Shots: 

• A UK observational study spanning 17 years shows a 2.9-fold increase in Cardiac Amyloidosis diagnoses, highlighting significant progress in awareness among healthcare professionals and advancements in diagnostic tools 

• The study underscores the importance of improving the identification and treatment of Cardiac Amyloidosis, particularly in cases with overlapping conditions such as heart failure 

• Mina Makar, SVP and Commercial Lead of the Global Cardiovascular, Renal, and Metabolism (CVRM) Biopharmaceuticals Business Unit at AstraZeneca, engages in a compelling discussion on this study with PharmaShots.   

Saurabh: How did the incidence rates of cardiac amyloidosis change over the 17-year study period, and what factors might explain this trend?   

Mina: Our retrospective observational study presented at ESC, titled “Patient Characteristics and Incidence of Cardiac Amyloidosis”, offers insights into the true incidence and prevalence of cardiac amyloidosis within the United Kingdom (UK). The study revealed a notable 2.9-fold increase in cardiac amyloidosis diagnoses from 2004 to 2021. This upward trend may be attributed to several factors, including growing awareness among healthcare practitioners and advancements in diagnostic tools. It might also be due to improved recognition rather than a true surge in cases as cardiac amyloidosis may have been significantly underdiagnosed in earlier years.   

Saurabh: What clinical presentations were most commonly observed in patients prior to their diagnosis of cardiac amyloidosis, and how might these symptoms contribute to misdiagnosis?   

Mina: The most frequent comorbidities prior to cardiac amyloidosis diagnosis included essential (primary) hypertension (18.6%), dyspnoea (17.7%), cough (13.%), heart failure (13.0%) and atrial fibrillation and atrial flutter (10.5%). These symptoms are often subtle and non-specific, frequently overlapping with other interconnected cardiovascular conditions such as heart failure, resulting in a delayed or missed diagnosis.    

For example, heart failure is a frequent initial presentation, but cardiac amyloidosis is rarely considered as a potential cause. The overlap of these symptoms with more common heart conditions underscores the need for greater awareness and specific screening protocols, particularly for at-risk populations, to ensure that CA is diagnosed accurately and earlier in the disease progression.    

Saurabh: In your view, what are the study's main conclusions and what are the next steps needed to improve the detection and characterization of cardiac amyloidosis in clinical settings?  

Mina: The upward trend in diagnoses is encouraging as it suggests that more patients are being correctly identified and that historically, cardiac amyloidosis may have been significantly underdiagnosed. The study reinforces the urgent need to improve healthcare provider training to recognize subtle symptoms and refine diagnostic protocols to ensure that the full spectrum of patients affected by cardiac amyloidosis is properly identified and treated, particularly where there is overlap with other interconnected cardiovascular conditions such as heart failure. Only with an accurate and full diagnostic work-up for ATTR-CM can a tailored treatment plan be developed to improve the outcome for individual patients.        

Image Source: Canva 

About the Author: 

Mina Makar 

Mina Makar is the Senior Vice President and Commercial Lead of the Global Cardiovascular, Renal, and Metabolism (CVRM), BioPharmaceuticals Business Unit at AstraZeneca. In this role, Mina addresses the critical unmet needs in four interconnected disease areas: metabolism, heart failure, cardiovascular disease, and renal diseases. Through expanding the use of medicines today, and developing the next wave of innovations while advancing the pipeline, he drives the ambition to improve and save lives for the millions of people who are living with the complexities of CVRM diseases. ​   ​   

His 30-year healthcare career began as a pharmacist and includes over two decades with AstraZeneca, encompassing experience in marketing and sales, payer and access strategies, as well as leadership and engagement. His previous role as SVP of US Respiratory & Immunology highlights a track record of achievement, including significant franchise growth and successful new product launches, such as the company's first respiratory biologic. ​   ​   

Makar's dedication to the use of digital technologies and engaging with industry partners to transform science, has been pivotal to driving earlier diagnosis for CVRM patients, advancing understanding of disease drivers, and helping to bring medicines to patients faster. His leadership in CVRM extends to embedding sustainability into every initiative, from the laboratory to the patient to strengthen healthcare systems to be more accessible and resilient.      

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