Heartening news

Research — By on May 31, 2017 10:16 am

Professor Rob Doughty speaks to Suzi Phillips.

There’s good news and bad news on heart attacks in New Zealand.

First the bad news is that one in four New Zealanders who have heart attacks are below the age of 55 years.

The good news is that acute care for heart attack patients has improved over recent years, right across the country.

And here are the sobering and sad statistics.

One third of all deaths in New Zealand each year are due to cardiovascular disease, and about every 90 minutes one New Zealander dies from heart disease. Heart attacks happen to 10,000 people each year – those are the figures for New Zealanders admitted to hospital with an acute heart attack. And while a heart attack is an acute event, heart disease is a life-long issue and affects about 172,000 people – those are the people living every day with the impact of heart disease.

Professor Rob Doughty holds the Heart Foundation Chair of Heart Health at the University of Auckland, where he runs a programme of research designed to improve understanding of the causes, prevention and treatment of heart disease in New Zealand.

Ironically, Rob is himself a fairly recent heart attack survivor. As a 51-year-old male with a healthy diet and lifestyle, he was in the lowest part of the risk charts. “But we know that the risk is never zero and I’ve proved that myself,” he says. “On just another workday morning, walking across a quiet courtyard, I found myself experiencing what I’d dealt with in other people for many, many years.”

The experience, which luckily occurred within easy reach of help – between his two places of work, Auckland Hospital and the University’s School of Medicine – has given him a unique perspective on what he has been researching for more than half his life.

Genetics in heart disease in New Zealand is a major focus of the research programme Rob is leading, with several interlinking studies that will contribute to understanding the role of genetics and gene-environment interactions in heart disease in the New Zealand context.

“Important disparities in heart disease exist in New Zealand for some ethnic groups and for people living in areas of greater deprivation,” says Rob. “Māori are at higher risk of heart disease at a younger age; age-standardised death rates from heart disease are about 50 percent higher for Māori men and twice as high for Māori women compared to non-Māori.”

One of the programme’s major studies is MENZACS, the Multi-Ethnic New Zealand Study of Acute Coronary Syndromes. This Rob describes as a case-controlled study that aims to gain better understanding of risk factors that predispose certain individuals to a high risk of developing heart disease (and heart attacks).

“We hope to understand the genetic factors and gene-environment interactions that contribute to disease, outcomes and response to therapy,” he says.

This is one study you won’t be involved in unless you’ve had a heart attack. It’s run as a web-based hospital registry, collecting data on patients who have heart attacks in New Zealand. “This allows for a simple and cost-efficient means to conduct large scale research studies across multiple centres in New Zealand,” says Rob.

The study, run (as part of Rob’s Heart Health Research Group) by Associate Professor Malcolm Legget from the School of Medicine, began in July 2015 and is now recruiting patients at Auckland City Hospital, Middlemore, Waikato and Christchurch Hospitals. More than 600 participants have already been enrolled after suffering a heart attack and have been asked some simple questions about their food, lifestyle and family history. They also give a blood sample for genetic and biomarker analysis.

“Due to the nature of this multi-ethnic study, extensive work has been developed with regard to Māori participation,” says Rob.

Dr Anna Rolleston (Ngati Ranginui/Ngai Te Rangi), previously the Heart Foundation Māori Cardiovascular Fellow and now a co-investigator on the study, has provided guidance on the project from a Māori worldview. “She has developed and leads the Māori Governance Group, whose members act as kaitiaki (custodians) for Māori participating in the MENZACS study,” (which received initial funding from the Heart Foundation Heart Health Trust project grant from 2015 to 2017, and is supported in part by the “Healthier Lives” National Science Challenge.

Another study, led by Dr Katrina Poppe, has resulted in the development of a new clinical risk score, which helps to assess risk of future clinical disease for people with previous heart disease. Katrina, a former Heart Foundation Fellow, is now working with Rob’s group and with the VIEW/PREDICT Group led by Professor Rod Jackson from Epidemiology and Biostatistics.

“The risk score,” says Rob, “is based on clinical factors easily available for use with people in the community. It can help health professionals to target those people at higher risk for more intensive interventions, so as to prevent recurring heart problems.”

The research of Heart Foundation Research Fellow, Dr Nikki Earle, also working with Rob’s group, has recently revealed shocking statistics on heart attacks in younger people. Her study showed that one in four patients admitted to hospital in New Zealand with their first heart attack is less than 55 years old.

“These younger patients have a very high risk factor burden, including smoking, obesity and diabetes,” says Rob.

Nikki’s research includes a study to determine whether microRNAs, (small non-coding portions of genetic material), are associated with the presence of subclinical atherosclerosis (known in layman’s language as “hardening of the arteries”). This work is conducted in close collaboration with colleagues from the Christchurch Heart Institute at the University of Otago: Heart Foundation Senior Fellow, Dr Anna Pilbrow, Professor Vicky Cameron and Professor Mark Richards (Heart Foundation Chair of Cardiovascular Studies).

At present, traditional risk factors such as age, blood pressure and smoking status are used to predict the risk of heart attacks and cardiac deaths, says Rob. “Nikki’s research is intended to make this prediction more accurate by finding new genetic risk markers as well as new biomarkers that circulate in the blood.

“She and her team are looking for these markers in people from across the spectrum of heart disease, ranging from the early stages before clinical symptoms are evident to advanced stages such as heart failure. Identifying those at risk at an earlier stage allows better targeted early intervention such as medications or behavioural change.”

Rob acknowledges the multiple collaborations which he says are “fundamental to the success of contemporary research”. These include the close working relationship with the other Heart Foundation Chair, Mark Richards, and Heart Foundation-funded researchers at the University of Otago.

Rob is sure these studies across community population and clinical arenas will greatly improve prevention and treatment of heart disease in New Zealand.

Meantime, something he still doesn’t understand is why he had the heart attack, and this he will only discover through continued research: “It was a salient personal reminder that there is a hell of a lot more still to do.”

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