Atherosclerosis - HDL, ApoA-I, Carotid MRI and 64-slice CT offer opportunities
Scope
Report Highlights
Reasons to Purchase
Table of Contents
- ABOUT DATAMONITOR HEALTHCARE - page 2
- About the Cardiovascular pharmaceutical analysis team - page 2
- CHAPTER 1 EXECUTIVE SUMMARY - page 4
- Objective of the analysis - page 4
- Datamonitor insight into the atherosclerosis market - page 4
- CHAPTER 2 MARKET OVERVIEW - page 13
- Market coverage for this report - page 13
- Introduction - page 13
- Pathogenesis of atherosclerosis - page 14
- Atherogenic risk factors - page 15
- Atherogenic protective factors - page 18
- Histopathology of atherosclerotic lesions - page 18
- Role of endothelium - page 19
- Role of lipoproteins - page 21
- Role of inflammation - page 22
- C-reactive protein - page 22
- Role of infection - page 24
- Plaque growth and vascular remodeling - page 26
- Positive remodeling - page 27
- Negative remodeling - page 27
- Stenosis severity and clinical events - page 27
- CHAPTER 3 EPIDEMIOLOGY OF ATHEROSCLEROSIS - page 29
- Objectives - page 29
- Overview - page 29
- Methods - page 30
- Disease Definition - page 30
- Measures of sub-clinical atherosclerosis - page 31
- Carotid intima-media thickness (CIMT) - page 31
- Coronary artery calcium score (CAC) - page 32
- Ankle-brachial index (ABI) - page 32
- Pulse wave velocity (PWV) - page 33
- Atherosclerosis related epidemiologic studies - page 33
- Risk Factors - page 33
- Risk Factors and Cardiovascular Outcomes - page 36
- Epidemiology Estimates - page 37
- United States - page 38
- Europe - page 38
- European Statistics - page 39
- United Kingdom - page 39
- Japan - page 41
- Review of literature on the prevalence of sub-clinical atherosclerosis. - page 41
- Risk factors and outcomes associated with atherosclerosis - page 50
- Risk Factors and co-morbidities - page 50
- Hypertension - page 50
- Dyslipidemia - page 52
- Diabetes - page 56
- Obesity - page 58
- Outcomes of Atherosclerosis - page 60
- Risk Factors and co-morbidities - page 50
- CHAPTER 4 CURRENT CLINICAL PRACTICE - page 63
- Diagnosis of atherosclerosis - page 63
- Spectrum of presentation - page 63
- Diagnostic procedures - page 65
- "Gold standard" treatment - page 67
- Medical care - page 67
- Relief of symptoms - page 67
- Prevention of future cardiac events - page 68
- Statins - page 68
- Treatment regimens - page 77
- Treatment of vulnerable plaques - page 79
- Surgical care - page 82
- Percutaneous coronary interventions - page 82
- Coronary artery bypass surgery - page 83
- Other surgical procedures - page 83
- Further inpatient care - page 84
- Further outpatient care - page 85
- Medical care - page 67
- Unmet needs in primary prevention - page 86
- Unmet needs in secondary prevention - page 90
- Views on plaque stabilization (with and without outcomes data) - page 93
- Views on plaque regression (with and without outcomes data) - page 94
- Will ASTEROID change clinical practice? - page 96
- Diagnosis of atherosclerosis - page 63
- CHAPTER 5 PLASMA BIOMARKERS - page 100
- How useful are plasma biomarkers? - page 100
- C-reactive protein - page 100
- Homocysteine - page 102
- Emerging plasma biomarkers - page 103
- Lipoprotein-associated phospholipase A2 - page 103
- Myeloperoxidase - page 105
- Oxidized LDL - page 107
- Lipoprotein (a) - page 108
- Isoprostanes - page 109
- Small, dense LDL - page 110
- Other plasma markers - page 112
- Drivers and barriers to greater use - page 113
- CHAPTER 6 IMAGING STUDIES AND PROCEDURES - page 115
- Introduction - page 115
- Currently used imaging studies - page 118
- Echocardiography - page 118
- Nuclear imaging studies - page 118
- Electron beam CT scanning - page 119
- Currently used imaging procedures - page 120
- Coronary angiography - page 120
- Coronary blood flow determinations - page 120
- Intravascular ultrasound - page 121
