Monthly Archives

August 2018

John Eikelboom, explorer, co-principal investigator of COMPASS

Cancer and heart disease: An unexpected discovery

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Hamilton Health Sciences researchers have discovered that patients with heart disease who develop major internal bleeding are much more likely to be diagnosed with cancer.

Patients with gastrointestinal (GI) bleeding are 18 times more likely to be diagnosed with GI tract cancer, and those who major genitourinary (GU) tract bleeding are 80-fold more likely to be diagnosed with GU cancer, than patients without internal GI or GU bleeding.

The clinical study, called Cardiovascular Outcomes for People Using Anticoagulation Strategies (COMPASS), is led by the Population Health Research Institute (PHRI), of Hamilton Health Sciences and McMaster University.

The COMPASS study involves more than 27,000 patients with coronary or peripheral artery disease in 33 countries.

“This startling insight should stimulate a search for cancer in patients with cardiovascular disease who develop bleeding.”

Previously, COMPASS found that the combination of a blood thinning drug (rivaroxaban) combined with aspirin reduces cardiovascular death, stroke or heart attack by 24 per cent compared with aspirin alone. Increased bleeding was found to be an unwanted side effect of the drug combination, although there was no significant increase in fatal or critical organ bleeding in patients who took both.

The newest findings show that patients who developed internal bleeding were more likely to be diagnosed with cancer, particularly when the bleeding occurred in the GI or GU tracts. One in five of all new cancer diagnoses during the trial were in patients who had experienced bleeding.

“This startling insight should stimulate a search for cancer in patients with cardiovascular disease who develop bleeding,” said John Eikelboom, co-principal investigator of COMPASS and hematologist at HHS.

“Most of our efforts have been focused on discovering better ways to prevent and treat bleeding, but if bleeding allows us to diagnose cancer earlier, it may lead to an unexpected benefit,” says Dr. Stuart Connolly, co-principal investigator of the COMPASS study and cardiac electrophysiologist at HHS.

Explorer, Dr. John Eikelboom

salted pretzels

Pass the salt: Average sodium intake proven safe, after all

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When it comes to salt consumption – an ever-controversial topic in the world of nutrition and health – the old adage “everything in moderation” has proven to be true. Researchers at the Population Health Research Institute (PHRI) of Hamilton Health Sciences and McMaster University have discovered that, for most people, sodium (a.k.a. salt) consumption does not increase the risk of health problems except for those who eat more than five grams a day, the equivalent of 2.5 teaspoons of salt.

Andrew Mente, an author of the study, and his colleagues at PHRI along with researchers from across countries found that salt intake above five grams, equal to 2.5 teaspoons, per day can increase a person’s risk of health problems like cardiovascular disease. But, fewer than five per cent of people who live in developed countries, including Canada, exceed that level. The average sodium consumption is between 3 to 5 grams – or 1.5 to 2.5 teaspoons – of salt per day.

The findings are part of a larger, long-term study led by PHRI looking at how nutrition impacts health in populations around the world. Last year, the same team found that a higher versus lower intake of fat can also reduce the risk of health problems and death. The findings are challenging global dietary guidelines, which Andrew and his team argue need to be revisited.

There’s only an associated risk of heart disease and stroke when a person’s average daily salt is greater than five grams.

“The World Health Organization recommends consumption of less than two grams of sodium – one teaspoon of salt – a day as a preventative measure against heart disease, but there is little evidence in terms of improved health outcomes that individuals ever achieve at such a low level,” says Andrew.

The study followed 94,000 people aged 35 to 70 from 18 countries around the world for an average of eight years. The results show that there’s only an associated risk of heart disease and stroke when a person’s average daily salt is greater than five grams. When the average intake is less than five grams, the evidence shows that there is no correlation between salt intake and risk of heart disease and death.

“Our findings show that community-level interventions to reduce salt intake should only target communities with high salt consumption, and should be embedded within approaches to improve overall dietary quality,” says Andrew.

Of all 18 countries involved in the study, China was the only country where the majority of people consume more than five grams of sodium a day.

The study findings have been published in The Lancet in August 2018. Click here to read the full article.

Acting VP Research, Ted Scott

BLOG: Redefining research

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By: Ted Scott, Acting Vice President Research & Chief Innovation Officer

The dictionary definition of “researcher” is painfully self-explanatory: “someone who conducts research.” Based on my experience at Hamilton Health Sciences (HHS) over the last few years, this description does no justice.

The word “research” itself has attracted a certain connotation that invokes images of anonymous individuals in lab coats analyzing samples in whitewashed, sterile rooms in the pursuit of some far-off, seemingly impossible discovery. Sure, some discovery happens that way. But, so often, it’s so much more than that.

