The Heart and Stroke Foundation proudly supports the work of Canada’s leading researchers. In Ontario, funding from the Foundation’s Provincial Office builds and sustains essential heart and stroke research through training and salary awards. Awardees are selected through a rigorous application and assessment process to ensure that donor and supporter funds are wisely invested.
Click below to learn how the Ontario award recipients are helping prevent disease, save lives, promote recovery and improve quality of life.
Canada’s urban planners may be the secret weapon in the fight against diabetes.
“Our genes haven’t changed, yet we’re seeing a massive number of people with diabetes, heart disease and stroke,” says Dr. Gillian Booth, a researcher at the St. Michael’s Hospital Centre for Research on Inner City Health in Toronto. Dr. Booth is investigating how the design of neighbourhoods contributes to the development of Type 2 diabetes, a risk factor for heart disease and stroke.
Suburban sprawl is one of her targets. “The ability to walk somewhere within 10 to 15 minutes seems to make a big difference when choosing to walk or drive,” she says. The problem is that most suburbs are filled with winding roads and disconnected cul de sacs that discourage walking.
Planning environments that encourage walking, biking and the use of public transit would improve the health of more Canadians, Dr. Booth says.
Dr. Booth will also examine how built environments impact new immigrants. “People who have just moved to Canada face a greater risk of developing diabetes,” she says, “They’re exposed to a more Western diet and if they move to an area less supportive of physical activity, they’re placed at even greater risk.”
Today more than 2.7 million Canadians are living with Type 2 diabetes. That’s the equivalent of Toronto’s entire population. In the next seven years, that number will soar to 4.2 million, and nearly 80 per cent of them will suffer a heart attack or stroke. Regions like Peel, west of Toronto – an area with one of the highest rates of diabetes in Ontario – are taking action and starting interventions.
Though Atrial fibrillation (Afib) is the most
common heart rhythm disorder and an important risk factor for stroke, Dr. Vijay
Chauhan believes there’s room for a deeper understanding of this condition.
Currently, to identify the progression and
severity of the disease, doctors use fairly simple markers like the patient’s
history and echocardiography, an ultrasound of the heart, to help guide their
decisions for treatment.
Dr. Chauhan, a scientist at the Toronto General Research
Institute and a clinical electrophysiologist, believes he can take
this assessment much further.
need to characterize this disease better,” he said. “The heart is beating
irregularly, but it can do that for many reasons, and it’s not always clear why.
My research is about understanding Afib better so that we can direct therapy
Using cutting-edge computer
programs, Dr. Chauhan and his team will take detailed recordings of the
electrical signals of the hearts of about 100 patients. By analyzing the
complex electrical signals during Afib, he hopes to understand the electrical
pathways that cause Afib and gain a clearer picture of the severity and progression
of each patient’s condition.
“These are novel experiments in
patients because up until very recently, a lot of information about the extent
of disease and the electrical pathways were described in animal studies,” he
Connected to this, Dr. Chauhan
will also explore the effectiveness of catheter ablations – a common procedure
to treat Afib that involves burning away small areas of heart tissue where the Afib may start.
Though it is a standard
treatment, the success rate with catheter ablation is less than 50 per cent in
some patients, and many require repeat procedures. By better understanding the
severity of their disease, Dr. Chauhan’s research aims to improve patient
selection for this invasive procedure.
Blood thinning medications help prevent blood
clots and are used by millions of Canadians. But Dr. John Eikelboom of McMaster
University believes there’s plenty of room for improvement.
While many research efforts in this field focus
on the development of new medicines, Dr. Eikelboom wants to explore how current
medications could be made more effective. It’s an area he and his team have been
researching for more than 10 years.
Using lab experiments and patient studies, he
intends to look at the dosage of current blood thinning medications such as Aspirin,
dabigatran, rivaroxaban and apixaban. Standard doses are often prescribed, but
the levels of these drugs in patients’ blood varies, leading to different
levels of effectiveness.
Next, he wants to
understand why sometimes patients don’t respond well to these treatments. “We’ve got great blood thinning medications, but some people appear to
be resistant or respond differently to these drugs,” said Dr. Eikelboom, an associate professor
at McMaster University’s Department of Medicine and a haematologist at Hamilton
the safety of these medications, he is also studying the complication of
bleeding in patients – why it happens and if it’s a sign that a more serious
event is coming.
different types of bleeding, and the consequences– anything from minor nose
bleeds, to more serious bleeding from organs like the bowels.
“Is it just
something in the drugs or are there other things happening?” he asked. “Minor
and major bleeds actually predict who will have heart attacks and strokes.”
Completing this study
will be a look at price barriers that prevent patients from
accessing blood thinning medicines.
Dr. Slava Epelman looks at the heart in a
different way. Looking beyond the muscles and valves, he sees an intricate
collection of cells – cells that could unlock a great deal of information about
how the heart repairs itself after a cardiac event.
Dr. Epelman has learned that deep inside the
heart are immune cells that were created before birth, and these cells continue
to live in the heart into adulthood. (The heart also houses another type of
immune cell that is continually created and replaced through a bone marrow
Some of these cells can
cause tissue damage. Others help heal the heart after injury by promoting the
regeneration of heart tissue. But exactly which cells do what, and how they do
it, isn’t well understood.
“We know these
primitive immune cells improve tissue healing but we don’t know how,” said Dr.
Epelman, an assistant professor at the University of Toronto and a cardiologist
at the Toronto General Hospital Peter Munk Cardiac Centre.
He and his team will study
patients with heart damage following heart attacks and other types of heart
disease in an effort to better identify which immune cells
help the heart repair itself after injury.
