New Lancet Commission led by cardiology consultant calls for rethink on coronary artery disease
A new Lancet Commission led by Dr Rasha Al-Lamee, cardiology consultant and co-lead of the cardiovascular theme of the National Institute for Health and Care Research (NIHR) Imperial Biomedical Research Centre (BRC), proposes reframing coronary artery disease as a lifelong condition, prioritising early detection, prevention and treatment.
Traditionally, coronary heart disease has been understood to be a result of a restriction in blood flow to the heart muscle - known as myocardial ischemia - and leads to cardiac events such as heart attack. However, the new Lancet Commission argues that this model is flawed, as it often identifies the problem too late for effective intervention. Instead of focusing on acute cardiac events, the report calls for a shift towards early diagnosis, prevention and management of the buildup of plaque that narrows arteries over time – called atherosclerosis.
Titled ‘The Lancet Commission on rethinking coronary artery disease: moving from ischaemia to atheroma’, the commission was produced by 26 experts from across the globe and led by Dr Al-Lamee, who is also a clinical reader in cardiovascular science at Imperial College London. Dr Al-Lamee has been at the forefront of research into coronary artery disease, notably leading the ORBITA trial, which explored the effectiveness of coronary interventions like stents in alleviating symptoms of the disease.
Cardiovascular disease is the leading cause of death worldwide, and atherosclerotic coronary artery disease is the main contributor, predicted to be responsible for the death of 10.5 million people annually by 2050 – double the current rate.
The commission highlights the most important strategies to prevent, regress and cure atherosclerosis. It advocates for a shift from diagnosing coronary artery disease after the development of ischaemia or a cardiovascular event, towards assessing an individual’s lifetime risk at the earliest opportunity. Once ischaemia and obstruction develop, prevention is no longer possible, and the effectiveness of interventions in reducing disease and mortality is reduced.
Dr Rasha Al-Lamee said, “Coronary artery disease remains a major cause of death worldwide. It will only become more prevalent in most countries worldwide over the next 25 years. With this Commission, we aimed to highlight the most important strategies to reverse this trend.
“At its essence, coronary artery disease is preventable. It is time that we recognised this and adapted our approach to healthcare and research to enable measures that will prevent, regress, and cure the disease. It is possible to imagine a world where heart attacks are rare events and seen as a failure of upstream care. I hope that the Commission will provide a platform for a change.”
Some of the commission’s other key findings include implementing effective strategies for early screening and detection of coronary artery disease, developing new therapies for atherosclerosis and crucially the allocation of funding, resources and workforces to combat the consequences of this preventable disease.
Research at the Trust is supported by the NIHR Imperial BRC, a translational research partnership between Imperial College Healthcare NHS Trust and Imperial College London, which was awarded £95m in 2022 to continue developing new experimental treatments and diagnostics for patients.
