A new publication by Abbas Zaidi published this week in the AHA Circulation journal, has garnered attention for its study of the “Physiological right ventricular adaption in elite athletes of African and Afro-Caribbean origin”.

Featured as “Editors pick of the week”, the publication has also spurned an article from Johnathan Weinstock and Mark Estes who have comended the authors for bringing to the forefront the “important clinical implication”s of this trial, and the emphasis that should be placed upon them.

Click here to read the study

Click here to read the article

World-renowned team of contributors

Click here to read full application details

The project aims to test for early signs of heart disease such as cardiomyopathy, that may be the root cause of sudden cardiac death instances in the region. The screening tested hundreds of patient under 35, for any signs of inherited or early heart disease. Beginning in Patna, and later moving to other parts of the globe, the screening was offered free of charge under humanitarian grounds.  The team, headed up by Dr Narain,  screened the patients using an ECG machine. If neccessary they were then offered a further Echo scan, overseen by the highly experienced Cardiology unit at St George’s hospital, London.

Click here to read the full article

The highlights from the confwerence can be seen in the recordings below. Our next meeting will be on 9th December 2013, with the programme to be announced shortly. You can pre-register for this event by following the link on our site.

Introduction from Prof. Kaski and talk by Dr Cockerill on HDL

Prof. Von Eckardstein discussing proteomics and lipidomics of HDL and its subfractions

Prof. Packard discusses CETP inhibition as a target for CHD prevention

Prof. Ray discusses statins and diabetes risk

Prof. Badimon discusses coronary artery disease and HDL

Prof. Luscher discusses HDL-Cholesterol

Dr. Wierzbicki discusses LDL reduction beyond statins

Abdominal aortic aneurysms can rupture and kill without warning. They are responsible for around 23,000 hospital visits and cause around 4,000 deaths each year in the UK. There are no therapeutic treatments for aneurysms. Patients are monitored until the aneurysm reaches what is considered to be a critical size where it is at significant risk of rupturing – 5cm in diameter – and then it is repaired by surgery. Each operation costs the NHS between £8,000 and £12,000.

In laboratory-based experiments, researchers from St George’s, University of London found that elevating the amount of high-density lipoprotein (HDL) cholesterol inhibited growth and reduced the size of an experimental aneurysm.

The researchers say that, in principle, if raising HDLs can be induced using a drug, then aneurysms could be treated from early diagnosis and it could negate the need for surgery.

This finding also potentially explains why patients with abdominal aortic aneurysms have lower concentrations of HDL.

Lead researcher Dr Gillian Cockerill from St George’s said: “More studies are needed but this finding could be the first step in finding a drug treatment for abdominal aortic aneurysms. It provides evidence to support the idea that a drug based on HDL raising could be a viable treatment option. Drug therapy is preferable to surgery. It is less distressing for the patient and could see their condition treated sooner.”

While more work is needed to understand the exact mechanism that enables this effect, their investigations show that raising HDL cholesterol influences changes in signals sent between cells, and programmed cell death (an essential part of the cell lifecycle in healthy organisms) in the aneurysmal artery. These changes were restricted to the specific region of the artery where HDL levels had been raised.

The researchers found that, by influencing these intracellular signals, introducing more HDLs reduced the activity of a protein known as ERK1/2, which is recognised for its cell growth properties, and promoted the death of those cells that were causing the aneurysm to grow.

So far, studies have focused on a model of the suprarenal area of the aorta (just above the kidney) and the infrarenal region, (the area that is just below the kidney and more commonly associated with aneurysm formation, accounting for approximately 90 per cent of aneurysms in humans). The researchers hope that this site-specific effect will help explain basic mechanisms of aneurysm formation.

Dr Cockerill says: “HDLs are a complex family of heterogeneous particles that may vary in composition, size and function. Whilst we have shown that elevating the concentration of the so-called ‘good-lipid’ can modulate site-specific cellular responses and inhibit aneurysm formation, it is important to learn more about changes that occur on HDL complexity in addition to the effects in the vascular responses that influence aneurysm development.”

The next phase of the investigations, which the researchers hope will begin in early 2013, will see the researchers test families of drugs that can elevate HDLs and reproduce the observed effects on aneurysms.

