Today's Lancet publishes The Lancet Commission on rethinking coronary artery disease: moving from ischaemia to atheroma.
Summary, key messages, citation and a comment from me below.
SUMMARY: The prevention of ACAD must begin with early detection and modification of risk factors. If behavioural and metabolic risk factors, such as smoking, hypertension, high cholesterol, and poor diet, were eliminated or controlled early in life, the global burden of ACAD could be dramatically reduced. Eliminating these risk factors by 2050 could decrease the rate of ACAD deaths by 82·1%, potentially saving 8·7 million lives annually. Public health initiatives should emphasise lifestyle changes and the management of metabolic disorders to prevent the onset of atherosclerosis.
Here are some of the key messages:
Atherosclerotic coronary artery disease (ACAD) clinical pathways must be refocused away from ischaemia and towards atherosclerosis
The focus of management of coronary artery disease needs to shift from the late stages of the disease, coronary artery obstruction and resultant ischaemia and infarction, towards strategies aimed at early prevention, regression, and cure of atherosclerosis
ACAD and associated cardiovascular events must be recognised as preventable. Complete elimination of known behavioural and metabolic risk factors by 2050 would reduce the rate of ACAD deaths by 82·1% and save 8·7 million lives per year globally
Effective strategies for early screening and detection of ACAD are needed
Implementation of evidence-based knowledge in ACAD is poor and variable, contributing to avoidable death, disability, and waste of resources
The global workforce must be trained to redirect delivery of care to prevention, detection, and management of earlier stages of ACAD, considering the relevant national context
Research funding must reflect the global burden of ACAD
CITATION: The Lancet Commission on rethinking coronary artery disease: moving from ischaemia to atheroma
Zaman, Sarah et al. The Lancet, Volume 405, Issue 10486, 1264 - 1312
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(25)00055-8/fulltext
COMMENT (NPW): As the paper states: 'Between 2022 and 2050, mortality rates from ACAD are forecasted to increase by 19·2% in lower-middle-income countries and 4·2% in upper-middle-income countries. This global disparity underscores the importance of equitable access to prevention, diagnosis, and treatment to reduce the global burden of ACAD.' The authors emphasise that 'The global workforce must be trained to redirect delivery of care to prevention, detection, and management of earlier stages of ACAD, considering the relevant national context'. I would add that it is vital to promote the availability of relevant, reliable healthcare information for the prevention, diagnosis and management of coronary artery disease - for the general population, health workers and policymakers. A large multi-national survey 'reveals significant gaps in the promotion of CVD prevention by healthcare workers' (2024; https://academic.oup.com/eurheartj/article/45/Supplement_1/ehae666.2621/... ).
I did a quick google search to get a sense of the level of awareness of risk factors for coronary artery disease. This paper from Saudi Arabia (2024) indicates that most of the respondents 626 (68.1%) had a good level of awareness. https://pubmed.ncbi.nlm.nih.gov/38370989/#:~:text=The%20results%20showed.... However, an earlier study (2018) in the same country found 'There is an evident limited knowledge among the population in Jeddah, Saudi Arabia regarding the risk factors for CAD, and it is recommended that the healthcare sector in the country focus on public health education programs about the disease'. https://www.dovepress.com/population-awareness-of-coronary-artery-diseas...
Coming back to The Lancet Commission, what are the implications of a shift in emphasis to atheroma in terms of health communication and training strategies for the general public and for health workers?
Email: hifa@hifaforums.org
Best wishes, Neil
HIFA profile: Neil Pakenham-Walsh is coordinator of HIFA (Healthcare Information For All), a global health community that brings all stakeholders together around the shared goal of universal access to reliable healthcare information. HIFA has 20,000 members in 180 countries, interacting in four languages and representing all parts of the global evidence ecosystem. HIFA is administered by Global Healthcare Information Network, a UK-based nonprofit in official relations with the World Health Organization. Email: neil@hifa.org