18 VOLUME 19 NUMBER 1 • July 2022 DIABETES NEWS SA JOURNAL OF DIABETES & VASCULAR DISEASE AHA names 2021’s top advances in heart disease and stroke research A major funder of heart- and strokerelated research, the American Heart Association (AHA) compiles an annual recap of noteworthy scientific studies. Here is an overview of 2021’s pivotal developments. As the COVID-19 pandemic continued to dominate public health headlines in 2021, vital research progressed on a variety of cardiovascular, and coronavirus, fronts. Some of the most consequential findings addressed cardiovascular-relevant diseases such as kidney failure and obesity. Studies highlighted better ways to deliver care for stroke, heart failure and high blood pressure. And cutting-edge developments in the practice of precision medicine could improve the futures of old and young. A stubborn health challenge, obesity, meets an effective medicine Some 650 million people worldwide have obesity, and the problem continues to grow. But a drug developed for type 2 diabetes, semaglutide, may help. In June, semaglutide, as a weekly, under-the-skin injection, became the first drug since 2014 to be approved by the US Food and Drug Administration (FDA) for chronic weight management. A series of studies in 2021 detailed potential weight-loss benefits of semaglutide, even in non-diabetic subjects. Investigators in an international trial called STEP 1 tested semaglutide injections versus placebo in about 1 900 patients, most of them women, who had obesity or were overweight and had at least one other weight-related risk factor (but not diabetes). After 68 weeks, the two-thirds of subjects given semaglutide lost an average of 14.9% of their body weight, compared with just 2.4% among those given the placebo, the researchers reported in the New England Journal of Medicine. STEP 3, another placebo-controlled trial, included eight weeks of a low-calorie diet at the outset and intensive behavioural therapy for 68 weeks for both study groups. Among about 600 US participants, nearly 500 of them women, those given semaglutide on average lost 16% of their body weight, compared with a 5.7% average loss in the placebo group, researchers wrote in the Journal of the American Medical Association. Another international study, STEP 4, examined whether the weekly shots of semaglutide versus placebo along with lifestyle counselling could help maintain weight loss. About 800 participants, most of themwomen, were treated with semaglutide for 20 weeks, charting an average 10.6% body weight loss plus other health improvements. Then one-third was switched to placebo injections for 48 weeks. On average, those who continued on semaglutide lost 7.9% of their body weight and had additional health improvements over the additional 48 weeks, while people on placebo saw their weight increase by 6.9%, investigators reported in the Journal of the American Medical Association. Meanwhile, doctors trying to balance the risks versus rewards of bariatric surgery in patients with heart troubles have a new study of about 2 600 patients in Canada to help inform decision making. That study, published in the AHA journal Circulation, used medical records to track two sets of patients with cardiovascular disease and severe obesity. Compared with matched peers in similar health who did not have bariatric surgery, those who underwent the operation had a 42% lower risk of dying or having major cardiovascular problems such as heart attack, stroke and heart failure hospitalisation. The findings require confirmation by a large-scale, randomised trial, the authors note. Clinical trials continue to expand a diabetes drug’s turf On the heels of previous successes, medicines called SGLT2 inhibitors have continued to extend their potential beyond their initial approved use to treat type 2 diabetes. In late 2020, the SCORED trial studied the SGLT2 inhibitor sotagliflozin in patients with type 2 diabetes and chronic kidney disease. Compared with a placebo group, those receiving the drug had a lower risk of hospitalisation/urgent care for heart failure or death from heart disease. Findings from another placebo-controlled trial released in late 2020, SOLOIST-WHF, showed sotagliflozin could lower those same risks in people with diabetes and a recent worsening of heart failure. Other research is suggesting SGLT2 inhibitors might also help patients who have heart failure with preserved ejection fraction, a condition with few available treatments (ejection fraction describes the strength of the heart’s left ventricle). In the EMPERORPreserved trial, testing the SGLT2 inhibitor empagliflozin in nearly 6 000 of these patients, investigators found the drug could reduce rates of cardiovascular death or hospitalisation due to heart failure by over 20%. Empagliflozin appeared effective in patients both with and without diabetes, scientists reported in The New England Journal of Medicine. Drug trials score new successes in avoiding cardiovascular complications of diabetes As type 2 diabetes rates climb worldwide, therapies addressing diabetic complications are an urgent priority. People with type 2 diabetes have at least double the risk of developing and dying from cardiovascular disease, and kidney disease is a common longterm complication. Research had already shown that the drug finerenone could improve cardiovascular outcomes and limit renal decline in patients with type 2 diabetes and advanced kidney disease. A new, international study expanded the list of patients who might benefit. Like the earlier study, this one, dubbed FIGARO-DKD, was conducted in people with type 2 diabetes. But this time, participants had earlier-stage kidney disease and severely elevated albumin levels in the urine, a marker of kidney damage, or later-stage disease but moderate albuminuria. Among more than 7 400 patients, finerenone reduced the risk of cardiovascular death or complications by 13% compared with placebo. The reduction was primarily a result of a decrease in heart-failure hospitalisations. Another international study,AMPLITUDE-O, tested the drug efpeglenatide in people with type 2 diabetes and a history of cardiovascular disease or current kidney disease, plus at least one other cardiovascular risk factor. Among more than 4 000 participants, weekly under-the-skin injections of efpeglenatide were linked to risk-factor improvements and a 27% lower odds of experiencing a heart attack, stroke or death from cardiovascular or unknown causes. Both trials were described in the New England Journal of Medicine. Precision medicine may help spare hearts in two devastating diseases Using precise gene editing, investigators may have opened new therapeutic doors for two life-threatening diseases, transthyretin amyloidosis and Duchenne muscular dystrophy. In transthyretin amyloidosis, also called ATTR amyloidosis, abnormal versions of the transthyretin protein, or TTR, build up in the heart, nerves and other tissues. The condition, which often goes undiagnosed, can cause symptoms including numbness and weakness, can affect balance and posture, lead to
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