He will also study
mice, investigating individual cell
types to determine their roles in tissue healing. “We’ll essentially
try to answer the same question in patients – to understand how the balance of
these immune cells affects how well patients recover after a heart attack.”
to prevent strokes in patients with A-fib
the last few years, new blood thinning medications have become available in
Canada to help prevent stroke in patients with atrial fibrillation, an
irregular heart rhythm or arrhythmia, explained Dr. Shaun Goodman, a professor
of medicine at the University of Toronto. They’re effective, but one side
effect is bleeding – ranging from minor bleeds to major ones that require a
Goodman is the Heart and Stroke Foundation/Polo for Heart Chair at the University
of Toronto, and his research of the use of blood thinning medication is just
one of many clinical trials he has conducted to advance care for patients with
Goodman and his team approached 700 primary care physicians across Canada, who
surveyed more than 10,000 patients. The surveys looked at their risk of stroke,
their course of treatment, and the challenges they face.
“Generally, physicians tend to underestimate the
risk of stroke in some cases, and over-estimate the risk of bleeding,” said Dr.
Goodman. “As physicians, they only see the bleeding as a side effect of giving
these blood thinners. They don’t see the strokes they prevent, leading to patients
not getting the best therapy to treat their A-fib.”
“Most of those bleeds are reversible, they’re
treatable, they’re not life threatening,” said Dr. Goodman. “But the strokes of
these patients are often fatal, or severely disabling.”
A paper from this research has recently appeared
in the American Journal of Cardiology,
with a second soon to be available from the Canadian
Journal of Cardiology. Dr. Goodman hopes his Heart and Stroke
Foundation-funded research will help physicians make better choices in trying
to prevent strokes in patients with A-fib.
cardiovascular research is a team game, Dr. Goodman also decided to take his chair
position in a new direction. As chair, he is able to help mentor young
researchers and university faculty.
He created the opportunity
to help kick-start or support the research careers of young researchers and
His goal is to help
the next generation of cardiovascular researchers and young university faculty
become established, and conduct world-class research that could lead to further
discoveries and better treatment.
researchers start as junior faculty, it’s tough to get your research programs
up and running, particularly clinical, direct patient-related research
programs,” he said.
He’s also promoted
collaborative cardiology research at the teaching hospitals affiliated with the
University of Toronto.
And he has established
a mentoring group, pairing young researchers from University of Toronto, the
University of Alberta and the University of British Columbia with well
established, nationally (and internationally) known researchers, to advance
their training and research expertise.
These groups of researchers
take part in online and face-to-face meetings and explore the unmet needs in
cardiovascular research, and discuss how they can work collaboratively to meet
them – what Dr. Goodman refers to as “cross pollination.”
pretty excited about all the things that we’ve done,” he said. “It’s been a
collaborative effort – we’ve done some things differently with the support from
the Heart and Stroke Foundation/Polo for Heart Chair over the past five years
and hopefully, with some of these approaches, a little ‘thinking outside of the
box’ can be continued.”
When it comes to atrial fibrillation, what you don’t know can hurt you.
Atrial fibrillation (AF) means you have an irregular heartbeat or arrhythmia. Silent or intermittent arrhythmias are a major cause of stroke in Canada. In these cases you may feel perfectly fine, or you may only experience mild, non-specific symptoms such as lightheadedness, fluttering heartbeat and nausea – that only lasts a few minutes.
“Doctors used to think that patients with intermittent symptoms weren’t worrisome, but that’s starting to change,” says Dr. Jeff Healey, an associate professor of cardiology at McMaster University in Hamilton. “We’re seeing that most patients with atrial fibrillation— whether they feel symptoms or not— are predisposed to stroke.”
“If we rely solely on symptoms, we’re going to miss a lot,” he says. “The good news is that there is a wealth of new, inexpensive, easy-to-use technologies that can record the heart’s electrical activity and help detect if an irregular heartbeat is present.”
More than 350,000 Canadians live with AF – many of them unaware of the condition. Dr. Healey hopes to use existing technologies to detect and treat these silent cases to further reduce the number of strokes.
Protecting and rebuilding blood vessels
Geoffrey Pickering finds the body’s blood vessels fascinating – so much so, he
almost takes offence when they’re referred to as “plumbing.”
Heart and Stroke Foundation Barnett-Ivey Chair at Western University is a
clinician scientist who has devoted countless hours to researching how blood
vessels around the heart function, age and recover, particularly after a
cardiac event or disease.
work covers blood vessels of varying sizes – from large vessels such as the
aorta, to the smallest blood vessels where oxygen is ultimately delivered to
discover events that are happening in our blood vessels when they are injured
or diseased, and we uncover what’s going on at the cellular level, all with a
view to capitalizing on what the body tries to do as it attempts to heal,
repair or regenerate its own blood vessels,” he said. “It’s remarkable how
alive our blood vessels are.”
blood vessels are subject to a tremendous amount of stress, explained Dr.
Pickering. In some people that stress causes the vessels to age faster than the
rest of their bodies and to deteriorate, if there isn’t some kind of mechanism
to strengthen them.
learned that our blood vessels can engage certain pathways to be as resilient
as possible when faced with the unrelenting stresses that are imposed on them,”
Dr. Pickering and his team have been able to identify some of these pathways,
which could pave the way for the development of new therapies that can strengthen
vulnerable blood vessels.
For example, research has shown the body tries to regenerate
new blood vessels after a cardiac event or disease, to replace vessels that
have been lost.
“In adults, the body makes an attempt, but it doesn’t work
that well,” said Dr. Pickering. “Adults can only go so far in creating good
quality new blood vessels. We have identified some of the gaps that the body
doesn’t do well.”
