Christopher P. Cannon

BackgroundOverweight and obesity are key pathophysiological drivers of the incidence and progression of cardiovascular disease (CVD). In the SELECT trial, weekly semaglutide 2.4 mg reduced recurrent CVD by 20% vs. placebo in patients with a body mass index (BMI)> 27 and established CVD. However, the generalizability of these findings to real-world populations remains unknown.MethodsWe identified patients within the Mass General Brigham (MGB) health system who, based on electronic health records (EHR), would be eligible for semaglutide based on the SELECT inclusion and exclusion criteria.ResultsOf 1,247,794 patients with a visit in the MGB system between 2018 and 2023 with a BMI≥ 27 kg/m2, 81,413 (6.5%) had a diagnosis of myocardial infarction, stroke, or peripheral arterial disease documented in the EHR. Of those, 43,854 (54%) met eligibility criteria for the SELECT trial with 37,559 (46 …

BackgroundDiabetes mellitus (DM) and Lp (a) are well-established predictors of coronary artery disease (CAD) outcomes. However, their combined association remains poorly understood. we aimed to investigate the relationship between high Lp (a) and DM with CAD outcomes.MethodsA retrospective analysis of the MGB Lp (a) Registry involved patients≥ 18 years who underwent Lp (a) measurements between 2000-2019. Exclusion criteria were severe kidney dysfunction, malignant neoplasms, and prior atherosclerotic cardiovascular disease (ASCVD). The primary outcome was a combination of cardiovascular death or myocardial infarction (MI). Elevated Lp (a) was defined as≥ 90th percentile (≥ 216 nmol/L.).ResultsA total of 6,238 patients met the eligibility criteria, median age of 54, 45% women, 12% with DM. Patients with DM were older, more frequently male, and with higher prevalence of other …

BackgroundPrevious meta-analyses of summary data from randomised controlled trials have shown that statin therapy increases the risk of diabetes, but less is known about the size or timing of this effect, or who is at greatest risk. We aimed to address these gaps in knowledge through analysis of individual participant data from large, long-term, randomised, double-blind trials of statin therapy.MethodsWe conducted a meta-analysis of individual participant data from randomised controlled trials of statin therapy that participated in the CTT Collaboration. All double-blind randomised controlled trials of statin therapy of at least 2 years' scheduled duration and with at least 1000 participants were eligible for inclusion in this meta-analysis. All recorded diabetes-related adverse events, treatments, and measures of glycaemia were sought from eligible trials. Meta-analyses assessed the effects of allocation to statin therapy …

The year in cardiovascular medicine 2023: heart failure and cardiomyopathies—the top 10 papers. Left: Studies in acute/worsening heart failure. Right: Studies in chronic heart failure/cardiomyopathies. EF, ejection fraction; GRMT, guideline-recommended medical therapy; HF, heart failure; HFmrEF, heart failure with mildly reduced ejection fraction; HFpEF, heart failure with preserved ejection fraction; HFrEF, heart failure with reduced ejection fraction; KCCQ, Kansas City Cardiomyopathy Questionnaire; NYHA, New York Heart Association; TEER, transcatheter edge-to-edge repair.

BackgroundPatients with immune-mediated inflammatory diseases (IMIDs) have an increased risk of cardiovascular (CV) disease. Lp (a) is associated with atherosclerotic, thrombotic, and proinflammatory effects. We aimed to assess the relationship between Lp (a) and IMIDs with adverse CV events among patients with and without a history of ASCVD.MethodsRetrospective cohort of patients who underwent Lp (a) testing at two medical centers. IMIDs were identified by ICD codes prior to Lp (a) testing. The population was divided into 4 Lp (a) percentile groups based on prior literature. Cox proportional hazards were used to assess the association of IMID and Lp (a) with incident CV mortality or myocardial infarction (MI).ResultsAmong 16,419 patients in the cohort, 445 (2.7%) had IMIDs. Patients with IMID were significantly older [64 (54-75) vs 60 (49-72)], more likely to be female (57% vs 40%), have hypertension …

