TY - JOUR
AB - Leaders in cardiovascular medicine Keith Fox: Caledonian collaborations and translational triumphs Judy Ozkan continues the series of today's leaders in cardiovascular medicine Keith Fox Keith Fox, MB ChB, FRCP, FESC, FMedSci, FACC, Duke of Edinburgh Professor of Cardiology at the University of Edinburgh since 1989, is a founding Fellow of the European Society of Cardiology (ESC). As a medical student in Edinburgh he frequently witnessed the ‘horrendous outcomes’ of heart attack patients for whom there was little effective treatment apart from resuscitation from ventricular fibrillation. When he later returned to the University as a senior clinical academic, he focused on applying the latest scientific discoveries to ensure the best possible clinical outcomes for cardiac patients. To aid the effective translation of research, he pushed for the establishment of an inter-disciplinary institute in a clinical setting and this became the Queen's Medical Research Institute (QMRI), which opened in 2005. Tell me about yourself I was born and grew up in Zimbabwe and later lived in Malawi. We moved around during my childhood as my father worked in banking and I attended local schools which were very basic. Most of the students had never envisaged studying outside of Africa. I won a scholarship to the University of Cape Town, South Africa, to study medicine, but I did not want to go under the apartheid system. I considered London and a couple of places wrote back along the lines of ‘thank you for your interest, but we have no places for people from Malawi’. So, I understood a bit about having doors closed in your face. I eventually settled on the University of Edinburgh in Scotland which offered excellent training in both science and medicine. After a post-doctoral fellowship in the USA, and a period in Cardiff, UK, I returned to Edinburgh in 1989 and was delighted to be appointed as Duke of Edinburgh Chair of Cardiology. How did your interest in medicine and cardiology start? I had an excellent biology teacher who would come into the classroom with the textbooks under his arm and throw them into a corner saying: ‘You can read those if you want, but we're going to do something more interesting’. Much later, at Edinburgh there were some really inspiring individuals such as Desmond Julian, who established the first coronary care unit in Europe in the City. As medical students we were very aware of the high mortality of MI, which in the late 1970s stood around 50% with half of those dying before they got to hospital and the other half within 30 days of admission. The outcomes for people who did reach hospital were often horrendous and it was a real challenge to manage such patients and to have any impact on outcomes for MI. Where and with whom did you do your medical training? In Edinburgh both the scientific and medical training were excellent. As well as Desmond Julian there were people like Michael Oliver and Bobby Marquis who were extraordinary physicians with incredible abilities when it came to understanding disease mechanisms. They had a very powerful influence on my early training in cardiology. Which person has influenced you the most and why? Desmond Julian for providing the inspiration to train in cardiology and Burton Sobel who was head of the cardiovascular division at Washington University for the research inspiration. He was a very insightful and incisive researcher with the ability to understand complex mechanisms and the ability to present any of the research programmes from the department. What are the key areas of research for you and how was your interest in these areas first aroused? My main focus is acute coronary disease and this spans the mechanisms of atherogenesis and plaque rupture through to clinical presentation and thrombosis. So, perhaps the two key themes of my research have included atheroma development on one side and thrombosis on the other. There was not much in the way of organized clinical research in Edinburgh during the late 1970s and early 1980s, but when I went to the States in 1983 I found a growing interest in reperfusion of the myocardium and our group developed some key experimental and imaging (positron emission tomography) techniques to study ischaemia and reperfusion. We were approached by Désiré Collen from Belgium who wanted to test a molecule from a melanoma cell line in an animal model we had developed. I did the studies with Steve Bergmann although we nearly went astray when the samples were delayed in US customs and became inactivated as they thawed out! However, on our third set of studies we