DALLAS, Dec. 10, 2024 — Progress in assessing cardiovascular risk and identifying early prevention opportunities, improvements in treating heart failure, new therapies for bleeding strokes, strategies for reducing the life-threatening risks of cardiogenic shock and a growing list of the wide-ranging benefits for anti-obesity medications were among the significant scientific research developments in the fight against heart disease and stroke that emerged in 2024. The American Heart Association, the largest non-governmental funder of heart and stroke related research in the U.S and now celebrating a century of lifesaving service as the world’s leading nonprofit organization focused on heart and brain health for all, has been issuing an annual year-end list of major advances in heart disease and stroke science since 1996.
“When our founders formed the American Heart Association 100 years ago, they did so at a time when there was very little known at all about heart disease and stroke – even less about what caused these diseases, how to treat them and certainly not how to prevent them,” said Mariell Jessup, M.D., FAHA, chief science and medical officer of the American Heart Association. “As we reflect on the important cardiovascular-related scientific findings of this past year, it is very exciting to see just how far we have come in our understanding of these leading causes of death in the U.S. and worldwide. I’m especially encouraged by how much we are learning about how to prevent heart disease, stroke and risk factors like high blood pressure and the recognition that we can change the trajectory of these diseases with important interventions early in life. That is the Association’s focus as we start our second century of lifesaving work in 2025.”
A complete review of the Association’s top picks for leading cardiovascular-related research can be found here. Here are brief summaries of the most significant developments from 2024:
Forecasting the burden of cardiovascular disease
Cardiovascular disease (CVD) remains the leading causes of death in the U.S. According to extensive research that led to a new American Heart Association Presidential Advisory, the prevalence of cardiovascular disease and many of its risk factors is expected to continue to climb over the next 30 years. In a second Presidential Advisory, researchers warned the associated economic burden would also continue to rise in the U.S. in the coming decades. At least 6 in 10 U.S. adults (61%), more than 184 million people, are expected to have some type of CVD within the next 30 years, reflecting a disease prevalence that will have a $1.8 trillion price tag in direct and indirect costs.
Predicting – and preventing – future cardiovascular disease
A growing number of studies focus on ways to predict who is at risk for future cardiovascular disease so that more targeted efforts may be made to prevent it.
One group of researchers developed a new way to identify people at risk for cardiovascular disease based on whether their blood platelets were more prone to clumping together to form potentially deadly blood clots in the arteries. After extensive gene research, the investigators developed PRESS, the Platelet Reactivity ExpreSsion Score – a tool that assesses platelet reactivity using genetic signatures. Additional research validated the tool could be useful in identifying people who could benefit from antiplatelet therapy to lower their risk for future cardiovascular events.
Three new studies suggest cholesterol, hypertension and sedentary behavior – all major cardiovascular risk factors for adults – may begin doing damage as early as childhood.
High cholesterol is a major risk factor for the buildup of plaque in the arteries that can lead to heart attacks and strokes. A group of international researchers set out to determine how early exposure to cholesterol may impact long-term CVD risk. Their findings show early, intermittent exposure to cholesterol may be a strong predictor of accelerated plaque growth, suggesting high cholesterol early in life may be even more damaging than cholesterol that doesn’t rise until later adulthood.
A group led by researchers in Canada added to the evidence that hypertension that develops in childhood is a strong predictor of poor cardiovascular health in adulthood. Researchers compared long-term health data for children who had been diagnosed with hypertension to their peers who had not. They found that, up to 20 years later, children who had been diagnosed with high blood pressure faced more than twice the risk for a major adverse cardiovascular event including stroke, hospitalization for a heart attack or unstable angina, coronary intervention or congestive heart failure.
In a secondary analysis of the Avon Longitudinal Study of Parents and Children in the UK, researchers investigated the impact of sedentary time, light intensity physical activity and moderate to vigorous physical activity on cardiac structure and function for more than 1,000 children over the course of 13 years. They found that overall, sedentary time contributed to an increase in body fat, inflammation, blood pressure, cholesterol, arterial stiffness and subsequent cardiac enlargement, raising the risk for cardiovascular problems later in life. Reducing sedentary behavior by engaging in light physical activity at least three hours a day lessened these impacts.