Time to clinical benefit with sotagliflozin in patients with type 2 diabetes and chronic kidney disease: Insights from the SCORED randomized trial Time to clinical benefit with sotagliflozin in patients with type 2 diabetes and chronic kidney disease: Insights from the SCORED randomized trial Eur J Heart Fail. 2024 Apr 17. doi: 10.1002/ejhf.3240. Online ahead of print. Authors Rahul Aggarwal 1 , Deepak L Bhatt 2 , Michael Szarek 3 4 , Lawrence A Leiter 5 , Christopher P Cannon 1 , Renato D Lopes 6 , Michael J Davies 7 , Phillip Banks 7 , Bertram Pitt 8 , Ph Gabriel Steg 9 10 Affiliations 1 Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, MA, USA. 2 Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, USA. 3 CPC Clinical Research and University of Colorado Anschutz Medical Campus, Aurora, CO, USA. 4 State University of New York …

Background Lipoprotein(a) [Lp(a)] is associated with an increased risk of atherosclerotic cardiovascular disease (ASCVD). However, whether the optimal Lp(a) threshold for risk assessment should differ based on baseline ASCVD status is unknown. Objectives The purpose of this study was to assess the association between Lp(a) and major adverse cardiovascular events (MACE) among patients with and without baseline ASCVD. Methods We studied a retrospective cohort of patients with Lp(a) measured at 2 medical centers in Boston, Massachusetts, from 2000 to 2019. To assess the association of Lp(a) with incident MACE (nonfatal myocardial infarction [MI], nonfatal stroke, coronary revascularization, or cardiovascular mortality), Lp(a) percentile groups were generated with the reference group set at the first to 50th Lp(a) percentiles. Cox proportional hazards modeling was used to assess the association of Lp …

BackgroundHigh sensitivity troponin T (hsTnT) & I (hsTnI) have similar diagnostic performance in patients with AMI, but their comparative association with prognosis in stable ASCVD is unclear.MethodsWe assessed the correlation, concordance, & predictive association of hsTnT and hsTnI in patients with ASCVD from PEGASUS-TIMI 54 and HPS3 TIMI 55-REVEAL. HsTn was modeled both continuously and categorically (< LOQ, LOQ-99% ile,> 99% ile URL). Log-transformed hazard ratios (adjusted for age, sex, and comorbidities) and categorical C-indices for the primary endpoint (PEP; CV death, MI, or stroke) and all-cause mortality (ACM) were calculated over 3 years.ResultsAmong the 37,886 patients, mean age was 66 years, 82% were men, and 70% had CAD. The median hsTnT level was 9 ng/L (IQR 6-14), with 78%≥ LOQ and 24%≥ URL. The median hsTnI was 4 ng/L (2-7), with 55%≥ LOQ and 5%≥ URL …

Background: Several sodium-glucose transport protein 2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1 RA) reduce cardiovascular (CV) events and improve kidney outcomes in patients with type 2 diabetes (T2D); however, utilization remains low despite guideline recommendations. Methods: A randomized, remote implementation trial in the Mass General Brigham network enrolled patients with T2D at high CV and /or kidney risk. Patients eligible for, but not prescribed, SGLT2i or GLP-1 RA were randomly assigned to simultaneous virtual patient education with concurrent prescription of SGLT2i or GLP-1 RA ("simultaneous") or two months of virtual education followed by medication prescription ("education-first") delivered by a multi-disciplinary team driven by non-licensed navigators and clinical pharmacists who prescribed SGLT2i or GLP-1 RA using a standardized treatment algorithm …

AimDescribe the rationale for and design of Diabetes Remote Intervention to improVe use of Evidence-based medications (DRIVE), a remote medication management program designed to initiate and titrate guideline-directed medical therapy (GDMT) in patients with type 2 diabetes (T2D) at elevated cardiovascular (CV) and/or kidney risk by leveraging non-physician providers.MethodsAn electronic health record based algorithm is used to identify patients with T2D and either established atherosclerotic CV disease (ASCVD), high risk for ASCVD, chronic kidney disease, and/or heart failure within our health system. Patients are invited to participate and randomly assigned to either simultaneous education and medication management, or a period of education prior to medication management. Patient navigators (trained, non-licensed staff) are the primary points of contact while a pharmacist or nurse practitioner …