managed to open the in vivo experimental coronary artery occlusion and achieve successful recovery of perfusion. The first human study on a patient with MI and a blocked by-pass graft soon followed and infusion of the melanoma-derived tPA into the graft achieved remarkable reperfusion despite an extensive thrombus. It opened the whole bypass graft and we realized that something very revolutionary was developing. In 1989 the research group in Edinburgh numbered 9 or 10 people including PhD students and technicians. It was a tremendous opportunity to start from the beginning and although it took a while to get going, we made major steps after we developed collaborative programmes with key researchers from neuro-sciences, vascular biology, and endocrinology, and shared out interests in vascular and inflammatory mechanisms. With help from the University and funding from the Wellcome Trust and the British Heart Foundation we eventually established the interdisciplinary QMRI and now have about 165 people doing research in cardiovascular sciences. My colleague David Newby is currently leading on one of our big steps towards understanding vulnerable plaque using combined PET/CT imaging. This is highly innovative and may revolutionize the way that we understand individual plaques, because the real challenge is to understand which plaques are susceptible to rupture, so-called vulnerable plaques, so we can modify our therapies to deal with them. Progress has also been made on the inhibition of the PCSK9 protein and its impact on lipid lowering. If we can change the balance of partially oxidized lipids within plaque, the hypotheses is that this will change their susceptibility to rupture. Key work on inflammation from our group and other collaborators followed. The very exciting news in the last year is that two different variations of these PCSK2 inhibitors have shown changes in early clinical trials of lipid lowering and this is beyond what could be achieved with statins. In parallel with this are ongoing studies looking at ways to modify inflammation within plaque. How has your research evolved over the years? Two factors have been critical: firstly, the superb interdisciplinary approach in Edinburgh and secondly, having large-scale research programmes one can draw on for answers to key questions. I led the development and conduct of the GRACE programme, together with a colleague from the University of Massachusetts, and this has allowed us to define the characteristics and outcomes of the whole spectrum of acute coronary disease. It has revealed not only what the early risks of acute coronary syndrome are, but also the diversity of the syndrome and it has also defined the long-term risks. We have been able to develop a risk score (the GRACE Score), to help stratify patients, particularly those with non-ST elevation acute coronary syndrome. This is needed because at the moment there is a real risk of a ‘treatment paradox’ in this area. People who are lower risk tend to get more interventional therapy and more aggressive pharmacological interventions and paradoxically not the higher risk individuals who have most to gain. We demonstrated that this ‘risk-treatment paradox’ exists across 14 different countries and different healthcare systems. We have also demonstrated that if centres adopt a systematic strategy to give more invasive-type therapies to high-risk patients' outcomes can be remarkably different. By changing policy about 80 more MI patients per 1000 could be saved. What piece of work are you most proud of? Difficult question! In my early research career, probably the work with Steve Bergmann on coronary thrombosis and mechanisms of reperfusion and the work with melanoma-derived tPA. That was what really triggered my interest in coronary thrombosis. What do you do outside your profession? I enjoy cycling and in early May 2015 along with my son, I completed the Etape Caledonian challenge which was 130 km around Scotland's lochs and glens in horrendous weather but it was for the charity Marie Curie Cancer Care so we were glad to have achieved it. I also enjoy hiking and taking care of the environment along with my wife who is involved in organizations such as the Royal Society for the Protection of Birds. As a voluntary activity I have been involved with Action on Smoking and Health (ASH), since 1989, first as Chair and now President. Action on Smoking and Health led the programme to establish smoke-free public places in Scotland and this brought about a documented decrease in hospital admissions for acute coronary syndromes. Which book would you take with