Cardiovascular medicine has advanced tremendously during the last 30 years with groundbreaking advances in medicines, procedures, and surgeries. Despite major steps forward, however, heart disease stubbornly remains the No. 1 killer of men and women in the United States.
At the Intermountain Heart Institute at Intermountain Medical Center, physicians and researchers work diligently in many branches of research to improve the ways they predict, detect, and treat heart disease. Just as importantly, they are dedicated to applying this new knowledge to personalized care for each unique patient.
Twenty years ago, the team began collecting DNA from cardiac patients and searching for the inherited, genetic factors that cause heart disease. Now, the research laboratory is home to one of the world’s largest cardiovascular DNA and plasma bank repositories, which includes samples from more than 27,000 consenting patients.
Intermountain has an extensive collection of computerized health data, first pioneered by physicians and scientists beginning in the 1950s. Because of this trove of patient records and DNA and plasma specimens, along with the latest technology, they’re uniquely equipped to conduct studies that combine real-time clinical data with a patient’s unique genetic and biomarker information.
A recent international study on the genetics of coronary heart disease included the Intermountain Heart Institute as a main contributor to this science. The study, the largest ever of its kind, included DNA samples and follow-up data from a total of 150,000 patients and discovered 23 genetic markers linked to coronary heart disease. These findings are just the beginning, however. Although each of these 23 genetic markers are significant in predisposing to heart disease, each of them plays only a modest role. It’s the job of researchers now to discover the missing genetic risk factors and determine the interaction among these markers and our patient’s environment.
Patterns of Cardiovascular Disease
In population studies, researchers examine medical record data (stripped of personal identifiers) to unlock patterns that identify the causes of and risk factors for cardiovascular disease. Intermountain has a high volume of heart patients and a robust collection of electronic medical records that make them exceptionally suited to perform these types of studies.
For example, they performed a population study that revealed the relationship between vitamin D and heart disease. The study looked at more than 41,000 patients whose vitamin D levels were normal, moderately low, or severely low. Patients with severely low levels of vitamin D were most likely to have been diagnosed with heart disease or stroke. Further follow-up also showed that these patients were more likely to suffer a heart attack, stroke, or die in the future.
Further studies confirmed vitamin D as a major risk factor for heart disease. Now, vitamin D levels are tested in at-risk patients. If needed, clinicians add a vitamin D supplement to their personal care plan.
The Intermountain Risk Score is the product of another one of our population studies that gives physicians a tool to predict which heart patients may have an adverse outcome, such as returning to the hospital, developing heart failure, or dying prematurely. The study looked at a population of 4,000 heart patients, and analyzed 51 factors including age, gender, common blood test information, other health problems, a history or depression, body mass index, and more.
All this information is compiled by a new tool – a sophisticated computerized algorithm – that calculates a risk score for each unique patient. The tool gives physicians a way to measure their patients’ risk and possibly manage their care differently.
During the past four years, the Intermountain Heart Institute has participated in a series of clinical trials, called The PARTNER Trials (Edward Lifesciences), that provide a new treatment opportunity for patients needing aortic valve replacement. In PARTNER, doctors use a catheter, a narrow tube, to place a new aortic valve inside the heart. The trial compares the new catheter-based methods to traditional open-heart surgery.
The first study in the series, now complete, enrolled patients who were either unable to undergo open-heart surgery, or who were considered to be at high risk by their medical team. The study concluded that catheter-based aortic valve replacement was safe and effective for these patients and is now approved by the Food and Drug Administration.
Recently, scientists moved into the second phase of the PARTNER series and are currently enrolling patients of medium-risk for traditional open-heart surgery. This is just one example of clinical research that has advanced the care we provide to our patients.
Cardiovascular medicine is rapidly evolving, and at Intermountain Heart Institute at Intermountain Medical Center , we are very excited about the potential for scientific advances that will personalize medicine and overcome cardiovascular disease. Our research will adapt what we know today into even more powerful treatments and therapies of tomorrow. Indeed, our efforts will finally knock cardiovascular disease down from the No. 1 killer in our country.