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World Heart Day is as good a time as any to take stock of the situation
Forbes  Sep 26  Comment 
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Wall Street Journal  Sep 24  Comment 
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MarketWatch  Sep 24  Comment 
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I went to Kigali in Rwanda to report on the type of heart disease afflicting Chance and millions of other young people. I was supposed to be a fly on the wall. Before I knew it, I was trying to help.

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In modern times, cardiac disease has emerged as the leading cause of death worldwide, particularly in developed countries. The World Health Organization reported that 16.7 million deaths in 2003 (29.2% of total global deaths) were caused by some form of cardiovascular disease. Though the rate of cardiac disease is highest in developed countries, developing countries are seeing an increase in the occurrence of cardiac disease, as well as a corresponding rise in the number of heart-related deaths. The World Health Organization estimates that by 2010, cardiac disease will surpass AIDS as the leading cause of death in developing countries.

As the largest cause of death worldwide, cardiac disease has spawned the development of an entire industry dedicated to its treatment. There are a wide range of both drug treatments and surgical procedures that are used to either prevent or treat cardiac disease. Additionally, food and beverage manufacturers have responded to concerns about cholesterol intake by producing and marketing a wide range of low-cholesterol foods. In spite of this, people still maintain relatively poor diets and engage in activities that increase their risk of developing cardiac disease. This is likely due to the fact that heart problems develop years after exposure to risk factors, decreasing the urgency of taking preventive measures. As such, the demand for pharmaceutical and surgical treatments has remained strong and is unlikely to ebb in the near future.

Which companies are involved in the treatment of cardiac disease?

Pharmaceutical companies

  • Pfizer (PFE) produces Lipitor, one of a class of drugs known as statins, which are used to lower cholesterol. Lipitor is currently the best-selling drug in the world, bringing in $12.2 billion in 2005. Pfizer also produces Norvasc, an antihypertensive drug, though its patent expired in 2007.
  • AstraZeneca (AZN) makes Crestor, another statin aimed at lowering cholesterol levels and preventing cardiac disease.
  • Merck (MRK) sells Zocor and Vytorin (which it co-produces with Schering-Plough (SGP)), two other leading brands of cholesterol-lowering statins. Vytorin is a combination of the main ingredients in Zocor and another drug called Zetia and works to prevent the absorption of cholesterol in the intestines. Merck's patent for Zocor expired in June of 2006, allowing Teva Pharmaceutical Industries (TEVA) and Ranbaxy Laboratories to produce generic versions. However, Merck has drastically cut prices on Zocor, minimizing its loss of sales volume to competitors. Merck also produces the antihypertensive Cozaar.
  • Bristol-Myers Squibb Company (BMY) and Sanofi-Aventis SA (SNY) produce and market the drug Plavix, which is used to prevent the aggregation of platelets, a potential source of arterial blockage. Plavix is often used in patients with a history of cardiovascular problems and can help prevent future strokes, heart attacks, etc.
  • GlaxoSmithKline (GSK) makes Coreg, used to treat mild to moderate congestive heart failure.

Medical device manufacturers

  • Boston Scientific (BSX) is a leading producer of both traditional coronary stents and newer, drug-eluting stents. These are used in angioplasty, a procedure to mechanically widen constricted blood vessels, decreasing the risk of heart attacks and other cardiac diseases. BSX also makes pacemakers, which help to regulate heartbeats.
  • JOHNSON & JOHNSON (JNJ) and Medtronic (MDT) also offer stents and other devices used in the surgical treatment of vascular blockages or constriction, as well as pacemakers.
  • Abbott Laboratories (ABT) also manufactures medical devices used in the treatment of cardiac disease. In recent clinical trials, its new Xience V drug-eluting stent was shown to be safer and more effective than competitors' products, which could benefit Abbott in terms of market share and revenue.
  • Medtronic (MDT) and St. Jude Medical (STJ) are medical device companies with leading marketshares in ICDs, pacemakers, and other cardiac devices.
  • Edwards Lifesciences (EW) is a device company that only sells devices to treat advanced cardiovascular disease, holding over forty percent of the 2007 replacement heart valve market.

Worldwide Market for Cardiovascular Drugs is Large

Cardiovascular drugs comprised the largest pharmaceutical drug category in 2006 worldwide.