you on an island and why? At school I built a 6-inch reflector telescope and managed to get it to work, but I did not manage to do much astronomy so a good astronomy guide would be great for a desert island—ideally with the telescope! If a second choice is allowed, perhaps it would be a poetry anthology as I have always enjoyed a wide range of poets from the Rubaiyat by Omar Khayyám to Shel Silverstein! What advice would you give to young researcher as they set out on their career? I am involved in a Europe-wide mentoring programme and we advise young scientists that by the time they finish their PhD they should be internationally leading in their field. They also need to be aware that really novel ideas can often lead to failures, but they should not be afraid to have them—as perhaps one will work! Being a part of an academic department with good mentoring and good interactions is critical. We are fortunate in the UK in having access to the BHF, the MRC, and NHRI so obtaining funding is not an obstacle if ideas are good and well-presented. The reality of research is that there are blind alleys and you can have disasters where you have to start again from zero. For this reason, well-organized programmes should have a number of strands of research, and access to expert advice, so if one comes up against the buffers you may be able to find a novel solution! New European Heart Journal international editorial board members New members have been appointed to the European Heart Journal Editorial Board during April 2015 Barry A. Borlaug MD Barry Borlaug has been an Associate Professor of Medicine and the Director Circulatory Failure Research at the Mayo Clinic, Rochester, MN, USA, since 2011 and 2012, respectively. A Bachelor of Science graduate in biochemistry of the University of Wisconsin, Madison, WI, USA, in 1994 he entered the same university medical school to graduate MD in 1999. Thereafter followed an internship and residency in internal medicine at Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA, and a postdoctoral Fellowship in cardiovascular disease at Johns Hopkins Hospital and School of Medicine, Baltimore, MD, USA, which ended in 2006. Dr Borlaug then returned to the Mayo Clinic in 2007 as an Assistant Professor of Medicine for 4 years to become an Associate Professor of Medicine in 2011. Then in 2012 he was elected Director, Circulatory Failure Research, Mayo Clinic, Rochester, MN, USA, a position he still holds. Barry Borlaug has been the recipient of many awards beginning as a Phi Beta Kappa graduate from Honours Program with Distinction followed by the Lucille O'Keefe Award and George and Laura Maki Scholarship for full medical school tuition. As a medical graduate he was co-recipient of the Stanley Blumenthal Award in Clinical Research at Johns Hopkins Hospital and the Marie Ingalls Career Development Award in Cardiovascular Research, Mayo Clinic. Still at the Mayo Clinic he received the Mayo Cardiovascular Division Teacher of the Year Award and New Investigator Award. He has published extensively, more than107 publications since 2005. Dr Borlaug's particular interest is heart failure. Michele Brignole, MD, FESC Michele Brignole, MD, FESC is the Director of the Cardiology Department at Ospedali del Tigullio, Lavagna, Italy. He is registered as a full professor of cardiology by the Italian Ministry of Health. Dr Brignole's main fields of research are diagnosis, pathophysiology, and therapy of syncope and rhythm disturbances, and catheter ablation of arrhythmias. He has published more than 250 peer-review articles on these topics and is co-Editor of six books on syncope. He also served as the chairman of the Guidelines on Syncope of the European Society of Cardiology (versions 2001 and 2004) and chairman of the Guidelines on Cardiac Pacing and Cardiac Resynchronization Therapy of the European Society of Cardiology. He is the present chairman of the 2017 Guidelines on Syncope of the European Society of Cardiology. Victoria Delgado MD PhD Victoria Delgado is currently a full staff member in the Department of Cardiology at the Leiden University Medical Centre in The Netherlands. A native of Spain she was born in Barcelona, she later went to University and obtained her medical degree. Graduating in 1999 she began her cardiology training in 2000 where she was placed 16th from 2000 applicants and completed her residency in 2005. The years 2005 and 2006 were spent in her doctorate programme also in Barcelona, moving to Leiden University in the Netherlands in 2011 for her MD thesis in Novel Cardiac Imaging Technologies. In addition to almost 