- Emerging imaging techniques - page 124
- Non-invasive imaging techniques - page 124
- Magnetic resonance of coronary arteries - page 124
- Multidetector row computed tomography angiography (MDCTA) - page 125
- Multislice computed tomography (MSCT) - page 126
- Positron emission tomography (PET) (detection of inflammation in vulnerable plaques) - page 126
- Invasive imaging techniques - page 127
- Intravascular MRI - page 127
- Near-IR spectroscopy - page 128
- Palpography - page 128
- Non-invasive imaging techniques - page 124
- CHAPTER 7 COMPOUNDS IN DEVELOPMENT - page 131
- ApoA-I mimetic ETC-216 (Pfizer/Esperion) - page 131
- ApoA-I mimetic D-4F (Novartis/Bruin) - page 133
- CETP inhibitors - page 134
- Torcetrapib (Pfizer) - page 135
- JTT-705 (Japan Tobacco and Roche) - page 136
- CETP vaccine (Avant Immunotherapeutics) - page 137
- AGI-1067 (AtheroGenics/AstraZeneca) - page 137
- Nicotinic acid agonists - page 142
- Gemfibrozil - page 142
- PPARs - page 143
- Gene therapy - page 143
- Endothelial lipase - page 144
- LXR agonists - page 144
- MTP inhibitor - page 144
- CHAPTER 8 FUTURE COMMERCIAL FOCUS - page 145
- "Gold standard" diagnosis pathway in 5 years time - page 145
- "Gold standard" treatment in 5 years time - page 146
- Most promising advances/compounds in development - page 148
- Where future funding should be focused - page 150
- APPENDIX A - page 153
- EPIDEMIOLOGY STUDIES - page 153
- Multi-Ethnic Study of Atherosclerosis (MESA) (1999-2009) - page 153
- Atherosclerosis Risk in Communities (ARIC) (1985-2006) - page 153
- The Coronary Artery Disease Risk Development in Young Adults (CARDIA) (1984-2003): - page 154
- Framingham Heart Study: (1948-2001) - page 155
- Cardiovascular Health Study (CHS) (1988-2005) - page 155
- Insulin Resistance Atherosclerosis Study (IRAS): Insulin, Insulin Resistance, Hyperglycemia and Cardiovascular Disease (1995-1999) - page 156
- National Health and Nutrition Examination Survey (NHANES IV) (1997-2004) - page 156
- Pathobiological Determinants of Atherosclerosis in Youth Study (PDAY): - page 157
- The Rotterdam Study - page 157
- Kuopio Ischemic Heart Disease Study - page 158
- West of Scotland Coronary Prevention Study (WOSCOPS) - page 158
- Bogalusa Heart Study (1972-2005) - page 159
- Atherosclerosis risk in young adults (ARYA) study - page 159
- BIBLIOGRAPHY - page 160
- References - page 160
- Epidemiology References - page 165
- EPIDEMIOLOGY STUDIES - page 153
- APPENDIX B - page 176
- Contributing experts - page 176
- About Datamonitor - page 177
- About Datamonitor Healthcare - page 177
- About the Cardovasular analysis team - page 178
- Disclaimer - page 179
- List of Tables
- Table 1: Epidemiology estimates of atherosclerosis-related disease in the United States, Europe and Japan - page 43
- Table 2: Prevalence of hypertension in the seven major markets (000s), 2003 - page 52
- Table 3: Estimated prevalent persons with dyslipidemia, 2005 - page 53
- Table 4: Dyslipidemia epidemiology figures by age for the seven major markets, 2005 - page 54
- Table 5: Prevalence of low HDL cholesterol (<40mg/dL) in England in 1998 - page 55
- Table 6: Estimated absolute prevalence of diabetes in the seven major markets (millions), 2006 - page 57
- Table 7: Prevalence of obesity in the seven major markets by age (000s), 2005 - page 59
- Table 8: Prevalence of overweight in the six major markets by age (000s), 2005 - page 60
- Table 9: Disability and mortality burdens of heart disease and stroke in the seven major markets in 2002 - page 61
- Table 10: Current estimated incidence of stroke in the seven major markets, 2006 (000s) - page 62
- Table 11: Diagnostic laboratory tests - page 65
- List of Figures
- Figure 1: Pathogenesis of a plaque leading to rupture - page 28
- Figure 2: Commonly used PCI interventions - page 83
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