High cholesterol in young adults is being left untreated, anticoagulation after stent implantation is excessive, combination pills for heart failure are superior, and tailoring vitamin D supplementation could halve heart attack risk.
Alongside findings for long-term melatonin use and PCSK9 inhibitors for cholesterol management, some interesting abstracts were presented at the 2025 American Heart Association conference.
Here are some of the highlights.
Clot prevention is going too far
Standard care after a stent implantation is an antithrombotic regimen for a year.
As The Medical Republic previously reported, there has been suggestion that prolonged use of these medications carries greater risk than reward.
The OPTIMA-AF trial found that one month of clot-preventing therapy was as effective as a year-long course for preventing stroke, heart attack and death.
The study included 1100 adults with atrial fibrillation and a drug-eluting stent. Assignment was randomised but the trial was not blinded.
All were given dual therapy; a direct oral anticoagulant and a P2Y12 inhibitor.
After one month, half of participants ceased the P2Y12 inhibitor and continued the oral anticoagulant alone. Researchers assessed outcomes at 12 months.
The findings suggested the shorter approach was equally effective, researchers said, as 5.4% of participants in the one-month group and 4.5% in the 12-month group experienced heart attack, stroke or death.
Participants in the one-month treatment group also had notably fewer bleeding complications than the 12-month group (4.8% vs 9.5%).
“Previous studies confirmed that using two anti-clotting agents instead of three reduced bleeding, however, no study has tested whether the duration of dual therapy could be safely shortened to just one month,” Dr Yohei Sotomi, director of the Osaka Cardiovascular Conference Multicentre Clinical Research Lab at University of Osaka Graduate School of Medicine, told media.
“Our study is the first to show that a one-month strategy is both safe and effective, offering real-world benefits for patients and doctors.”
The average age was 75 years, 79% were men and the stents were implanted at 75 hospitals in Japan between 2019 and 2024.
One pill is better than three
Current PBS restrictions do not allow single pill combinations (SPCs) or fixed dose combinations (FDCs) as first-line treatment in Australia, despite all major international guidelines recommending this.
The body of evidence for the use of SPCs in heart failure continues to grow, however.
A new study has found that patients taking an SPC of three medications for heart failure had improved heart function and symptoms, better quality of life, fewer hospitalisations and greater medication adherence than those taking the same medications as separate pills.
The SPC group had a 3.4% higher absolute left ventricular ejection fraction (LVEF), a 60% reduction in heart failure-related hospitalisations and emergency room visits, and higher quality of life scores on a 100-point scale (72 vs 63).
Blood tests also confirmed the SPC group had more than four-fold greater odds of taking all tested medications than those taking separate pills.
“In recent decades, there have been important, effective treatment advances for patients with heart failure,” said study author Dr Ambarish Pandey, associate professor of internal medicine and medical director of the heart failure with preserved ejection fraction program at UT Southwestern Medical Centre in Dallas.
“However, use of these treatments remains disappointingly low, with only 15% of patients receiving all guideline-recommended therapies at any dose for heart failure after hospitalisation.”
The study included more than 200 adults with heart failure with reduced ejection fraction (HFrEF), with an average LVEF of 26%. Participants were assessed for six months.
The median participant age was 54 years, a fifth were female, 54% self-identified as Black, and a third were Hispanic.
Related
Nearly 70% of participants had no health insurance or were receiving county-sponsored health coverage, 42% reported food insecurity and 32% reported housing instability.
“In our study, we focused on socially disadvantaged populations to demonstrate the positive impact of an easier-to-follow medication regimen of only one pill vs. three pills daily, and we found significant improvements even after six months,” said Dr Pandey.
Vitamin D could be key
Tailoring and monitoring vitamin D reduced heart attack risk by 52%, according to preliminary findings of the TARGET-D clinical trial.
The randomised trial compared two groups: a treatment group receiving targeted vitamin D supplementation to maintain optimal levels, and a standard care group with no vitamin D monitoring or dose-tailoring.
“Previous clinical trial research on vitamin D tested the potential impact of the same vitamin D dose for all participants without checking their blood levels first,” said Professor Heidi May, epidemiologist and principal trial investigator.
“We took a different approach. We checked each participant’s vitamin D levels at enrolment and throughout the study, and we adjusted their dose as needed to bring and maintain them in a range of 40-80ng/mL.”
More than 600 adults with acute coronary syndrome were recruited from the Intermountain Medical Centre in Utah between 2017 and 2023.
They were followed up, on average, for 4.2 years. More than 85% of participants had baseline levels below 40ng/mL, a level many experts believe is insufficient for optimal health.
Over half of the treatment group required more than 5000 IU of vitamin D daily to reach target blood levels, a dose more than six times higher than the FDA’s 800 IU recommendation.
While tailored vitamin D doses did not significantly reduce the primary outcome of death, heart failure hospitalisation or stroke, supplementation appeared to be beneficial for preventing heart attack specifically.
Just over 100 major cardiac events occurred during the study period, including heart attack, heart failure hospitalisation, stroke and death – 15.7% of the treatment group and 18.4% of the standard care group.
Around half of participants had previously experienced a heart attack. Average participant age was 63 years, 78% were men and 9 in 10 identified as white.
Researchers also monitored calcium levels of the treatment group to prevent vitamin D toxicity. Doses were reduced or stopped if vitamin D levels rose above 80 ng/mL.
These studies are currently research abstracts only. The findings are considered preliminary until published as full manuscripts in a peer-reviewed scientific journal.
Young adults with high cholesterol are often untreated
Fewer than half of adults aged 18 to 39 years with severely high LDL-C levels start taking a statin within five years of their first high measurement.
According to a study presented at the conference and published in the Journal of the American College of Cardiology, only 28% of those with LDL-C of 190mg/dL or greater initiated a statin within one year.
The 2018 ACC/AHA Cholesterol Guideline recommends statins for patients with LDL-C over 190mg/dL.
From 2008 to 2018, statin initiation within one year for those with LDL-C of 190mg/dL or greater dropped from 36% to 13%.
Data of more than 771,000 people in this age group who had their first elevated LDL-C measurement between 2008 and 2020 were analysed.
The study marked one of the largest to date which examined real-world patterns of LDL-C testing and statin initiation in this age group.
Among those in the LDL-C range of 160–189mg/dL with high 30-year ASCVD risk, 25% initiated a statin within one year and 46% initiated within five years.
Follow-up LDL-C testing among high-risk individuals within a year declined from around 53% in 2008 to 35% in 2018.
Over that same decade, statin initiation within one year in this LDL-C range with high risk declined from 32% to 20%.
The study was conducted within an insured health system population in Southern California. Statin adherence was not assessed, nor why patients or clinicians decided not to initiate or perform follow-up testing.
“Our findings underscore that early adulthood is a critical window for prevention, and identifying these areas of opportunities for earlier intervention is essential to reducing young adults’ lifelong heart risk,” said Ms Teresa Harrison, lead author and researcher at Kaiser Permanente Southern California Department of Research & Evaluation.
“By identifying and addressing these gaps early, we can change the trajectory of heart disease across the lifespan,” said Dr Harlan Krumholz, JACC Editor-in-Chief.
