Will big pharma's loss be biotech's gain?

Cholesterol drugs are falling on their own sword. Pfizer, Merck and Schering Plough had great hopes for such patent extenders as Torcetrapib and Zetia, but they turned out to be less than useless. As BusinessWeek reports this week, even statins--the $28 billion a year behemoth drug--aren't nearly as miraculous as they've been made out to be, and are waaay overprescribed.

All of this madness spells opportunity for a handful of small, scrappy biotech firms have been working on therapies for heart disease that have nothing to do with cholesterol lowering. A few of them, after the jump.

Cholesterol isn't the key to treating heart disease, and a few smart scientists have known this for over a decade. They suggest heart attacks and strokes are the result of inflammation of the arteries, brought on by stressors of various types. So, in their view, arteries aren't comparable metal pipes that get all gunked up with cholesterol, but living entities. Makes a whole lot more sense when you think about it.

With the advent of high speed gene sorting technology, some small firms have been able to pinpoint some of the ways that inflammation starts. Leading the pack are AtheroGenics of Alpharetta, Ga. which has an anti-inflammatory heart disease drug in phase three clinical trials, and deCODE Genetics of Rekyavik, Iceland, which is in the late second stage of clinical trials for its drug, also aimed at reducing inflammation in the arteries.

Celera Diagnostics is also in this cutting edge field. This company has identified genetic biomarkers that can predict not only a person's susceptibility to heart disease, but also their ability to respond to existing treatments, such as statins. Read my article about them here.