300 published papers, Victoria Delgado is an author in five book chapters and has been the recipient of many prizes and grants. She has been on the editorial board and a reviewer of several internationally renowned journals and a task force member of the European Society of Cardiology Committee for cardiac pacing and resynchronization therapy guidelines. Nicolle Kränkel MSc, Dr. rer. nat. (PhD) Nicolle Kränkel joins the editorial board from her position as head of the translational cardiovascular research lab at the Charité University Hospital campus Benjamin Franklin in Berlin, Germany. Nicolle holds an engineering degree in biotechnology and a PhD in biology. An initial graduate in biotechnology from Jena, Germany in 2001, she continued as a Research assistant at the Leipzig Heart Centre to complete a PhD in biology at the University of Leipzig in 2006. Her interest lies in vascular biology, especially the interactions between cells of the immune system and the endothelium, as well as the various means of intercellular communication. Her cellular and molecular research is strongly linked to in vivo situation in patients with cardiovascular diseases or increased cardiovascular risk, such as diabetes mellitus, and covers mechanisms of disease as well as preventive and therapeutic strategies. During her PhD at the Heart Center in Leipzig, Germany, she investigated molecular and functional alterations in endothelial-supportive circulating cell types in patients with diabetes, as well as protective effects of regular exercise training in patients with cardiovascular diseases. Dr Kränkel then joined the group of Prof. Paolo Madeddu at the University of Bristol, UK, where she studied the role of bradykinin signalling for the interaction between myeloid cells and endothelium, especially in the context of diabetes and angiogenesis. Supported by an ‘Ambizione’ Fellowship of the Swiss National Research Foundation, she then joined the group of Prof. Ulf Landmesser at the University of Zurich, Switzerland, where she continued her research on kinin-mediated intercellular communication between myeloid cells and the macrovascular endothelium. Nicolle has been a reviewer for several medical journals: European Heart Journal, PLoS ONE, Cardiovascular Research, and European Journal of Preventive Cardiology, Atherosclerosis, also in the Working group ‘Vascular Biology’ of the German Cardiac Society and a Nucleus Member of the Exercise Basic & Translational Research (EBTR) Section of the European Association for Cardiovascular Prevention and Rehabilitation (EACPR). Since 2013 she has been Secretary of the section Exercise Basic & Translational Research of the EACPR. Carolyn Lam Su Ping MBBS, MRCP, MS, FACC, FESC Dr Carolyn Lam is a Senior Consultant of the National Heart Centre, Singapore and an Associate Professor of Duke-NUS Cardiovascular Academic Clinical Program, and Chairperson of the Asia Pacific Association of Women's Cardiovascular Disease. She graduated from the Faculty of Medicine, National University of Singapore, completed advanced specialty training in Cardiology in Singapore, and pursued her Research Fellowship at the Cardio renal Laboratory, Heart Failure Fellowship at the Division of Cardiovascular Diseases, and Advanced Cardiology and Master of Biomedical Sciences at Mayo Clinic, Rochester, MN, USA. She obtained further training in clinical and genetic epidemiology at the Framingham Heart Study in Boston, MA, USA, before returning to Singapore in 2010 on the National Medical Research Council's Clinician Scientist Award. Dr Lam's clinical sub-specialty is heart failure, and she is recognized globally for her expertise in heart failure with preserved ejection fraction. She also has expertise in women's cardiovascular disease, haemodynamics, echocardiography, biomarkers, and clinical trials. She started the first Heart Failure with Preserved Ejection Fraction Programme and Women's Heart Health Clinic in Singapore, was awarded the L'Oréal Women In Science Award (2012) for her work in women's cardiovascular disease, was named an InterAcademy Medical Panel Young Physician Leader at the World Health Summit in Berlin (2012), and won the award for the Junior Chamber International (JCI) Ten Outstanding Young Persons of the World for 2014–Singapore (2014). She is the Programme Lead of the Asian neTwork for Translational Research and Cardiovascular Trials (ATTRaCT)—an A*STAR Biomedical Research Council-funded research platform; and principal investigator of an ongoing nation-wide heart failure study in Singapore [the Singapore Heart Failure Outcomes and Phenotypes (SHOP) study] and a multinational Asian study of patients with heart failure across 11 Asian countries [Asian Sudden Cardiac Death in Heart Failure (ASIAN-HF) study]. She is on the Executive Committees of several global heart failure trials. Gaetano Antonio Lanza MD Dr Gaetano Antonio Lanza is Researcher and Aggregate Professor in Cardiology at the Cardiology Institute, Università Cattolica del Sacro Cuore, Rome, Italy. He is a clinical cardiologist, with a vast expertise in the field of electrocardiology, and heads the section of Non-Invasive Cardiology at the Department of Cardiological Sciences, Agostino Gemelli University Hospital, Rome, Italy. He is an author of about 250 articles in peer-reviewed medical journals and serves as a reviewer for several international cardiology journals. Dr Lanza has been a Fellow of the European Society of Cardiology since 1994 and a member of the Società Italiana di Cardiologia since 1982; he was Deputy Editor of the Italian Heart Journal (now Journal of Cardiovascular Medicine) in during the years 2000–2002. His main field of research concerns pathophysiology and clinical aspects of ischaemic heart disease, in particular of coronary microcirculation, and coronary spasm, but his scientific interests also involve endothelial function, as well as cardiac autonomic function and arrhythmias. John Lekakis MD Dr John Lekakis graduated from the Medical School of University of Athens, Greece, and completed his fellowship in Cardiology in Athens in 1982. He continued with further cardiology training at Boston University 1982–1984, in Paris, 1987 and Einthoven, 1988. Currently he is a Professor of Cardiology at Athens University in the Attikon Hospital. He served as the President of the Hellenic Cardiological Society 2003–2004, as a member of the Guidelines Committee of the European Society of Cardiology 2002–2004 and 2004–2006, Chairman of the Working Group of Peripheral Circulation of the European Society of Cardiology 2008–2010, and Chairman of the Board of Onassis Cardiac Surgery Center. He served as an ad hoc member of the Congress Program committee of the European Society of Cardiology. His main research interests are endothelial function and arterial stiffness in health and disease. John Lekakis is an author of more than 250 articles in peer review journals. He also has contributed with chapters in many Greek and International books. Currently he is the President of the Hellenic College of Cardiology and Chief of the Department of Cardiology, Attikon Hospital, Athens University. Felix Mahfoud MD Dr Felix Mahfoud studied medicine at the Johann-Wolfgang-Goethe University, Frankfurt, Germany. He completed his residency at the Department of Internal Medicine and Cardiology, Angiology and Intensive Care Medicine, Saarland University Hospital, Homburg, Germany. Since 2014 he has been an associate professor and a senior physician of Internal Medicine and Cardiology at Saarland University Hospital and Affiliate/Visiting Professor of the Harvard-MIT, Biomedical Engineering, Boston, MA, USA. Dr Mahfoud is a recipient of multiple national and international awards. His special scientific interest includes pathophysiology, conservative, and novel interventional therapies of heart failure and hypertension. He is a member of several editorial boards and serves as a nucleus member of the Task Force Hypertension (European Society of Cardiology), Working Group Interventional Hypertension Treatment (European Society of Hypertension), EuroPCR Board of Directors, Co-Chairmen of the Resistant Hypertension Course Berlin, TCT Associate Director, and programme committee member of the ESC Congress 2015 and 2016. Dipen Shah MD Professor Dipen Shah is a director of the Cardiac Electrophysiology Unit at the University Hospital of Geneva (HUG), Switzerland. Having obtained his MD in internal medicine and cardiology in India, Dipen Shah took a fellowship in cardiac electrophysiology at the Hôpital Haut-Lévêque of Bordeaux, specializing in electrophysiology interventions, in particular, the ablation of atrial fibrillation, the ablation of left atrial flutters and of complex ventricular and atrial arrhythmias. Working at the University Hospitals of Geneva (HUG) since 2002, his clinical and research interests focus on atrial fibrillation, macro-re-entrant atrial tachycardia including different and complex flutters and new technologies to improve the ablation of cardiac arrhythmias, e.g. real-time contact force sensing. He is a Fellow of the Heart Rhythm Society and co-author of over 173 indexed publications. He is a member of the Editorial Board of