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Better understanding of the risk factors for heart failure

Better understanding of the risk factors for heart failure

Photographer:Fotograaf: Joey Roberts

Wishful thinking

Imagine you, a researcher, are given a bag of money, unlimited time and personnel. What research would you do? Professor Blanche Schroen wants to get a better understanding of the risk factors of heart failure in order to develop more effective medication.

High blood pressure, diabetes, and obesity. These are the three main risk factors when it comes to heart failure. There is medication to reduce high blood pressure or to keep blood sugar levels in check, but there is more going on in the body. “The small blood vessels get damaged and that is often a sign of dysfunctioning organs, such as the heart,” says Blanche Schroen, professor of Experimental Cardiology.

The medication that we have today cannot prevent this damage, but not all patients sustain damage. Why this is so, is not clear. What we do know is that in someone who has suffered from high blood pressure, diabetes, or obesity for a long time, many more processes are in motion. “In addition to damage to the microvessels, chronic inflammation in the blood circulation occurs and a stress system is activated. That is not good for the heart or other organs, but it is not monitored. A patient only comes to see the cardiologist when there are already heart problems.”

Schroen wonders why the risk factors lead to heart failure in one patient and not in another. What exactly happens in the body prior to the disease and how can we prevent it?

“There are new tools now that make it possible to observe damage in the small vessels. Using an MRI or skin analysis, or by looking at the vessels in the eye or under the tongue. We are now applying this method to a select group of patients. A group for whom it is really already too late; they are already heart patients. I would like to screen everyone with one of the risk factors as soon as possible.”

Schroen also wants to remove tissue from the patient and take it to the lab. “I could, for example, let stem cells grow into heart muscle or vascular cells. I would like to expose those cells to blood from a diabetes patient, from a healthy person, and from someone who has reached the age of a hundred. This in order to better understand the reaction between cells and blood.”

Cell models are not enough; eventually animal tests will be necessary too. “The blood pressure, the circulation, the blood platelets, all have an influence on how the heart works. Cell models are still too simple. To know how potential medication really works, you would have to recreate a human being. Aside from the fact that this is not possible, it is also unbelievably unethical.”

Schroen argues for a ‘humane model’ for animal tests. “I mean that in two ways. Firstly, of course, that they suffer as little as possible, and we are already doing as much as possible in this area. But also that they resemble humans more closely. The latter often have all three risk factors, which are interrelated. It would be more realistic if it were the same in laboratory animals. We would then, for example, give mice a combination of an unhealthy diet with a lot of fat (causing obesity and ‘pre-diabetes’), and a substance that causes high blood pressure.”

Eventually, Schroen hopes to develop a medicine that combats the damage to the heart and vessels. Co-operation is vital here. “I would set up an institute for that purpose, it could also be virtual, where doctors and researchers from different departments collaborate. There is already a lot of co-operation within MUMC, but now we are all focusing on our own favourite organ, while the risk factors are the same for many diseases. A cardiologist cannot see all high blood pressure patients, but there has to be a middle course between that and waiting until they have heart failure.”

According to Schroen, it is important that doctors and researchers get to understand each other better. “Doctors should learn the language of researchers early on in their training. So that later on, when they constantly come up against the same problem, they know whom to contact to look for a solution. For researchers it would be good if they got to know the urgency of clinical practice and the patient as an individual. You do have to generalise somewhat for research, label people. But this is done too quickly and too easily.”

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