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• Veterans with traumatic brain injury who were treated with the psychedelic ibogaine saw improvements in daily functioning and mental health symptoms.
• Ibogaine was given alongside intravenous magnesium to protect participants’ heart from a potential side effect of the psychedelic.
• Additional studies are needed, including U.S.-based clinical trials, before ibogaine can be recommended as a treatment.

Treatment with the psychedelic ibogaine improved daily functioning and mental health symptoms in a small group of veterans with mainly mild traumatic brain injury, a new pilot study found.

Study author Dr. Nolan Williams, associate professor of psychiatry at Stanford University in California, said the improvements in veterans’ symptoms of post-traumatic stress disorder (PTSD) and depression were “substantial.”

In addition, “on the [traumatic brain injury] disability front, there’s not really any therapeutic options available, so it’s really useful to see improvements there,” he told Healthline.

More research is needed before ibogaine can be recommended as a treatment, including U.S.-based clinical trials done under more controlled settings.

“But the results are pretty exciting so far,” said Williams.

The study was published Jan. 5 in Nature Medicine.

What is ibogaine?

Ibogaine is a psychoactive compound found in the West African shrub iboga. It is traditionally used in the local Bwiti religion for religious, spiritual and healing ceremonies.

The Drug Enforcement Administration classifies ibogaine as a Schedule I drug, indicating it has “no currently accepted medical use” and “a high potential for abuse.”

In order to undergo treatment with ibogaine for the new study, 30 male Special Operations Forces veterans traveled to a site in Mexico where legal ibogaine treatment is available. 

The veterans received ibogaine under medical supervision, along with intravenous (IV) magnesium to protect the heart.

One of the possible side effects of ibogaine is a potentially fatal abnormal heart rhythm. None of the participants in this study experienced this kind of heart problem. Veterans reported only typical symptoms such as headache and nausea.

Participants also had the opportunity to try massage, yoga, meditation or other complementary wellness activities, although researchers did not collect data on which of these activities veterans did.

Researchers found that a few days after treatment, participants saw improvements in functioning and symptoms of PTSD, depression and anxiety. These effects persisted until at least one month after treatment, which was the length of follow-up in the study.

Functioning includes areas such as interpersonal relationships, daily life activities and cognitive abilities.

Growing interest in psychedelic treatments

Approved therapies currently exist for traumatic brain injuries and for mental health conditions such as depression, anxiety and PTSD. 

This includes antidepressants, anti-anxiety medications and drugs to help with cognitive function. These may be paired with psychotherapy.

These treatments can be effective for some people, but not for others, said Dr. Sheital Bavishi, associate professor of physical medicine and rehabilitation at The Ohio State University Wexner Medical Center in Columbus, Ohio. These drugs also have side effects, she added, which some people may not be able to tolerate. 

“So having more options — or more tools in our toolbox — is definitely helpful,” she told Healthline.

Because traditional treatments may not work for everyone, some people with PTSD, depression or anxiety have been seeking out unapproved therapies such as ibogaine for relief from their symptoms.

Other psychedelics, including psilocybin (the active ingredient in “magic mushrooms”) and MDMA, have also been researched for various psychiatric conditions, with some promising results.

Both MDMA and psilocybin are used alongside psychotherapy. With ibogaine, the treatment approach is a little different.

“There are some psychotherapy aspects to [ibogaine treatment] — there’s a prep and there’s an integration— but it’s not psychedelic-assisted psychotherapy, like what you see with MDMA,” said Williams. “There’s no psychotherapy during the actual [ibogaine] treatment itself; rather, it’s all happening before and after.”

Ibogaine is still in the early stages of clinical research, with much of the research to date focused on treating substance use disorder. However, interest in the compound’s potential is growing.

For example, the recently passed National Defense Authorization Act has “$10 million earmarked to fund clinical trials researching ibogaine and other psychedelics as a treatment for [PTSD or] traumatic brain injuries experienced by active duty members of the U.S. military,” said Williams.

The big goal with ibogaine, he said, is to do a U.S.-based trial, which would allow researchers to control for many of the factors that could affect the results.

