AHA Names Top Heart Disease, Stroke Research Advances of 2019

Since 1996, the American Heart Association (AHA) has compiled an annual list of major advances in heart disease and stroke science. This year's list highlights the biggest scientific victories achieved in 2019, grouped into 10 subject areas, as determined by AHA leadership.

"Numerous research findings in 2019 yielded critical new information that builds on our vast, existing knowledge of cardiovascular disease — unfortunately, the leading cause of death worldwide," Mariell Jessup, MD, AHA chief science and medical officer, noted in a statement.

"Scientific research and discovery are essential to improving our understanding of the intricacies of how the heart supports, impacts, and interacts with every other part of the body, thus improving health outcomes and reducing deaths due to cardiovascular disease," said Jessup.

The 2019 list includes six studies that are leading to shifts in care that the AHA selection committee called "momentous" for patients:

Icosapent ethyl (Vascepa, Amarin), a prescription form of the omega-3 fatty acid, reduced the risk for cardiovascular (CV) events by 25% in people with elevated triglyceride levels who were taking statins. The results, from the REDUCE-IT study, led the US Food and Drug Administration (FDA) to approve icosapent ethyl for CV risk reduction in December.

The COMPLETE trial showed that patients who have ST-segment elevation myocardial infarction (STEMI) with multivessel disease benefit from complete revascularization of any other angiographically significant lesions, rather than a strategy of intervention only in the culprit lesion.

The landmark DAPA-HF trial showed that the glucose-lowering drug dapagliflozin (Farxiga, AstraZeneca) provides "quite stunning, pretty consistent benefit" in patients with heart failure, both with and without type 2 diabetes.

In a large-scale study of more than 419,000 Apple Watch users, the device accurately detected atrial fibrillation in more than one third of the participants who received notifications of an irregular pulse.

The EXTEND trial showed that it's possible to extend the window for thrombolysis out to 9 hours after ischemic stroke onset in some patients.

The PARTNER 3 trial showed that patients with severe aortic stenosis at low surgical risk who had transcatheter aortic valve replacement (TAVR) using the SAPIEN 3 system (Edwards Lifesciences) had lower odds of stroke, rehospitalization, and death compared with those who had traditional surgery.

The following are the other advances in 2019 highlighted by the AHA selection committee:

Pulmonary Hypertension

Pulmonary hypertension is a rare condition has recently become more common; new research this year has helped reveal how this disease works. One study found that bone morphogenetic protein 9 (BMP9) is a sensitive and specific biomarker of portopulmonary hypertension (PoPH), predicting transplant-free survival and the presence of pulmonary arterial hypertension in liver disease.

Another study helped explain how a gene that provides protein production instructions known as BOLA3 plays a crucial role in the disease, opening the door for potential therapies in the future.

Familial Hypercholesterolemia

A long-term study of children with familial hypercholesterolemia (FH) showed statin therapy beginning at a young age reduced incidence of CV events from 26% to 1% at age 39, and reduced death from CV causes from 7% to 1% at age 39.

Physical Activity for Older Women

A study in older women found that reducing sedentary time by just 1 hour each day equated to a 26% lower risk of heart disease and a 12% lower risk of CVD overall. Notably, the physical activity didn't have to happen all at once — it could be accumulated throughout the day.

Another study suggested that older women who engaged in light physical activity, such as gardening or walking, had a 42% lower risk of MI or coronary death than the least-active women.

Refining Blood Pressure Control

A study found that taking antihypertensive medication at bedtime led to a 45% reduction of CV events, and the SPRINT MIND study found that intensive blood pressure lowering cuts the risk for mild cognitive impairment (MCI) in adults aged 50 years and older.

Risks for Children and Women After Pregnancy

A study showed that children exposed to secondhand smoke from their parents were at a higher risk for atrial fibrillation. For every pack per day increase in parental smoking, their children were 18% more likely to develop atrial fibrillation.

A study found that gestational diabetes might signal future health problems in African American women. Among women who reported a previous pregnancy complication, those who had gestational diabetes were most likely to have coronary artery disease visible on an angiogram.

Gene Studies Expand Knowledge of CVD

Two human genome studies offered new insights into venous thromboembolism (VTE) and peripheral artery disease (PAD). One study examined DNA from more than 650,000 people and found 22 new regions of the human genome that correspond with VTE. In the other study, researchers tested DNA from more than 637,000 people and identified 18 new parts of the genetic code associated with PAD.

A New Understanding of Heart Failure

Researchers developed a model of heart failure in mice and uncovered a previously unknown driver of heart failure with preserved ejection fraction. These findings could lead to new treatment options that can reduce symptoms and help people with this type of heart failure live longer.

Exploring Options in Congenital Heart Disease

In the phase 3 FUEL study, the phosphodiesterase-5 (PDE-5) inhibitor udenafil (Mezzion Pharma) did not improve the primary endpoint of oxygen consumption at peak exercise, but was associated with improved submaximal exercise in adolescents who were born with single ventricle heart disease and had palliative Fontan surgery.

Engineering T cells to Fight Heart Damage

Finally, the AHA points to a mouse study that suggests engineered T cells could be used to treat and reduce scarring in the heart.

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