ICYMI: Highlights From ACC 2023

Our top coverage from the 72nd American College of Cardiology (ACC) Scientific Session included STELLAR, CLEAR Outcomes, ACCESS, and HALO trial results, as well as a spotlight on health equity in heart failure (HF).

Here are the ACC 2023 conference highlights. Click here to catch up on all of our coverage from the conference.

5. Dr Clyde Yancy: Redefine Greatness Through a Quest for Health Equity in Heart Failure

During the Kanu and Docey Chatterjee Keynote Address, Clyde W. Yancy, MD, MSc, vice dean for diversity and inclusion at the Feinberg School of Medicine at Northwestern University, highlighted the need to redefine success in health care, emphasizing a legacy of positive impact rather than metrics and profit margins. The address paid tribute to the late cardiologist Kanu Chatterjee, known for his scientific achievements and compassion, leaving behind foundational algorithms for HF guidelines. The 2022 HF guidelines represent progress but may not fully address health equity challenges, but the presentation stressed the importance of aggressive hypertension treatment, personalized approaches, and consideration of social determinants of health in HF care.

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4. HALO Misses End Point, but Optimism Remains for Baxdrostat in Resistant Hypertension

The phase 2 HALO trial of the investigational hypertension therapy baxdrostat showed a reduction in systolic blood pressure (SBP) that did not reach statistical significance. However, a post-hoc analysis revealed that nonadherence in one study arm influenced the results, and when adherent patients were considered separately, a reduction in SBP was observed. Baxdrostat is a highly selective aldosterone synthase inhibitor, and previous studies, including the BrigHTN trial, demonstrated its efficacy in reducing SBP in patients with resistant hypertension. AstraZeneca acquired CinCor, the developer of baxdrostat, on January 9, 2023, for $1.3 billion, recognizing its potential complementarity to dapagliflozin.

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3. Making Preventive Drugs Free Doesn’t Change Health Outcomes, Study Finds

The ACCESS trial revealed that eliminating co-payments for drugs aimed at preventing heart attacks, strokes, or hospital visits did not significantly improve health outcomes among seniors who are low-income with chronic diseases in Canada. The study saved participants an average of $26 per month for 3 years, but showed only a small increase in medication adherence and no significant benefits in the primary endpoint, a composite rate of death, heart attack, stroke, coronary revascularization, or hospitalization for cardiovascular-related conditions. The findings highlight the complexity of improving medication adherence in vulnerable populations, with those experiencing the greatest financial barriers showing the least benefit.

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2. Bempedoic Acid, Approved to Treat LDL Cholesterol, Cuts Risk of Major CV Events by 13%

Bempedoic acid, approved as Nexletol in 2020, demonstrated a 13% reduction in the risk of major cardiovascular events, particularly heart attacks, according to data from the CLEAR Outcomes trial. The trial involved 13,970 patients unable or unwilling to take statins due to adverse effects, and the drug significantly lowered the incidence of a 4-point major adverse cardiovascular events composite endpoint, including cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, or coronary revascularization. Bempedoic acid works differently from statins, inhibiting ATP citrate lyase instead of HMG-CoA reductase, resulting in a reduced likelihood of muscle-related side effects. The findings suggest a potential alternative for patients intolerant to statins.

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1. Phase 3 Data for Sotatercept in PAH Meets Mark for Walk Test; Huge Drop Seen in Risk of Death and Clinical Events

A groundbreaking phase 3 trial, known as the STELLAR trial, revealed positive results for sotatercept, a novel drug for pulmonary arterial hypertension (PAH). The study involved 323 patients and demonstrated that those taking sotatercept experienced a 40.8-meter improvement in a 6-minute walk test, meeting the primary endpoint, and achieved 8 of 9 secondary endpoints. Notably, sotatercept reduced the risk of clinical worsening or death by 84%, with fewer adverse events compared with the placebo group. The drug's mechanism targets abnormal signaling in pulmonary blood vessels, marking a paradigm shift in PAH treatment, and the findings suggest a potential new era in therapeutic strategies for this condition.

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