Established and Emerging Therapies for Cardiovascular-Kidney-Metabolic Syndrome: Harnessing the Benefits of SGLT-2 Inhibitors, GLP-1 Receptor Agonists, and Beyond.

Cardiovascular-kidney-metabolic (CKM) syndrome is a term that is increasingly used to describe interconnected conditions that lead to poor health outcomes, including cardiovascular disease, chronic kidney disease, type 2 diabetes, and obesity. Historically, there have been very few targeted pharmacotherapies available that have changed cardiovascular outcomes for people with CKM syndromes; however, over the past decade, new pharmacologic options have rapidly expanded, with strong evidence for cardiovascular and kidney protective benefits in CKM conditions. Of note, sodium-glucose cotransporter-2 inhibitors and glucagon-like peptide-1 receptor agonists have emerged as key therapeutic options and are now widely guideline-endorsed.

Cardiovascular, kidney, and metabolic health: an actionable vision for heart failure prevention.

The substantial and growing prevalence of heart failure, which remains the leading cause of preventable hospitalisation worldwide, has brought heart failure prevention into sharp focus. Although this condition has historically been characterised by impaired cardiac function, mounting evidence has underscored its complex and multisystem pathobiology. Epidemiological studies have indicated that other forms of cardiovascular disease, along with kidney and metabolic dysfunction, frequently and increasingly contribute to heart failure onset.

Impact of Obicetrapib on Major Adverse Cardiovascular Events in High-Risk Patients: A Pooled Analysis.

Background: The cholesteryl ester transfer protein inhibitor obicetrapib decreases levels of atherogenic lipids and raises high-density lipoprotein cholesterol (HDL-C).

Objectives: In this study, we sought to determine the effect of obicetrapib on cardiovascular events.

Methods: The effects of 10 mg obicetrapib and placebo daily on major adverse cardiovascular event (MACE) rates were investigated in a pooled analysis of 354 patients with heterozygous familial hypercholesterolemia (HeFH) and 2,530 patients with atherosclerotic cardiovascular disease (ASCVD) over 365 days.

Application of health data analytics in pharmacy - An innovative approach to developing a heart failure dashboard.

Background: There has been increasing interest in the utilisation of health data analytics for decision support systems and prioritising pharmacy clinical work. Despite this potential, there remains limited evidence in the Australian context regarding the design and implementation of data-driven dashboards tailored specifically for pharmacists.

Objectives: We aimed to develop a disease state dashboard in an Australian hospital to assist clinicians identifying and prioritising the review of heart failure (HF) patients when admitted for other reasons, enabling timely optimisation of their care.

Pop-Up Cardiovascular Screening Within Community Pharmacies and an International Sporting Event.

Background: Atherosclerotic cardiovascular disease is a leading cause of mortality and morbidity. However, screening for cardiovascular risk at a population level remains challenging due to variable uptake and compliance.

Objectives: This study investigated an opportunistic pop-up approach to community screening for cardiovascular risk and the differences in captured populations according to screening station location and day and time of screening.

Characteristics of patients prescribed SGLT-2i and/or GLP-1RA among cardiology clinics in the US: insights from the COORDINATE-diabetes trial.

Background: Antihyperglycemic agents with cardiovascular (CV) benefits, including SGLT-2i and GLP-1RA, are underused in clinical practice, particularly by cardiologists. Understanding the prescribing patterns of these agents by cardiologists may aid in implementation efforts.

Methods: The COORDINATE-Diabetes trial enrolled participants with type 2 diabetes (T2D) and atherosclerotic cardiovascular disease (ASCVD) from US cardiology clinics and evaluated the impact of cluster randomization to a multifaceted implementation intervention versus usual care on proportional prescription of evidence-based therapies; the present analyses focus on SGLT2i and GLP-1 RA prescription.

Impact of evolocumab on plaque phenotypic changes in patients with acute coronary syndrome and elevated lipoprotein(a) levels: a HUYGENS secondary analysis.

Aims: The proprotein convertase subtilisin/kexin Type 9 inhibitor, evolocumab, promoted plaque stabilization on serial imaging in patients following an acute coronary syndrome. The impact of evolocumab in patients with varying lipoprotein(a) [Lp(a)] levels is unknown.