Identifying these gaps could lay the foundation for
developing therapies that could help the body along. “We have taken important
steps in that direction,” said Dr. Pickering. “We have identified factors in
the body that can be used to overcome those gaps and actually strengthen these
newly formed blood vessels.”
And recently, Dr. Pickering and his team have taken this
research even further. He is beginning to move towards a more personalized approach
for patients with vulnerable blood vessels.
It may soon be possible to understand individual patients’
diseases to predict how the vessels will react and behave.With this information, tailored and
patient-targeted therapies could be designed.
Imagine being able to accurately map a patient’s blood
vessel regeneration processes and administering therapies to assist in healthy
regeneration and blood flow.
This is where we are headed, believes Dr.
Pickering. “It’s the blending of the biology of an individual with their
disease. We have been resolving the processes not just to any old cell, but to their cells.”
Dr. Ravi Retnakaran
Tracing the path from diabetes to heart disease
By Jane Doucet
Researchers know that people with diabetes have an increased risk of developing heart disease. Dr. Ravi Retnakaran is working to better understand the progression of these diseases and how prevention strategies could stop that progression.
His research team at Mount Sinai Hospital’s Leadership Sinai Centre for Diabetes is monitoring more than 500 women who were recruited when they were pregnant, in order to gain insights into the natural progression of diabetes.
Some of the women being studied have gestational diabetes mellitus (GDM), or temporary diabetes. “Women with GDM have an increased risk of developing type 2 diabetes after pregnancy, and type 2 diabetes is a risk factor for heart disease,” says Dr. Retnakaran. Their children also have a higher risk of developing heart disease.
Over a timeline of one to two decades, the researchers will compare the body changes that take place in the women who had GDM and those who didn’t (they will also follow their children). The aim is to understand the early changes in the women’s bodies that may lead to the development of high blood sugar and heart disease, to learn how the two conditions are linked over time
“How a woman’s body handles sugar in pregnancy gives us a window into the future risk of both her and her child developing heart disease,” says Dr. Retnakaran.
“We’re using the unique opportunity provided by pregnancy to ideally affect the lives of two generations — mother and child — long before the development of diabetes and heart disease.”
Making new discoveries demands more complex approaches to analyzing data, Dr. Austin believes. “My research is focused on improving and expanding statistical tools and expanding the types of analyses researchers can conduct.”
For example, say a researcher wants to examine the effect of smoking on heart disease. The researcher would create two study groups – those who smoke and those who don’t. But within these groups are many more variables: weight, family history, diet, exercise patterns and others.
That’s where Dr. Austin comes in. “Statistics provides ways to factor out patient characteristics to see the pure effect of a single factor or treatment,” he says.
A statistician who initially found medieval history far more interesting than math, Dr. Austin hopes to equip researchers with ever more sophisticated tools to draw crucial answers out of their data.
Dr. Rob Beanlands
Creating a clearer picture of cardiovascular disease
Creating a clearer picture of cardiovascular disease
Dr. Rob Beanlands spends time making pictures. They’re not showcased in living rooms or galleries, but they are saving lives.
Dr. Beanlands is an international leader in cardiovascular nuclear imaging – in particular, positron emission tomography or PET. This state-of-the-art technology allows researchers to see into the cell function within a patient’s heart and blood vessels without making a single cut. Each 3D image is unique. Some show layers of plaque forming, while others capture blood flowing through arteries. The technology can be used to see how new treatments are working and improving a patient’s condition.
The National Cardiac PET Centre in Ottawa, where Dr. Beanlands is the founding director, is the country’s only PET imaging facility dedicated to cardiovascular disease. He was recently awarded a 2013 Heart and Stroke Foundation Career Investigator Award – funding that will support his research in cardiac imaging.
As the chief cardiologist at the University of Ottawa Heart Institute, Dr. Beanlands continues to develop new methods to improve cardiac care. And while he spends much of his time on research, patients are always on his mind.
“We’re always looking for better ways to give care. It’s an exciting and rewarding process when you can improve the care you’re giving patients.”
Dr. Steffen-Sebastian Bolz
Turning up the flow of knowledge
What does a garden hose have in common with your cardiovascular system? Lots, according to Dr. Steffen-Sebastian Bolz, associate chair of research at the University of Toronto’s department of physiology and director of the university’s Centre for Microvascular Medicine.
To change the water flow through a hose you open or close the nozzle, says Dr. Bolz, recipient of a 2013 Heart and Stroke Foundation Career Investigator Award. This control lets you dispense ample water to your dry lawn, while lightly sprinkling your newly-seeded flowers. Blood flow control follows the same principle. The smallest vessels act like millions of nozzles – they open when working tissues need more blood and narrow when they return to rest.
Cardiovascular diseases cause blood vessels to stay narrow, even when tissues need more blood. This can injure organs and cause them to fail. Researchers are trying to understand why this happens.
Using mice, Dr. Bolz’s team identified mechanisms that narrow blood vessels in heart failure, stroke, diabetes and hearing loss. They are now exploring whether these principles apply to humans. If so, the door is open to test targeted treatments shown to work in mice, to improve patient health.
Dr. David Birnie
Finding answers to real-life questions
Sometimes patients ask doctors questions that don’t have answers. That's what happened when one of Dr. David Birnie's patients learned that her heart failure was caused by a rare cause of cardiac inflammation known as cardiac sarcoidosis.
"Naturally, she wanted to know what it was, how it should be treated and what her prognosis was," says Dr. Birnie, staff cardiac electrophysiologist and the director of arrhythmia service at the University of Ottawa Heart Institute. “I read all the existing literature but I came up empty handed.”