BackgroundWe have demonstrated success with an entirely remote HTN management program, involving algorithmic guideline-directed care coordinated by patient navigators and pharmacists. We examined blood pressures to 42-months beyond enrollment, to assess any sustained long-term benefits from the programMethodsPatients enrolled in this remote HTN management program were categorized into 3 groups: those who 1) achieved target BP and were transitioned into maintenance phase, 2) entered medication titration but made an early exit, and 3) opted for education-only. Postenrollment outpatient BP readings were obtained from EHR for this secondary analysisResultsA total of 3601 participants had longitudinal BP data for this secondary analysis. Mean (SD) age was 61 (11) years, 57% females, 60% whites and 52% had ASCVD. Mean qualifying BP in education group was 139/79 mmHg compared to …

BackgroundWhether contemporary real-world anti-obesity medication (AOM) prescribing varies according to medication type or provider specialty has not been rigorously evaluated.MethodsWe retrospectively identified, among adults, all first-time outpatient prescriptions for AOM approved by the US FDA for longterm use (liraglutide [3.0 mg], naltrexone-bupropion, orlistat, phentermine-topiramate, and semaglutide [2.4 mg]) in the multicenter Mass General Brigham healthcare system (Boston, MA) between 01/01/2018-01/01/2023. Prescribing patterns were evaluated by AOM type and provider specialty.ResultsOverall, 19,119 first-time AOM prescriptions were observed, increasing from 1,090 in 2018 to 9,823 in 2022. Liraglutide (3.0 mg) was the most prescribed agent, followed by semaglutide (2.4 mg) and naltrexone-bupropion (Figure 1A). Between 2021-2022, liraglutide (3.0 mg) and semaglutide (2.4 mg …

CONCLUSIONSReal-world data from a single US health system suggest that the SOLOIST-WHF trial results are very generalizable to the real-world population. Encouragingly, 25% of patients are being treated with SGLT2i in 2022, but efforts are needed to improve this and adherence to all guideline-directed medical therapy, including ARNI and MRA.

BackgroundMajor gaps in lipid-lowering therapy persist and many fail to achieve guideline-defined LDL-C levels. Previously, we reported absolute LDL-C reduction in a remote disease management program. We now report the proportion of patients who achieved target LDL-C at the completion of the program and during follow-up.MethodsWe implemented a remote, algorithmically driven lipid management program between 2018 and 2022. 7079 pts were enrolled in medication management, and 1215 opted for education only. Target LDL-C levels at 6 and 12 months across 4 ASCVD risk groups were based on the 2018 ACC/AHA Cholesterol Guideline (LDL-C target for ASCVD< 70 mg/dL and< 100 mg/dL for other groups).ResultsOf the 8294 patients, 2656 had known ASCVD, 2887 had LDL-C> 190mg/dL, 1388 had type 2 diabetes, and 1363 had a 10-year ASCVD risk of≥ 7.5%. Of the patients fully completing …

Patients with atherosclerotic disease have an increased risk of cardiovascular events proportional to the number of diseased vascular beds, leading to increased recognition of polyvascular disease (PVD)(defined as having at least 2 of the following: coronary artery disease [CAD], atherosclerotic peripheral artery disease [PAD], or cerebrovascular disease [CVD]) as a marker of disease and risk. 1 In clinical trials, patients with PVD have a higher risk of major cardiovascular events and death than patients with CAD or PAD alone. 2 The 2018 and 2019 American College of Cardiology/American Heart Association guidelines place these patients in the highest risk category, recommending maximally tolerated statin therapy and ezetimibe or proprotein convertase subtilisin/kexin type 9 inhibitor (PCSK9i) to achieve the lowest possible low-density lipoprotein cholesterol (LDL-C) values. 3, 4 Patients with PVD had greater …