Future studies may also recruit veterans with varying severity of traumatic brain injuries or psychiatric symptoms.

Bavishi, who leads the Disorders of Consciousness Program at The OSU Wexner Medical Center, said it’s important to have treatments that address the multiple symptoms that people with traumatic brain injury experience.

“It’s not just brain trauma, but there’s also stress-related trauma,” she said. “So we need to be treating both at the same time; not as individual entities, but really as a combination.”

Ibogaine may directly improve brain injury

Researchers are not sure why ibogaine might help people with these different conditions, but Williams said the drug works “across a lot of different systems” in the brain.

It’s also not clear if the daily functioning benefits seen in the new study were due to a reduction in the psychiatric symptoms or if there was also a direct effect on the traumatic brain injury.

“We do have data showing that people who have prolonged symptoms after a concussion or mild brain injury usually have an [accompanying] anxiety or mood disorder — anxiety, PTSD or depression — that is actually prolonging their symptoms,” said Bavishi.

In this study, “it seems like ibogaine is reducing the mood-related symptoms that are a result of the brain injury or PTSD,” she said. “That, in turn, is improving their cognitive functioning.”

Williams thinks the disability from the traumatic brain injury is likely to be partially independent of the psychiatric symptoms.

“We’ll have to do some work to tease that out,” he said. “You’d have to essentially enroll people that didn’t have any of the psychiatric symptomatology, but still had [traumatic brain injury], in order to see if there is still a disability improvement [with ibogaine].”

“What we may be looking at is a neuro-rehab drug,” he added. “If this is true, then it’s really exciting, because people have been looking for a neuro-rehab drug for some time. There have been candidates in the past, but nothing that has been super-compelling on that front.”

Takeaway

A new study finds a type of psychedelic may help people with traumatic brain injury.

In the study 30 male Special Operations Forces veterans with traumatic brain injury underwent treatment with the psychedelic ibogaine, along with IV magnesium to protect their heart. They were also offered complementary wellness activities such as yoga and meditation.

A few days after treatment, participants saw improvements in their daily functioning and symptoms of PTSD, anxiety and depression. These benefits lasted for at least one month.

This was a pilot study, so additional research is needed, including a U.S.-based trial, which would allow researchers to control for factors that can affect the results.

• A new study suggests that blue light such as from phone screens may not be as disruptive to sleep as previously thought.
• The study looked at how people reacted to different types of light.
• They found that between the blue, yellow and white light there was no conclusive evidence that blue was worse than other forms of light.

Light from smartphone screens, tablets, and computers has widely been thought to be disruptive to our natural circadian rhythms. As a result, an industry has sprung up around “sleep hygiene.”

But a new study released last month in the journal Nature suggests that so-called blue light — the type of light emitted from these devices — may not be as disruptive as previously understood.

The study from the University of Basel and the Technical University of Munich, studied “effects of calibrated blue–yellow changes in light on the human circadian clock.” Researchers exposed 16 subjects to three different types of light for an hour before they went to sleep for the night. After using blue-dim, yellow, and constant white background/control light, the study authors determined that there was “no conclusive evidence for an effect of calibrated silent-substitution changes in light colour along the blue–yellow axis on the human circadian clock or sleep.”

Light itself can be a general disruptor to human sleep patterns, but perhaps not in the way that modern devices may have been seen in recent years.

How does light affect sleep patterns?

The human eye converts light into electrical impulses via a series of cones, rods, and “so-called intrinsically photosensitive retinal ganglion cells” (ipRGCs). Blue light, which is emitted from devices like smartphones and tablets, is a short-wavelength form of light, and it is converted to the color blue by cones, which respond to bright light; rod cells are only operational in low-light conditions and don’t differentiate between color.

The ipRGCs in the eye receive information about the intensity of light rather than color, and they also keep regular circadian rhythms in check. The photopigment melanopsin, which is expressed by ipRGCs, helps regulate nighttime melatonin suppression. Cones send information to ipRGCS, which suggests that the color of light could affect these regular circadian rhythms and a person’s ability to fall asleep or stay asleep.

