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Personalised care for risky hearts

Coronary heart disease (CHD) and stroke – the top two leading causes of death and disability in Europe – amount to over EUR 170 billion in healthcare costs. However, tens of thousands of these deaths from cardiovascular disease (CVD) could be prevented.

Health

The increasingly ageing European population makes it imperative to find evidence-based solutions for accurate and early diagnosis, as well as better clinical management of CVD. The EU-funded project EPIC-CVD (Individualised CVD risk assessment: tailoring targeted and cost-effective approaches to Europe's diverse populations) was established to provide clinicians and policymakers with personalised predictive tools. The aim of EPIC-CVD was to build upon previous research in CVD risk prediction by using population resources, biomarker technologies, and translational studies. The pan-European multidisciplinary consortium comprised 28 partners from 10 European countries, who focused their expertise on translational research, epidemiology and diagnostic technology. Project partners identified 11 000 stroke cases and retrieved their biological samples for testing, making it one of the largest epidemiological studies on stroke. They also assayed most of the 42 000 samples for nutritional biomarkers such as fatty acids, vitamin C, metabolites of vitamin D and carotenoids. Samples from CVD patients as well as controls were used for comparison. Another area of focus was to identify biomarkers of 'nature' such as genetic variants, telomere length and components in circulating serum. Researchers developed and tested a high-throughput monochrome multiplex quantitative polymerase chain reaction assay specifically for leukocyte telomere length. Pilot testing on 40 000 EPIC-CVD participants demonstrated the efficacy of this assay against Southern blotting, the current ′gold standard′ technique. One of the project’s key aspects involved ensuring the clinical and public health utility of novel CVD risk scores. Through systematic reviews scientists selected the most promising modifiable risk scores and methodologies for CVD risk prediction. Considerable inroads were made with regard to cost-effectiveness analyses and developing a cardiovascular risk assessment tool. A major achievement was to successfully obtain ethical approval for the randomised controlled trial – INFORM, which assessed the clinical applicability of the CVD risk scores in 1 000 patients. The single biggest impact of EPIC-CVD has been to provide clinicians and policymakers with an evidence-based list of options. These for targeted and cost-effective CVD risk approaches. These options are tailored to the needs of Europe’s diverse populations and will contribute to the health and well-being of citizens, as well as enhancing innovation and research competitiveness within the EU.

Keywords

Cardiovascular disease, EPIC-CVD, biomarkers, translational studies, high-throughput monochrome multiplex quantitative polymerase chain reaction assay

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