Victorian Heart Hospital leads approach to cardiovascular health
Victorian Heart Hospital leads approach to cardiovascular health
Heart disease is Australia’s biggest killer – of both men and women. Which is why the Victorian Heart Hospital is such a game-changer.
Want to live a long life? Start now. And start with your heart, because heart disease is the country’s biggest killer. But looking after your heart is not just a case of eating well and doing exercise – rather, it’s a complex cocktail of genetics, diet, activity, medicine and socio-economic factors.
But despite all the advances in heart medicine over the past 20 years, there is still so much more we need to know when it comes to our heart health. And that’s why some of Monash’s finest minds are determined to make a difference.
Back in the 1960s, the death rates in Australia, the United States and the United Kingdom due to heart disease were awful,” says cardiologist Professor Stephen Nicholls.”
But in the 1980s, scientists found that if you give medication to bust up the clots that block blood vessels and cause heart attacks, patients did much better. Then they discovered that if you lower both blood pressure and cholesterol, you lower the risk of heart attack and stroke.”
These two key pieces of knowledge – discovered through painstaking clinical trials and research – have saved millions of lives. However, Nicholls points out: “Our ability to prevent the disease has improved remarkably and we’ve done a lot better, but heart disease is still Australia’s leading cause of death.”
Nicholls is Director of the Monash Victorian Heart Institute and the new Victorian Heart Hospital (VHH), a state-of-the-art hospital and research and teaching centre. The first heart hospital in Australia, it represents a joint partnership between Monash University, the Victorian Government and Monash Health.
The impact will be both local and global: heart patients will get world-class treatment and have the opportunity to take part in trials of the very latest devices and drug therapies; medical students will work with patients both real and virtual in the suite of simulation rooms; and researchers will study in medical and bioengineering labs equipped with access to the cutting-edge tech needed to study heart disease – to its cells and beyond.
Dr Chengxue Helena Qin is one of those researchers. She has very personal experience of the devastation heart disease can leave in its wake: her grandfather passed away from a stroke and her grandmother died of a heart attack. “I wanted to find better ways of practising cardiovascular medicine which, right now, is not good enough,” she says. It is her aspiration to deliver breakthrough cardiovascular medicine, cure disease and restore normal life.
Current cardiovascular medicines often just treat the symptoms of the disease but not the underlying problem, such as persistent inflammation. If you’ve ever cut your finger and seen it become red and painful, that’s inflammation: it is nature’s way to heal. This is a significant and relatively new area of study in cardiovascular disease, and scientists are only just starting to work out when it’s harmful – or when it helps to heal. "Steroids are the classic anti-inflammatory drug,” says Qin.
They [steroids] switch off the whole inflammatory process, which could make people suffering from cardiovascular disease more susceptible to bacterial and viral infections. But we know that inflammation is really important in the healing response, as well. So, with steroids, we turn off the bad and the good at the same time.”
Her team is looking to develop innovative drugs that actively promote the “healing” response – such as reducing scar formation in the heart and the blood vessels – but allow the body’s natural healing processes to take place. They are currently working on a treatment for pulmonary arterial hypertension – high pressure in the lung – which is incurable, very rare and has limited treatment options. It affects mainly young women who were previously well, and around half of those diagnosed die within five years. “We identified a targetable protein on the cell surface that receives inflammatory signals,” says Qin. “Nature is much richer than we thought. If we could fine-tune this protein’s activity, we might find a new way of treating this disease.”
Along with finding a cure for this rare condition, Qin’s lab is also dedicated to finding better treatments for high blood pressure – also known as hypertension, the “silent killer” of cardiovascular disease. Often without obvious symptoms, it affects around a third of the adult population and is a major risk factor for heart disease and stroke if left untreated.
Patients suffer from uncontrolled high blood pressure, partially due to stiff blood vessels – normal ones will stretch easily. “There are so many things that contribute to stiff vessels in hypertension – for example the intake of salt, lack of exercise, stress, genetics,” says Qin. “We need to tackle the underlying problem, not one single factor.”
