Periodic Reporting for period 2 - CLIP (Comprehensive Lifestyle Intervention Project (CLIP))
Reporting period: 2019-01-01 to 2019-12-31
Cardiovascular (CV) disease is the leading cause of death in Europe, and its prevalence continues to rise at an alarming rate largely because of behavioural risk factors (smoking, unhealthy diet, physical inactivity, obesity, etc.). CLIP (Comprehensive Lifestyle Intervention Project) was funded by a Marie Skłodowska-Curie Action from the European Union Horizon 2020 Research and Innovation Program. The Project tackled novel approaches to health promotion and CV disease prevention.
Treatment of disease once symptoms are present represents a huge economic burden to societies and healthcare systems. This problem is anticipated to be exponentially magnified in the coming years due to the alarming increase in obesity (especially in children) and unhealthy lifestyles. One of the most effective ways to tackle this epidemic would be to implement preventive strategies before the disease appears [Image 1. Taken from Fernandez-Jimenez et al. J Am Coll Cardiol. 2018;72(25):3310-3319]. These preventive strategies apply to both adults and children. A key remaining problem is that advanced CV disease is recognized too late.
The overall objectives of the project were to perform extensive and multidisciplinary training on innovative strategies for effective lifestyle modification in adults and children (24-month outgoing phase), and to transfer the new methodology to Europe by carrying out a pilot lifestyle-centered program in Spain (12-month incoming phase). The new abilities I acquired from various areas will enable me to implement new programmes to attain primary CV disease prevention after becoming an independent group leader upon my return to Europe at my host institution.
Treatment of disease once symptoms are present represents a huge economic burden to societies and healthcare systems. This problem is anticipated to be exponentially magnified in the coming years due to the alarming increase in obesity (especially in children) and unhealthy lifestyles. One of the most effective ways to tackle this epidemic would be to implement preventive strategies before the disease appears [Image 1. Taken from Fernandez-Jimenez et al. J Am Coll Cardiol. 2018;72(25):3310-3319]. These preventive strategies apply to both adults and children. A key remaining problem is that advanced CV disease is recognized too late.
The overall objectives of the project were to perform extensive and multidisciplinary training on innovative strategies for effective lifestyle modification in adults and children (24-month outgoing phase), and to transfer the new methodology to Europe by carrying out a pilot lifestyle-centered program in Spain (12-month incoming phase). The new abilities I acquired from various areas will enable me to implement new programmes to attain primary CV disease prevention after becoming an independent group leader upon my return to Europe at my host institution.
CLIP provided me with innovative skills on new methods to achieve lifestyle changes in adults and children. For this endeavour, I very actively participated in a study focused on CV disease prevention at the Icahn School of Medicine at Mount Sinai (ISMMS) in New York, led by Dr Valentin Fuster (supervisor during the outgoing phase). This study had the necessary infrastructure in place to develop the research and training activities proposed in CLIP. The work performed from the beginning of the project and main results achieved so far were are as follows:
AIM 1: Training in novel strategies for lifestyle modification and CV disease prevention.
Taking advantage of the unique setting and the interaction with team members in charge of the design, randomization and statistical management of the trial conducted in New York, I was able to accomplish the following tasks: (i) promote the study at schools, and actively recruit participants for the study; (ii) perform participant assessments; (iii) apply original tools to induce positive behavioural changes; (iv) provide health counselling to participants; (v) participate in events at schools sharing my expertise with parents on health topics; (vi) trial database management; (vii) statistical analysis; (viii) presentation of results at international scientific conferences; (ix) draft and publication of manuscripts; (x) complete training courses as described in the CLIP proposal.
AIM 2: Generation of a computational network model of the genomic/molecular signature of favourable vs poor responders to lifestyle intervention.
The genomic influences on the outcome of behavioural modifications have not been studied in relation to CV disease. As a major innovation, the trial in New York included RNA-sequencing of lipid-loaded macrophages, which are a hallmark of atherosclerosis. These cells were isolated before and after the intervention from a subsample of adults participating in the global lifestyle program outlined above to identify novel genetic markers of subclinical atherosclerotic disease. I was trained in a multidisciplinary environment and learned how to apply computational network models to test the association of genomic and phenotypic data collected at baseline and after intervention. All these activities offered comprehensive training in applied genomics, and strengthened my multidisciplinary skills and contact networks for successful implementation of this novel methodology on my return to Europe.
AIM 3: Implementation of learned skills at the host institution through the implementation of a lifestyle modification and genomic pilot study on Spanish adults.
During the last year of the project, I transferred the new methodology to Europe by carrying out a pilot lifestyle modification study program in Spain. To this purpose, I studied pre- and post-intervention blood samples of adult participants who were randomly assigned to receive a novel intervention for health promotion or traditional counselling on cardiovascular risk factors. The incoming phase was enriched by an active collaboration with clinical scientists from industrial partners and my involvement in health promotion trials targeting adolescents and using activity-monitoring devices to track physical activity and sleep patterns.
AIM 1: Training in novel strategies for lifestyle modification and CV disease prevention.
Taking advantage of the unique setting and the interaction with team members in charge of the design, randomization and statistical management of the trial conducted in New York, I was able to accomplish the following tasks: (i) promote the study at schools, and actively recruit participants for the study; (ii) perform participant assessments; (iii) apply original tools to induce positive behavioural changes; (iv) provide health counselling to participants; (v) participate in events at schools sharing my expertise with parents on health topics; (vi) trial database management; (vii) statistical analysis; (viii) presentation of results at international scientific conferences; (ix) draft and publication of manuscripts; (x) complete training courses as described in the CLIP proposal.