A 2019 study suggested that “mistimed light exposure” — namely, the artificial light from devices we use throughout the day — could have detrimental effects on sleep and health. But the process that our brains use to modulate internal circadian rhythms is quite complex, said Dr. Alexander Solomon, surgical neuro-ophthalmologist at Pacific Neuroscience Institute at Providence Saint John’s Health Center in Santa Monica.

“There is a master ‘clock’ set by these melanopsin cells (which, again, are still most sensitive to blue light) but other activities such as meal timing and exercise can feed back to that master clock as well,” Solomon told Healthline. “I think if a person is having difficulty regularly sleeping and waking at a regular time needed for their lifestyle, one change could be to either use blue light blocking glasses or a similar phone/screen setting, but it’s also to decrease overall exposure to bright light.”

Should you avoid using your smartphone before bed?

Solomon said the study’s findings do not mean that people should expect a good night’s sleep if they’re on their phone before bed. Solomon pointed out that the study may not reflect the way most people interact with light in general.

“This study had specifically designed the light exposure…to avoid triggering the light-sensitive cell in our eye known to be responsible for resetting our circadian rhythm, which does not match real-world lighting environments,” Solomon said. “This cell is sensitive to blue light, so saying blue light doesn’t play as much of a role is untrue. It’s simply saying a bright yellow light can affect things as much as a dim blue light.” 

Keiland Cooper,Ph.D, a neuroscientist at the University of California, Irvine, told Healthline that the recent study just means more research is needed to fully understand how these devices affect our health.

“While a single study in isolation is rarely conclusive, the main takeaway from present study is that more work needs to be done to further pin down which aspects of screens at night-time negatively impact our sleep,” Cooper said. “Understanding the precise mechanisms of screens on our neural functioning is important because it will help inform device designers and manufactures as to which aspects of their screens may be augmented to aid users sleep and mitigate the side-effects of using our devices.” 

How can you get better sleep?

Many devices do have a low-light setting that can reduce the brightness of light, and blue-light blocking glasses can reduce the amount of short-frequency waves one is exposed to before bed. But Solomon pointed out that sharp contrasts in exposure to light — and that light’s intensity — may ultimately be a driving factor in how our systems determine sleep schedules and regularity.

“The strongest opportunity for light to set our circadian rhythm comes after prolonged darkness. For example, studies have shown shift workers who work overnight and see the sun while driving home (again, not a blue light specifically, but instead a bright light) have much more trouble sleeping on an appropriate schedule than those who manage to get home and sleep before sunrise,” Solomon said. “I think it’s not something the average person has to consider strongly unless they are having trouble appropriately adapting to the goal sleep/wake times or experiencing excessive daytime sleepiness. There can be many other factors that play a role in difficulty sleeping and seeing a sleep specialist/hygienist may be helpful before attributing it to a single factor such as light exposure.”

“While lowering the intensity of light may help, recommended across countless studies is that the ideal screen-hygiene prior to bed is to avoid them altogether,” Cooper said. 

Takeaway

While “screen time” before bed has recently been thought to disrupt natural circadian rhythms, it’s still a bit murky as to how much disruption the light from smartphones and tablets can cause. A new study finds that blue light is not clearly worse for sleep than other forms of light.

Reducing the use of screens before bed is still not a bad idea, given the potential for disruption.

More research needs to be done to fully understand how our systems respond to blue light.

• People with type 2 diabetes taking an anti-diabetes medication such as semaglutide did not have an increased risk of pancreatic cancer, a new study found.
• These drugs, known as GLP-1 receptor agonists, are used to treat type 2 diabetes and obesity.
• While the results are “comforting,” more research is needed, including longer-term studies, experts say.

People with type 2 diabetes who take an anti-diabetes medication such as semaglutide don’t have a higher risk of developing pancreatic cancer, a new study found.

These drugs called glucagon-like peptide-1 (GLP-1) receptor agonists have skyrocketed in popularity sold under the brand names Ozempic, Wegovy and Mounjaro among others.

