomes.

• O3 Exposure and Hypoxia: Although known for its fresh smell, O3 exposure could reduce oxygen availability and worsen arterial stiffening. Researchers out of China studied 210 healthy adults living on the Tibetan Plateau and found that O3 exposure of 10-ppb was linked to significant decreases in SpO2 (−0.42%), increases in RBC (+0.92%), hemoglobin concentration (+0.97%), and hematocrit (+1.92%). O3 exposure also led to a 1.04%-1.33% increase in carotid-femoral pulse wave velocity, leading to increased arterial stiffness.

• Tissues for a Failing Heart: Early results from a small clinical trial suggest lab-grown cardiac muscle could help mend failing hearts. Researchers in Germany first tested the process on monkeys and eventually grafted small patches of stem cell-grown tissue onto a 46 year-old woman’s heart, finding that the patch was able to “adapt, grow, mature, and start to support the failing heart” without causing any side effects. Although promising, researchers cautioned that this process takes time and wouldn’t help with cardiac emergencies like MI.

Merge and Duly Health Streamline Cardiology Reporting

Over the last 10 years, Dr. Sujith Kalathiveetil of Duly Health and Care has seen a significant evolution in cardiovascular imaging and experienced a similar evolution with Merge’s cardiology solutions. See how Merge Cardio has helped make cardiology reporting more consistent, accurate, and easier to obtain for Dr. Kalathiveetil and his colleagues.

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The Resource Wire

• Configure Your PCI Study: See for yourself how cardiac imagers use GE HealthCare’s Centricity Cardio Enterprise Universal Viewer to do their PCI studies, including configurable viewport setup and side-by-side comparisons.

• A Single Cardiac Service Line Platform: Transitioning across multiple imaging platforms is a daily reality for many cardiologists, but it doesn’t have to be. See how three leading cardiac imagers are leveraging Circle CVI’s unified multi-modal software across their diverse caseloads, without switching to other platforms.

• Cardiology AI: From Research to Clinical Practice: Explore how AI algorithms are reshaping cardiology with insights from Tempus’ recent webinar, featuring Dr. David Ouyang of UCLA and Cedars-Sinai, alongside Tempus’ Dr. John Pfeifer and Dr. Brandon Fornwalt. This expert panel dives into how AI can bridge diagnostic gaps, enhance patient outcomes, and streamline workflows for conditions like AFib and pulmonary hypertension. Read the full recap to glimpse the future of AI-driven cardiology.

• An All-in-One Coronary Care Solution: See how HeartFlow ONE is transforming precision heart care as the first all-in-one CCTA pathway, combining FFRCT, stenosis, and plaque analysis in a single workflow.

• A Better Way to Coordinate Post-Stroke Care: Think your EHR messaging system might be holding back your post-stroke care? See how UC San Diego Medical Center streamlined its neuro and EP teams’ post-stroke workflow with Viz Connect, and the impact it had on cardiac monitor placements in inpatient and outpatient settings.

• Uncover Cleerly’s Clinical Success: Interested in learning more about the science behind Cleerly’s suite of medical technologies that are revolutionizing cardiac imaging? Read here for all of Cleerly’s recently published clinical studies. 

• The Benefits of Outsourced Post-Processing: Using an outsourced cardiac image post-processing solution doesn’t have to mean sacrificing control of the results. Discover how PIA’s customizable post-processing workflow can help you get the most out of your images.

• Cloud-Based Enterprise Imaging Empowerment: Do your cardiology imaging workflows follow cloud best practices? Read Optum and Frost & Sullivan’s enterprise imaging whitepaper to help you ensure your team is optimally housing, accessing, analyzing, and leveraging imaging data as the industry shifts to value-based care.

• Addressing Coronary Artery Disease: Learn how the AGENT™ Drug-Coated Balloon provides a new treatment option for in-stent restenosis in the U.S. Rx Only. (Sponsored by Boston Scientific)

The Industry Wire

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8. Public trust in health agencies and vaccines decline.
9. Providence restructures its executive team – again.
10. Trinity Healthcare gives docs go-private ultimatum.