the JICE (Journal of Interventional Cardiac Electrophysiology), JCE (Journal of Cardiovascular Electrophysiology, Journal of Arrhythmia), Persian Heart Journal, JAFIB (Journal of Atrial Fibrillation), and Cardiovascular Medicine. Agostino Virdis MD Dr Agostino Virdis a hypertension specialist is an Associate Professor of Internal Medicine, Department of Clinical and Experimental Medicine at the University of Pisa, Italy. A native of La Spezia, Italy, he studied medicine at the University of Pisa graduating in 1990. He continued on in Pisa to specialize in clinical pharmacology and internal medicine after which, he joined the staff as an assistant Professor in Internal Medicine in the Department of Clinical and Experimental Medicine at the University of Pisa. Hypertension aroused his interest for which he joined the Multidisciplinary Research Group on Hypertension at the Clinical Research Institute of Montreal, University of Montreal, Quebec, Canada. Dr Virdis has been a scientific reviewer for Circulation, Hypertension, Journal of Hypertension, American Journal of Hypertension, Journal of Pharmacology and Experimental Therapeutics, and European Heart Journal. His major research interests are local neuro-humoral control of peripheral vessels in primary and secondary hypertension, as well in other cardiovascular risk factors both in animal and in human models, with particular emphasis on the endothelium and the renin–angiotensin system. Dr Virdis has expertise in vascular testing of micromyography and forearm plethysmography for assessing endothelial function and vascular structure in the peripheral microcirculation. The author of 160 publications in peer-reviewed journals with a total impact factor (‘Institute of Scientific Information’ of ‘Journal of Citation Report’, 2012) of 810 and h-index (‘Scopus’ and ‘Web of Science’) of 47. He has been a National Counsellor of the Italian Society of Hypertension since 2012 and is currently Secretary of the Italian Society of Hypertension. Andros Tofield Action to tackle non-communicable diseases globally A policy statement from the American Heart Association, European Society of Cardiology, European Association for Cardiovascular Prevention and Rehabilitation, and American College of Preventive Medicine on action needed. Experts call for ‘all hands on deck’ to tackle global burden of non-communicable disease A group of some of the world's top doctors and scientists working in cardiology and preventive medicine have issued a call to action to tackle the global problem of deaths from non-communicable diseases (NCDs), such as heart problems, diabetes, and cancer, through healthy lifestyle initiatives. They say that identifying the enormous burden caused by NCDs is not enough and it is time for ‘all hands on deck’ to pursue strategies both within and outside traditional healthcare systems that will succeed in promoting healthier lifestyles in order to prevent or delay health conditions that cause the deaths of over 36 million people worldwide each year at a cost of at least US $6.3 trillion—a cost that is projected to rise to $13 trillion by 2030. In a policy statement from the American Heart Association (AHA), the European Society of Cardiology (ESC), the European Association for Cardiovascular Prevention and Rehabilitation (EACPR), and the American College of Preventive Medicine (ACPM), which was published simultaneously in Mayo Clinic Proceedings and the European Heart Journal,1,2 the authors propose that organizations at every level of society, from the family unit, to companies, to industry, to government, and non-governmental organizations worldwide should collaborate to create, implement, and sustain healthy lifestyle initiatives that will reverse the current upward trajectory of NCDs. ‘All of the non-communicable diseases that are caused by these risk factors are potentially preventable, or can be changed, through people leading healthy lifestyles’, said Professor Ross Arena, of the University of Illinois at Chicago (USA), who was chair of the policy statement authors. ‘The challenge is how to initiate global change, not towards continuing documentation of the scale of the problem, but towards true action that will result in positive and measurable improvements in people's lifestyles’. The experts call for a paradigm shift in the prevention and treatment of NCDs. ‘The importance of promoting and leading a healthy lifestyle must take a significantly more prominent role, from the individual/family to global population level, capitalising on all forms of preventive strategies. … We must look beyond the traditional