First-year Internal Medicine resident Stefano Byer, MS, MD, was recently awarded a distinction in the Original Research Abstract – Clinical Science category by the American College of Cardiology (ACC) for his submission, Impact of SGLT2 Inhibitors on Cardiovascular Outcomes in ATTR-CM and HFrEF. His submission was selected as one of the top three abstracts for the 2024 Advancing the Cardiovascular Care of the Oncology Patient annual conference.

Byer has been working with second-year Hematology and Medical Oncology fellow, Udhayvir Grewal, MBBS, and cardiologist Paari Dominic, MD, in studying the evolving field of cardio-oncology, which Grewal describes as “more and more important” because of the increasing effectiveness of cancer therapies.

As more people with cancer live longer, Grewal said, the “unique cardiovascular adverse effects” of some of these novel therapies emerge. “A deeper understanding of these adverse effects is going to be paramount for us to be able to make these therapies more tolerable, and henceforth more impactful, for our patients.”

Byer’s current interest has been in cardiac amyloidosis, or “stiff heart syndrome,” a rare disease that occurs when the amyloid protein builds up in the heart and takes the place of normal heart muscle. Amyloidosis can be caused by lots of different problems, Byer said, “but the ones that affect the heart are caused either by basically old age mutations in a certain gene or certain kinds of cancers.”

While rounding in clinic, Byer said he saw a patient who had amyloidosis, heart failure, and diabetes, which signaled to Byer an opportunity to prescribe an SGLT-2 inhibitor to help all three conditions.

He noted that although SGLT-2 inhibitors are primarily used to remove excess sugar from the bloodstream in people with diabetes, “during clinical trials, they found it was cardioprotective. People who took it and had existing heart failure had reduced trips to the hospital.”

“Studies have mainly looked at preventing people who have heart failure from having heart attacks, or all the plaques in their coronary arteries that lead to heart attacks, but none of these studies really looked at people with amyloidosis and have heart failure,” Byer said.

Byer and his mentors, Grewal and Dominic, accessed the TriNetX database to review data from 79 hospitals across the nation to identify patients who had reduced heart function or heart failure, as well as a diagnosis of cardiac amyloidosis. They drilled down farther to compare those on SGLT-2 inhibitors with those who were not. Not only did those on SGLT-2 inhibitors avoid hospitalization in significant numbers, but they had fewer heart attacks in comparison to those who were not on them. The data further suggested the inhibitor may reduce the amount of times people experience atrial fibrillation (AFib).

“I was able to present this research at the headquarters of the American College of Cardiology in what they call the Heart House, which is on brand,” Byer said. “I submitted it thinking, ‘There’s no way these guys will accept my dinky little poster,’ but they accepted it and then they really liked it, and they actually gave me an award for one of the best abstracts in original clinical research. At the conference, I had great discussions with these big wigs from all over the nation in this field, which is really cool because it is pretty brand new and is treating a very unique and very sensitive patient group.”

Byer is committed to continuing this research to understand how to better understand effects and treatment options for patients with amyloidosis. “It’s an interesting field because we’re developing better tools to identify people that have it, but as a result, there’s a burden on us to ask, well, can we do anything about this?”

Byer said that faculty across the department, especially in the Division of Cardiovascular Medicine, have been “extremely helpful” in helping him get answers to questions like these. “Nothing but supportive. And then allowing me to go to this meeting where half of the attendees were program directors and department leaders for these sorts of units, and getting to meet with them and starting to collaborate with them is an incredible thing.”