“This is a very important study, because it’s a large population-based study with a very good follow-up,” said Dr. Anton Bilchik, surgical oncologist, chief of medicine and director of the Gastrointestinal and Hepatobiliary Program at Saint John’s Cancer Institute in Santa Monica, Calif., who was not involved in the new research.

In general, pancreatic cancer hasn’t been a big concern among people taking these types of medications, said Dr. Mir Ali, bariatric surgeon and medical director of MemorialCare Surgical Weight Loss Center at Orange Coast Medical Center in Fountain Valley, Calif. 

“First of all, it’s a very rare form of cancer,” he told Healthline, “and second, there hasn’t been a lot of reports of that type of cancer in patients using these drugs.”

“So this study is reassuring, in that if you prescribe these drugs to patients long-term, it’s not increasing their risk for pancreatic cancer,” said Ali, who was not involved in the new research.

The new study was published Jan. 4 in JAMA Network Open.

No increased risk of pancreatic cancer

Dr. Kishore Gadde, a bariatric medicine physician with UCI Health in Orange, Calif., who was not involved in the new study, called the findings “comforting.”

However, he pointed out that some earlier studies have suggested a possible increased risk of pancreatic cancer among people taking these types of medications. 

For example, two studies published in 2022 and 2023, which looked at data from the FDA Adverse Events Reporting System (FAERS), “have shown a strong association between use of GLP-1 receptor agonists and pancreatic cancer,” he told Healthline.

Other research, though, including a 2019 meta-analysis of 12 previous studies, found no link between GLP-1 receptor agonists and pancreatic cancer. 

Some of these studies had short follow-up periods or followed a relatively limited number of patients, the authors of the new study pointed out.

To address the limitations of these earlier studies, they looked at data on more than 500,000 patients with type 2 diabetes who were prescribed a GLP-1 receptor agonist, and followed people for an average of 6 years.

They found that patients with type 2 diabetes who took a GLP-1 receptor agonist did not have a higher risk of pancreatic cancer.

“At the end of the day, this study is very reassuring,” Bilchik told Healthline, “in that there is no increase in the development of pancreatic cancer in patients taking these drugs.”

The new study was limited to use of these drugs as a treatment for type 2 diabetes, so the findings may not apply to people taking the drugs for weight loss.

Gadde also pointed out that clinical trials for GLP-1 receptor agonists typically exclude people with significant pre-existing pancreatic disease. As a result, he thinks more real-world data and additional large studies are needed.

“Until we have more data, we need to be watchful about the risks of pancreatitis, pancreatic cancer, bowel obstruction and gastroparesis [delayed gastric emptying] when prescribing GLP-1 receptor agonists,” he said.

In addition, new GLP-1 receptor agonists are being developed, said Bilchik, and “they seem to work in slightly different ways, so there needs to be more investigation of some of these other types of drugs.”

Who is at risk for pancreatic cancer?

In the new study, researchers examined electronic medical records from 543,595 patients with type 2 diabetes. The data came from the largest health maintenance organization in Israel and the Israel Cancer Registry.

The study included more than 33,000 people who were treated with a GLP-1 receptor agonist, as well as those who weren’t. The average age of patients was 60 years, with around half female.

In addition, 79% of people had overweight or obesity, and more than one-third had a history of smoking tobacco products. Around 3% of people had a history of pancreatitis.

During the 9-year follow-up period, 1,665 patients were diagnosed with pancreatic cancer. These patients tended to be older and have a lower body mass index (BMI), compared to those without pancreatic cancer.

However, there were similar rates of pancreatic cancer among people who took a GLP-1 receptor agonist and those who didn’t, researchers found.

Patients who used only insulin to treat their diabetes had a slightly higher rate of pancreatic cancer, but researchers said this is “most probably due to their older age and longer diabetes duration.”

How Ozempic, Wegovy and similar drugs may lower cancer risk

Bilchik agrees that longer-term studies are needed, in particular, to look at whether GLP-1 receptor agonists actually lower the risk of pancreatic cancer. Past research has found that these drugs have lowered the risk of cardiovascular disease likely in part by reducing obesity.

