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Cardiovascular diseases

Cardiovascular diseases

There are many forms of cardiovascular disease. Heart failure, a huge burden for mankind. Diabetes Mellitus 2, which affects heart and blood veins. Stroke and infarction: how to predict the risk of rupture of an individual plaque?

The major objective of the cardiovascular program within CTMM is to improve and personalize the stratification of high risk cardiovascular patients, which will facilitate earlier recognition, with subsequent rational and personalized intervention. In each of the four chosen disease areas, it is vital to develop biological markers of disease, develop and apply innovative biosensor technologies, and Molecular Imaging modalities and develop early intervention strategies. A close collaboration between academia and industry is vital to focus on clinically relevant innovations that can be brought to theclinical market within a reasonable timeframe.

The four major cardiovascular disease areas are:

The vulnerable Patient/Instability of the Atherosclerotic Plaque, which is the main underlying cause of symptoms of cardiovascular disease
Cardiac Failure,
the major chronic complication of myocardial and vascular disease
Sudden Cardiac Death (SCD), the single most important cause of death in the adult population of the industrialized world due to coronary disease
Diabetes Mellitus, which is rapidly becoming the most important (pre)morbid condition preceding cardiovascular disease.

The vulnerable Patient/Instability of the Atherosclerotic Plaque

Atherosclerosis is the underlying cause of the majority of cardiovascular diseases. Most of the clinical manifestations of atherosclerosis are not due to the presence of a slowly growing, stable, atherosclerotic plaque, but are caused by cardiac- or cerebrovascular complications initiated when a plaque becomes unstable and ruptures. This process is associated with vascular inflammation and a pro-thrombotic stage. Morphological criteria to discriminate between stable and unstable plaques are well-described, but the major limitation of these morphological criteria is that they rely on an invasive procedure to be determined. As a result, there is great need for non-invasive markers that can be easily applied to identify unstable or ruptured plaques quickly, sensitively, and specifically.

Over the years, several potential biomarkers for plaque instability have been identified. A prospective cohort of patients developing cardiovascular events will be collected to establish a biobank for analysis of biomarkers. A second major development in this field is the availability and improvement of noninvasive imaging modalities such as Magnetic Resonance Imaging (MRI), Ultrasound (US), Computed Tomography (CT), Positron Emission Tomography (PET) and Single Photon Emission Computed Tomography (SPECT), which are able to appreciate biological plaque characteristics missed by angiography, which only measures the vessel wall lumen and not the biological characteristics of the atherosclerotic plaques. A third major advancement in the field is the development of Molecular Imaging in which important biological disease markers, such as Annexin V, are combined with listed imaging modalities to evaluate the biological status of the atherosclerotic plaque. These three developments will lead the way to improved stratification of patient at risk for plaque rupture.

CTMM's PARISk project focuses on how to predict the risk of rupture of an individual plaque. The Circulating Cells project aims to investigate 'circulating cells' (e.g. white blood cells and platelets) to see if they carry biomarkers suiteable for discriminating patients with an increased risk of developing unstable plaques.

Cardiac Failure

Myocardial infarction, atherosclerosis, and related diseases like hypertension and diabetes are all major causes for heart failure. However, it is still impossible to predict which patients will develop heart failure and which will not. We are forced to wait until symptoms appear before beginning treatment, as now happens in 40,000 patients per year in the Netherlands alone. There is much to gain from easy-to-use screening of high risk patients. It is safe to assume that in the Netherlands at least 600,000 patients (e.g., diabetics, hypertensives, stable atherosclerotic disease) face an increased risk of developing heart failure. The potential alternative of testing blood samples of these 600,000 patients twice a year will save both patients and the economy from symptomatic heart failure. Such testing could yield commercial revenues of EUR 12 m per year (EUR 10 per serological test) for the Netherlands alone, making this a highly attractive enterprise for innovators in healthcare.

