and

It wasn’t until 2011 that the American Heart Association and American Stroke Association came out and said changes in vascular health can cause cognitive impairment and dementia.

Novo ran two trials: evoke, which assessed Rybelsus in patients with early Alzheimer’s disease, and evoke+, which was expected to enroll about 20% of patients with vascular dementia as well as people with Alzheimer’s and mixed dementia, which is when a patient is diagnosed with more than one type of dementia.

The evoke+ trial appeared to have under-recruited patients with vascular dementia, and Novo said that the drug demonstrated an improvement in Alzheimer’s-related biomarkers.

There’s now a “recognition that vascular factors play a very important role, and the need for trials targeting vascular is going to remain,” said Dr. Sudha Seshadri, founding director of the Glenn Biggs Institute for Alzheimer’s and Neurodegenerative Diseases at UT Health San Antonio.

In South Texas, for example, Alzheimer’s and dementia often co-exist in the patients who are managing obesity, diabetes and high blood pressure, according to Seshadri, who noted that the chronic conditions all “cause not just atherosclerosis, but stiffening of the arteries.”