"Refocusing and reframing the definition and discussion of coronary artery disease (CAD) from late-stage ischemia and acute coronary events to early detection of coronary artery atheroma and prevention of advanced acute coronary syndrome (ACS) has the potential to save 8.7 million lives globally every year," according to a new report from The Lancet Commission presented at ACC.25.

The report, authored by Sarah Zaman, MD, Jason H Wasfy, MD, MPhil, FACC, et al., highlights the constraints posed by current definition of CAD and related ICD codes for ischemic heart disease in devising clinical pathways for early diagnosis and effective strategies for prevention and cure of the disease. Given these challenges, the report argues for reclassifying the condition as atherosclerotic coronary artery disease (ACAD), with earlier measurement and recognition of the disease "at a much earlier stage, when the opportunity to make an impact is greatest."

"Our goals should not just to be to manage symptoms and events but to prevent the disease from developing in the first place and, where possible, reverse its course," the authors write.

The Commission advocates for a framework that stresses early detection and prevention of ACAD across a lifetime continuum. This includes early risk factor modification; the development of strategies for early screening and detection; and support for local and global research, data collection and dissemination to inform population-based decision making and address care disparities.

The development of innovative new therapies, as well as realignment of the health care workforce to prevent, detect and manage earlier stages of ACAD vs. the current strategy of diagnosing and treating later stages of the disease, are also critical, according to the Commission. The rigorous testing of new health policies and the creation of public education, particularly for diverse patient populations, are other key areas of focus.

"We hope that this Commission will reach patients and the public, policy makers, international societies, research funders, researchers, and health-care providers to advocate for the stabilization, reversal and future elimination of ACAD as a realistic and attainable goal," write the authors. "The allocation of funding, resources, and workforce to the research highlighted in this Commission is urgently needed to combat the consequences of this preventable disease."

In a related editorial, The Lancet writes: "Progress in reducing coronary artery disease mortality has stalled. …Lifelong management of atherosclerosis must become the norm if patient outcomes are to be improved—and indeed, if we hope to prevent most of the population from becoming patients with coronary artery disease at all."