“So many cancers are related to obesity,” he said, “so it seems logical that if we’re going to see a reduction in obesity in these patients that they will be at lower risk for developing obesity-related diseases, of which pancreatic cancer is one.”

This would be an important finding, he said, especially since the rates of pancreatic cancer cases and deaths have remained largely unchanged over the past 20 years, “unlike the significant improvement seen with other cancers.”

“Any reduction in the development of pancreatic cancer would have a significant impact in healthcare,” he said.

Takeaway

A large real-world study found that patients with type 2 diabetes who took a GLP-1 receptor agonist such as Ozempic or Wegovy did not have an increased risk of pancreatic cancer. This contrasts with earlier studies which found a possible increased risk.

GLP-1 receptor agonists are approved as a treatment for type 2 diabetes, with some now approved for treating obesity. Doctors may also prescribe these drugs off-label as an obesity treatment.

Experts say longer-term studies are needed to confirm the results and to see if the drugs can lower the risk of pancreatic cancer by reducing obesity. Obesity increases the risk of pancreatitis, which itself is a risk factor for pancreatic cancer.

• Obesity is a rising health concern in the United States.
• New medical breakthroughs have delivered new tools that can help treat obesity.
• Among the year’s most impactful breakthrough’s is the approval of new GLP-1 medications like Zepbound that can aid with weight loss.

One of the most prevalent chronic health issues in the United States is obesity and it’s linked to higher risks of other serious chronic diseases like type 2 diabetes and heart disease.

Recent figures from the Centers for Disease Control and Prevention (CDC) reports that 41.9% of Americans are living with obesity, and medical costs associated with the condition totaled nearly $173 billion in 2019.

It’s an issue that is only continuing to grow in national impact. Population data from 2022 reveals an adult obesity prevalence of 35% in 22 states — a number that has shot up from 19 states just the year before.

However, new innovations and breakthroughs in 2023 have resulted in new tools that can help effectively treat obesity.

Here’s an overview of how those breakthroughs have changed obesity treatment this year and a look ahead at what’s to come in 2024 and beyond.

The approval of Zepbound for weight loss

In 2014, liraglutide, a glucagon-like peptide-1 (GLP-1) receptor agonist drug for diabetes was approved by the Food and Drug Administration (FDA) for weight management in people living with obesity who don’t have diabetes.

It was the first drug of its kind to be approved for this purpose, according to the NEJM Journal Watch.

That was followed by semaglutide (sold under the brand names Ozempic and Wegovy) in 2021, reports Harvard Health Publishing.

This paradigm shift in how these drugs were being used came to a head this year, when it seemed like every major health news headline revolved around GLP-1 medications and their implications for tackling the nation’s obesity epidemic.

In November, the FDA approved the Eli Lily and Co. diabetes medication Zepbound (tirzepatide) — which was originally approved and marketed as Mounjaro to help treat diabetes — for chronic weight management in people with obesity who don’t have diabetes.

How Zepbound works

The medication essentially turns on the hormones GLP-1 and GIP (glucose-dependent insulinotropic polypeptide).

These hormones work in concert to essentially cut down on one’s appetite and food consumption.

The drug spurs insulin production, which is effective for people with type 2 diabetes.

However, it’s that key element of cutting down on food intake that makes it particularly effective for people who are attempting to lose weight.

Why Zepbound is being hailed as a significant breakthrough

Dr. Angela Fitch, FACP, FOMA, chief medical officer at knownwell, president of the Obesity Medicine Association, and an Assistant Professor of Medicine at Harvard University, told Healthline that the approval of these newer, more effective weight loss medications like Zepbound are “the biggest breakthrough we’ve had in the past five years.”

Others agree. This year, Science named these drugs the single biggest scientific breakthrough of 2023.

“We’ve had semaglutide on the market for a significant period of time — that was a huge advancement scientifically in the treatment of weight — and most recently, you had tirzepatide advancing, which is also a significant,” Fitch said. “We are just getting better and better scientifically in figuring out the chemistry behind metabolism, which is what we are ultimately talking about.”

Dr. Steven Nissen, a cardiologist at Cleveland Clinic, pointed out that tirzepatide has been revealed to result in a 20% reduction in body weight for people who are living with overweight or obesity.