At HHS, our researchers are so much more than people in lab coats. They are innovative, strategic, highly creative minds who translate complex data into new knowledge. Many of our researchers are also healthcare providers. Every day, they work alongside the patients who are the inspiration for their research pursuits. Their “labs” are patients’ rooms, clinics, and operating theatres. Every day, they’re on the front lines of our healthcare system, asking questions and solving problems. Their roles span the entire spectrum of healthcare professions: they’re surgeons, pediatricians, physiotherapists, nurses, students. They’re also our neighbours, friends, family members and, sometimes, they’re patients, too.

In my short time at HHS, I’ve learned that our researchers are also some of our community’s top innovators and collaborators. They’re forming networks across our city and region that are aimed at improving the way we provide healthcare, applying technology and expertise to make our healthcare system better. And, most importantly, their work has immense, tangible impact. Beyond the lab and the computer database, our nearly 2,000 researchers and research staff are discovering and implementing new knowledge that’s changing the way we care for people, in real-time.

For example, they’re testing in-home technology that our nurses and doctors can use to monitor patients once they go home after heart surgery. They’re working with tech innovators to find better ways of predicting outcomes for cancer therapies, so patients can make better decisions around their treatment options. They’re trialling the latest therapies to help make life easier for kids with chronic diseases, like inflammatory bowel disease (IBD).

This is just a sampling of the research happening at our hospitals, right now. It wouldn’t be possible without our researchers and research staff who are unwavering in their pursuit of making life better for people in our community, across our country, and around the world.

It’s this insatiable drive to know the unknown that I believe better defines a researcher.

I admire their persistence, their patience, and their will to keep exploring, even when the answers aren’t clear. And especially when competing commitments – of being doctors, nurses, allied health professionals, students – are as demanding as they are in our very busy health system.

It’s this insatiable drive to know the unknown that I believe better defines a researcher, no matter how big or small the issue at hand.
At HHS, we’re redefining what “research” means to our community, and to the world.

We’re not just researchers. We are explorers. It’s in our DNA.

Read our stories here.

Dr. Harriette Van Spall, Explorer, cardiologist at Hamilton Health Sciences

Helping those with heart failure live long healthy lives

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Carol has been an avid clogger for the past 20 years. What’s clogging, you ask? It’s a folk dance similar to tap dancing. Carol is part of a clogging group that travels all over the United States for workshops and conventions. Clogging is about more than exercise and socializing for Carol. It’s part of who she is.

In the fall of 2017 Carol started to notice an unsteadiness in her legs. Despite using her asthma inhalers, she also had a cough that wouldn’t go away. Both issues were starting to affect her life, including her clogging.

“My legs would get wobbly when I was clogging, so I’d sit down and take a break. Then when I stood up they’d be wobbly again and it would take me a minute to reorient myself. I just couldn’t keep up anymore,” she recalls.

As advised by her family doctor, Carol went to the emergency department at Hamilton Health Sciences’ Juravinski Hospital and Cancer Centre. She was in heart failure.

Heart failure is one of the most common causes of hospitalization in older adults.

Heart failure occurs when damage to the heart makes it too weak or stiff to work properly. Common causes include heart attacks, high blood pressure and other conditions that affect the heart. When someone is in heart failure, their heart must work much harder to pump blood through the body.

Carol is not alone. There are about 600,000 Canadians living with heart failure. It’s one of the most common causes of hospitalization in older adults. For about a month after they leave the hospital, these patients have a higher risk of their symptoms becoming worse. One in four patients return to the hospital during this period.

A Hamilton doctor is on a mission to change this.

Finding a way for heart failure patients to live long healthy lives

Dr. Harriette Van Spall, a cardiologist at Hamilton Health Sciences and researcher at Population Health Research Institute, is exploring how improving services for heart failure patients can benefit their health. She has led the Patient-centered Care Transitions in Heart Failure (PACT-HF) clinical trial, which is investigating how education and access to resources following hospital discharge can help patients like Carol avoid another hospital admission.

Her prior research shows certain services, like regular nurse visits and multidisciplinary clinics, can reduce readmissions in heart failure patients. These services require collaboration among multiple health care settings and professionals, which makes them difficult to implement. The PACT-HF study is bringing everyone together to set patients up for success.

“Heart failure requires lifelong management,” says Dr. Van Spall. “Supporting these patients when they’re most vulnerable is a key way to ensuring they’re well equipped to manage their condition. And, if managed with appropriate services, they can live long healthy lives and stay out of hospitals.”

“If managed with appropriate services, they can live long healthy lives and stay out of hospitals.”

