ESC 2024: Advancing Care With New Cardiovascular Research

From August 30 through September 2, all aspects of cardiology care were on display as the focus of the 2024 European Society of Cardiology Congress in London. From abstracts to posters to scientific sessions to trial results to late-breaking science and beyond, experts from around the world convened to discuss the latest news on obesity, the cost of cardiovascular care, finerenone, semaglutide, and more.

With so much top-notch news to deliver, here are additional data and developments presented over the 4 days of the conference from among the thousands of presentations. Make sure to sign up for our e-newsletter so you do not miss our exclusive conference coverage and interviews with top experts.

Cardiovascular Disease in Women

In a study from Denmark,¹ women with endometriosis were found to have a 20% higher risk of long-term cardiovascular outcomes compared with a matched control population. Endometriosis is a condition in which tissue similar to that lining the uterus grows outside of the uterus,² and this study’s authors highlighted that it has pathophysiological similarities with cardiovascular disease (CVD). Noting that endometriosis affects close to 10% of reproductive-age women, they investigated rates of acute heart attack and stroke, as well as arrhythmias, heart failure, and all-cause mortality in these patients.

In adjusted and unadjusted models, there were higher risks of acute myocardial infarction (AMI) (unadjusted HR, 1.38; adjusted HR [aHR], 1.35), ischemic stroke (unadjusted HR, 1.19; aHR, 1.18), arrhythmias (unadjusted HR, 1.24; aHR, 1.21), and heart failure (unadjusted HR, 1.16; aHR, 1.11). For the composite outcome of AMI and ischemic stroke, the HRs were 0.93 and 0.92, respectively.¹

How outcomes may differ between women with heart failure who were considered premenopausal (mean [SD] age, 40.3 [8.7] years) or postmenopausal (68.2 [8.9) years) and randomized to either omecamtiv mecarbil, a cardiac myosin activator, or placebo was investigated by a team from Brigham and Women’s Hospital and Harvard Medical School in the GALACTIC-HF trial (NCT02929329). The authors were interested in outcomes among patients with chronic heart failure with reduced ejection fraction (HFrEF)—for this analysis, the patients had to have a left ventricular ejection fraction of 35% or less—because few data are available on heart failure outcomes among patients who are pre- and postmenopausal.³

Data were collected on New York Heart Association disease class, eGFR rates, NT-proBNP and troponin levels, and heart failure therapies. The primary outcome was worsening heart failure event or CV death. Per 100 patient-years, there were 8.6 and 10.2 CV-related deaths in the pre- and postmenopausal groups, respectively, and 10.2 and 17.2 HF events. The authors found similar rates of adverse CV outcomes between the 2 patient cohorts, leading them to conclude that omecamtiv mecarbil benefits did not differ by menopausal status.³

Research presented at the 2024 ESC Congress covered all aspects of cardiology care and cardiovascular research through poster presentations, late-breaking science, and topline trial results.| Image Credit: Atlantist studio-stock.adobe.com

Mental Health, Heart Disease, and Smoking

The referral for and management of cardiac distress were investigated among 214 patients aged 18 to 86 years whose cardiac disease history consisted of cardiac arrest (n = 13), AMI (n = 35), percutaneous coronary intervention (PCI; n = 31), rhythm disturbance (n = 24), or coronary artery bypass graft surgery (CABG; n = 17). Sixty-one percent of patients self-reported high levels of distress; 53%, depression; and 49%, anxiety, according to the Cardiac Distress Inventory Short Form. Results were compared for baseline and at discharge. All participants were referred to a specialist psychocardiology clinic, the Australian Centre for Heart Health, by specially trained cardiac rehabilitation staff.⁴

Patients chose 1 of 4 responses to questions asked during their counseling sessions: severe distress, moderate distress, slight distress, and no distress. The highest levels of severe distress were seen when patients were asked about what the future held, if they were emotionally exhausted, and if they had physical restriction. Significant reductions were seen in levels of anxiety (15%), distress (18%), and depression (19%) (all P < .001) when counseling was completed, with the authors concluding that more training is needed to identify patients with cardiac-related distress “due to the absence of clear pathways for referral.”⁴

The Systemic Coronary Risk Estimation 2 (SCORE2) algorithm was evaluated by authors from Argentina for its ability to accurately identify risk of chest pain in patients with a smoking history. Typical criteria fed into this algorithm are geographical origin, age, gender, current smoking status, systolic blood pressure, and cholesterol values. Not previously considered is averaged total cigarettes smoked, just that patients did or did not smoke. Outcomes were compared between male patients and female patients (N = 2774) for nonfatal and fatal events, and patients were classified as having low-moderate (n = 1015), high (n = 855), or very high risk (n = 838); 66 patients were classified as heavy smokers younger than 70 years.⁵

