Cardiovascular disease is set to surpass infectious diseases to become the leading cause of death worldwide by 2020, but there is still low public awareness of the risk factors involved, according to Datamonitor.

In order to arrest this trend, the market analysts say that it is necessary to identify those individuals with vulnerable plaques, the areas of fatty deposits in the arteries, and those patients who are at the highest risk of a second cardiovascular event, such as a heart attack or stroke.

The study adds that it may be possible to provide a non-invasive method to detect vulnerable plaque, but screening “also produces the clinical dilemma of whether cardiac catheterisation can be performed in such a high-risk individual who has no cardiac symptoms”.

Datamonitor cardiovascular lead analyst Allison Fleetwood said that “all the emerging imaging techniques hold promise, but they also all have drawbacks at the moment, meaning further development is needed. In addition, access and expense are the main barriers to their wider use, particularly in Europe.” However, the report also notes that “fortunately, advances are available that can provide improved risk stratification of patients,” adding that it is possible to envision a screening system based on three components – the standard risk factors, novel blood biomarkers, plus multislice computed tomography and nuclear methods. Such a screening system is likely to identify some asymptomatic individuals at very high risk – a greater than 10% chance of a cardiac event in the ensuing year, it adds.

Dr Fleetwood concludes that ultimately, raising public awareness of the risk factors for atherosclerosis is a key unmet need in primary prevention as well as improvements in medical therapies. “In addition there is a need for studies showing that early identification of early atherosclerosis leads to improved outcomes. Only then is current treatment practice likely to change,” she says.