For Dr. Birnie, “I don't know” wasn't enough, so he and his team started looking for answers. Most of his research program is inspired by similar clinical questions he sees in his daily practice. He has already shown the impact such work can have in redefining best practices.
In a study published in 2013 in the New England Journal of Medicine, he questioned a long accepted practice – that patients who need to have a pacemaker or defibrillator implanted should stop taking any blood thinner medications before the surgery, in order to manage their stroke risk and control bleeding. In fact, Dr. Birnie’s research showed that continuing medication is a safer choice.
That question, like the ones he’s currently researching, was inspired by a few patients. The answer is impacting thousands. In Canada, nearly 40,000 device procedures are completed each year and Dr. Birnie estimates that one third of those patients are on blood thinners.
Guiding the battle against dangerous clots
By Maggie Vourakes
If you’ve ever cut your finger, you’ve experienced the upside to blood clotting, as it seals your wound and stops the bleeding.
It’s the blood clots that spontaneously form in the blood vessels that cause concern. These clots can balloon, blocking blood flow; if left untreated they can lead to heart attack or stroke.
Blood thinners can help reduce the risk of developing these clots. Dr. Mark Crowther helps physicians identify new ways to use the medication and improve patient care.
Dr. Crowther, a researcher in hematology at McMaster University’s Department of Medicine, develops the guidelines doctors refer to when prescribing blood thinners.
“Guidelines provide nurses, physicians, and other people who might be prescribing medications with what we think is the best evidence around using these drugs to massively improve the health of Canadians,” says Dr. Crowther, recipient of a Heart and Stroke Foundation Career Investigator Award.
To produce the guidelines, Dr. Crowther and his team have to accumulate all the existing research, review the findings, and then distill them into practical recommendations physicians can use.
Those recommendations include information on dosing – crucial for blood thinners, where too small a dose won’t dissolve the clot, but too much can increase the risk of bleeding.
The guidelines also identify new patients who would benefit from the medication. For example, a finding that blood thinners can reduce stroke risk by 80 per cent in people with atrial fibrillation remains one of the best success stories.
By finding new uses for existing therapies, Dr. Crowther explains, we can save lives and reduce the devastation caused by heart disease and stroke, which in turn reduces the burden on the healthcare system.
Dr. Stephen Ferguson
Going cellular to treat high blood pressure
To Dr. Stephen Ferguson, every cell in our bodies is a complex machine constantly conducting processes that keep us alive.
The University of Western Ontario researcher is especially fascinated with the activity of tiny receptors in the body’s vascular system that control blood pressure. These receptors are proteins on the cell’s surface; they respond to hormones that either increase or decrease blood pressure.
His work involves understanding which pathways contribute to disease, and which to healthy cell function.
Dr. Ferguson has also learned that constantly stimulating receptors with hormones leads to “desensitization” which can result in hypertension or high blood pressure, as the receptors no longer respond the way they’re supposed to. He is trying to better understand what causes this lack of responsiveness.
Having studied proteins and pathways in mice with encouraging results, he hopes to one day transfer this research to human patients.
What could this lead to? New treatments for high blood pressure with drugs that could target different pathways and specific proteins.
Dr. Michael Gollob
Seeking the genetic keys to atrial fibrillation
Dr. Michael Gollob’s father was in his 40s and healthy when he developed atrial fibrillation (AF), a condition involving an irregular heart beat.
While his father lived into his 80s, not all AF patients do as well. Affecting about 350,000 Canadians, AF is “reaching epidemic proportions,” says Dr. Gollob – and it puts people at much higher risk for stroke.
Helping to understand AF at a genetic level and develop effective treatments is a goal of Dr. Gollob, who is a cardiac electrophysiologist and director of the Inherited Arrhythmia Clinic and Arrhythmia Research Laboratory at the University of Ottawa Heart Institute. “Medications and procedures are frequently ineffective,” he says. “That’s why it’s important to get a grasp on this situation.”
The focus of his laboratory is to discover genes that, when defective, can give rise to AF in otherwise healthy people. Already, he and colleagues have identified two such genes. “By understanding how these defective genes alter the physiology of the heart and cells, we may be able to develop better treatments,” he says.
For patients who can’t benefit from traditional cardiology treatments such as bypass surgery and angioplasty, stem cell therapy may provide them with one more option to repair damage caused by heart attack.
He is also using stem cells to test new treatments for disease within a dish, rather than on a human patient. In particular, he is exploring how this method can be used to develop new treatments for diabetes. People with diabetes are twice as likely as other people to experience heart attack or stroke.
“You can tell just from looking at the stem cells who has diabetes and who doesn’t,” says Dr. Husain, explaining that the method offers a faster, simpler way to investigate new treatments. “Researchers won’t necessarily need to test new treatments on a patient; they’ll just need a few of their cells.”
Finally, Dr. Husain is also leading new clinical trials to test whether existing drug therapies for diabetes can help heal the heart after heart attack.
Dr. Amer Johri
Finding answers on atherosclerosis
By Jane Doucet
People with metabolic syndrome — those who are obese or who have high blood pressure, high cholesterol or abnormal blood-sugar levels — are especially at risk of hardening of the arteries, or atherosclerosis. A molecule called L-carnitine may improve the symptoms of this potentially fatal condition, but researchers need to find out for certain.
Dr. Amer Johri is working to solve that puzzle and possibly point the way to an effective new treatment. He’s leading a three-year L-carnitine study from his lab at the Cardiovascular Imaging Network at Queen’s University in Kingston, Ont., which is affiliated with Kingston General Hospital. He and his team will collaborate with Dr. David Spence at the Stroke Prevention & Atherosclerosis Research Centre in London, Ont.