A new tool to help calculate cardiovascular risk
The PREVENT risk calculator is a new tool, developed by volunteer science experts working with the American Heart Association, to help people better understand their risk for developing heart disease, stroke or heart failure. It calculates 10- and 30-year total cardiovascular disease risk using heart, kidney and metabolic health measures such as cholesterol, blood pressure, blood glucose, weight and age. The tool was validated using data from more than 6 million U.S. adults. Over an average 4.8 years of follow-up, PREVENT accurately and precisely predicted risk for cardiovascular disease and its many subtypes in a large, diverse and contemporary sample of U.S. adults. Further research investigated how well PREVENT estimated cardiovascular risk compared to the Pooled Cohort Equation which was the previous standard for calculating 10-year cardiovascular risk. The PREVENT calculator predicted lower estimates for atherosclerotic cardiovascular disease risks than the older tool, suggesting prior estimates may have been too high and some people may have been overtreated with medications to lower lipids and blood pressure.
Growing evidence of the wide-ranging benefits of anti-obesity drugs
According to the U.S. Centers for Disease Control and Prevention, 40% of U.S. adults are obese, a problem that has been steadily growing over the past decade. Obesity contributes to cardiovascular disease and other chronic illnesses. A growing body of evidence finds anti-obesity drugs developed to treat diabetes can have wide-ranging benefits for people with and without diabetes, reducing cardiovascular, kidney and heart failure-related symptoms and deaths and improving weight loss. A number of such studies were published in 2024.
Three studies investigated potential uses for semaglutide, a glucagon-like peptide-1 receptor agonist, which has previously been shown to reduce cardiovascular risks in people with diabetes. A multi-center, double-blind, randomized, placebo-controlled, event-driven superiority trial of 17,604 middle-aged adults found that the medication could also reduce these risks in people who didn’t have diabetes. Another investigation found people with obesity-related heart failure with preserved ejection fraction and type 2 diabetes could reduce their heart failure symptoms and achieve greater weight loss with the medication. And a third study showed people with chronic kidney disease and type 2 diabetes improved kidney function and reduced their risk of dying from all causes on a low dose of semaglutide.
A new study presented at the American Heart Association’s 2024 Scientific Sessions in November found that tirzepatide, another glucagon-like, peptide-1 receptor agonist, similarly reduced the risk of cardiovascular-related deaths and worsening heart failure in people with obesity who had heart failure and preserved ejection fraction.
Additional new evidence found liraglutide, a third glucagon-like, peptide-1 receptor agonist that has been shown to induce weight loss in obese adults and adolescents, also can be used to improve weight loss in children under 12, when daily injections are added to lifestyle interventions. No medications have yet been approved to treat weight loss in children in this age group.
More advances in heart failure treatment and prevention
Heart failure occurs when the heart can’t properly pump blood to the rest of the body, depriving it of oxygen.
In an international, double-blind, clinical trial, patients who took finerenone, which belongs to a class of drugs known as steroidal mineralocorticoid receptor agonists, had a significantly lower rate of worsening heart failure events and death from cardiovascular causes than those who took placebo. These findings could have potentially practice-changing implications.
Another study looked at ways to repair heart valves in people who have heart failure. The RESHAPE HF-2 trial investigated whether a minimally invasive procedure to repair the mitral valve would improve outcomes in patients with heart failure and functional mitral valve. The addition of transcatheter mitral valve repair resulted in lower rates of first or recurrent hospitalizations for heart failure or cardiovascular death, better health a year later and a lower rate of first or recurrent hospitalization for heart failure two years after the repair.
A study in the American Heart Association journal Circulation looked at how heart failure develops by investigating the ways cells in the hearts of mice interact. Researchers in this study looked at the role played by endothelial cells, which regulate the movement of materials in and out of the bloodstream. They found that when stressed, endothelial cells produce a protein called Igfbp7, which causes cardiac dysfunction. But a vaccine that targeted Igfbp7 improved cardiac function, suggesting vaccine therapy could be a promising treatment for preventing the development heart failure.
New management strategies for hypertrophic cardiomyopathy (HCM)
Hypertrophic cardiomyopathy, or HCM, occurs when the walls of the heart’s left ventricle are thicker than normal, which can make them stiff. This reduces the amount of blood taken into the heart chamber and pumped out to the body. There are two main interventions for HCM – septal myectomy, a surgical procedure to remove excess heart muscle that allows blood to empty from the chamber more easily, and alcohol septal ablation, a minimally invasive procedure in which alcohol is injected into a blood vessel, causing some of the heart muscle to die.
