Highlights of the American Heart Association Scientific Sessions 2016
The American Heart Association (AHA) Scientific Sessions (November 12–16, 2016) was attended by >18 000 people from over 200 countries and featured more than 5000 presentations. In addition to the usual outstanding presentations in basic, clinical, and population science, there were special emphasis programs in the areas of stem cell biology, thrombosis, precision medicine, peripheral arterial disease, and emerging mobile and health technologies. In his Presidential Address, Steven Houser, PhD, related his personal and scientific journey inspired by his father’s struggle with heart disease. Other notable lectures included this year’s Nobel Lecture by James Rothman on mechanisms of vesicle transport, the Paul Dudley White lecture by Stefanie Dimmeler on the roles of noncoding ribonucleic acid in cardiovascular disease, and the Lewis A. Conner Lecture by FDA Commissioner Robert Califf on the power of medical data sharing.
As is typical, Late Breaking Clinical Trials afforded the most “buzz” at the meeting. EUCLID (Examining the Use of Ticagrelor in PAD), one of the largest peripheral arterial disease trials ever, found no difference in long-term cardiovascular outcomes among patients randomized to ticagrelor versus clopidogrel. PRECISION (Prospective Randomized Evaluation of Celecoxib Integrated Safety vs Ibuprofin or Naproxen) reported no difference in the risk of adverse cardiovascular events among patients randomized to celecoxib versus ibuprofen or naproxen. Interpretation of these findings is complex, given that trial enrollment occurred over a decade and was challenged by a high degree of study drug discontinuation. HOPE-3 (Heart Outcomes Prevention Evaluation-3) examined whether lowering of cholesterol or blood pressure impacted neurocognitive function; no benefit was found after a median of 5 years follow-up in this modest risk population. The PIONEER AF-PCI study (An Open-label, randomIzed, controlled, multicenter study exploring two treatment strategies of Rivaroxaban and a dose-adjusted oral vitamin K antagonist treatment strategy in subjects with Atrial Fibrillation who undergo Percutaneous Coronary Intervention) found that either of 2 low-dose rivaroxaban regimens (with a P2Y12 inhibitor ± aspirin) reduced the likelihood of major bleeding after percutaneous coronary stenting compared with conventional triple therapy with a vitamin K antagonist plus dual antiplatelet therapy. The ART trial (Arterial Revascularisation Trial) compared the use of bilateral internal mammary artery grafts versus a single internal mammary artery, reporting no differences in mortality, MI, stroke, need for repeat revascularization, or quality of life at 5 years. However, a nearly 2-fold increase in sternal wound complications and a 3-fold increased need for sternal reconstruction was observed in the bilateral internal mammary artery group. The GARY trial (German Aortic Valve Registry) examined a large number of intermediate-risk patients from Germany, comparing transcatheter aortic valve replacement with surgical aortic valve replacement. While patients with surgical aortic valve replacements fared better overall, the patients with transcatheter aortic valve replacement were marked by a higher risk profile.
Four cell therapy trials were presented which examined both peripheral and myocardial effects. While each trial provided some evidence of efficacy, all were underpowered and none demonstrated conclusive benefit. Additionally, there were 5 trials examining newer nonstatin drugs for lowering cholesterol. These included a novel PCSK9 (proprotein convertase subtilisin/kexin type 9) ribonucleic acid interference agent, Apo-A (apoliprotein A) inhibition, and antisense inhibition of angiopoietin–like protein 3. All demonstrated significant lipid lowering efficacy. However, we await larger outcomes studies to determine the effect of these agents on clinical events.
In summary, this year’s Scientific Sessions provided many exciting new findings in basic biology, translational research, and population health. The meeting was marked by considerable energy and excitement. Going forward, it is our hope that discoveries reported at this meeting will pave the way for important and innovative ways to treat patients with cardiovascular disease and stroke.
Circulation is available at http://circ.ahajournals.org.
- © 2016 American Heart Association, Inc.