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 2013 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.
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.
Dr. Peter Austin Using numbers to take aim at heart disease and stroke
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.
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.
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. 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. 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. 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.”