Pharmaceuticals World Market of Top 5 Therapeutic Classes (2006) [1]

Value ($bn)* % of Total Growth vs. 2005**
Cardiovascular 100.8 17% 7%
Central nervous system 99.9 16% 8%
Alimentary tract and metabolic 73.6 12% 9%
Anti-infectives (bacterial,viral and fungal) excluding vaccines 61.4 10% 3%
Respiratory 40.1 7% 6%

Note: *Based on an average 2006 £/$ exchange rate of 1.85 [2]

Note: **Based on £ figures from 2005; does not account for exchange rate difference between 2005 and 2006

What is cardiac disease?

Cardiac (or cardiovascular) disease refers to any condition affecting the ability of the heart and/or blood vessels to function properly. There are many different kinds of cardiac disease, but they all threaten the circulatory system in one way or another. This is what makes cardiac disease so deadly; a disruption of the blood supply to any part of the body can lead to tissue damage or death, often within a matter of minutes. Some of the major types of cardiac disease include:

  • Coronary heart disease
    • CHD is the condition that results from the buildup of plaques within the walls of arteries that supply the heart muscle with oxygen and nutrients. CHD can lead to heart attacks, which occur when the buildup suddenly interrupts the heart's supply of blood, leading to the damage or death of heart tissue. This is the single largest cause of death in the world.
  • Cerebrovascular disease
    • Cerebrovascular disease is a condition in which the arteries leading the to the brain become obstructed, which can decrease blood supply to the brain. A stroke occurs when one of these arteries becomes completely blocked, cutting off the blood supply to all or part of the brain. This can result in significant brain damage, depending on the size of the obstructed artery and the duration of the blockage.
  • Hypertensive heart disease
    • Hypertension, also known as high blood pressure, can increase the risk for a number of other heart-related conditions, including heart attack, stroke, cardiac arrest, and congestive heart failure.

What causes cardiac disease?

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Prevalence of cardiac disease in the U.S., by age group
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Number of U.S. deaths due to cardiac disease, from 1900-2004

Most cardiac diseases are caused by the buildup of cholesterol and other lipids in the walls of blood vessels, which can cause them to constrict or reduce their ability to expand and contract in response to changing demand for blood circulation. This buildup can even cause blockages in the arteries, blocking the blood supply to a certain part of the body. Additionally, some factors can increase blood pressure or elevate the heart rate, which can increase the risk of developing cardiac disease. The combination of the two factors, arterial buildup and high blood pressure, can greatly increase the likelihood of heart problems. Many factors can contribute to a higher risk of heart disease, including:

  • Tobacco smoking
  • High cholesterol levels
  • Obesity
  • Physical inactivity
  • Diets high in fat, salt, or refined carbohydrates
  • Elevated heart rate - can be caused by overuse of stimulants

These risk factors are generally preventable, though there are some risk factors that cannot be prevented. Genetics have been linked to cardiovascular disease; some people with a family history of heart problems are naturally more predisposed to develop cardiac problems themselves. In addition to the hereditary aspect, males are more likely than females to suffer from cardiac diseases. Old age is also a risk factor. The risk of heart attack, stroke, and cardiac arrest increases with age, and over half of all people over the age of 60 suffer from some form of cardiac disease.


The treatment of cardiac disease is divided into two categories: preventive treatment and the treatment of existing conditions. The risk factors for cardiac disease are well-known, and much of the preventive treatment involves lifestyle changes aimed at decreasing a person's risk of developing problems later on. Common recommendations for preventing heart disease include avoiding smoking, eating a generally healthier diet, and getting regular aerobic exercise, among other things. When the lifestyle changes aren't sufficient, there are a wide range of pharmaceuticals available to lower blood cholesterol levels and decrease blood pressure, which are both risk factors for cardiac disease. Antihypertensives, which lower blood pressure, and statins, which lower cholesterol, have become widely used to decrease the risk of developing heart problems.

The treatment of existing cardiac diseases includes both surgical and drug therapies. Angioplasty is a commonly used procedure that physically widens constricted or blocked arteries. In more severe cases, coronary bypass surgery replaces damaged blood vessels with healthier ones. This surgery is used to repair the critical coronary arteries, which supply blood to the heart muscle itself and, if damaged, can lead to heart attacks. In addition to surgical procedures, drugs are also commonly used to treat existing heart conditions. Specifically, drugs aimed at lowering blood pressure and preventing the aggregation of platelets in the bloodstream are the most widely used. These don't specifically work to repair damaged vessels or heart tissue, but they do help to prevent the recurrence of acute cardiac problems like strokes and heart attacks. As with preventive therapies, abstinence from known risk factors is key to the treatment of cardiac diseases.


  1. GlaxoSmithKline 2006 20-F Filing, p. 26
  2. GlaxoSmithKline 2006 20-F Filing, p. 94
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