Dr. Van Spall and her team have worked with hospitals, home care agencies, and clinics in participating regions in Ontario to coordinate education and care. Before leaving the hospital, a nurse navigator teaches patients and their caregivers how to recognize and manage symptoms, and what to do if things get worse at home. Patients who need additional support are referred to specialized clinics in the community. They also receive regular nurse visits in the month after they’re home to ensure their recovery is on track.

“Dr. Van Spall understood how important it was to me to return to clogging so she told me about her study. Now, I’m thrilled to be back to clogging three times a week,” says Carol.

The primary goal of the study is to reduce hospital visits after discharge, but Dr. Van Spall hopes to accomplish that and more.

“We’re hoping we also find that patients felt more prepared for their recovery process and ongoing management once they’re home,” she says.

Dr. Van Spall developed the program so it can be easily integrated on a more permanent basis. If it proves effective, she hopes to make it a routine part of care for heart failure patients at Hamilton Health Sciences.

Dr. Harriette Van Spall, Explorer, cardiologist at Hamilton Health Sciences

Dr. Van Spall will present results of the PACT-HF study at a Late Breaking Clinical Trials session at the European Society of Cardiology Congress in August 2018.

Click here for more stories of our explorations.

 

Research at Hamilton Health Sciences is conducted in partnership with McMaster University.

researcher analyzing a brain scan after a stroke

Creating a world without stroke

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For decades, our teams have been tackling stroke head-on. Their discoveries have set the compass for how we treat and prevent stroke worldwide.

Cutting stroke in half

Can you imagine a world without stroke? Dr. Jackie Bosch can, and she’s leading a mission to make that vision a reality.

While research has made great strides in finding new and better ways to treat stroke, prevention is even more important. Dr. Bosch has led worldwide studies showing that certain safe, inexpensive, easily accessible medications (e.g. blood pressure-lowering and cholesterol-lowering drugs) are better at reducing the risk of stroke than previously believed. Together, these medications have the potential to prevent 50 per cent of all strokes, which equates to tens of thousands of lives saved each year.

Stopping stroke in its tracks, sooner

When a stroke happens, millions of brain cells die with each minute that passes. In other words, the quicker a person receives emergency treatment, the less likely they are to suffer severe, potentially disabling brain damage. In recent years, the discovery of clot-busting drugs and special clot removal procedures have benefited countless patients by limiting the effects of stroke once it happens, but their effectiveness depends on how quickly the person receives treatment. Dr. Michael Sharma and his team are testing new drugs that act even faster and more effectively against a stroke to limit progression, giving more stroke victims a chance at life and, for many, a full recovery.

Treating the worst strokes, better

Strokes are devastating, but some are worse than others. Hemorrhagic strokes, which happen when blood vessels rupture and cause bleeding in the brain, are more likely to lead to death and severe disability, yet fewer researchers have ventured into understanding them. Dr. Ashkan Shoamanesh is one of those few, and he leads a Canada-wide research group aimed at exploring how to prevent hemorrhagic strokes and to better treat people who suffer from them.

HHS & McMaster researchers find “simple” methods to prevent heart attack & stroke

Three simple methods to prevent heart attack and stroke have been proven by an international team led by Hamilton Health Sciences (HHS) and McMaster University researchers.

The research team, based at the Population Health Research Institute of HHS and McMaster, studied more than 12,000 patients from 21 countries to evaluate drugs that can prevent cardiovascular disease (CVD), which cause 18 million deaths and about 50 million heart attacks and strokes around the world each year.

“These are incredibly important findings with potential for significant global impact,” says Dr. Salim Yusuf, principal investigator and executive director of PHRI. “If just 10 per cent of the world’s population at intermediate risk of CVD is impacted, we’re talking about 20 to 30 million people who could be helped by these drugs.”

The study, “HOPE-3”, examined three methods using two forms of therapy: Statins, a group of cholesterol-lowering drugs, and antihypertensives, a class of drugs used to treat high blood pressure. In addition, a combination of statins and antihypertensives was reviewed.

Statins proved to significantly and safely reduce CVD events by 25 per cent in patients at intermediate risk without CVD. Antihypertensives did not reduce major CVD events overall in the population studied, but did reduce such events in the group of people with hypertension, but not in those without hypertension. When combined, statins and antihypertensives reduced CVD events by 30 per cent—with a 40 per cent benefit in those with hypertension, suggesting that patients with hypertension should not only lower their BP but also consider taking a statin.

“These simple methods can be used practically everywhere in the world, and the drugs will become even cheaper as more and more systems and people adopt these therapies,” he said.

 

This article is featured in the latest Explorers publication.