AIM 2: Generation of a computational network model of the genomic/molecular signature of favourable vs poor responders to lifestyle intervention.
The genomic influences on the outcome of behavioural modifications have not been studied in relation to CV disease. As a major innovation, the trial in New York included RNA-sequencing of lipid-loaded macrophages, which are a hallmark of atherosclerosis. These cells were isolated before and after the intervention from a subsample of adults participating in the global lifestyle program outlined above to identify novel genetic markers of subclinical atherosclerotic disease. I was trained in a multidisciplinary environment and learned how to apply computational network models to test the association of genomic and phenotypic data collected at baseline and after intervention. All these activities offered comprehensive training in applied genomics, and strengthened my multidisciplinary skills and contact networks for successful implementation of this novel methodology on my return to Europe.
AIM 3: Implementation of learned skills at the host institution through the implementation of a lifestyle modification and genomic pilot study on Spanish adults.
During the last year of the project, I transferred the new methodology to Europe by carrying out a pilot lifestyle modification study program in Spain. To this purpose, I studied pre- and post-intervention blood samples of adult participants who were randomly assigned to receive a novel intervention for health promotion or traditional counselling on cardiovascular risk factors. The incoming phase was enriched by an active collaboration with clinical scientists from industrial partners and my involvement in health promotion trials targeting adolescents and using activity-monitoring devices to track physical activity and sleep patterns.
CLIP is expected to have a strong societal impact because it will directly contribute to Europe’s aim of fighting the CV disease epidemic. CLIP also addresses the lack of specialized workforce in Europe to lead innovative CV disease prevention programs. CLIP aspires to reduce the huge economic burden to society and healthcare systems associated with CV disease treatment.
CLIP has generated several high-impact factor publications [Image 2. Taken from Fernandez-Jimenez et al. J Am Coll Cardiol. 2019;73(16):2011-2021] with results presented at renown international scientific congresses. This will help to maintain the EU research community at the forefront of the advances in CV disease prevention. The Spanish National Center for Cardiovascular Research (CNIC) is at the centre of European cardiovascular research and will be a catalyst for transferring the new knowledge to Europe via its numerous partnerships with European institutions involved in cardiovascular research. On a personal level, I have been able to make smooth transition towards an independent research position at my host institution (https://www.cnic.es/en/investigacion/cardiovascular-health-and-imaging).
The topic of the CLIP proposal is of great social relevance. Dissemination activities included publications related to the project posted in Twitter; promotional video of the project uploaded to Youtube; and the participation in the European Commission Steering Group on Promotion and Prevention-Marketplace workshop on nutrition and physical activity best practices (https://ec.europa.eu/health/non_communicable_diseases/events/ev_20180315_en). In addition, I was selected as participating Young Researcher (Marie Skłodowska-Curie fellow) by the 68th Lindau Nobel meeting committee and the European Commission for the 68th Lindau Nobel Laureate Meeting dedicated to Physiology and Medicine.
As a culmination of the project, I was awarded the Marie Skłodowska-Curie Actions Award 2019 [Image 3. Taken from http://msca2019.eu/photo-gallery/] that recognized CLIP as the best MSCA project in the category of “Scientific Careers for Policy Making” (http://msca2019.eu/award-competition/). In addition, I was selected for presentation of the project at the Falling Walls Lab-MSCA celebrated at Kanal-Centre Pompidou in Brussels on September 26, 2019 as part of the European Research and Innovation Days.
CLIP has generated several high-impact factor publications [Image 2. Taken from Fernandez-Jimenez et al. J Am Coll Cardiol. 2019;73(16):2011-2021] with results presented at renown international scientific congresses. This will help to maintain the EU research community at the forefront of the advances in CV disease prevention. The Spanish National Center for Cardiovascular Research (CNIC) is at the centre of European cardiovascular research and will be a catalyst for transferring the new knowledge to Europe via its numerous partnerships with European institutions involved in cardiovascular research. On a personal level, I have been able to make smooth transition towards an independent research position at my host institution (https://www.cnic.es/en/investigacion/cardiovascular-health-and-imaging).
The topic of the CLIP proposal is of great social relevance. Dissemination activities included publications related to the project posted in Twitter; promotional video of the project uploaded to Youtube; and the participation in the European Commission Steering Group on Promotion and Prevention-Marketplace workshop on nutrition and physical activity best practices (https://ec.europa.eu/health/non_communicable_diseases/events/ev_20180315_en). In addition, I was selected as participating Young Researcher (Marie Skłodowska-Curie fellow) by the 68th Lindau Nobel meeting committee and the European Commission for the 68th Lindau Nobel Laureate Meeting dedicated to Physiology and Medicine.
As a culmination of the project, I was awarded the Marie Skłodowska-Curie Actions Award 2019 [Image 3. Taken from http://msca2019.eu/photo-gallery/] that recognized CLIP as the best MSCA project in the category of “Scientific Careers for Policy Making” (http://msca2019.eu/award-competition/). In addition, I was selected for presentation of the project at the Falling Walls Lab-MSCA celebrated at Kanal-Centre Pompidou in Brussels on September 26, 2019 as part of the European Research and Innovation Days.