Methods And Results: Serial optical coherence tomography imaging was performed to evaluate changes in plaque composition in response to treatment with evolocumab 420 mg or placebo for 50 weeks.

Current perspectives on Lp(a)-lowering therapies: Who may benefit?

Increasing evidence has implicated lipoprotein(a) [Lp(a)] in the pathogenesis of atherosclerosis and calcific aortic valve disease. There are currently no therapies available in clinical practice that selectively lower Lp(a) levels. In the current state, the presence of an elevated Lp(a) level plays an important role in risk enhancement and triaging patients to the use of more intensive targeting of established cardiovascular risk factors.

Safety and Efficacy of Obicetrapib in Patients at High Cardiovascular Risk.

Background: Obicetrapib is a highly selective cholesteryl ester transfer protein inhibitor that reduces low-density lipoprotein (LDL) cholesterol levels. The efficacy and safety of obicetrapib have not been fully characterized among patients at high risk for cardiovascular events.

Methods: We conducted a multinational, randomized, placebo-controlled trial involving patients with heterozygous familial hypercholesterolemia or a history of atherosclerotic cardiovascular disease who were receiving maximum tolerated doses of lipid-lowering therapy.

The management of cardiovascular risk in people with diabetes: Insights from an audit of health services providing diabetes care.

Aims: To assess cardiovascular risk management among Australians with diabetes.

Methods: Retrospective analysis of clinical audit data collected from diabetes centres participating in the Australian National Diabetes Audit in 2022. Adults (≥18 years) with type 1 or type 2 were included.

Achieved levels of apolipoprotein B and plaque composition after acute coronary syndromes: Insights from HUYGENS.

Background And Aims: Addition of the PCSK9 inhibitor, evolocumab, to statin therapy promoted coronary plaque stabilization after an acute coronary syndrome. While apolipoprotein B (ApoB) has been proposed as a goal for lipid-lowering therapy in the prevention of cardiovascular disease, its association with plaque stability has not been studied.

Methods: The High-Resolution Assessment of Coronary Plaques in a Global Evolocumab Randomized Study (HUYGENS) used serial optical coherence tomography to assess coronary plaque phenotypes in patients with non-ST elevation myocardial infarction treated with evolocumab plus statin or placebo plus statin for 52 weeks.

Achieving More Optimal Lipid Control with Non-Statin Lipid Lowering Therapy.

Purpose Of Review: The use of statins has transformed approaches to the prevention of cardiovascular disease. However, many patients remain at a major risk of experiencing cardiovascular events, due to a range of factors including suboptimal control of low-density lipoprotein cholesterol (LDL-C). Accordingly, there is an ongoing need to develop additional strategies, beyond the use of statins, to achieve more effective reductions in cardiovascular risk.

Prognostic Implications of Machine Learning Algorithm-Supported Diagnostic Classification of Myocardial Injury Using the Fourth Universal Definition of Myocardial Infarction.

Background: With widespread adoption of high-sensitivity troponin assays, more individuals with myocardial injury are now identified, with type 1 myocardial infarction (T1MI) being less common despite having the most well-established evidence base to inform care. This study assesses the temporal time course of cardiovascular events among various forms of myocardial injury.

Method: Consecutive hospital encounters were identified.

Learnings from Implementation Strategies to Improve Lipid Management.

Purpose Of Review: Lowering low-density lipoprotein (LDL)-cholesterol reduces cardiovascular risk. International lipid management guidelines recommend LDL-cholesterol goals or thresholds for initiating lipid-lowering therapy. However, contemporary real-world studies have shown that many high- and very high-risk patients are not attaining LDL-cholesterol goals and are not receiving intensive lipid-lowering therapies.

Discontinuation of SGLT-2i and GLP-1RA among persons with Type 2 diabetes and atherosclerotic cardiovascular disease treated in US cardiology clinics.

Background: SGLT-2i and GLP-1RA are recommended for persons with type 2 diabetes and atherosclerotic cardiovascular disease (ASCVD); for those prescribed, little is known about reasons for discontinuation.

Methods: From the COORDINATE-Diabetes randomized trial database, the frequency and reasons for discontinuation of SGLT2i or GLP-1RA were analyzed.

Results: 1045 participants were enrolled 7/2019 to 5/2022; 290 (27.