Can We Cure Coronary Artery Disease in the Next 50 Years?

Coronary artery disease (CAD) has long been a major health concern, often overshadowed by the nation's love affair with traditional staples like the biscuit. Over a 20-year period from 1998 to 2018, the prevalence of obesity in the United States increased from 30% to 42.9%, and severe obesity doubled to 9.2% [CDC data]. This raises a critical question: can we cure this disease, or are we stuck owing to societal and economic factors?

The Current Landscape of Coronary Artery Disease

The annual healthcare expenditures in the United States for obesity and its related illnesses amount to $180 billion, which is roughly the same as the annual spending on all forms of cancer. This immense financial commitment underscores the severity of the issue. However, explanations that absolve individuals of responsibility, such as the use of high fructose corn syrup, or the "supersize this" mentality in fast food marketing, are disingenuous. The continuous bombardment of unhealthy food options is a significant contributor.

Prevention: The Most Effective Approach

Interestingly, we already have the necessary tools to prevent the development of coronary artery disease. Prevention, unfortunately, doesn't generate the financial returns that pharmaceuticals and other business solutions do. The best business solutions are often those that address a part of the problem rather than the root cause entirely, leading to recurring revenue instead of a one-time solution.

Understanding the Mechanisms of Coronary Artery Disease

Coronary artery disease results from a complex interplay of factors, including:

Oxidative stress, which oxidizes LDL particles Chronic inflammatory signals from the immune system that promote clotting Morphed macrophages that turn into foam cells as they engulf oxidized LDL

Given this complexity, Big Pharma tends to market solutions in the form of statin medications, such as Pfizer's Lipitor, which brought in $130 billion in revenue over its patent lifespan. However, despite the patent expiring 20 years ago, coronary artery disease remains one of the biggest killers worldwide. This is because the real issue isn't the synthesis of excess cholesterol, which is poorly understood, but rather the wider interplay of oxidative stress, inflammation, and immune dysfunction.

Market Dynamics and the Role of Big Pharma

Businesses are driven by profit, and expanding the market for existing solutions ensures ongoing revenue streams. Big Pharma would be unlikely to develop a cure for coronary artery disease since doing so would eliminate the potential for substantial drug subscription revenues. Instead, they would focus on maintaining the status quo, muddying the waters by suggesting that their products are the ultimate solution.

Conclusion: Prevention and the Possibility of Reversal

While we are capable of preventing coronary artery disease, reversing it might not be feasible overnight. Years of neglect and poor lifestyle choices contribute to the condition, and reversing the damage could be thermodynamically challenging. Similar to how the COVID-19 vaccines work, reversing CAD would require significant lifestyle changes and possibly medical interventions.