Buongiorno from the ESC Congress!
Earlier this week we had the opportunity to attend the 2016 European Society of Cardiology (ESC) Congress in Rome. ESC has become the largest cardiology meeting in the world with more than 32,000 physicians and other healthcare care professionals in attendance this year. This is one of the most important scientific events of the year for cardiovascular disease research, particularly for those focused on developing drugs to help patients around the world lower their levels of LDL-cholesterol.
Key highlights we observed from attending the many sessions and presentations include:
- Cardiovascular disease remains the number one cause of death in the developed world – and is growing significantly in the developing world – thus the worldwide interest in combatting the effects of this disease.
- In lipids, the new ESC and European Society of Atherosclerosis Society (EAS) Clinical Practice Guidelines were released and presented (http://bit.ly/2bSxfVo). Most interesting, and as we expected, these Guidelines recommend targeting both LDL-cholesterol lowering to a specific goal based on level of risk, and a percent LDL-cholesterol lowering. We think this is a welcome and pragmatic approach. In addition, the new Guidelines talk about statin intolerance, further recognition that patients can be unable to take the necessary dose of a statin to appropriately reduce their elevated LDL-cholesterol levels.
- Interestingly, there were very few studies with significant data from LDL-cholesterol lowering therapies presented at this year’s Congress. All eyes are now on the future results from the cardiovascular outcomes studies for the PCSK9 inhibitors, which are expected to be announced as early as the first quarter of next year. KOLs are speculating that the expected relative risk reductions would be the range of 20-25 percent. The PCSK9 discussions also included the issues of cost and access in the US, Europe and around the world, as well as focusing on their use in the highest risk patient populations (i.e. those patients who require a substantial degree of LDL-cholesterol lowering, such as patients with heterozygous familial hypercholesterolemia [HeFH]). The results of ODYSSEY-ESCAPE were presented (http://bit.ly/2ca5mH6) and showed that use of alirocumab in HeFH patients was able to reduce the frequency or even eliminate the need for lipoprotein apheresis.
- While not an LDL-cholesterol lowering drug class, there was a presentation (http://bit.ly/2c4Y9YM) on evacetrapib, a failed CETP inhibitor – a class of therapies that raise HDL-cholesterol and lower LDL-cholesterol through an unknown mechanism. Researchers are still trying to understand why this drug class has repeatedly failed to demonstrate a cardiovascular disease risk benefit. It was noted that inflammatory and blood pressure effects of CETP inhibitors could attenuate any benefit from the changes in lipids.
- Perhaps the most interesting presentation to us was made by Dr. Brian Ference in a “Hot Line” session (http://bit.ly/2bHLABI). Ference reported results from his study which used genetic and cardiovascular risk factor data from over 100,000 subjects of 14 prospective cohort or case-control studies to show that LDL-cholesterol and systolic blood pressure have independent, multiplicative and cumulative causal effects on the risk of cardiovascular events. Dr. Ference’s LDL-cholesterol lowering genetic validation work on statins and ezetimibe has previously been published in the Journal of The American College of Cardiology (JACC) (http://bit.ly/2bW1M4z) and signals an exciting new way to look at the potential success of new therapies in development to treat cardiovascular disease.
The next major scientific cardiovascular disease-focused meeting will be held in November in New Orleans – the American Heart Association (AHA) Scientific Sessions 2016 (http://bit.ly/2bI6iOS). We will be attending this event in person and will be sure to share with you LDL-cholesterol lowering highlights from that meeting as well.