Analysis of the clinical trials for coronary artery disease (CAD) – with start dates between 1 January 2009 and 4 November 2019 – found that the majority of trials were completed (69.6%) in this period, according to GlobalData.

CAD is a disease that occurs when the coronary arteries become blocked or damaged. This is caused by the formation of plaques (cholesterol deposits) inside the arteries, resulting in obstruction and inflammation. When plaque formation increases, there is a shortage of blood flow to the muscle tissue of the heart, which can then cause angina and potentially lead to a heart attack. Risk factors include age, smoking, high blood pressure, high cholesterol, diabetes and obesity.

As the disease develops gradually, it is more prevalent in the elderly. A total of 85% of CAD deaths occur in people older than 65 years of age. Treatments can include a range of various drug therapies such as antiplatelets, statins, beta-blockers, nitrates and angiotensin-converting enzyme inhibitors.

During the 10-year timeframe used for the GlobalData analysis, 15.5% of trials were ongoing (Figure 1), while Phase IV had the highest amount of trials at 35.7%, followed by Phase II at 32.6% (figure 2).

According to the Journal of the American College of Cardiology, investment into cardiovascular drug development has decreased compared to other therapeutic areas. This could explain why there is an increased amount of post-market studies and a reduced amount of ongoing trials. Several factors contribute to this trend. The first is that it is extremely costly to conduct cardiovascular trials that use cardiovascular endpoints, so companies have a preference to focus on other therapy areas.

Another point is that pharmaceutical companies are focusing on therapy areas that are most lucrative to them, which allows them to maximise their return on investment if a new entity were to be approved. Even though new drug entities for cardiovascular research are increasing, funding for trials seems to be limited compared to other therapeutic indications. Out of all the trials analysed, the US had the highest percentage of trial initiation rates at 56.9%.