Market Report Source

Overview

Introduction
Atherosclerosis generally begins in childhood and manifests clinically in mid-to-late adulthood. While the mortality from atherosclerotic conditions has declined significantly, in developed countries cardiovascular disease accounts for nearly 50% of all deaths, and within the next 15-20 years, is projected to surpass infectious diseases to become the leading cause of death worldwide.

Scope
Understand key opinion leaders’ (KOL) views on topical issues in the atherosclerosis field
Provide epidemiological data for the prevalence of atherosclerosis and its associated risk factors and outcomes
Explore the pipeline and discuss mechanisms of action of developmental agents for the treatment of atherosclerosis
Assess the value of emerging plasma biomarkers in the identification and treatment of atherosclerosis

Highlights
While screening for sub-clinical stages of atherosclerosis could potentially be beneficial in avoiding future cardiovascular events, a barrier to screening for primary prevention is the cost involved in the screening and the implication of identifying somebody at risk being the decision to begin treatment at an early stage.

It would be possible to envision a screening system based on the standard risk factors, blood biomarkers, and non-invasive imaging methods. Such a screening system would identify asymptomatic individuals at high risk. However this would produce the dilemma on whether catheterization should be performed on individuals with no cardiac symptoms.

For patients with atherosclerosis, diagnosis is usually based on coronary angiography. If significant stenosis is detected, treatment consists of PCI or CABG followed by medical management. Although it is widely acknowledged that the benefits of medical therapy are substantial, room for improvement remains, as exemplified by the PROVE-IT study.

Reasons to Purchase
Target physicians more effectively, through an understanding of treatment options and prescription choices
Identify the current clinical practice in terms of diagnosis, medical and surgical care
Recognize lucrative target populations, in terms of unmet need and patient potential, in order to successfully position developmental products

Table of Contents

About the Cardiovascular pharmaceutical analysis team

CHAPTER 1 EXECUTIVE SUMMARY

Objective of the analysis

Datamonitor insight into the atherosclerosis market

CHAPTER 2 MARKET OVERVIEW

Market coverage for this report

Introduction

Pathogenesis of atherosclerosis

Atherogenic risk factors

Atherogenic protective factors

Histopathology of atherosclerotic lesions

Role of endothelium

Role of lipoproteins

Role of inflammation

C-reactive protein

Role of infection

Plaque growth and vascular remodeling

Positive remodeling

Negative remodeling

Stenosis severity and clinical events

CHAPTER 3 EPIDEMIOLOGY OF ATHEROSCLEROSIS

Objectives

Overview

Methods

Disease Definition

Measures of sub-clinical atherosclerosis

Carotid intima-media thickness (CIMT)

Coronary artery calcium score (CAC)

Ankle-brachial index (ABI)

Pulse wave velocity (PWV)

Atherosclerosis related epidemiologic studies

Risk Factors

Risk Factors and Cardiovascular Outcomes

Epidemiology Estimates

United States

Europe

European Statistics

United Kingdom

Japan

Review of literature on the prevalence of sub-clinical atherosclerosis.

Risk factors and outcomes associated with atherosclerosis

Risk Factors and co-morbidities

Hypertension

Dyslipidemia

Diabetes

Obesity

Outcomes of Atherosclerosis

CHAPTER 4 CURRENT CLINICAL PRACTICE

Diagnosis of atherosclerosis

Spectrum of presentation

Diagnostic procedures

“Gold standard” treatment

Medical care

Relief of symptoms

Prevention of future cardiac events

Statins

Treatment regimens

Treatment of vulnerable plaques

Surgical care

Percutaneous coronary interventions

Coronary artery bypass surgery

Other surgical procedures

Further inpatient care

Further outpatient care

Unmet needs in primary prevention

Unmet needs in secondary prevention

Views on plaque stabilization (with and without outcomes data)

Views on plaque regression (with and without outcomes data)

Will ASTEROID change clinical practice?

CHAPTER 5 PLASMA BIOMARKERS

How useful are plasma biomarkers?

C-reactive protein

Homocysteine

Emerging plasma biomarkers

Lipoprotein-associated phospholipase A2

Myeloperoxidase

Oxidized LDL

Lipoprotein (a)

Isoprostanes

Small, dense LDL

Other plasma markers

Drivers and barriers to greater use

CHAPTER 6 IMAGING STUDIES AND PROCEDURES

Introduction

Currently used imaging studies

Echocardiography

Nuclear imaging studies

Electron beam CT scanning

Currently used imaging procedures

Coronary angiography

Coronary blood flow determinations

Intravascular ultrasound

Emerging imaging techniques

Non-invasive imaging techniques

Magnetic resonance of coronary arteries

Multidetector row computed tomography angiography (MDCTA)

Multislice computed tomography (MSCT)

Positron emission tomography (PET) (detection of inflammation in vulnerable plaques)

Invasive imaging techniques

Intravascular MRI

Near-IR spectroscopy

Palpography

CHAPTER 7 COMPOUNDS IN DEVELOPMENT

ApoA-I mimetic ETC-216 (Pfizer/Esperion)

ApoA-I mimetic D-4F (Novartis/Bruin)

CETP inhibitors

Torcetrapib (Pfizer)

JTT-705 (Japan Tobacco and Roche)

CETP vaccine (Avant Immunotherapeutics)

AGI-1067 (AtheroGenics/AstraZeneca)

Nicotinic acid agonists

Gemfibrozil

PPARs

Gene therapy

Endothelial lipase

LXR agonists

MTP inhibitor

CHAPTER 8 FUTURE COMMERCIAL FOCUS

“Gold standard” diagnosis pathway in 5 years time

“Gold standard” treatment in 5 years time

Most promising advances/compounds in development

Where future funding should be focused

APPENDIX A

EPIDEMIOLOGY STUDIES

Multi-Ethnic Study of Atherosclerosis (MESA) (1999-2009)

Atherosclerosis Risk in Communities (ARIC) (1985-2006)

The Coronary Artery Disease Risk Development in Young Adults (CARDIA) (1984-2003):

Framingham Heart Study: (1948-2001)

Cardiovascular Health Study (CHS) (1988-2005)

Insulin Resistance Atherosclerosis Study (IRAS): Insulin, Insulin Resistance, Hyperglycemia and Cardiovascular Disease (1995-1999)

National Health and Nutrition Examination Survey (NHANES IV) (1997-2004)

Pathobiological Determinants of Atherosclerosis in Youth Study (PDAY):

The Rotterdam Study

Kuopio Ischemic Heart Disease Study

West of Scotland Coronary Prevention Study (WOSCOPS)

Bogalusa Heart Study (1972-2005)

Atherosclerosis risk in young adults (ARYA) study

BIBLIOGRAPHY

References

Epidemiology References

APPENDIX B

Contributing experts

About Datamonitor

About Datamonitor Healthcare

About the Cardovasular analysis team

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