Aims Interest in targeted screening programmes for atrial fibrillation (AF) has increased, yet the role of genetics in identifying patients at highest risk of developing AF is unclear. Methods and results A total of 36,662 subjects without prior AF were analyzed from four TIMI trials. Subjects were divided into quintiles using a validated polygenic risk score (PRS) for AF. Clinical risk for AF was calculated using the CHARGE-AF model. Kaplan–Meier event rates, adjusted hazard ratios (HRs), C-indices, and net reclassification improvement were used to determine if the addition of the PRS improved prediction compared with clinical risk and N-terminal pro-B-type natriuretic peptide (NT-proBNP). Over 2.3 years, 1018 new AF cases developed. AF PRS predicted a significant risk gradient for AF with a 40% increased risk per 1-SD increase in PRS [HR: 1.40 (1.32–1.49); P < 0.001]. Those …

1 BACKGROUNDCardiovascular (CV) disease is the leading cause of morbidity and mortality for people with type 2 diabetes (T2D). 1, 2 Accordingly, CV risk reduction is a key component of the standard of care for T2D, with professional society treatment recommendations endorsing a multifactorial approach that simultaneously targets individual atherosclerotic CV disease (ASCVD) risk factors. 1, 3 These risk factors include obesity, physical inactivity, smoking, hypertension, hyperglycaemia, insulin resistance/hyperinsulinaemia and dyslipidaemia. 1, 3, 4 With regards to lipids, statins are the mainstay for ASCVD risk reduction for people with T2D, but even when low-density lipoprotein cholesterol (LDL-C) levels are controlled, residual ASCVD risk remains. 5, 6 Results from the REDUCE-IT trial demonstrated that icosapent ethyl (IPE) decreased the risk of ischaemic events, including CV death, in a population with …

Background The COVID‐19 pandemic disrupted traditional health care; one fallout was a drastic decrease in blood pressure (BP) assessment. We analyzed the pandemic's impact on our existing remote hypertension management program's effectiveness and adaptability. Methods and Results This retrospective observational analysis evaluated BP control in an entirely remote management program before and during the pandemic. A team of pharmacists, nurse practitioners, physicians, and nonlicensed navigators used an evidence‐based clinical algorithm to optimize hypertensive treatment. The algorithm was adapted during the pandemic to simplify BP control. Overall, 1256 patients (605 enrolled in the 6 months before the pandemic shutdown in March 2020 and 651 in the 6 months after) were a median age of 63 years old, 57% female, and 38.2% non‐White. Among enrolled patients with sustained …

Aims The ongoing Olpasiran Trials of Cardiovascular Events and Lipoprotein(a) Reduction [OCEAN(a)]-Outcomes trial is evaluating whether Lp(a) lowering can reduce the incidence of cardiovascular events among patients with prior myocardial infarction (MI) or percutaneous coronary intervention (PCI) and elevated Lp(a) (≥200 nmol/L). The purpose of this study is to evaluate the association of elevated Lp(a) with cardiovascular outcomes in an observational cohort resembling the OCEAN(a)-Outcomes trial main enrolment criteria. Methods and results This study included patients aged 18–85 years with Lp(a) measured as part of their clinical care between 2000 and 2019. While patients were required to have a history of MI, or PCI, those with severe kidney dysfunction or a malignant neoplasm were excluded. Elevated Lp(a) was defined as ≥200 nmol/L consistent with the …

Background: Cuffless BP devices can potentially enhance hypertension management and remote BP monitoring. Patient experience with these devices is a key driver of their acceptability and uptake. Methods: We implemented a remote hypertension program within the Mass General Brigham health system using traditional home BP monitoring to adjust medications. Selected patients in this program were enrolled in an ancillary study where BP was also measured via a cuffless wrist monitor (Aktiia SA, Switzerland). We analyzed patient experience surveys of all patients who successfully used each device for at least one full week in the program and completed surveys at 30, 60, and 180 days after enrollment. Final (180-day) surveys were analyzed. Results: Of 35 patients who used both devices, 34 completed all 3 surveys. Thirty-one patients (91%) indicated they preferred using the cuffless wrist monitor over the …