Taking Heart Medicine Beyond Heart Drugs

It could be years before we see the next big drug. Time to make better use of the medicines we have.

For anyone looking for new treatments to reduce the 860,000 deaths that occur every year in the U.S., the annual meeting of the American Heart Association was pretty scant on hope.

No major studies of new drugs and devices were presented. But many cardiologists say the drought is less worrisome than the fact that many existing drugs are not being used enough.

Patients in clinical trials are getting such a big benefit from existing medicines that it is difficult for a new one to add much. But patients in the real world are not getting the same level of treatment as those in clinical trials.

"We've made so much progress," says Elliott Antman of the Harvard-affiliated Brigham & Women's Hospital. "There is a greater need to use the drugs we have." Adds Raymond Gibbons of the Mayo Clinic, "We're not doing very well delivering the standard of care."

After a series of high-profile failures, many companies are cutting back research on heart drugs in a big way. Pfizer (nyse: PFE - news - people ), for instance, is stopping work on a whole swath of cholesterol drugs. That's astounding, given that, right now, the two best-selling drugs in the world--Pfizer's Lipitor and Plavix from Bristol-Myers Squibb (nyse: BMY - news - people ) and Sanofi-Aventis (nyse: SNY - news - people )--are heart drugs.

Just about the last big class in development are drugs to prevent the blood clots that cause heart attacks and strokes. But these are risky, because so far they also increase bleeding. Small differences in bleeding rates can be the difference between a blockbuster and a niche product, and the only way to know is with a gigantic clinical trial. Bayer (nyse: BAY - news - people ) and Johnson & Johnson (nyse: JNJ - news - people ) presented their entrant, rivaroxaban, at the conference. (See "J&J's High-Wire Heart Drug.")

Even the one big success of the meeting, a trial called Jupiter, in which Crestor from AstraZeneca (nyse: AZN - news - people ) dramatically reduced the rates of heart attacks and strokes, is in a sense a last hurrah. Crestor is the last-to-market of the legendary drug class called the statins, and this was probably the last big study to test a statin for preventing a first heart attack.