ARCHIVED - Research About – Cardiovascular Health

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The Canadian Institutes of Health Research (CIHR) is the Government of Canada's agency for health research. CIHR's mission is to create new scientific knowledge and to catalyze its translation into improved health, more effective health services and products, and a strengthened Canadian health-care system. Composed of 13 Institutes, CIHR provides leadership and support to more than 13,000 health researchers and trainees across Canada. Through CIHR, the Government of Canada invested approximately $ 101.2 million in 2008-09 in cardiovascular health-related research.

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The Facts

• Cardiovascular disease, or heart disease, is the number one killer in Canada and the most costly disease, putting the greatest burden on our health-care system.*
• Among people who were aged 40 or older and free of heart disease in 1994-95, 19% of men and 15% of women had developed or died from heart disease by 2006-07. The risk of heart disease was significantly higher for women who had depression, but not for men.**
• The increasing incidence of heart failure – a disease in which the heart struggles to pump blood – is a byproduct of success in treating heart attacks and other cardiac conditions. As people with damaged hearts live longer, they become more susceptible to heart failure.***
• Blood pressure increases with age. More than nine in 10 Canadians will develop high blood pressure (hypertension) unless they follow a healthy lifestyle. High blood pressure can cause strokes, heart attacks, and heart and kidney failure.****

Sources: * Health Canada, Health Concerns, Heart and Stroke;
** Statistics Canada, July 2008, Health Reports: Depression and risk of heart disease;
*** The Heart and Stroke Foundation of Canada, Statistics;
**** Blood Pressure Canada, What is blood pressure?.

Finding Solutions

Heart cell-death discovery has cancer care implications

A Manitoba researcher's discovery of the master switch for a gene that triggers cell death during heart attacks also has important implications for cancer treatment. Dr. Lorrie Kirshenbaum of the St. Boniface Hospital Research Centre led a team investigating the mechanisms of a gene called Bnip3 that is switched on when oxygen levels in the heart drop below a certain level, signaling cells to die. Dr. Kirshenbaum and his group also found that turning Bnip3 on can prevent some cancer tumour cells from growing. Findings from the CIHR-funded research, which marks a major leap forward in understanding how cells grow and die, were published in the Proceedings of the National Academy of Sciences in December 2008.

Targeting inflammatory protein prevents heart attack and stroke

Lowering the level of an inflammatory protein in an otherwise healthy person's blood can reduce risk of heart attack and stroke, according to a major American-Canadian research project. Researchers in the almost 18,000-patient study found that people with healthy LDL-cholesterol levels who had elevated levels of high-sensitivity C-reactive proteins saw a significant reduction in the risk of cardiovascular events by taking a cholesterol-lowering statin drug daily. "We expected that we would have a robust reduction in heart disease but not to the level that we observed," McGill University's Dr. Jacques Genest told the Globe and Mail. The CIHR-funded Dr. Genest was the lead Canadian investigator in the study, published in November 2008 in the New England Journal of Medicine. C-reactive proteins can be easily traced with a blood test.

Too much chair time linked to sleep apnea

A sedentary lifestyle appears to contribute to obstructive sleep apnea (OSA), which steals sleep from 10 to 15% of adult North Americans. OSA causes a person's throat passage to close during sleep, waking them frequently to catch their breath. The condition is linked to higher risk of hypertension, heart failure and stroke. CIHR-funded researcher Dr. Douglas Bradley of the University of Toronto found that the severity of OSA was closely related to the amount of fluid shifting from the legs to the neck during sleep. Because long periods of time spent sitting cause fluid retention in the legs, prevention could be as simple as taking regular walk breaks. The findings were published in January in the American Journal of Respiratory and Critical Care Medicine and have been highlighted in Men's Health magazine.

Key questions about non-cardiac surgery

A half-million Canadians go under the knife each year for non-cardiac surgeries such as hip and knee replacements. But how many heart attacks, cardiac arrests or strokes occur during or after such surgeries? And what's the best way to estimate a patient's risk of vascular complications? These are questions that McMaster University's Dr. P.J. Devereaux wants to answer. Co-author of a 2008 Lancet report that showed beta-blocker drugs given to help prevent heart attacks during surgery may increase the risk of stroke or death, Dr. Devereaux leads a four-year CIHR study to investigate vascular events in non-cardiac surgery patients. Given that Canada's population is aging rapidly and more people are having these surgeries, knowing the number of vascular complications will help policy makers, health-care providers and patients understand the risks and make informed decisions.

The Researchers

Dr. Matthias Friedrich – Pictures of the Heart

When a patient with a suspected heart attack arrives at Calgary's Libin Cardiovascular Institute, pictures could help save that patient's life.

"In certain cases of an acute heart attack, we can make a diagnosis with cardiac magnetic resonance imaging, or CMR, hours before some of the other biomarkers, such as blood chemistry, show evidence of a heart attack," says Dr. Matthias Friedrich, Director of the Libin Institute's Stephenson CMR Centre and a cardiac researcher at the University of Calgary.

Dr. Friedrich is a pioneer in the use of CMR, and his CIHR-sponsored research is helping turn this powerful imaging technique into a clinical mainstay for diagnosing heart disease. "Compared to all other imaging techniques, CMR is unique," says Dr. Friedrich, who runs one of North America's largest academic CMR centres, with about 2,000 patients a year from across Western Canada.

Unlike a CT scan, or techniques using radioactive dyes, CMR involves no radioactivity. With CMR, clinicians not only see the heart's shape, as with a CT scan or ultrasound, but they can also characterize the health of the heart muscle tissue. And all of this information is collected within about 10 to 45 minutes.

"If you take into account the amount of information that CMR can deliver, it's by far the fastest, safest and most accurate heart imaging technique that we have," says Dr. Friedrich, who was recruited to Calgary from Berlin in 2004 to create Canada's first dedicated CMR centre.

His research is focused on turning the promise of CMR into a widespread, everyday reality. As well as identifying new CMR biomarkers for diagnosis, he's researching how to best implement these new procedures in a cost-effective clinical context.

This year, he led the publication of the Lake Louise Criteria, the international standards for the diagnosis of heart inflammation using CMR. These criteria are the result of an international meeting of 24 researchers convened by Dr. Friedrich in 2006.

With several colleagues, including his wife, Dr. Silke Friedrich, he also cofounded Circle Cardiovascular Imaging Inc. The company, with staff in Calgary, Berlin and Seattle, is leading the way in developing CMR image-analysis software to streamline the diagnosis procedure.

When Dr. Friedrich arrived in Canada, there were only two MR departments. Now, there are more than 15 sites with a strong focus on CMR, and he's working with other cardiac centres to establish new units.

But this medical imaging visionary sees the success of CMR as one step towards a bigger health goal. "MRI could be an excellent central tool for personalized health care," he says. "When we learn to use it more economically, it would be an excellent overall health screening tool, for issues from metabolic diseases to cancer."

For More Information

CIHR's Institute of Circulatory and Respiratory Health (CIHR-ICRH) has identified eight strategic research directions: obesity, diabetes and cardiovascular complications; technology for diagnostic and therapeutic advances; the determinants of at-risk behaviour for chronic disease; sleep; biomarkers for chronic disease; aging and the cardiorespiratory system; injury repair and inflammation; and transplantation-regeneration-cell based therapies. To learn more about these priorities and other CIHR-ICRH activities, please visit the Institute's website.

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