It isn’t clear whether metabolic syndrome patients produce low levels of L-carnitine or if their body functions that respond to the molecule may not be working properly.
“Previous studies have revealed that L-carnitine supplements help blood pressure and blood sugar, but no one has looked at whether they can change the course of hardening of the arteries in a positive or negative way,” says Dr. Johri, a recipient of a 2014-15 Heart and Stroke Foundation Clinician-Scientist Award.
Although many scientists believe supplements would have a positive effect, one study on rodents reported a negative outcome. “We’re at a clinical crossroads,” says Dr. Johri. “Our study is proposing a way to settle the score.”
Before and after the 160 study participants are treated with L-carnitine supplements or placebo, they’ll undergo a 3D ultrasound to look for plaque buildup in their neck arteries.
“The study can’t fail because the answer to whether L-carnitine is helpful or not will be useful either way, in terms of where our research must go next,” says Dr. Johri.
It can be challenging for doctors to know when a patient has a life-threatening blood clot. And the need is urgent: clots that travel from the veins of the legs to lodge in the lungs (pulmonary embolism) are the third-leading cause of death from vascular disease, after heart attack and stroke.
Dr. Clive Kearon has been working for almost 25 years to improve the diagnosis and treatment of blood clots in the veins and lungs (venous thromboembolism).
When a clot or thrombus is suspected, tests are needed to confirm it, says Dr. Kearon, who trained in his native Ireland and now holds the Jack Hirsh Professorship in Thromboembolism at McMaster University in Hamilton. These tests range from a blood test for a substance called D-dimer, to ultrasounds, to CT imaging of the lungs using dye.
Dr. Kearon is researching ways to make better use of the D-dimer test to reduce the need for additional diagnostic testing and get patients the treatment they need faster. His work is also designed to save scarce healthcare dollars and protect patients from the radiation used in CT scanning. On the treatment side, Dr. Kearon is working to identify which thrombosis patients should stop “blood thinning” therapy at three months and who would benefit from long-term therapy to prevent further episodes.
As a recipient of a 2013 Heart and Stroke Foundation Career Investigator Award, Dr. Kearon says both the recognition and the funding have a big impact on his work. The salary support allows him to dedicate most of his time to research. “That has been incredibly valuable to me and the research that I do.”
Dr. Dennis Ko
Better evidence, better cardiac care
Dr. Dennis Ko performs incredibly precise, potentially life-saving procedures such as implanting stents to open arteries that are too narrow to provide the heart with adequate blood supply.
But Dr. Ko is also skilled at making sure high-tech procedures aren’t done arbitrarily. His research focuses on harnessing medical evidence so doctors know how to best use existing resources to improve patient care.
“It’s all about getting the best value for our resources,” says Dr. Ko, who works as an interventional cardiologist at the Schulich Heart Centre of Sunnybrook Health Sciences Centre in Toronto. “We need to understand care patterns and identify gaps in knowledge. Where are the deficiencies? Where can we improve quality of life and outcomes in cardiovascular patients?”
His early research showed that preventive treatments such as Aspirin and beta blockers should be used more often than they are. Recently, his team showed that more widespread use of an emergency procedure called primary angioplasty for heart attack victims will save more lives.
These findings have led to greater use of these effective treatments across Ontario. “It is pretty gratifying that our work has been used to make impactful policy decisions and has also been used to guide physicians to change the way they practice,” says Dr. Ko, who is an associate professor at the University of Toronto and a recipient of a 2013 Heart and Stroke Foundation Clinician-Scientist Award.
Dr. Gregoire Le Gal
Building a better
test to detect dangerous blood clots
Building a better
test to detect dangerous blood clots
Dr. Gregoire Le Gal wants to take a leap forward when it comes to
testing for potentially dangerous blood clots that originate in the legs.
Blood clots in the veins of the legs (called venous
thromboembolism or VTE) can be very dangerous. If a clot travels to the lungs, it
could cause potentially deadly pulmonary embolism.
is difficult to diagnose because there’s no simple test for VTE, explains Dr.
Le Gal, an internal medicine physician at the Ottawa Hospital and a senior scientist at the Ottawa Hospital
Research Institute. The
diagnosis is made through a combination of tests – bloodwork, a leg ultrasound
and CT scan of the chest and lungs.
Combined, these tests
are complicated and expensive and require time-consuming preparation. For the
patient, they can be uncomfortable because of the need for dye injections and
the use of radiation.
multi-layered approach works for most patients, but diagnosing VTE remains challenging
in certain patient groups such as pregnant women or seniors – patients who
should avoid exposure to radiation.
Le Gal and his team are researching how testing for VTE can be made more effective
for these groups, while remaining cost effective for hospitals.
a huge number of tests every year for blood clots,” he said. “But we only
actually confirm the diagnosis in one in 10 patients we send for testing. The
majority of the time it’s not a clot, it’s not pulmonary embolism, but because
the condition can be so serious, these tests are done.”
research aims to improve this testing process and better select patients who
actually need testing, ultimately reducing the exposure to radiation for
certain patient groups.
Dr. Le Gal’s team will also assess a new
imaging process called the V/Q SPECT scan. This test provides imaging of both
the lung’s blood flow and air flow in one test, without dye injection.
Most people don’t know that chronic kidney disease is a major risk factor for heart disease. Nor do many realize that an estimated one in four Canadians older than 60 have chronic kidney disease. Even more startling: 40 per cent of those with end-stage kidney disease die from heart disease, not kidney failure. And in a 30-year-old with chronic kidney disease, it may cut life expectancy by up to 25 years.