Nissen, who has been leading an ongoing 15,000 patient study on tirzepatide, calls the drug “a turning point in the battle against obesity.”

2023: The year of reframing how we see and treat obesity

Fitch said the rise of these drugs as effective tools for treating obesity has helped refocus how we approach treatment.

“Another thing we have accomplished in the past year, this highlight that obesity is not about your character, it’s not because you are lazy and can’t do the work yourself — it’s because this is a medical problem that has real needs for medical treatments that are much more effective than they were in the past,” Fitch explained.

The growing popularity of these drugs is as much a cultural advancement as it is a scientific one.

She said other chronic conditions like diabetes and heart disease are viewed from a holistic standpoint.

While lifestyle modifications, like diet and exercise, are needed to help manage those conditions, we also have widely adopted medications that complement those behavioral changes.

Fitch explained that you wouldn’t tell someone with heart disease to solely eat salads and work out, and then not take medication that might save their life.

With obesity, the focus in society at large falls squarely on people needing to make these lifestyle shifts, while people look suspiciously on those who might opt for a medical solution.

“In the 1800s we didn’t have blood pressure medicine. We didn’t live so long. We didn’t live so healthily and we ended up dying earlier from all of these other diseases,” she said. “Today, we do have to focus on the combination of taking care of our lifestyle, improving our lifestyle, because the environment we are living in today is not promoting health in any way.”

Fitch said the new awareness that has been generated around these medications is having a concrete, positive effect on people who are seeking treatment for obesity.

Dr. Sarah Kim, professor of medicine, UCSF ZSFG Division of Endocrinology, Diabetes and Metabolism, director of ZSFG Adult Diabetes Clinic and ZSFG Adult Weight Management Clinic, and director of the UCSF Diabetes Teaching Center, told Healthline that it’s crucial we understand that obesity is often the “core reason why people are getting type 2 diabetes, getting coronary disease.”

She stressed that if you can treat this root cause of other serious, life threatening chronic illnesses with this type of medication, then you will start to see all of the wider “collateral benefits.” Tackling obesity can go a long way to promoting greater overall health.

“The data suggests that if you don’t lose weight on these medications, you don’t get as much cardiovascular benefit. So, is it the weight loss that is mediating all of it? Probably, as opposed to some sort of direct effect on the hormone on your heart, on the vessels. It’s really lowering weight, which is the core problem that has led to all of these metabolic conditions,” Kim explained. “We have gotten better at medication-assisted weight loss.”

New obesity treatments on the horizon

Zepbound isn’t the only drug on the block.

Right now, another medication from Eli Lily and Co. — retatrutide — is in clinical trials.

The triple-hormone-receptor agonist has been showing signs of spurring significant weight loss in study participants.

Kim said that is is “showing even more weight loss and stronger and stronger weight loss [than other related drugs] by manipulating all these hormones.”

She added that it will be completing it’s phase III clinical trial in 2024 and it’s assumed to go up for FDA approval similar to Zepbound.

Fitch said the biggest challenge moving forward is “supply, access, and cost.”

How insurance coverage of obesity treatments needs to evolve

Fitch also pointed out that one of the big challenges with obesity treatment is that the condition isn’t considered a “standard benefit” in the health insurance arena.

That means there needs to be a special “carve out” in most employers’ health plans to provide treatment coverage to their workers.

The big obstacle is that most people will likely be employed at a given company for just a year or two. Because of this, many businesses are often unmotivated to make an investment in treatment that will likely be costly for them over such a short period of time.

Fitch said her hope is that 2024 will see obesity transition to being a “standard benefit” and people seeking these treatments won’t have to deal with these complexities and insurance hurdles.

“The goal is to develop these comprehensive, longitudinal care paths that are covered like other diseases are — like diabetes, like cancer,” she said. “If you get a new job, you don’t wonder ‘is my insurance going to cover my cancer treatment?’ You don’t question that because it covers your cancer. So, we need that to be the same for obesity.”