healthcare model (i.e. hospital and clinical settings) to implement healthy lifestyle initiatives. Effective communication and meaningful partnerships amongst stakeholders is essential’, write the authors in the paper. They suggest ways that all these different stakeholders could integrate and collaborate more effectively. These include: Prof. Arena said: ‘We are proposing a level playing field for all stakeholders; a collaborative initiative can be started through any stakeholder, and the number of stakeholders would be flexible to take account of local circumstances. Our hope is that this novel, non-hierarchical model optimizes global applicability and creativity, as successful healthy lifestyle initiatives are not one size fits all. Governments can play a role, but this non-hierarchical model does not require government involvement, although such involvement would certainly optimize any initiative and its reach’. Appointing ‘healthy lifestyle ambassadors’: organizations at every level, from families, schools, and healthcare organizations up to employers, governments, industry, and the media, should appoint ‘healthy lifestyle ambassadors’ who will take the lead in promoting and implementing change. Creating a non-hierarchical model: all stakeholders play an equally important and valuable role, but are connected and work together, with no silos, in order to optimize flexibility and creativity. ‘In addition, we are proposing the treatment of NCDs should move outside of the traditional, often reactionary, healthcare model. Prevention is the key and preventive strategies at earlier stages in the community are best, for instance at the very beginning of life. Thus, this document proposes a rethinking of healthcare delivery. Lastly, the “healthy lifestyle ambassadors” will be drivers of this process, representing stakeholders and collaborating with one another. They are at the grass roots level and will provide the “people power” that is needed’. The paper identifies a number of barriers or challenges to implementing healthy lifestyles, and it suggests possible solutions. Barriers and challenges include the public perception of the ‘nanny state’ and intrusion into private lives and individual rights; pressure applied by lobbying groups for special interests such as the food industry, leading to loss of public trust in government actions; the short-termism of governments that base their priorities on the election cycle and are unable or reluctant to take a longer view; the difficulty of adhering over the long-term to ‘new’ healthier lifestyles; the need to continue to educate women, particularly in racial and ethnic minorities, as women are often the key decision-makers about diet and lifestyle in the family; and low participation rates in healthcare programmes aimed at helping people with NCDs to improve their lifestyles, for instance, by stopping smoking. The authors conclude that they hope their paper will motivate organizations at all levels of society to: ‘(1) Embrace their defined roles with respect to HL [healthy lifestyles] promotion and take action that will result in meaningful and positive change; (2) officially designate one or more healthy lifestyle ambassadors that have the organisational support needed to develop and implement HL initiatives; and (3) commit to ongoing communication amongst stakeholders that will result in collaborative HL initiatives’. Andros Tofield ESC Press Office References References are available as supplementary material at European Heart Journal online. Patients visualizing their calcified coronary arteries may be wake-up call to change lifestyle Looking at images of their own calcified coronary arteries may be a wake-up call for patients with newly diagnosed coronary artery disease to change their lifestyles, according to research presented at EuroHeartCare 2015. The aim of the prospective, randomized, controlled study was to assess the influence of visualization of coronary artery calcification in addition to standard information about risk and lifestyle modification on plasma cholesterol concentrations and other risk factors in patients with hyperlipidaemia and a new diagnosis of non-obstructive coronary artery disease. The study included 189 patients with hyperlipidaemia who had undergone a coronary computed tomography angiography (CTA) of their coronary arteries and been diagnosed with non-obstructive coronary artery disease. Patients were prospectively randomized in a 1:1 fashion to the intervention or to standard follow up in general practice which consisted of information about risk and lifestyle