The CTMM TRIUMPH project aims to identify biomarkers (both blood-based and tissue-based) that can be used to assess the level and nature of left ventricle overload as well as the level and nature of inflammation. The ENGINE valorization project builds on validation studies carried out using the TRIUMPH projects heart failure patient cohort.

The EMINENCE project aims to develop multiple diagnostic technologies to enable the early and sensitive detection of neovascularization, and novel tools to stratify individual patient's risk of cardiovasculair disease. The INCOAG projects aims to develop a new set of tests to estimate the risk of thrombosis. The PREBAT valorization project is an additional workpackage in the INCOAG project that builds on the results of an existing workpackage on assessing a patient's risk of thrombosis.

Sudden Cardiac Death (SCD)

The single most important cause of death in the adult population of the industrialized world is Sudden Cardiac Death (SCD) due to coronary disease. SCD claims almost a million deaths annually in Western Europe and the US and ventricular fibrillation (VF) is the most common underlying arrhythmia. Because of the magnitude of the problem, the opportunity for a real public health impact are enormous: even minor improvements (10-20%) in risk detection could reduce the number of victims by 100,000 or more.

Ventricular fibrilation is the most frequent cause of SCD in patients with atherosclerosis, cardiomyopathy, and primary arrhythmic heart disease. Cardiac Resynchronization Therapy (CRT – a type of pacemaker that paces both ventricles) and Implantable Cardioverter Defibrillators (ICDs) – are devices that can detect and stop ventricular fibrillation by applying a synchronized electrical impulse to heart muscle. The CTMM COHFAR project focuses on the likely success of these devices. The Tailor-CRT valorization project is an additional workpackage in the COHFAR project that builds on the results of an existing workpackage on optimizing patient response to implantable cardiac devices.

Diabetes Mellitus

Diabetes is a chronic metabolic disorder in which the amount of blood glucose has been increased. Diabetes is sometimes underestimated, which can have serious consequences. About 2/3 of all patients with established coronary artery disease do have abnormal glucose metabolism or frank diabetes, as indicated by surveys supported by the Netherlands Heart Foundation. This pandemic increase in the incidence of diabetes mellitus are due to a tremendous increase in the incidence and prevalence of obesity in westernized populations. 36% percent of the Dutch population is moderately overweight and 12% is severely overweight or obese. By 2024, the prevalence of moderately overweight people will be 35-41% and that of obese people 18-30% (RIVM Rapport 260301003).

The CTMM PREDICCt project focusses on early diagnoses and treatment of Diabetes.

You can find more information on diabetes on: http://www.diabeticlifestyle.com/type-2-diabetes/type-2-diabetes-causes-symptoms-diagnosis

CARDIOLABORATE

How to accelerate biomarker discovery and assay development and validation?

CARDIOLABORATE is an inter-academic science broker that stimulates public-private collaborations in the field of cardiovascular biomarkers in the Netherlands. CARDIOLABORATE has the ambition to build new public-private collaborations by revealing a portfolio of facilities and unique opportunities in (pre)-clinical research that will accelerate biomarker discovery and assay development and validation.

Their slogan: "Infobase for knowledge transfer in cardiovascular biomarkers".

The CARDIOLABORATE website contains a database for available services and facilities.

Examples:

- cardiovascular biomarkers for different types of cardiovascular disease,
- animal and human disease models,
- research facilities,
- technology platforms and
- unique clinical cohorts

More information: www.cardiolaborate.org.

April 8, 2014

Office workout

The ultimate workout in the office, with demonstrations of a couple of office exercises. Physical activity also protects against the development of type 2 diabetes.

The most important complication of DM2 is cardiovascular disease, including myocardial infarction, cerebro-vascular incidents and kidney failure. DM2 has a huge impact on the healthcare budget: DM2 related costs account for 1.3% of the total Dutch healthcare budget. Often, by the time DM2 is diagnosed complications have already occurred.

Watch the video.