Dr. Charmaine Lok, a researcher with Toronto’s University Health Network, hopes the results of two studies she’s leading of end-stage kidney disease patients will shed light on this complex condition.
The first study will examine whether the risk and occurrence of heart disease can be lowered in dialysis patients. Dr. Lok and her team will monitor more than 600 dialysis patients who will be given specially formulated fish oil. In a smaller study, fish oil reduced the risk of heart attacks and strokes.
“The supplement is safe, natural, easily available and affordable,” says Dr. Lok. “It’s exciting to think that something so simple could have potentially life-changing benefits.”
The second study is investigating a non-surgical intervention that could be a simpler alternative to the surgery currently required to prepare a patient for their “lifeline” connection to a dialysis machine.
“Chronic kidney disease is a silent condition that often comes on slowly,” says Dr. Lok, the recipient of a 2014 Heart and Stroke Foundation Mid-Career Investigator Award. “Our research has the potential to reduce heart disease in people who are at high risk and improve their quality of life.”
Dr. Lisa Mielniczuk
Improving the odds for the sickest patients
Dr. Lisa Mielniczuk’s patients have serious heart conditions. They often require aggressive therapy – multiple medications, insertion of a mechanical heart, or even a heart transplant. It is one of the perils of her job that they don’t always make it.
“We watch patients battle their illness courageously every day,” says Dr. Mielniczuk, a staff cardiologist and medical director of the Pulmonary Hypertension Clinic at the University of Ottawa Heart Institute. Her research is dedicated to improving their odds. “These patients motivate me. I’ve been in clinical practice for a number of years and my research work is born out of my experience with patients.”
Dr. Mielniczuk, recipient of a 2013 Heart and Stroke Foundation Clinician-Scientist Award, is studying a condition called pulmonary hypertension, in which there is high blood pressure in the blood vessels inside the lungs. This can lead to heart failure on the right side of the heart. “Right now, there are limited treatments for right heart failure. Patients are often young and survival maybe measured in months or years.”
Studies point to heart metabolism – or how the heart uses energy – as a potential factor in pulmonary hypertension. Dr. Mielniczuk is exploring whether normalizing metabolism can reduce illness. “If we change metabolism, for instance, by drug therapy, can we prevent heart failure?” She hopes to find out.
Pregnancy can be a dangerous time for women with thrombophilia, as the tendency to develop blood clots in the veins of the legs and lungs is amplified. In fact, these blood clots are the leading cause of maternal death in Canada.
Dr. Marc Rodger is investigating the factors that make this common condition – which affects one in six Canadians – a potential contributor to other serious pregnancy complications including stillbirth, miscarriage, pre-eclampsia and low-weight babies.
It was curiosity that hooked him early in his career. “There were a lot of unanswered questions surrounding thrombophilia,” he recalls. “That sparked an interest for me.”
Now chief and chair of the hematology division at the Ottawa Hospital, Dr. Rodger has dedicated the past 10 years researching the condition and its role in pregnancy complications.
A 2013 Heart and Stroke Foundation Career Investigator Award will help him continue this work, along with testing a potential diagnostic tool doctors can use to decide which patients should receive lifelong blood thinners for blood clots. “We’ve developed a rule we will be testing in the next phase of research that we believe will help doctors easily identify, diagnose and protect Canada’s most at-risk patients.”
Dr. David Steinman “goes with the flow” to help physicians better understand cardiovascular disease.
The professor of mechanical and industrial engineering at the University of Toronto studies how blood flows through the body, or hemodynamics. It is widely thought to play a key role in the development, diagnosis, and treatment of cardiovascular diseases.
Dr. Steinman’s research combines cutting-edge medical imaging with simulations that require some of the world’s most advanced computers. And while you might think blood flow is simple, the images reveal complicated patterns and turbulence as blood travels through an artery.
Having created precise flow pattern simulations for arteries, Dr. Steinman is turning his attention to aneurysms. These are bulges in a weakened area of the artery wall, which can cause strokes if they rupture. His research is showing that current medical imaging and simulation techniques might not be producing the most accurate blood flow readings, which could affect how aneurysms are diagnosed and treated.
“If you use a normal resolution simulation, you’re likely to completely misinterpret the hemodynamics,” said Dr. Steinman, recipient of a 2013 Heart and Stroke Foundation Mid-Career Investigator Award. He will broaden his study to see if his initial findings hold true. Ultimately, he hopes to find practical ways to help doctors diagnose aneurysms more accurately – ways that don’t require super computers.
One clue might be found in the physical shape of an artery. Over more than two decades of studying arteries, Dr. Steinman is finding aneurysm shape characteristics that might be just as good as hemodynamics for predicting rupture.
This award builds on Dr. Steinman’s past work with Foundation support, which includes the development of the Vascular Modeling Toolkit – a collection of libraries and tools for physicians for the 3D reconstruction and analysis of blood vessels.
Dr. Keith St. Lawrence
Protecting vulnerable brains
What do people recovering from a serious stroke have in common with premature babies? They can both be at risk of ischemia, a potentially life-threatening disruption in the brain’s blood flow.
But detecting ischemia is difficult in these intensive-care patients, because of the challenge of moving them to imaging equipment and the unpredictability of ischemia. Bedside monitoring is preferable, especially in newborns, who can’t undergo brain imaging until they are at least four weeks old.
“There’s a whole span of time when we’re unable to look at the brain, and missing a lot of critical information,” says Dr. Keith St. Lawrence, associate professor at Western University’s department of medical biophysics, and scientist at Lawson Health Research Institute.
His team is working to develop a non-invasive light-based system that could monitor the brain continuously – and ultimately reduce the risk of death and disability to these patients.
