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A global Commission published in the has called on the medical profession to change the way it treats coronary artery disease – the most common form of heart disease – encouraging clinicians to shift away from a focus on the late stages of the disease towards early prevention and cure. 

The Commission involved more than 20 experts from across the world, including lead author Associate Professor Sarah Zaman, Principal Research Fellow at the Westmead Applied Research Centre and a cardiologist at , from the at and from , as well as experts in the UK, China, Thailand, the US and Saudi Arabia. 

Associate Professor Zaman said: “It’s often thought that heart disease is a condition that develops in older age, but in fact the risk starts in utero and signs of coronary heart disease can be seen in children and adolescents. 

“At the moment, the early stages of coronary artery disease often go undetected which means we’re missing an opportunity to make changes early on to stop the disease escalating into more serious health events, such as heart attack and stroke.”

Coronary artery disease is the leading cause of death globally and researchers project it will be responsible for the death of 10.5 million people annually by 2050. 

Experts involved in the Commission are calling on governments, funding bodies and clinicians to prioritise research into the early detection of coronary artery disease, including advanced CT scans to identify plaque build-up before acute symptoms develop. 

The researchers also want to see lifestyle risk factors – such as smoking, diet and exercise – addressed through public health campaigns and targeted screening programs to identify early signs of disease. If lifestyle risk factors were eliminated by 2050, deaths from coronary artery disease could decrease by more than 80 percent, saving 8.7 million lives annually.  

Professor Parsonage said: “Health systems are stretched and the global burden of atherosclerotic coronary disease is increasing.

“While we have many effective ways of preventing the disease that improve individual outcomes, globally we often don’t implement these as well as we should. 

“For sustainable health services there is an urgent need to re-focus on prevention and early disease detection.”

The disease occurs when plaque (made up of fat, cholesterol and other substances) builds up in the arteries and reduces blood flow, leading to chest pains (angina), shortness of breath and even heart attack. The main contributors to the progression of heart disease are lifestyle factors such as poor diet, high cholesterol and smoking. 

Currently, the medical profession focuses on treating the acute symptoms of heart disease – including heart attacks and angina, using stents – but treating acute symptoms means that patients are receiving care only when the disease is already advanced.

Professor Nicholls said: “We need to shift our perspective and turn back time on heart disease. By viewing it as a lifelong disease and not just as a mid-late life problem we will save lives by intervening sooner. 

“Investing in transformative research programs, early detection, and equitable healthcare is crucial to preventing, reversing, and ultimately eliminating atherosclerotic coronary artery disease worldwide.”

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Al-Lamee, Rasha K., Zaman, Sarah, et al. ‘The Lancet Commission on rethinking coronary artery disease: moving from ischaemia to atheroma’ (The Lancet, 2025)  

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Professor Zaman received grants from Abbott Vascular and personal fees from Novartis and Boston Scientific. Professor Parsonage holds a leadership and fiduciary role within the Cardiac Society of Australia and New Zealand. Professor Nicholls has received grants from AstraZeneca, Amgen, Anthera, CSL Behring, Cerenis, Cyclarity, Eli Lilly, Esperion, Resverlogix, New Amsterdam Pharma, Novartis, InfraReDx, and Sanofi-Regeneron. He has received personal fees from Amgen, Akcea, AstraZeneca, Boehringer Ingelheim, CSL Behring, Eli Lilly, Esperion, Kowa, Merck, Takeda, Pfizer, Sanofi-Regeneron, Vaxxinity, Sequiris, and NovoNordisk. He is also listed as inventor on the patent for effects of PCSK9 inhibition on coronary atherosclerosis, has a leadership and fiduciary role with Cardiac Society of Australia and New Zealand and is director of Evidence to Practice (a not-for-profit company).