• Heart disease affects millions of people every year.
• Several advancements in treatment and prevention occurred throughout 2023.
• Among these innovations are new injectable medications that are making treatment easier and more effective.

As 2023 comes to a close, cardiologists are reflecting on some of the advancements and breakthroughs in their field over the past 12 months.

Heart disease is a pressing issue in the United States. The American Heart Association reports that more than 130 million adults (about 45.1% of the population) will develop some form of cardiovascular disease by 2035, which will lead to $1.1 trillion in projected total costs.

This reality means researchers and clinicians are invested nationwide in developing better interventions and treatments to address the rising prevalence of heart disease among Americans.

To put in perspective how serious this is, heart disease stands as the leading cause of death regardless of gender and spans most racial and ethnic groups in the United States, according to the Centers for Disease Control and Prevention (CDC).

Heart disease kills one person for every 33-second interval nationwide.

Healthline spoke with several experts who weighed in on the major breakthroughs and innovations of the past year as well as promising developments on the horizon in 2024.

Diabetes medications may offer cardiovascular benefits

Dr. Joseph C. Wu, Ph.D., FAHA, American Heart Association president and director, Stanford Cardiovascular Institute and Simon H. Stertzer Professor of Medicine & Radiology at Stanford School of Medicine, said that glucose-lowering drugs have been a game changer for people with type 2 diabetes, helping them to reduce cardiovascular events and improve their heart health.

Research is now suggesting these same drugs may also improve heart health in people with obesity who aren’t also living with diabetes.

“In one trial of semaglutide, a medication shown to lower the risk of heart problems in people with diabetes and approved for long-term weight management, people with heart failure with preserved ejection fraction and obesity fared better on the drug than on placebo,” Wu said.

What is preserved ejection fraction?

Wu explained that this happens “when the heart muscle becomes thick and stiff and can’t pump out enough blood to meet the body’s needs.”

“The semaglutide group had greater reductions in heart failure-related symptoms, greater improvements in the ability to exercise and greater weight loss,” he added.

Wu also singled out a late-breaking trial of the GLP-1 (glucagon-like peptide 1) receptor agonist drug that was presented at the American Heart Association’s Scientific Sessions 2023.

In that trial, researchers looked into whether semaglutide benefitted people who are living with overweight or obesity who did not have diabetes, but who had cardiovascular disease.

The findings show that the drug was “superior to placebo in reducing cardiovascular-related death, nonfatal heart attacks, and nonfatal strokes,” Wu told Healthline.

Dr. Steven Nissen, a cardiologist at Cleveland Clinic, pointed to a different type 2 diabetes medication that he said is also a “blockbuster” — tirzepatide.

He cited findings released this year that showed the cardiovascular benefits of the dual-acting GIP and GLP-1 agonist, which was originally made available solely for diabetes under brand name Mounjaro, and was recently approved for weight loss and the treatment of obesity under the name Zepbound.

“We’ve had these drugs, but we didn’t really know whether they’d have a favorable effect on cardiovascular outcomes on people who are being treated for obesity,” he said.

The research conducted on this drug had a “very robust result,” Nissen stressed.

It was shown to have a 20% reduction in body weight for people who were overweight, while showing clear, “promising hard endpoints” of lower risk of cardiovascular death, stroke, myocardial infraction, or heart attack.

“That’s a big reduction, it’s a turning point in the battle against obesity,” he added.

Injectable medications are making some treatments faster and easier

Dr. Karol Watson, PhD, an attending cardiologist and a Professor of Medicine/Cardiology at the David Geffen School of Medicine at UCLA, said all of the big 2023 developments in cardiovascular health center on preventive measures for lipid and hypertension management.

Watson, who is also the director of the UCLA Women’s Cardiovascular Health Center, the UCLA-Barbra Streisand Women’s Heart Health Program, the co-director of the UCLA Program in Preventive Cardiology, and director of the UCLA Fellowship Program in Cardiovascular Diseases, told Healthline that the big goal is “trying to figure out how to get people to take their medications in the least invasive way possible.”

Watson said that, traditionally, you had daily pills people would take or injectables they would have to receive every two weeks. Today, there are more options.