SCORE2 was shown to be more accurate at predicting CV risk among female and male patients who were nonheavy smokers (less than 20 cigarettes per day) but not for heavy smokers (20 or more cigarettes per day). The authors highlighted that heavy smokers have a higher risk regardless, due to negative results on functional tests and other risk factors; the highest risk they saw was 12% in female patients younger than 70 years who were heavy smokers. Overall, they recommend that all patients with a smoking history undergo an anatomical evaluation for coronary stenoses, which can up their CV risk even more, regardless of function test outcomes.⁵

Lipoprotein(a)

Lipoprotein(a), or Lp(a), is a subtype of low-density lipoprotein shown to increase risks for heart and blood vessel disease,⁶ including heart attack, stroke, inflammation that can result in plaque rupture, and fast-forming clots.⁷ A study from Hospital de Santa Cruz, in Portugal, evaluated how history of MI and total MI may be correlated with serum levels of Lp(a) and coronary artery disease (CAD), using electronic health record data on patients (N = 116) who underwent coronary angiography and Lp(a) measurement of their major coronary arteries from May to November 2023. The mean (SD) patient age was 62 (13) years, 71% had dyslipidemia, and medial Lp(a) level was 72 (range, 20-183) nmol/L.⁸

For the 3 levels of Lp(a) that were considered (≤ 34, 34-146, and ≥ 146 nmol/L), total previous MI, PCI, and CABG rose with each higher category, as did the mean previous MI, PCI, and CABG. However, for total blocked vessels (0-2 vs 3-4), no significant differences were seen. A second analysis that compared outcomes between patients with a history of MI/revascularization vs those with no such history found higher levels of Lp(a) in patients with more extensive CAD: 3 to 4 vessels with evidence of disease and mean Lp(a) level of 158.4 (145.2) nmol/L vs 0 to 2 vessels with evidence of disease and mean Lp(a) level of 103.16 (104.6) (P = .044).⁸

A study from Greece comprised a long-term follow-up of patients with heterozygous familial hypercholesterolemia (FH; n = 433)) and familial combined hyperlipidemia (FCH; n = 476) to define their risk of premature CVD per Lp(a) level vs the general population with elevated Lp(a). The composite end point was major CV events (CAD and stroke), and for their comparison, the investigators took baseline blood samples and evaluated patient results after a mean (SD) of 9.6 (7.6) years; all patients were on lipid-lowering therapy during the follow-up.⁹

Overall, 6.5% of the entire study population experienced a major CV event during the follow-up, and more patients with FH vs FCH experienced a major CV event (8.1% vs 5.5%). Risk factors predisposing them to this outcome included male sex (HR, 2.76; 95% CI, 1.60-4.73), presence of diabetes (HR, 2.75; 95% CI, 1.32-5.78), and smoking history (HR, 1.81; 95% CI, 1.05-3.13). Further, elevated Lp(a) (≥ 30 mg/dL) was shown to be an independent predictor of major adverse CV events only in patients with FH (HR, 2.74; 95% CI, 1.04-7.14); in patients with FCH, diabetes was the sole independent predictor (HR, 3.56; 95% CI, 1.19-11.33).⁹

References

1. Havers-Borgersen E, Hartwell D, Ekelund C, et al. Endometriosis—a prevalent disease—is associated with significant cardiovascular disease. Presented at: ESC Congress; August 30-September 2, 2024; London, England.

2. Endometriosis. Cleveland Clinic. Updated July 27, 2022. Accessed September 5, 2024. https://my.clevelandclinic.org/health/diseases/10857-endometriosis

3. Pabon MA, Vaduganathan M, Claggett BL, et al. Menopausal status and clinical outcomes in women with heart failure with reduced ejection fraction: the GALACTIC-HF trial. Presented at: ESC Congress; August 30-September 2, 2024; London, England.

4. Jackson A, Le Lrande M, Murphy B. The identification, referral and management of patients with cardiac-related distress: a new model to support psychological recovery after a cardiac event. Presented at: ESC Congress; August 30-September 2, 2024; London, England.

5. Cosmi D, D’Orazio S, Mariottoni B, Tarquini B, Cosmi F. SCORE-2 in heavy smokers: are we underestimating the risk? Presented at: ESC Congress; August 30-September 2, 2024; London, England.

6. Lipoprotein (a). Cleveland Clinic. Updated August 31, 2023. Accessed September 5, 2024. https://my.clevelandclinic.org/health/articles/25226-lipoprotein-a

7. About lipoprotein (a). CDC. May 15, 2024. Accessed September 5, 2024. https://www.cdc.gov/heart-disease-family-history/about/about-lipoprotein-a.html

8. Azevedo S, da Silva Correia D, Sousa RB, et al. Lipoprotein(a) levels in acute myocardial infarction patients and their associations with prior events and coronary artery disease severity: a real-world cohort study. Presented at: ESC Congress; August 30-September 2, 2024; London, England.

9. Andrikou I, Skoumas I, Grigoriou K, et al. Lipoprotein(a) and cardiovascular prognosis of familial dyslipidemias: data from a 10-year follow-up study. Presented at: ESC Congress; August 30-September 2, 2024; London, England.