The monitoring system uses near-infrared light and can be used safely even on tiny preemies. The portable machine can be wheeled to the bedside in the intensive-care unit. Fibre optic cables placed on the patient’s scalp emit a low-intensity light. Blood naturally absorbs the light, so healthy circulation makes less light visible to the machine’s reader, says Dr. St. Lawrence, recipient of a 2013 Heart and Stroke Foundation Mid-Career Investigator Award.
Nearly 80 per cent of strokes are ischemic – meaning blood flow is blocked by a clot. With a better monitor, Dr. St. Lawrence explains, doctors would be able to spot a decrease in the brain’s blood flow, and act quickly to protect the brain.
Dr. Jeffrey Weitz
the deadly power of blood clots
One of Dr. Jeffrey Weitz’s favourite days is in mid-October.Sure, he enjoys Thanksgiving, but that’s not
No, one of his favourite days is Oct. 13 – that’s
World Thrombosis Day – a day that puts the spotlight on the problem of
thrombosis (blood clots).
Dr. Weitz is the Heart and Stroke Foundation J. Fraser
Mustard Chair in Cardiovascular Research and one of Canada’s few experts on blood
clots. The professor of medicine and bochemistry at McMaster University also
holds a Canada Research Chair in Thrombosis.
Thrombosis isn’t the most glamorous field of study and
yet, when you break cardiovascular events like heart attacks and strokes down
to the most basic biological processes, most often, the underlying cause is a blood
clot. Yet this tends to be ignored or overlooked.
Proof of this – a recent Ipsos Ried survey questioned 7,200
people from around the world in eight countries including Canada about their
understanding of thrombosis, relative to conditions like heart attack and
“Almost 90 per cent were aware of heart disease and
stroke, but 50 per cent or fewer were aware of thrombosis as the underlying
cause,” said Dr. Weitz. “So we have a long way to go.”
If Canada and other countries are going to make a committed
effort to reduce heart attacks and stroke, then there must be greater awareness
and understanding of blood clots, both in clinical practice and in the general
public, he believes.
Continuing to do his part, what sets Dr. Weitz apart from
other researchers is the fact he is a clinician-scientist. His spectrum of
research goes from the lab to the bedside to the community.
In the lab, he’s trying to better understand the biochemical
events that cause clot formation in arteries and veins. At the bedside he’s
involved in clinical trials looking at diagnosis and treatment of clotting in veins
and arteries. That includes better ways to prevent clotting in high-risk
patients, as well as the development of more effective and safer medications
that have a lower risk of causing bleeding.
And at the community level, he’s trying to boost the profile
of thrombosis by conducting public surveys like the Ipsos Reid, publishing papers
on the global burden of thrombosis and raising awareness through events like
World Thrombosis Day.
What also sets him apart is his approach. Because he’s both
a clinician and a scientist he starts his lab-based research on problems he sees
with his own patients.
“I start with a clinical problem and then I go to the bench
to understand it, and then I bring it back to the clinic,” he said. (While he
appreciates the bench work of all researchers, he feels some researchers work
in a vacuum and develop impressive scientific discoveries, but they are unable
to apply their advances directly to improving clinical care.)
While more attention needs to be paid to thrombosis, that’s
not to say there hasn’t been any progress in the field of blood clotting.
There’s been tremendous progress in the development of new anti-clotting drugs.
Thanks in part to Dr. Weitz’s work, hospitals across Canada
now use both injectable and oral thrombin inhibitors that are safer and more
convenient to use.
“For 65 years all we had was a drug called warfarin and now
we have four new drugs that are more convenient and safer to give,” said Dr.
he believes the future looks promising, with encouraging research that will
lead to even better treatments for patients with thrombosis and for those at
risk of developing it.
Dr. Lily Wu
Sugar study sweetens understanding of blood vessels
Sugar study sweetens understanding of blood vessels
Instead of, “Would you like fries with that?” Dr. Lily Wu thinks a better question at the fast food counter should be, “Would you like high blood pressure or diabetes with that?”
It’s no secret that fast food, as part of a high-sugar and high-fat diet, is causing sharp spikes in the prevalence of metabolic syndrome – a collection of symptoms that can include high blood pressure, obesity, high blood sugar and others – which increases the risk of heart disease and stroke.
But how fast food causes these problems is still a mystery and this is where Dr. Wu, a professor of health sciences at Lakehead University in Thunder Bay, Ont., is doing her work. She hopes to shed light on the regulation of sugar metabolism within blood vessel walls and its role in high blood pressure and diabetes.
Specifically, Dr. Wu will determine how MG is produced in blood vessel walls, how certain molecules affect MG production, how the interaction between different molecules and MG affects blood vessel structure and function, and finally how this knowledge can be used to invent specific therapies to remove or reduce MG in our bodies.
She believes better understanding of how MG weakens blood vessels will uncover great potential in the prevention and treatment of heart diseases and stroke.
No human can function without electricity. That lesson has shaped Dr. Shetuan Zhang’s medical career.
“I was studying medicine in China in the 1980s,” Dr. Zhang recalls, “and I remember one of my professors bringing in a recording that showed how electricity controlled the heart.” A first in China, the recording had a profound effect on the young student. “After that moment, I knew I wanted to spend my time finding answers and learning more.”
Ion channels are the pathways that carry the charged particles through heart tissue, where they produce the electricity that makes the heart beat. Certain prescription drugs and gene mutations can block one of the ion channels, known as hERG, creating a traffic jam of electric currents within the heart. This can result in a disorder called Long QT Syndrome, which can lead to life-threatening irregular heartbeats and sudden death.
