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Considero

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Alumni Research News from the Heart Foundation I ISSUE FOUR I 2015

Associate Professor Johanna Montgomery

Welcome to Considero 2015 I am pleased to bring to you this year’s edition of Considero, highlighting some of the exciting and potentially life-saving research being funded by the Heart Foundation.

This year, we received our highest-ever number of funding applications, which gave the Scientific Advisory Group an even more challenging task than usual. They eventually decided on 29 successful applicants and allocated funding worth $1.7 million. That, combined with funding committed earlier, brings our total 2015 investment in training and research to $2.6 million.

I hope you enjoy reading about the wide range of clinical, biomedical and public health projects we’re privileged to support.

Importantly, we continue to promote research that not only addresses evidence gaps internationally, such as Professor Ralph Stewart’s three-year investigation into the use of oxygen therapy in acute coronary syndromes, but also local New Zealand-specific questions, such as Miss Nikki Earle’s search for new genetic markers of cardiovascular disease, and Dr Corina Grey’s

quest to reduce inequalities in acute coronary syndrome outcomes.

We also catch up with some of our alumni and hear from Professor Rob Doughty, Chair of Heart Health, and Professor Mark Richards, Chair of Cardiovascular Studies, about research news at the universities of Auckland and Otago.

I am confident that New Zealand’s heart research is in good health, offering great hope in our continued fight to not only prevent but also reduce the burden of heart disease for all New Zealanders. Your continued support of the Heart Foundation with these endeavours is warmly appreciated.

Best wishes,

Associate Professor Gerry Devlin Heart Foundation Medical Director

Update from the Chair of Heart Health Contents Chair of Heart Health

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Chair of Cardiovascular Studies

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Our $55 million investment

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Oxygen therapy – is it helping?

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Tackling inequalities

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Other new research projects

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Grants awarded in 2015

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Catching up with Alumni 15 Scientific Advisory Group 20

The environment for cardiovascular research in NZ continues to evolve, and new approaches to study design and research methodologies are actively being addressed by a number of groups.

Recent months have seen the MENZACS study commence. Led

by Associate Professor Malcolm Legget, this is one of several registry-based studies associated with ANZACS-QI. It aims to determine the gene-environment interactions among patients with first-time acute coronary syndromes. The study involves wide collaboration across a nationwide multidisciplinary team.

Grants awarded by the Heart Foundation see a number of new areas of research associated with the Chair of Heart Health.

Dr Sarah Fitzsimons has received a project grant to support an echocardiographic sub-study of the IMPERATIVE-HF trial.

IMPERATIVE-HF is a randomised, controlled trial led from the Christchurch Heart Institute, in collaboration with the University of Auckland. It is assessing the role of NT-proBNP-guided clinical care for patients with recent acute decompensated heart failure. The new sub-study will provide important information on the role and timing of cardiac imaging in the weeks following acute heart failure.

Miss Nikki Earle has received a Fellowship to further her studies using DNA- and RNA-based technologies to improve risk assessment for people with both subclinical and established coronary artery disease. Nikki’s studies involve close collaboration with Dr Anna Pilbrow, current Heart Foundation Senior Fellow, and Professor Vicky Cameron, furthering the research relationships between the two Heart Foundation Chairs at the University of Auckland and Christchurch Heart Institute.

Dr Anna Rolleston, previously Heart Foundation M¯ aori Cardiovascular Fellow, is leading a kaupapa M¯ aori approach to risk reduction for M¯ aori in the Bay of Plenty. This exciting new study will utilise a novel study design to facilitate the methodology required for the proposed approach to risk reduction.

Professor Rob Doughty Heart Foundation Chair of Heart Health

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Update from the Chair of Cardiovascular Studies In the Heart Foundation’s 2015 grant round, the Christchurch Heart Institute (CHI) received support for projects driven

by Dr Anna Pilbrow, Professor Vicky Cameron and Dr Allamanda Faatoese.

These projects tackle new approaches to establishing the degree of risk for heart disease in our community.

Dr Faatoese’s grant will fund more peoplepower to accelerate her work screening for levels of heart risk factors (including high blood pressure, high cholesterol, diabetes, increased body weight and smoking rates) in Pasifika people in Canterbury. Allamanda’s project will provide reliable information on heart risk in this specific group, who may be at increased risk of heart problems.

Dr Pilbrow’s project will extend the CHI’s work in blood markers of heart disease with a special focus on small molecules known as microRNAs. We hope measurement of microRNAs in the blood will improve on traditional guides (cholesterol, blood pressure, smoking, etc) used to identify people at increased risk of heart problems.

