Cardiology for everyone - News of interest and relevance to general practitioners and non-cardiologist specialities. Part 2 new research

NewStudy Results(Selected):

Latestonatherosclerosis,atherosclerosis risk, anddyslipidemia:
A widely acclaimed study—theREACTstudyfrom Denmark—examined the prevalence of “silent atherosclerosis” in a cohort of 16,808 people (Denmark, Spain) consisting of individuals without known atherosclerosis, aged 18–70 years (mean: 45 years equal gender distribution) using multimodal imaging (3D ultrasound of the carotid and femoral arteries, CCTA, and CAC score of the coronary arteries). 

Results:

• silent atherosclerosis was detected in more than half (57.1%) of the participants;
• plaques and stenoses were detectable in at least one of the examined vessels (most often initially in the carotid arteries) at a younger age than expected;
• “silent atherosclerosis” was detected in 1 out of 13 people aged 18–29 and in 9 out of 10 people aged 60–70; by the middle age of 40, approximately 50% of men and approximately 40% of women already had “silent atherosclerosis”;
• not only the prevalence but also plaque volume and extent were significantly more pronounced with advancing age; on average, men were affected earlier (approximately 5–10 years earlier) than women.
• Comparison with the SCORE2 risk assessment often revealed a comparatively low 10-year risk, even in cases where “silent atherosclerosis” had already been detected by imaging, particularly among younger individuals.

However, the relationship between imaging evidence of plaque and the risk of serious events such as MI cannot be directly inferred from this cross-sectional study.
Imaging cannot replace the identification of risk factors and risk assessment using SCORE2.
An interesting question for future studies is whether imaging techniques—for example, using simple and cost-effective mobile ultrasound devices—could improve risk assessment with SCORE2 and enhance prevention (e.g., for determining the indication for LDL-lowering medication and ensuring treatment adherence). The study was published simultaneously in the NEJM.

Moreon this:Bundgaard H et al (2026). REACT: Prevalence of silent atherosclerosis across adult life. NEJM,
August 29, 2026 DOI: 10.1056/NEJMoa2609059

The results of this study show that the risk of early-onset atherosclerosis is largely underestimated and underscore the need to measure LDL-C, blood glucose, HbA1c, and blood pressure, as well as conducting a risk assessment using SCORE2, providing information on risk factors, and addressing them adequately through lifestyle modifications and, if necessary, medication as early as possible—in order to reduce the overall risk as effectively as possible over the course of a lifetime and to prevent serious events such as MI, stroke, and cardiovascular death at a later stage.

Prof. François Mach, Professor and Head of Cardiology at the University Hospital of Geneva,an expertin the field of atherosclerosis and Co-Chair of the ESC Guidelines Committee on Dyslipidemia and Prevention, once again emphasized in his presentations the importance ofrisk classification and risk-adapted LDL-C reduction in the primary andsecondary prevention of atherosclerosis. 
A summary of the guidelines in their current 2025 version has also been published in German; for details, see: Altmeyer’s Encyclopedia of Dyslipidemia Treatment Options.

In addition to statins , bempedoic acid is available as an alternative for patients with statin intolerance. Early combination therapy with ezetimibe and, if necessary, other new and highly potent lipid-lowering agents (PCSK9 inhibitors) should be pursued promptly when indicated. Various PCSK9 inhibitors are available when sustained, significant, and rapid LDL-C reductionis neededin high-risk patients to achieve even low LDL-C target levels.

The early use of these rapidly and highly effective agents, beginning as early as the diagnostic phase and during acute care for high-risk patients—such as those with clinically suspected acute coronary syndrome or MI—is currently being further investigated in clinical trials.

However, far too few patients— including many patients with known, confirmed atherosclerosis and very high or even extremely highrisk (e.g., following a myocardial infarction or stroke), receive no or insufficient lipid-lowering therapy , or fail to achieve the individually calculated necessaryLDL-C target levels. (For risk assessment and target value calculation, see alsoAltmeyer’s Encyclopedia of Dyslipidemia/Treatment Options).

It is also emphasized in this context that, contrary to their reputation, statins are very well-studied and well-tolerated medications. 

The results of the STAREE study, which was also presented at the conference, show thatstatins (atorvastatin 40 mg) are safe and effective even in patients aged ≥70 years and can still significantly reduce the risk of serious cardiovascular events inprimary prevention (by approximately 30%) even at this age (9,971 healthy individuals aged ≥70 years, mean follow-up of 5.9 years;investigator-initiated study).

The study fills an evidence gap, as there had been no previous studies on the safety and efficacy of statins in older adults. 

