Institute of Cardiovascular Science
Significant progress has been made in the establishment of the Institute of Cardiovascular Science, a partnership between Trinity College Dublin, the Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital (AMNCH), and St James's Hospital.
Since September 2002, Dr Niall Mulvihill, Research Lecturer in Physiology and Cardiology, TCD, and Project Manager for the development of the Institute's research portfolio, has worked extensively to develop collaborative links with colleagues across the founding institutions and with industry, and this has led to the emergence of four main themes in the research portfolio:
- Cardiovascular Risk Prediction and Health;
- Inflammation and Metabolism;
- Imaging and Physiological Measurement; and
- Invasive Cardiology and Electrophysiology.
These themes are underpinned by the founding institutions' special interest in global cardiovascular health, metabolic health, and advanced cardiovascular technologies.
Outlined below are two of the Institute's research projects, one of which relates to the theme Cardiovascular Risk Prediction and Health, and is based at AMNCH, and the other to Inflammation and the Metabolic Syndrome, based at St James's Hospital.
On 2 April, 2004, the European Society of Cardiology (ESC) launched 'HeartScore'®, an interactive cardiovascular disease (CVD) risk prediction and management system freely available through the ESC website, www.escardio.org/HeartScore . It is currently available in English but will eventually be translated into 24 official European languages. HeartScore® is a new and unique, evidence-based, interactive tool which:
- allows quick and easy estimation of a patient's CVD risk;
- can be tailored to an individual country's needs;
- identifies the relative impact of each modifiable risk factor in easy-to-understand graphical form;
- guides physicians in tailoring treatment to the individual using the most up-to-date evidence available for CVD prevention.
HeartScore® can calculate an individual's 10-year fatal CVD risk based on individual risk factors: including age, gender, smoking, blood pressure and total cholesterol. The inclusion of HDL cholesterol will also be available as an option. HeartScore® presents doctors as well as patients their CVD risk in bar chart form. The contribution of each risk factor to total CVD risk is represented using a pie chart, and the expected effect of intervention can be visually displayed and emphasised. Advice for lowering CVD risk can be printed out for the individual's benefit. The aim is to encourage patients to lower their risk by adopting behavioural change and complying with treatment.
HeartScore® has been developed by the Research Centre for Prevention and Health, Glostrup University Hospital, Denmark, under the direction of Dr Troels Thomsen, benefiting from the experience of the Danish PRECARD system. The hazard ratios used to calculate total CVD risk from factors such as smoking, hypertension and cholesterol were derived from the extensive dataset of the SCORE Project (an EU Concerted Action Project comprising partners from 10 member states and Russia, co-ordinated under the leadership of Professor Ian Graham, Consultant Cardiologist, AMNCH, and Professor of Epidemiology and Public Health Medicine, Royal College of Surgeons in Ireland). The SCORE Project forms a major component of the Epidemiology, Risk Prediction and Health theme of the Institute of Cardiovascular Science's research portfolio.
The new challenge to HeartScore® and CVD risk estimation overall is the incorporation of new risk factors such as homocysteine, C-Reactive Protein and the metabolic syndrome. It may also be possible to establish a system for European centralised data collection and analysis that would facilitate overview of a broad European picture of CVD prevention activity.
HeartScore® will eventually be delivered in each country's language of choice. One of the most distinctive and dynamic features of the HeartScore® programme is its ability to evolve and remain up-to-date. HeartScore®, like the SCORE system, can be incorporated with new cohorts as they become available. Because it is a web-based system, the most up-to-date version is constantly available to all on-line.
Alterations in vascular biology in early onset Type 2 diabetes and the metabolic syndrome
The obesity epidemic and attendant early onset of Type 2 diabetes and metabolic syndrome in young adults and children is a relatively new phenomenon in Europe and one which represents a very serious public health concern.
At St James's Hospital, Professor John Nolan, consultant endocrinologist, has been conducting research into this new phenomenon in Dublin, in collaboration with colleagues in the US and in Europe. Studies to date have shown that early onset Type 2 diabetes is characterised by severe insulin resistance, a greater degree of obesity than subjects presenting with later onset, more rapid loss of insulin secretion, and a cluster of cardiovascular risk factors in very young individuals. A new Young Person's Diabetes Clinic has recently opened at the Hospital and will cater equally for young people with Type 1 and Type 2 diabetes. It will combine clinical and academic strengths from the Hospital's and Trinity College's departments of metabolic medicine, cardiology, haematology/coagulation and physiology, to establish a novel clinical service and research programme which will have significant public health and social gain.
Amongst the research programmes to be conducted at the new Young Person's Diabetes Clinic, teams of multidisciplinary researchers will intensively study young cohorts of patients presenting with Type 2 diabetes to understand better the pathenogenesis of the increased atherogenic risk; to establish future cardiovascular risk and implement primary preventive strategies. The focus of research in this area will be on prevention of cardiovascular disease in this very high risk population and will include studies relating to:
- the assessment of cardiovascular risk using inflammatory markers;
- insulin resistance and thrombosis;
- metabolic investigations;
- the assessment of impact of exercise on metabolic and inflammatory markers; and
- non invasive imaging to assess the atherosclerotic burden and monitor progression of atherosclerotic vascular disease.