Along with supporting research like Qin’s, the VHH’s impact will also stretch beyond the lab bench (and the building) and into the wider community, says Nicholls. “We want to develop advances in treatment – but we also need to get existing advances to the people who need them now. Often, they are the more vulnerable members of our community – migrants, the Indigenous population or people with mental health issues. These individuals have a higher burden of heart disease but less access to proven therapies. Having equity and access is just as important.”
But equity and access are complex problems that reach far beyond the bounds of medical practice. So, two and a half years ago, Nicholls created the Victorian Heart Institute, bringing together experts from arts, law, engineering, architecture and design to work on the challenge of improving Australia’s heart health.
The Institute now has 600 members across the University and five main research strands, or Grand Challenges – women’s heart health; under-served populations; personalised medicines; new technologies; and living well – which will become the focus for the training and development of the next generation of cardiovascular healthcare professionals.
“It meant that, suddenly, I was having conversations with very different people about how their work impacted people like my patients,” he says. “It might be developing a new drug, a new device or a new test. It might be helping people get access to the therapies we already have, or developing better strategies to promote adherence to the therapies that work. Or it might be improving health literacy.”
Prevention will be a big part of the new hospital’s focus – and it’s at the heart of Associate Professor Francine Marques’s work. Her early research focused on the genetic element of cardiovascular disease. “Then, in 2015, I was diagnosed with stage three ovarian cancer and everything changed,” she says.
For stage three ovarian cancer, the prognosis is really poor – five-year survival rates are around 35 per cent. Today, I am seven years cancer-free. It changed my perspective on what I wanted my work to be. But even before I had cancer, I was always fascinated by how food can prevent some of our biggest killers, like cardiovascular disease and cancer.”
Now she studies the gut microbiome – the many different kinds of micro-organisms that live in our gut. Her lab was one of the first groups in the world to describe how our gut microbiome helps to regulate blood pressure. That in turn led to her current work: investigating how we can use fibre found in our daily diets to lower our risk of heart disease – with a little help from the microbiome.
“We discovered that when we have diets high in fibre – particularly fermentable fibre such as cooked and cooled rice, pasta and potatoes – the microbes ferment them for us,” she explains. “We don’t have the enzymes necessary to digest fibre. The fibre we eat reaches our large intestine intact, and that’s where we have the highest number of microbial communities in our body.
“During this fermentation process, three different substances or ‘short-chain fatty acids’ – acetate, propionate and butyrate – are released. We’ve now shown in both animal and human clinical trials that these amazing substances can lower blood pressure substantially. This can result in the prevention of high blood pressure and, in the long term, cardiovascular disease.”
In one randomised, placebo-controlled, double-blind clinical trial, patients took a supplement with very high levels of acetate and butyrate. Results showed that in as little as three weeks, the supplement reduced blood pressure to a level equivalent to taking a blood pressure- lowering pill. “One of our participants was a woman in her 30s,” says Marques. “She is now off medication, which she would otherwise have been on for the rest of her life.”
Another trial in animals found that a high-fibre diet eaten in pregnancy could help protect future generations from cardiovascular disease. Marques’s lab studied the offspring of mice fed a high- or low-fibre diet. “While we didn’t observe a difference in the mums themselves, we found that the offspring of mums on a high-fibre diet are protected against the development of heart disease,” she says.
So it’s also about minimising the risk to the next generation.”
From prevention to medication, and teaching to treatment, Monash’s heart specialists are constantly finding new ways to think about our hearts: how we look after them and how we mend them. And this is just the beginning. “Ten years from now, I want us to be one of the leading cardiovascular institutions in the world,” says Nicholls. “I want us to be a beacon.” Marques agrees. “I want to see our work having real impact,” she says. “That’s why I became a scientist in the first place: my professional mission is to empower other people to live their best lives.”