For more on this:Zoungas S et al (2026). Atorvastatin, Cardiovascular Events, and Disability-Free Survival in
Older Adults. NEJM August 28, 2026 DOI: 10.1056/NEJMoa2607314

A large Danish observational study (132,585 participants, without prior statin therapy) found evidence of a lower risk of dementia in patients with type 2 diabetes who were treated with statins early after diagnosis (15% lower relative risk over 10 years; a 10% lower relative risk with later statin therapy), suggesting a potential protective effect on cognition in additionto cardiovascular benefits.

LDL-C is not only one of the most important risk factors for atherosclerosis but is also cited by the
Lancet Commission on Dementia as one of 14 modifiable risk factors for dementia
. The study was simultaneously published in Lancet Regional Health-Europe.

Formoreinformation: Ternhammar T et al (2026) Association between timing of statin treatment after diabetes
diagnosis and risk of dementia: a nationwide observational study. The Lancet Regional Health-Europe, 2026;69. doi.org/10.1016/j.lanepe:2026.101814.

An interesting study on improving treatment adherence using a new care model with digital tools was theADHERE-ASCVD study. High-risk patients (20,604 patients) who had not renewed their prescription for statins received areminder via a secure digital channel —such as a patient portal, text message, or email.

This significantlyincreasedprescription requestswithin14days (primary endpoint) compared to standard care (14.4% versus 13.0%);asecondfollow-up with non-responders triggered a further increase of 13%. 

Automated digital tools (reminders for both physicians and patients) can be successfully, time-savingly
, and cost-effectively used in clinical practice to increase treatment adherence and
help patients achieveLDL target levels and effectively reduce cardiovascular risk. 

For more information: BhattAS et al. Digital Outreach to Improve Statin Refills in Patients with Low Statin Adherence. The ADHERE-ASCVD Randomized Clinical Trial. (2026). Published online in JAMA on August 29, 2026, doi: 10.1001/jama.2026.17092.

A new treatment option is availablefor the pharmacological management ofrareseverehypertriglyceridemia (sHTG) (≥500 mg/dL) (prevalence approximately 1 in 100 patients). These are patients with a significantly elevated risk of pancreatitis, who may also have
a residual risk of atherosclerosis—which has not yet been well assessed—particularly in the presence of concomitant type 2 diabetes mellitus (DM).

In this context, long-term results over 12 months were presented for novelRNA therapeutics targeting apolipoprotein C-IIIgene silencing:

A new internationalmulticenter study on plozasirsan(SHASTA-3/SHASTA-4) Apolipoprotein C-III silencing with siRNA (subcutaneous injection every 3 months) with 12-month follow-up in patients with severe hypertriglyceridemia ≥500 mg/dl (sHTG).

For more information:Watts GF et al (2026) SHASTA-3/4 12-month results presented during Hot Line 9 at the ESC Congress 2026 on August 30 in Munich.

As well as another study withlong-term resultson olezarsen for apolipoprotein C-III silencing using an antisense oligonucleotide (ASO) to deactivate the mRNA (monthly subcutaneous administration) in sHTG ≥500 mg/dl.

Olzarsen was already approved by the FDA in June 2026 as the first drug for the expanded indication
sHTG ( previously approved for Familial Chylomicronemia Syndrome (FCS)).

Both substances demonstrate a sustained, significant reduction in triglyceride levels (up to approximately 80%)
and a marked reduction in the risk of pancreatitis, while maintaining good tolerability (and no evidence of an increased risk of fatty liver on MRI; very low discontinuation rate).

AnextensionoftheapprovalforthesHTGindicationiscurrentlyunder reviewbytheEMA. There are currently no sufficient treatment options available for these patients. (More information on this will be available shortly under Altmeyer’s Pharmacology/Toxicology).

Bhatt AS et al. Digital Outreach to Improve Statin Refills in Patients with Low Statin Adherence. The ADHERE-ASCVD Randomized Clinical Trial. (2026). Published online in JAMA on August 29, 2026, doi: 10.1001/jama.2026.17092.

Bundgaard H et al (2026). REACT: Prevalence of silent atherosclerosis across adult life. NEJM, August 29, 2026, DOI: 10.1056/NEJMoa2609059

Ternhammar T et al (2026). Association between the timing of statin treatment following a diagnosis of diabetes
, and the risk of dementia: a nationwide observational study. The Lancet Regional Health-Europe, 2026;69. doi.org/10.1016/j.lanepe:2026.101814.

Watts GF et al (2026) SHASTA-3/4 12-month results presented during Hot Line 9 at the ESC Congress 2026 on August 30 in Munich.

Zoungas S et al (2026). Atorvastatin, Cardiovascular Events, and Disability-Free Survival in
, Older Adults. NEJM August 28, 2026 DOI: 10.1056/NEJMoa2607314