Drug and device firms invest in study of plaque to find trigger for heart attacks (11-26-06)
The International Herald Tribune
New York, 11/27/2006 - Most people have a clear image of how atherosclerosis, popularly known as hardening of the arteries, causes a heart attack: fatty deposits called plaque build up in a coronary artery until the day the blood flow that sustains the heart is blocked.
If only they were right. In reality, coronary artery blockages almost always cause chest pain known as angina and other symptoms as they form. But half of the men and two-thirds of the women who suffer heart attacks never experience warning symptoms.
And autopsies of such victims frequently show blood clots jammed into arteries that have been only modestly narrowed.
Standard atherosclerosis therapies include bypass surgery to route blood around blockages, angioplasty and stenting to clear blockages from inside the artery and drugs like statins that reduce cholesterol levels to slow the formation of plaque. But they have not been enough to prevent as many as 500,000 deaths a year in the United States alone from what doctors call coronary artery disease.
As a result, many researchers have turned their attention from atherosclerosis in general to the tendency of some patients to develop a form of plaque prone to inflammation and rupture, which can spill a stew of cells into the bloodstream that can incite rapid clotting.
Such plaques have been called "vulnerable" plaque." But little is known about how such plaques form and even less about how long they last or what makes them rupture.
"Figuring out who is going to have plaque rupture would be the Holy Grail of cardiology," said Deepak Bhatt, a leading research cardiologist at the Cleveland Clinic Foundation.
The broadest effort yet to do that was to be announced Monday by a consortium pledging to invest $30 million over the next four years in an international plaque research program that will be overseen by Valentin Fuster, a cardiologist at Mount Sinai Medical Center in New York.
The initial sponsors include Humana, a leading manager of health plans; AstraZeneca and Merck, from the drug industry; Philips Electronics, which makes diagnostic machines widely used to scan the heart, the arteries that supply it with blood and other parts of the circulatory system; and BG Medicine, a start-up in Waltham, Massachusetts, formerly known as Beyond Genomics.
The centerpiece of the research will be a study of 4,000 to 6,000 Humana patients with at least two known risk factors for heart attacks. As the outcome for the patients becomes clear over the next few years, researchers hope that the profiles that emerge from the study will show patterns pointing to the high-risk patients who actually suffered heart attacks. That in turn could help the companies create therapeutic products.
The payoff could be enormous for health care companies. Coronary stents, which limit the symptoms of atherosclerosis and the damage from heart attacks, but do not reduce the likelihood of future attacks, make up a $6 billion market for device makers and produce some of the biggest profit margins the industry has ever seen.
Drug makers have fared even better with statins, which partially reduce the risk of new attacks and top $20 billion in worldwide sales.
"How we treat the disease is up for grabs," said Andrew Plump, who monitors early-stage research on new cardiovascular medicines at Merck's research center in Rahway, New Jersey.
The initiative spotlights the growing lineup of research projects and technology investments that reflect competition between drug makers and device companies to develop the safest, most effective and cheapest products to combat atherosclerosis.