Medical Bulletin 27/June/2023

Overview

Here are the top medical news for the day:

Examining the use of bempedoic acid in preventing cardiovascular events in patients who are statin- intolerant

In a subgroup of high-risk primary prevention patients, bempedoic acid treatment was associated with reduced major cardiovascular events, according to a recent study published in JAMA Network. The effects of bempedoic acid on cardiovascular outcomes in statin-intolerant patients without a prior cardiovascular event (primary prevention) have not been fully described.

The study by Steven E. Nissen et al, aimed to determine the effects of bempedoic acid on cardiovascular outcomes in primary prevention patients.This masked, randomized clinical trial enrolled 13 970 statin-intolerant patients including 4206 primary prevention patients.

Mean participant age was 68 years, 59% were female, and 66% had diabetes. Participants were randomized to oral bempedoic acid, 180 mg daily or matching placebo.

Main Outcome Measures The primary efficacy measure was the time from randomization to the first occurrence of any component of a composite of cardiovascular death, nonfatal myocardial infarction (MI), nonfatal stroke, or coronary revascularization.

From a mean baseline of 142.5 mg/dL, compared with placebo, bempedoic acid reduced low-density lipoprotein cholesterol levels by 21.3%) and high-sensitivity C-reactive protein levels by 21.5%).. Follow-up for a median of 39.9 months was associated with a significant risk reduction for the primary end point and key secondary end points.

Reference: Nissen SE, Menon V, Nicholls SJ, et al. Bempedoic Acid for Primary Prevention of Cardiovascular Events in Statin-Intolerant Patients. JAMA. Published online June 24, 2023. doi:10.1001/jama.2023.9696

Intermittent fasting and conventional calorie counting show comparable effectiveness for weight loss

A small randomized controlled trial found that time-restricted eating, also known as intermittent fasting, produced similar weight loss results to traditional calorie counting in a racially diverse population of adults with obesity. The study also showed that participants who engaged in 8-hour time restricted eating had improved insulin sensitivity compared to those in the control group who ate their calories any time over 10 or more hours a day.

Researchers from the University of Illinois Chicago studied 90 adults with obesity from the Greater Chicago area to determine whether intermittent fasting or calorie restricted eating would be more effective for weight control and cardiometabolic risk reduction. Participants were randomly assigned to 1 of 3 groups: 8-hour time-restricted eating (eating from noon to 8:00 p.m. only, without calorie counting); calorie restriction (reduce 25% of their calories daily), or no change in calorie consumption, with eating taking place over 10 hours or more throughout the day.

Both the time-restricted eating and calorie restriction groups met regularly with a dietician. Participants were not blinded. The authors found that participants who engaged in time-restricted eating ate 425 fewer calories per day than the control group and lost about 10 more pounds than the control group after one year. The calorie-restricted group ate 405 fewer calories per day and lost about 12 more pounds after one year. Participants showed high adherence to both interventions.

Reference: AMERICAN COLLEGE OF PHYSICIANS, Annals of Internal Medicine, DOI 10.7326/M23-0052

New study enhances understanding of treatment-resistant hypertension

For many patients with hypertension—an elevated blood pressure that can lead to stroke or heart attack—medication keeps the condition at bay. But what happens when medication that physicians usually prescribe doesn’t work? Known as apparent resistant hypertension (aRH), this form of high blood pressure requires more medication and medical management.

Novel research from investigators in the Smidt Heart Institute at Cedars-Sinai, published in the peer-reviewed journal Hypertension, found that aRH prevalence was lower in a real-world sample than previously reported, but still relatively frequent—affecting nearly 1 in 10 hypertensive patients.

Through their analysis, investigators also learned that patients with well-managed aRH were more likely to be treated with a commonplace medication called mineralocorticoid receptor antagonist, or MRA. These MRA treatments were used in 34% of patients with controlled aRH, but only 11% of patients with uncontrolled aRH.

Study findings were based on a unique design, which used clinically generated data from the electronic health records of three large, geographically diverse healthcare organizations. Of the 2,420,468 patients analyzed in the study, 55% were hypertensive. Of these hypertension patients, 8.5%, or 113,992 individuals, met criteria for aRH.

Reference: Characterization of Individuals with Apparent Resistant Hypertension Using Contemporary Guidelines: Insights from CV-QUIC,Hypertension

DOI 10.1161/HYPERTENSIONAHA.123.20894