Is cardiovascular disease a ‘pandemic hiding in plain sight’?

Amarin’s Craig Granowitz discusses the impact of COVID on cardiovascular disease treatment and explains why there’s still a long way to go till we can truly tackle these diseases.

COVID-19 has shone a light on the dangers of cardiovascular disease (CVD), with patients with these underlying conditions at much higher risk of dying from the virus.

But Dr Craig Granowitz, chief scientific officer of cardiology drug developer Amarin, says that this is only the tip of the iceberg when it comes to the devastating impact of CVD on global populations.

“In the US there were about 550,000 deaths in the first year of COVID – but every year in the US there are around 800,000 deaths due to cardiovascular disease.

“Meanwhile, over the last year many CVD patients were unable to access care, either because their healthcare providers were not open or they were afraid to go into a healthcare setting – and the impacts of that will be felt for years to come.”

Part of fully tackling COVID-19 will therefore involve improving treatment of CVD – with the European Heart Network recently calling for urgent government action across the EU to improve care available to prevent a future crisis. Meanwhile, the European Society of Cardiology has called for a more integrated approach to managing CVD and comorbidities, and the NHS has set out a CVD prevention strategy to avert 150,000 heart attacks and strokes over ten years.

Granowitz says COVID highlighted the need to rethink the way healthcare systems treat CVD patients – but also drew attention to the disease area and the need to work towards better outcomes.

“Disruption creates opportunity, and what happens with that opportunity is up to us to shape.

“After COVID, there is an opportunity to reset the playing field for CVD.”

Notably, he says, the world now has a much greater understanding of how access to care has become a major issue.

“The people who are disproportionately affected by cardiovascular disease are those who are often underrepresented or have limited access to care, such as people in lower socio-economic strata. And those are exactly the patients that were most affected by COVID.

“I hope that healthcare systems across the world will therefore look to improve access to care, which will have an elevating effect for cardiovascular care in general.”

Meanwhile, the pandemic has taught the scientific community much about human biology, which can be applied to CVD research going forward.

“One of the key takeaways from COVID has been the importance of the endothelial cell – the lining of the blood vessel. Many of the complications that you can attribute to COVID are related to endothelial dysfunction, and that’s where the link with cardiovascular and lung disease lies.”

Granowitz adds that he hopes COVID will help pharma and healthcare systems challenge the assumption that just because treatments like statins are available CVD has been “solved”.

“I think it’s actually a pandemic hiding in plain sight. People have come to accept cardiovascular disease and related deaths almost as a part of life – but that doesn’t have to be the case.”

Part of the issue is that although statins are still the go-to treatment for reducing the risk of cardiac events, there remains a significant residual risk of between 65% to 75%, even for patients whose LDL cholesterol is well controlled.

Amarin recently saw its own cardiology drug Vazkepa (icosapent ethyl) licensed by the UK’s MHRA, based on results from the REDUCE-IT study, and Granowitz says he hopes the drug can contribute to a paradigm shift in the outcomes patients can expect from CVD treatment.

But one of the biggest issues in changing people’s expectations and improving outcomes is “apathy”, he says.

“The average UK patient only stays on their statins for a month. Statins have been on the market and widely communicated in the UK for decades, and yet fewer than 30% of patients take them, yet alone use them appropriately.

“Meanwhile, most people know about omega 3 treatments and aren't afraid of them like they are of statins, so they think they can just eat more fish or buy an over-the-counter triglyceride lowering agent and it won’t be any different from taking a prescription CVD drug.

“That’s a huge communication challenge. There are millions of patients and healthcare providers who are trying to do good, but because of misinformation or old hypotheses are actually either causing no benefit or even causing harm. And as a physician, I find that really painful.”

This is combined with broader issues around self-care and public education.

“I think the UK in general has done an extraordinarily good job in CVD awareness and preventative care, because there is high trust and awareness of the NHS. But there are still very high rates of obesity, smoking and inactivity.

“One of the main reasons I came to Amarin was that I saw the great need in this area and recognised that this opportunity to massively improve human health required us to fight a very tough battle.”

The barriers to developing new cardiovascular drugs can be enormous, Granowitz says, especially for a smaller company like Amarin – with Vazkepa taking more than ten years to develop. 

But he adds that much of Amarin’s drive in developing drugs like Vazkepa comes from the fact that current treatment options do not fully address cardiovascular risk, and that there is a need for “breakthrough” treatments in the area.

“That's why we're so bullish on the molecule, because we think that there's a real chance that it can make a huge difference in a difficult category.”

Granowitz says that the most sobering statistic from the REDUCE-IT study actually comes from the control group.

“Even though those patients were well managed for all known disease factors, 28% of them developed a major cardiovascular event within 4.9 years. Think about that. They were well treated, and they were motivated enough to be in a clinical trial, and 28% of them still experienced a heart attack, stroke, cardiovascular death, required a stent or had unstable angina requiring hospitalisation. That to me is shocking.”

About the interviewee

Dr Craig Granowitz joined Amarin in 2016 and brings experience managing multi-national medical affairs organisations and bringing portfolios of leading cardiovascular products to the company. Prior to joining Amarin, he was head of global medical affairs at Merck and Schering Plough.