All of this electrical activity happens below the surface, so it’s rare that a patient will show visible symptoms. The underlying cause often isn’t identified until doctors run an electrocardiogram (ECG) test. Meanwhile, a patient can be at high risk of sudden death.
Dr. Zhang and his team are working to save lives by learning more about how gene mutations and prescription drugs block the hERG channel, and what treatments can restore the channel’s function.
Can music “fool” the brain into pursuing healthy activity?
Think of the last song that left you tapping your toes. Now imagine listening to that song and feeling compelled to walk. When the song finishes a few minutes later, you’ve walked nearly a kilometre – yet you feel more energized than ever.
It’s not science fiction, but a real intervention Dr. David Alter, a cardiologist and senior scientist at both the Institute for Clinical Evaluative Sciences (ICES) and the Toronto Rehabilitation Institute/University Health Network, is researching to help the estimated 50 per cent of patients who habitually stop following their prescribed medication, nutrition or physical activity therapies. He is determined to reach this group, because the patient who quits his meds or therapy faces almost the same health outcomes as the one who receives no intervention at all.
Dr. Alter’s love of music follows him everywhere. He is an accomplished songwriter-musician who plays bass, guitar and piano, and who has written over 1000 songs. In 2007, he founded Vigour Projects, a non-profit dedicated to researching how music can be used to improve health outcomes. One solution to help patients stick to prescribed physical activity is creating a “remixed” music playlist using a process called neural entrainment. The audio in these playlists is synched to the patient’s brainwaves to help her walk to the beat. Additional high-frequency sounds are then layered overtop of the music to distract the patient from her task, reduce her exhaustion and increase motivation.
“We know we can fool the brain into thinking that exercise is not as hard as it is,” Dr. Alter says. “By taking a creative approach and engaging the non-adherers — even just a small fraction of them – we hope to make a sizeable impact on the larger population.”
Dr. Hsiao-Huei Chen
Targeting insulin to improve stroke recovery
By Jane Doucet
Targeting insulin to improve stroke recovery
By Jane Doucet
Dr. Hsiao-Huei Chen is exploring the connections between strokes and obesity-related diabetes, anxiety and inflammation. Her goal is to improve stroke recovery.
Strokes don’t happen as isolated incidents but are the result of a combination of metabolic disorders, which can include high blood pressure, high cholesterol and obesity. These factors are in turn worsened by unhealthy lifestyle habits such as poor nutrition and lack of exercise.
Dr. Chen’s team at the Ottawa Hospital Research Institute is zeroing in on the role of insulin, which regulates blood sugar and is needed for proper brain function.
“Inflammation could increase the amount of insulin needed to get an effect, which could worsen diabetes, and we know that diabetes is a risk factor for stroke,” says Dr. Chen, the recipient of a 2014 Heart and Stroke Foundation Mid-Career Investigator Award. “We’re looking at how to improve insulin sensitivity and suppress inflammation in the body.”
Part of this work will build on existing research that has identified a new anti-anxiety drug that can restore proper insulin delivery in the body and may improve stroke recovery.
Also, Dr. Chen notes, for those at risk of or recovering from a stroke, leading a healthy lifestyle is key, since regular physical activity reduces the amount of inflammation in our bodies and protects us from infection.
“We hope that a better understanding of the roles of inflammation and insulin will lead to improved outcomes for stroke survivors,” says Dr. Chen.
Dr. Rob Fowler thinks a lot about death. As a doctor who works in intensive care and cardiovascular intensive care at Toronto’s Sunnybrook Health Sciences Centre, he supports patients and their families as they wrestle with life-threatening critical illness, advanced heart disease, stroke and organ failure.
The reality is, not all are curable. “Our job is not to prevent death when it is inevitable but to make it as comfortable as possible.” Sometimes, that means bypassing life-support systems and accepting that the end is near, says Dr. Fowler.
He and colleagues are on a mission to find the best ways to engage patients, families and healthcare teams in discussions around improving end-of-life care. Research shows that while three-quarters of Canadians would prefer to die at home rather than hospital, the opposite is true: 60 per cent of us die in acute care.
One project is to develop videos and documentaries that help people understand when life support makes sense and when it doesn’t. He realizes it’s hard to opt out of heroic measures. “It’s a downer conversation. ‘We might beat this’ is an easier conversation. But death should be a component of rather than a failing of the health care system,” he says.
Dr. Ada Tang
Using exercise to help people thrive after stroke
Dr. Ada Tang is a five-time dragon boat world champion, and she still has days when she’s tempted by the snooze button.
“There are mornings when I don’t want to get up for a 5:30 a.m. practice, but my team is relying on me to be there. I get there because there are other people depending on me, I depend on them, and there’s a goal in mind.”
Dr. Tang, an assistant professor at McMaster University’s School of Rehabilitation Science, incorporated this team-based outlook while designing customized exercise plans for stroke survivors.
“When we do group exercise classes, the participants feel a sense of connection. We’ve seen that when stroke survivors have an exercise buddy, they’re more motivated to go.”
In the past, Dr. Tang says, exercise programs weren’t heavily promoted to people with stroke, as the health care team focused on getting them to walk, eat and dress themselves again. “In the last decade, however, research has shown that if they improve their physical fitness, they’ll be able to do more,” she adds “They’ll be able to take part in everyday activities like keeping up with their grandchildren or taking a trip.”
“After someone has a stroke, they’re put at a higher risk. Five years after a stroke, survivors have a 25 per cent risk of having a second stroke; after 10 years the risk jumps to 50 per cent. The good news is that it’s a modifiable risk factor – and physical activity can help reduce that risk.”