An analysis of data from 13 high-volume HCM centers from the international SHARE (Sarcomeric Human Cardiomyopathy Registry) looked at outcomes for people who underwent these two types of procedures. After 10 years of follow-up, the study showed an 83% overall survival rate for all patients, relatively free from heart failure with only rare occurrences of ventricular arrhythmias. The highest rate of heart failure-related complications occurred in a subgroup of women who underwent alcohol septal ablation, though it was unclear why.
Another new treatment was studied in a phase III, double-blind trial of patients with symptomatic HCM who were randomly assigned to receive the drug aficamten or placebo for 24 weeks. People who took aficamten achieved greater improvements in peak oxygen uptake than those taking placebo.
Lowering the life-threatening risks of cardiogenic shock
Cardiogenic shock is a life-threatening condition that occurs when the heart can’t pump enough blood and oxygen to the brain and other vital organs. It is often caused by a heart attack.
In an international, multicenter, randomized study, researchers described using a microaxial flow pump to move blood from the left ventricle into the aortas of patients who had gone into cardiogenic shock after a severe heart attack. The device successfully lowered the risk of dying from any cause for up to six months. However, patients treated with the microaxial flow pump had a greater risk of developing renal failure and experiencing other adverse events, such as moderate or severe bleeding, decreased blood flow to the limbs and sepsis.
Do nanoplastics pose a risk for cardiovascular disease?
A small, international study this year explored the potential link between exposure to microplastics and nanoplastics – tiny pieces of plastic that result from its disintegration in the environment – and a greater risk for cardiovascular disease. In this prospective, multicenter, observational study analyzed plaque specimens taken from patients who had surgery to remove build-up in their carotid arteries, the large vessels in the neck that bring blood to the brain.
Polyethylene – the world’s most commonly used plastic, found in everything from grocery bags to bullet proof vests – was present in the carotid artery plaque of more than 58% of patients in the study.Polyvinyl chloride, or PVC plastic, a high-strength material found in products such as medical devices and pipes, also was present in the plaques of 12% of people in the study.
After an average 34 months of follow-up, patients whose carotid artery plaques contained these microplastics had a higher composite risk for heart attacks, strokes and death from any cause than those whose plaques contained no traces of plastic debris.
Exploring new therapies for intracerebral hemorrhage
An intracerebral hemorrhage, or ICH, occurs when a weakened blood vessel ruptures and bleeds into the brain. It is the second most common cause of stroke and also the deadliest. A new study offers hope for at least some bleeding stroke patients. ENRICH (Early, Minimally Invasive Removal of Intracerebral Hemorrhage) is the first trial to show minimally invasive surgery performed within 24 hours of an acute bleeding stroke offered a greater survival benefit to patients than medical management. However, the surgery only improved survival for patients with a lobar hemorrhage – one that occurred in a superficial area of one of the main lobes of the brain – not for those with bleeding deeper in the brain.
Should beta blockers be prescribed to all heart attack survivors?
Beta blockers are a class of drugs used to treat a variety of heart conditions, including high blood pressure, irregular heartbeats and heart failure. The American Heart Association and American College of Cardiology recommend beta blockers for heart attack survivors, who often take them for at least a year, if not the rest of their lives. But a new study cast doubt on whether this treatment is right for everyone.
These new findings suggest this treatment might not be appropriate for people who have acute heart attacks and a preserved ejection fraction of 50% or greater. Among these patients, long-term beta blocker usage did not lower the risk of having another heart attack or dying.
“These important findings can help people, health care professionals, policymakers and others make better informed health care decisions,” Jessup said. “As the body of scientific knowledge continues to grow, we can help people live longer, healthier lives, and we want to ultimately see a world free of cardiovascular diseases and stroke.”
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About the American Heart Association
The American Heart Association is a relentless force for a world of longer, healthier lives. We are dedicated to ensuring equitable health in all communities. Through collaboration with numerous organizations, and powered by millions of volunteers, we fund innovative research, advocate for the public’s health and share lifesaving resources. The Dallas-based organization has been a leading source of health information for a century. During 2024 - our Centennial year - we celebrate our rich 100-year history and accomplishments. As we forge ahead into our second century of bold discovery and impact our vision is to advance health and hope for everyone, everywhere. Connect with us on heart.org, Facebook, X or by calling 1-800-AHA-USA1.