Current and future research into cardiovascular disease

Thought LeadersProfessor Eric de Groot Department of GastroenterologyUniveristy of Amsterdam

Cardiovascular disease (CVD) is the leading cause of death worldwide, resulting in 18.6 million deaths a year. It is estimated that 520 million people are currently living with CVD.

World Heart Day (WHD) takes place annually on the 29^th of September as part of the global effort to reduce and support patients to better manage CVD.

This day aims to reduce the global impact of Cardiovascular diseases by raising awareness of CVD and helping to better educate the general public on how to control and minimize the risks of developing these diseases.  

For WHD 2021, the World Heart Federation introduced the theme #UseHeartToConnect. This year's focus was on the benefits of digital health and the potential of telehealth technologies to improve the prevention, management and awareness of CVD.

For World Heart Day and as part of its core focus on leveraging its extensive knowledge, compassion and influence to improve patient outcomes worldwide, Atlantia Clinical Trials recently interviewed Professor Eric de Groot (Amsterdam, Netherlands).

The aim of this interview was to find out more about current research into Cardiovascular disease and the opportunities for further research.

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Please could you start by giving our readers a brief introduction to your role and background?

I have worked in pharma and in vascular medicine for many years and currently manage Imagelabonline & Cardiovascular, a CRO specialized in non-invasive vascular imaging technologies and blood pressure studies aimed at understanding cardiovascular health benefits of pharmaceutical, nutraceutical and lifestyle/stress interventions.

My academic research interests include diabetes, inflammatory bowel diseases and socio-economic factors and their relationships to atherosclerosis progression. I have published extensively in the cardiovascular field and currently serve as a reviewer for a number of scientific journals.

What has been the prevalence of Cardiovascular disease (CVD) in recent years, and what are some of the factors that have affected this?

We have already entered an era with an increasing number of older people in the population. This is both for demographic reasons as well as longevity. As a consequence, vascular-related diseases have become increasingly apparent, making disease prevention more important than ever.

We also need to realize that vascular diseases do not just include coronary heart diseases; they also entail a wide variety of disabling conditions like Alzheimer's disease, stroke and the consequences of metabolic syndrome and diabetes.

Common causes of early undesirable vascular harm leading to CVD include alcohol use, smoking, obesity and sedentary occupations. Health and well-being will always benefit from a healthy diet and a physically active lifestyle at any age and preferably built into one's daily routines.

What advancements have been made thus far in terms of the techniques used to diagnose heart disease?

As the topics are strongly interconnected, I would like to take your question on diagnosis a bit further and also extend it to prevention and treatment.

From a scientific perspective, the understanding of the mechanisms underlying heart and other vascular diseases, and their therapeutic consequences, have greatly advanced over the last few decades.

This is an ongoing multidisciplinary undertaking that includes insights into pathophysiology, epidemiology and genetics.

The identification of and the ability to modify risk factors by efficacious lifestyle, as well as by pharmaceutical and nutraceutical means, has created opportunities for symptomatic treatment and focused preventive measures.

On the clinical side, improved public awareness, the ability to recognize a vascular accident, diagnostic means and treatment of symptomatic patients in specialized units have all considerably increased the survival rate of patients suffering from coronary heart disease and stroke.

On the prevention side, laboratory parameters and genetics have become increasingly important in the early diagnosis of vascular disease risk.

Advanced multi-arterial blood pressure measurements and non-invasive imaging technologies like vascular ultrasound, MRI and coronary CT scans have improved individual risk scores.

These technologies have become more available, hence their applicability for preventive purposes and personalized treatment has also improved.

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Have any emerging factors leading to increased risk of CVD been identified?

There is increasing evidence to suggest that chronic inflammatory conditions of organs outside the arterial tree can greatly influence cardiovascular health.

For example, inflammatory bowel diseases, like ulcerative colitis and Crohn's disease, considerably increase the progression of atherosclerosis. Metabolic syndrome and being overweight can also cause a chronic inflammatory status, therefore increasing CVD risk.

Great effort is also put into the diagnosis of bowel microbiome composition, amongst others, by 'sniffing' volatile organic compounds in the expiratory air and inducing inhibition of inflammatory processes by favorably altering the microbiome using pre- and probiotic and dietary treatments.

How is the impact of nutrition on the prevention of CVD currently viewed, and how has this changed over time?

A long line of solid scientific knowledge now supports the effects of nutrition on cardiovascular health.

This is a promising development and runs parallel with the notion of the scientific and medical community that the incidence of CVD can be decreased by early identification of risk and early preventive measures.

Medical professionals have been very much inclined to focus on the treatment of symptomatic disease, but there is an increasing awareness by carers that the implementation of preventive measures can play active roles in primary and secondary CVD prevention.

Strictly speaking, I would be in favor of considerably more attention being paid to nutrition and physical education for school-age children –  key nutritional opportunities to help prevent cardiovascular disease/or improve and maintain heart health (for example, functional foods, etc.)

One example of a nutritional opportunity is our recent study into a type of sugar with a longer half-life that creates a more favorable vascular function profile and may benefit those with obesity and early diabetes. The favorable effects of unsaturated fats are well known.

The acceptance of a healthy lifestyle to promote well-being and prevent diseases is supported and guided by science. However, to make this work, there must be continuous effort to create awareness of the need for that healthy diet with consumers, producers and regulatory bodies alike.

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Does digital health have a role to play in the awareness, prevention and management of CVD? Are there any good examples of this in practice?

Opportunities to monitor and provide feedback on one's health via digital and wearable technologies are endless. It is a very exciting field.

The physics of the devices and physiology of the human body have been well understood for a long time, but the coming of age of smart technologies has provided real-time synchronous and complementary information on incoming medical data and, for example, location and time.

Smartphone apps can seamlessly integrate blood pressure, heart rate variability and other bodily functions. As feedback in the digital health environment can be immediate, it is a useful tool in personal training and in the understanding of medical conditions and their follow-up.

In line with the two previous questions, it is important to pay continuous attention to the human factor. As a health professional, one must take the time and make an effort to view the data with the right perspective to provide personalized feedback and advice.

What opportunities are there for further research in the area of CVD and heart health, and where do you see work in this area focusing in the future?

Science is about understanding, and research is its tool to provide valid quality-assured data.

Human cardiovascular studies using validated biomarker data can identify health status, disease risk and the efficacy of an intervention, even prior to the occurrence of disease. This research is, therefore, essential in proving product needs and efficacy.

Fueled by regulatory requirements, consumer and industry needs, I think the landscape of nutrition research and the improvement of heart health via efficacious diets have changed for the good.

The worldwide need for preventive health diets is increasing and product health claims must be solidly supported by human studies. I think this positive trend towards intensified nutrition research in the cardiovascular field will continue.

As these health needs are pursued, I foresee this trend being mutually beneficial for both producers and the well-being of customers.

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