modification. Risk factors were measured at baseline and 6 months. After excluding patients who discontinued statin therapy due to side effects (20 in the control group, 22 in the intervention group), the researchers found a significantly greater reduction in plasma total cholesterol concentrations in the intervention group compared with controls. More patients in the control group continued smoking and eating an unhealthy diet. The intervention group lost 1.5 kg on average while the control group gained an average of 0.5 kg. There was a tendency towards a higher degree of adherence to statin therapy in the intervention group. Jennifer Taylor MPhil VesselNavigator by Philips A new device presenting three-dimensional images during endovascular procedures With the increasing complexity of interventional procedures, there is a growing need for 3D image overlay (or fusion) to assist operators with device guidance and precise placement. The fusion of pre-procedural computed tomography (CT) scans with 2D fluoroscopy has shown positive outcomes in the treatment of complex aneurysms of the thoracic aorta.1,2 Using conventional 2D X-ray image guidance during endovascular procedures, clinicians often perceive the visualization of the vessel anatomy as if a dimension is missing, adding to procedure complexity. VesselNavigator brings back the 3D anatomy. VesselNavigator can be used for all types of endovascular procedures, the key applications are guidance during the treatment of carotid artery, thoracic aorta, abdominal aorta, and iliac artery aneurysms. VesselNavigator fuses live interventional X-ray images with pre-acquired 3D MRI or CT images of the patient's vascular structures. The resulting 3D colour-coded images of the vessels provide enhanced real-time visual guidance, making it easier to manoeuvre through the vascular network without the need to enhance the X-ray visualization with the repeated use of injected contrast medium. The overlaid image is shown on a separate screen. The tool also allows rotation of the C-arm without the loss of any of the vessels that are being visualized. With conventional X-ray imaging, it can be very challenging to guide the guidewire into the right-side branches of the aorta and to position a stent in the precise orientation. A 3D vascular representation can be of great assistance. Unlike 2D angiography images that can be limiting by vessel super positioning or foreshortening, providing 3D views of the vasculature allows easy definition of the right projection angle for optimal navigation and stent placement. The use of ring markers allows the easy localization of the ostia and landing zones. In recent studies, VesselNavigator has been shown to reduce the use of contrast medium by 70%1 and procedure times by 18%2 for complex aortic aneurysm cases, contributing to more patient-friendly, more efficient, and more cost-effective treatment of vascular conditions. Professor Frank Vermassen, Head of Vascular and Thoracic Surgery at University Hospital Ghent, Belgium, has said, ‘VesselNavigator gives the 3D view of the patient's anatomy, which physicians are familiar with from open surgery. It also significantly reduces the amount of contrast medium required, which means a lesser burden on the kidneys. And with a growing population of elderly and diabetic people who suffer from poor renal function, reducing contrast medium requirements will open up endovascular treatments to a wider range of patients’. Ruud Heugen Conflict of interest: R.H. is Senior Director, Marketing Image Guided Therapy Systems, Philips. References 1 Tacher V Lin M Desgranges P Deux J-F Grünhagen T Becquemin J-P Luciani A Rahmouni A Kobeiter H . Image guidance for endovascular repair of complex aortic aneurysms: comparison of two-dimensional and three-dimensional angiography and image fusion . J Vasc Interv Radiol 2013 ; 24 : 1698 – 1706 . Google Scholar Crossref Search ADS PubMed WorldCat 2 Sailer AM de Haan MW Peppelenbosch AG Jacobs MJ Wildberger JE Schurink GW . CTA with fluoroscopy image fusion guidance in endovascular complex aortic aneurysm repair . Eur J Vasc Endovasc Surg 2014 ; 47 : 349 – 356 . Google Scholar Crossref Search ADS PubMed WorldCat Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email: journals.permissions@oup.com Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email: journals.permissions@oup.com
TI - CardioPulse Articles
JF - European Heart Journal
DO - 10.1093/eurheartj/ehv388
DA - 2015-10-01
UR - https://www.deepdyve.com/lp/oxford-university-press/cardiopulse-articles-6y9cvuPJwe
SP - 2476
EP - 2483
VL - 36
IS - 37
DP - DeepDyve
ER -