Title : Chronic angina and the health economics of cardiovascular risk reduction in macro- and microvascular coronary disease
Abstract:
Background: Chronic-stable angina pectoris (CSAP) is the most prevalent clinical manifestation of coronary heart disease. Over the past decades, coronary disease prevention and treatment have produced tremendous morbidity & mortality gains. Conversely, prevalence and cost of CSAP as the main long-term sequala of coronary disease continue climbing. In a single decade, the US CSAP population increased from 7.8 in 2010 to 11.2M in 2020.
Current treatment of CSAP: After decades of ever-increasing emphasis on elective revascularization, mostly using coronary stenting, CSAP outcomes trials have conclusively demonstrated the fallacy of this approach as no more effective than medication-based management. Enthusiasm about revascularization as a potentially permanent solution to CSAP symptoms also led to considerable neglect of anti-angina drug R&D, with the last innovative anti-anginal introduced in 2006. In Europe and the US, an average of 3 anti-anginals are necessary to control angina symptoms, combined with another 3 medications to control the CV risk of the underlying coronary disease. CSAP patients today represent the classic challenges of polypharmacy with all the strains of managing future cardiovascular risk, adherence, drug interactions, and escalating costs of chronic disease management.
Health economic implications: US total annual direct cost of managing CSAP ballooned to $53 billion in 2025. Treating coronary disease without chronic angina costs about 50% of the outlays when CSAP is present. In addition, traditional macrovascular coronary CSAP prevalence estimates are being revised upwards as microvascular coronary disease takes center stage.
Conclusion: This Keynote session will summarize existing economic strain of CSAP management in view of new treatment recommendations, highlight opportunities for cost effective management in view of potentially millions of unaccounted patients with either combined macro- and microvascular coronary disease in addition to bona fide microvascular angina and analyze the existing chronic angina drug pipeline in development to face these challenges.
