ARCHIVED - Research About – Cardiovascular Health

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For the past 10 years, the Canadian Institutes of Health Research (CIHR) has supported better health and health care for Canadians. As the Government of Canada's health research investment agency, CIHR enables the creation of evidence-based knowledge and its transformation into improved treatments, prevention and diagnoses, new products and services, and a stronger, patient-oriented health-care system. Composed of 13 internationally recognized Institutes, CIHR supports more than 13,600 health researchers and trainees across Canada. Through CIHR, the Government of Canada invested approximately $95.6 million in 2009–10 in research related to cardiovascular health.

The Facts

• In 2009, females (17.3%) were more likely than males (16.4%) to be diagnosed with high blood pressure, or hypertension. Its incidence was up almost one percentage point in 2009 from 2007 (to 16.9% from 16%).¹
• Life stress, which can have negative health consequences on blood pressure, is on the rise. In 2009, 23.2% of Canadians aged 15 and older reported that most days were "extremely or quite a bit stressful," up from 22.3% in 2008. The numbers were higher for females (24.8%) than males (21.6%).²
• About 4% of Canadians aged 35 and older have Chronic Obstructive Pulmonary Disease (COPD). Smoking is the leading cause but exposure to lung irritants such as second-hand smoke, air pollution and chemical fumes can also contribute.³
• Respiratory diseases exert a significant economic impact on the Canadian health-care system. According to a 2007 report, almost 6.5% of total health-care costs (both direct and indirect) were related to respiratory diseases (not including lung cancer).⁴

Sources:

1. Statistics Canada: Health Fact Sheets High blood pressure 2009
2. Statistics Canada: Health Fact Sheets Perceived life stress 2009
3. Statistics Canada: Health Fact Sheets Chronic Obstructive Pulmonary Disease 2009
4. Public Health Agency of Canada Life and Breath Respiratory Disease in Canada

Finding Solutions

New anticoagulant is safer and more effective

An 18,000-patient clinical trial has demonstrated that a new anticoagulant called dabigatran is not only safer to use than the current decades-old therapy for the common heart rhythm disorder atrial fibrillation (AF), it also does a better job of preventing stroke. "This is a huge advance," says Dr. Stuart Connolly of McMaster University. Until now, patients with AF have been largely limited to using a blood thinner called warfarin, which comes with a risk of bleeding in the brain. Dabigatran significantly reduces the bleeding risk. "It's more effective, safer and easier to manage – so a lot more people will use it than currently take warfarin," says Dr. Connolly. More than 250,000 Canadians have AF. While the 44-country study was industry-funded, its foundations were put in place by CIHR research going back to 1989. "CIHR (then the Medical Research Council) funded one of the first studies to show that warfarin was effective against AF," says Dr. Connolly. "That's how we got into this field." The industry sponsor, Boehringer Ingelheim (Canada) Ltd., markets dabigatran as Pradax^®.

Pregnancy-triggered condition signals potential cardio trouble

If a woman develops preeclampsia during pregnancy, it not only puts her at immediate risk, it also signals potential cardiovascular trouble down the road, says clinician/researcher Dr. Graeme Smith of Queen's University. The condition, which affects between 5–10% of expectant mothers, is marked by high blood pressure and protein in the urine. Dr. Smith is monitoring the health of a group of women who contract the condition during pregnancy to see if they develop further cardiovascular problems. The goal is to find ways to identify those women who are at higher risk post-pregnancy in order to intervene earlier. "At no other time in their lives do women access the health-care system as frequently as during pregnancy," says Dr. Smith. "It's a real opportunity to look at health preservation and disease prevention from a future-health point of view."

The quicker the care, the better the outcome

When it comes to heart attacks, speed doesn't kill, it saves – heart muscle and lives, to be specific. Dr. Paul Armstrong of the University of Alberta spearheaded a new model of cardiac care in Edmonton in which people showing signs of the most deadly type of heart attack – acute ST elevation myocardial infarction, or STEMI – begin getting care before they go to the hospital. The Edmonton Vital Heart Response, established by Dr. Armstrong's collaborator Dr. Robert Welsh, calls for trained paramedics to conduct 12-lead electrocardiograms and send the results to a waiting cardiologist via cell phone. If the STEMI diagnosis is confirmed and the patient deemed an appropriate candidate, the paramedics administer a drug that can open blocked coronary arteries and restore normal heart function. "Everything we see confirms that if we can get to the patients within the first hour, at least one in four has a chance of avoiding the heart attack almost entirely," says Dr. Armstrong, who is investigating the use of the early-treatment approach for other types of myocardial infarction.

Long, hard look at diuretics validates their effectiveness

A long-term look at the role of diuretics in controlling hypertension has confirmed what was previously established: inexpensive water pills are just as good, or better, at preventing heart failure and stroke than the much-higher-priced alternatives. Dr. Frans Leenen of the University of Ottawa Heart Institute led the Canadian component of the initial study that tracked 33,000 patients over three to five years. Published reports from 2002–2004 found that diuretics, which cost pennies to take and flush salt from the system, are just as effective at lowering blood pressure as the aggressively marketed and pricey ACE inhibitors and calcium channel blockers. A 2010 report by American investigators found no problems had arisen in the years since the landmark study. "It's important to know whether any benefits or risks have been overlooked by doing only a three- or five-year study," says Dr. Leenen.

For More Information

Heart, lung and blood vessel diseases are the major health burdens facing Canadians - yet if we understood how our genes, the environment, and our behaviour interplay to cause these common conditions, they might be preventable. The CIHR Institute of Circulatory and Respiratory Health (CIHR-ICRH) is supporting research that asks tough questions about the causes, consequences, and control of these conditions. To learn more about these priorities and other CIHR-ICRH activities, please visit the Institute's website.

For more information, go to ARCHIVED - Your Health Research Dollars at Work