The findings are published online in the American Heart Association scientific journal Atherosclerosis Thrombosis and Vascular Biology.

For further information or to speak with the researcher, please contact Helena Clay in the St George’s, University of London press office on 020 8266 6831/07909 523 089 (out of hours) or hacly@sgul.ac.uk

• The article can be found online at: http://atvb.ahajournals.org/content/32/11/2678.abstract?sid=0e15c276-905d-4b0b-81bf-06d6c90d1938
• About St George’s, University of London:

St George’s, University of London (SGUL), established in 1733, is distinctive as the UK’s only independent medical and healthcare higher education institution. It benefits from strong links with the healthcare profession, including a shared site with St George’s Healthcare NHS Trust in Tooting, south west London.

SGUL is dedicated to the education and training of doctors, nurses, midwives, physician’s assistants, paramedics, physiotherapists, radiographers, social workers, healthcare and biomedical scientists. It attracts around 6,000 students, some of whom are taught in conjunction with Kingston University.

Research at SGUL has a UK and international focus and aims to improve prevention, diagnosis and treatment of disease in areas including infection and immunity, heart disease and stroke, and cell signalling. It also aims to enhance understanding of public health and epidemiology, clinical genetics, and social care sciences. www.sgul.ac.uk

The CRY research fellows based at the department of cardiovascular sciences, St George’s University London have been heavily involved in these screening programs under the supervision of Professor Sanjay Sharma. The funding for this project was provided by Philips®.

Between October 2007 and March 2012, 1100 elite British athletes underwent cardiac screening. A vast majority of these athletes participated in sports that feature in Olympic and Paralympic events.

The screening program incorporated a health questionnaire, 12-lead electrocardiogram and transthoracic echocardiogram. Those with an abnormality were referred for further diagnostic evaluation or follow-up; the CRY Specialist Centre for Sports Cardiology and Inherited Cardiac Diseases at St George’s Hospital served as one of the referral centres.

The athletes diagnosed with ECG abnormality included 1 with Wolff-Parkinson-White syndrome (WPW) and 2 with prolonged QT interval. One athlete (participating in a sport not featuring in Olympics) was identified with dilated aortic root with bicuspid aortic valve and aortic regurgitation; he required cardiac surgery following which he has returned to competitive sports.

Echocardiogram identified 12 more athletes with valve abnormalities who will require follow-up; these included 6 with bicuspid aortic valve, 5 with mitral valve prolapse, and 2 with pulmonary stenosis. None of the athletes were diagnosed with a cardiomyopathy, however some require long-term regular follow-up.

The study shows that cardiovascular abnormalities in highly trained British athletes are rare; however cardiovascular screening can lead to early identification of important conditions which may potentially predispose an athlete to sudden cardiac death. Most athletes with minor cardiac abnormalities can be allowed to compete with close monitoring.

Dr Saqib Ghani MBBS, MRCP

CRY Research Fellow

Cardiovascular Sciences, St George’s University London

The final programme for the Heart Failure Management meeting (May 16th 2012) is now available.

This meeting will focus on practical and strategic issues regarding heart failure management and we have designed a programme that will give the attendees ample time to interact with the members of the faculty.

Click here to download the final programme (PDF version).

Register now as places are limited to 150!

Click here to register

Professor Sanjay Sharma, from St George’s University of London appears on Sports Tonight Live to provide expert analysis of this event.

Current European Society of Cardiology (ESC) guidelines that are used by sports organisations are based on data obtained from white athletes.

For this study, Dr. Sheikh and colleagues analysed ECGs from 923 black athletes, 1,711 white athletes and 209 patients with hypertrophic cardiomyopathy and compared them to current and previous guidelines. The results showed 43% of the participating black athletes would have been highlighted for further investigation, despite being healthy. However, this is still a reduction from 60% false positive results using the 2005 ESC guidelines.

“It shows that we do need to take ethnicity into account during pre-participation screening if we want to avoid over-investigation of black athletes,” says Dr Sheikh. “The implications for practice are potentially huge, given that in both the United States and the United Kingdom an ever increasing proportion of elite athletes are of African/Afro-Caribbean ethnicity.”