“Now, there is data on the injectables people can do every every six months. Now, there are longer gaps [between injections]. The whole idea is one and done and doing something people will find easier for them. And, it works,” Watson explained. “The problem is, these things are not going to be cheap.”

The findings of the drug zilebesiran, which showed the potential to lower pressure with an injection every six months, were presented at the American Heart Association’s Scientific Sessions 2023.

Watson added that this kind of injectable “makes it easy for people to get the medication they need.” She reiterated a big problem persists.

“These [medications] are easy, you have one injection every six months,” she said, “but they are not cheap. That is the problem.”

A link between cardiovascular, kidney disease, and metabolic syndrome

Wu pointed back to the 2023 Scientific Statement from the American Heart Association, which offers a summary of cardiovascular-kidney-metabolic (CKM) syndrome. He said this is “an interconnection between obesity, chronic kidney disease, diabetes, and cardiovascular disease, which is linked to premature death and disability.”

He said concretely pointing out this relationship is one of the big cardiovascular headlines of the year.

“The statement summarizes what is known about CKM syndrome and how to prevent and manage it. It highlights a new way to calculate risk of the syndrome, as well as gaps in knowledge and needed research,” Wu added. “An accompanying Presidential Advisory helps define CKM syndrome and offers guidance on the prevention and treatment of the syndrome across different clinical and community settings.”

Thrombectomy may provide more independence to severe stroke patients

Wu pointed to research on endovascular thrombectomy, a minimally invasive surgical procedure used to remove a stroke-causing blood clot from an artery in the brain, as another one of 2023’s big stories.

This procedure restores blood flow and prevents further brain damage and disability. It’s the standard form of treatment for either small or medium-sized strokes.

“Until now, it wasn’t clear if endovascular thrombectomy would also benefit people with larger, more severe strokes, which account for up to one-fourth of all strokes.

In a study of people with severe strokes from China and in another trial of people in North America, Europe, Australia, and New Zealand, researchers found endovascular thrombectomy within 24 hours of a stroke was superior to standard medical care,” Wu said.

This research showed that these individuals who received this treatment showed signs of experiencing fewer disabilities and “were more functionally independent during the three months after treatment.”

He pointed to a third study of those treated for severe stroke in Europe and Canada who showed similar outcomes.

“Those who underwent endovascular thrombectomy were more functionally independent than those who had standard medical treatment, alone. This study also showed that thrombectomy patients were less likely to die,” Wu added.

New heart disease research and potential innovations in 2024

What do these experts see in the year to come? All three cited innovations in gene editing.

Watson said “we are starting to see the era of gene editing.”

She pointed to research out of New Zealand that shows, for the first time, gene editing technology can reduce low-density lipoprotein (LDL).

“What we’ve seen in this small proof of principle study, what we’ve seen in these first 10 patients, is that [we saw] durable LDL reduction, but of the 10 patients, two of them had very serious adverse events — one died and one had a heart attack, so the questions of safety will always persist,” she added.

Watson and Wu said that, even more promising, is the FDA approval of a cure for sickle cell disease that harnessed the same CRISPR gene-editing technology. The approval of Casgevy is a major breakthrough — the first medicine that utilizes CRISPR to receive U.S. approval, according to NBC News.

Nissen pointed to the number of drugs in development for treating lipoprotein (a), or Lp(a), as a development to keep front and center for the coming year. He said “this is a condition, which is a heart disease risk factor in 20 percent of the population that has never been treatable.”

Now, what is known as RNAi, or RNA interference, is being utilized to reduce Lp(a). Nissen said he and his team have published several articles on these new therapies, and one of them involves a clinical trial for a drug called pelacarsen, which he is chairing.

This study has enrolled 8,300 patients and “is now well along toward completion,” he said.

“If successful, it will be the first time ever that we can treat this disorder, everyone is waiting for the results of the trial,” he said.

Additionally, beyond these innovations, Wu said he’s excited about the FDA Modernization Act 2.0, which opens the door for moving beyond mandatory animal testing and toward a new era of using stem cells, organoids, artificial intelligence and machine learning, and in computer models for drug discovery.