CORDA has always focused research on the prevention of heart and arterial disease rather than just curing it or treating the symptoms. Prevention involves the elimination of a disease, either by removing its known cause or by making the population immune. It can also involve the detection of disease at an early stage, when it can be stopped or reversed by simple measures. For example, atherosclerosis can be prevented from worsening after a heart attack through the use of lipid lowering drugs.
Cardiovascular magnetic resonance (CMR) is useful for detecting atherosclerosis and can be used for related work too. Scientists and doctors at Royal Brompton Hospital CMR Unit have been involved in many great advances in the field of CMR.
Physicists at the Unit have been responsible for many improvements in the design of scanners, such as developing novel ways of obtaining scanned images by using columns of material rather than slices. This lets them produce high-resolution, three-dimensional images of arteries or the cardiovascular system, which in turn provides accurate diagnosis and treatment for the 1 in 100 people born with cardiac anomalies.
The team has also used CMR to help patients with thalassaemia, saving many lives. Another development involves using CMR to understand cardiac syndrome x, a previously unexplained condition causing severe chest pain in affected women. Since a cause for this condition was not known, some doctors dismissed sufferers as imagining the pain. However, simple CMR scans showed that there is a physical cause based in very small blood vessels which are invisible under x-ray.
Every artery is lined with endothelium. This layer is only one cell thick, but is extremely important in helping the blood to move around the body.
In a healthy person, the walls of the blood vessels constantly produce nitric oxide and this regulates the vessel walls, for example by expanding them for increased blood flow during exercise. The nitric oxide also prevents platelets, blood cells and fatty deposits from sticking to the artery, blocking blood flow and stiffening the artery walls. However, if any of the endothelial cells are damaged these benefits are lost and atherosclerosis develops.
Although it has been known for many years that damage to the artery walls often occurs in the first decade of life, it was not possible to identify and measure this before a team at Great Ormond Street Hospital sponsored by CORDA developed a non-invasive technique called flow mediated dilation (FMD), which is now used all over the world.
FMD lets us identify arterial damage in children as young as seven years old. The team has also used FMD to show that endothelial damage in young children has the same risk factors as atherosclerosis:
In addition, several unexpected novel influences, such as pre-natal factors, have been shown to affect arterial function in later life.
Because FMD is so simple, the team can also use it to evaluate the effectiveness of treatments.
Treatment of a disease may involve a complete cure, such as the removal of an aortic aneurysm, but more often treatment only means relieving the symptoms. There are several medical techniques used to treat atherosclerosis, but these generally only treat the symptoms and reduce the risk of further complications.
Surgery, such as cardiac artery bypass grafts and angioplasty (blowing up a balloon in the blood vessel), does nothing to reduce the incidence of atherosclerosis. Drug treatment is very effective at treating symptoms and lowering risk factors.
All of these procedures only treat the symptoms. They are expensive and do not cure the patient.
Our ambition is to prevent atheroma from being formed. How can we do that?