Heart Foundation Chair of Cardiovascular Studies

Professor Mark Richards

Professor Cameron’s project grant will boost the CHI’s search for ‘Heart Disease Risk Markers in Canterbury Healthy Volunteers’. Since 2002, the CHI has recruited about 3300 volunteers, all healthy at the time of recruitment, to provide samples of normal DNA and plasma to aid discovery of new blood tests for prediction of cardiac events. The Heart Foundation grant will fund measurement of stored samples of known markers – including blood cholesterol, blood uric acid and circulating markers of kidney function – for heart disease risk. We will compare levels of these markers (and any new ones discovered) in volunteers who were healthy at recruitment but have since had a heart event, with the remainder of the group.

This will improve our ability to identify and assist people at greater risk of future heart problems.

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Oxygen therapy – is it really helping?

A new nationwide study will investigate whether oxygen therapy is actually helping patients who present with acute myocardial infarction.

Professor Ralph Stewart is leading a research team – comprising cardiologists, emergency medicine specialists and ambulance services from throughout New Zealand – which has received a $150,000 grant from the Heart Foundation.

Professor Stewart says oxygen has for many years been routinely given to patients having a heart attack, but its benefits have recently been questioned.

“Some small studies suggest it may be harmful by decreasing blood flow.

Currently we do not know whether oxygen is beneficial, harmful or has no effect.”

He says use of high-flow oxygen was supported by studies from the 1970s, which suggested it decreased ischemic electrocardiographic changes in acute myocardial infarction.

But more recent studies show it can cause coronary and peripheral vasoconstriction, which reduces tissue perfusion.

Over the next three years, Professor Stewart – who currently works at Auckland City Hospital, Green Lane Cardiovascular Research Unit and Auckland Heart Group – will carry out a large randomised clinical trial in hospitals throughout New Zealand.

“We will evaluate two different protocols for giving oxygen, both of which are currently in common use, and this will allow us to determine whether one is preferred.”

He aims to determine whether 30-day mortality differs between the two oxygen administration protocols.

“We will evaluate differences during the study to identify if one approach is better than the other as early as possible. It is most likely that oxygen will have no, or a small influence, on the risk of death.”

A safety committee will monitor outcomes and advise if there is a benefit from one oxygen protocol during the study.

Because oxygen is so widely used, this research has the potential to influence treatment guidelines both in New Zealand and internationally.

Professor Stewart says the current view is that oxygen should still be given when the measured oxygen level in the blood falls too low, but this study will compare using high levels and low levels of oxygen.

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Tackling inequalities in heart outcomes Dr Corina Grey is on a mission to reduce inequalities in acute coronary syndrome outcomes.

Through her previous doctoral research, she has already found Maori and Pacific people, and those living in areas of high deprivation, are more likely to die from an acute coronary event before reaching a hospital, and in the subsequent 28 days.

“Maori and Pacific people are also more likely to die in the year following that event, but are less likely to be on statins in the long-term,” she explains.

Dr Grey has now received a three-year Fellowship to investigate where these inequalities arise – in the pathway of care or during the life-course of an acute coronary syndrome (ACS) – by age, gender, ethnicity, and socioeconomic status.

Those differences could be: • in the time it takes to get to hospital • who undergoes coronary procedures • who gets prescribed evidence-based preventive therapy at discharge • who gets referred for cardiac rehabilitation • who experiences complications following ACS

“Knowledge of where these inequalities occur will then enable us to develop targeted strategies and interventions to reduce inequalities in outcomes for high-risk patients.”

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She will find answers using data from the All NZ Acute Coronary Syndrome - Quality Improvement (ANZACS-QI) research programme, which provides detailed information about all patients admitted to hospital in New Zealand with an acute coronary syndrome.

As part of her Fellowship, Dr Grey will also seek to develop accurate equations to identify which patients with acute coronary syndrome are at high risk of experiencing a bleeding complication, and use this information to balance the risks and benefits of treatment.

“Evidence shows that higher-risk patients are more likely to benefit from early and more aggressive treatment strategies; however these patients might also be at high risk of experiencing a bleeding complication as a result of treatment.

“Through my research, I hope clinicians are able to more accurately identify patients who will benefit most from early and aggressive treatment, by balancing the risks and benefits of therapy.”

Dr Grey is based at the University of Auckland’s Section of Epidemiology and Biostatistics.

Better detection of vulnerable plaque Most myocardial infarcts and strokes occur due to a rupture of vulnerable atherosclerotic plaque in the arteries – often in people considered low risk beforehand.

Associate Professor Nigel Anderson, from the University of Otago, Christchurch, says the key to finding preventive treatments is being able to detect vulnerable plaque, regardless of size.

He is part of a multi-disciplinary team using the new multi-energy MARS spectral CT system (pioneered in Christchurch) to identify who has this unstable plaque.

“If our imaging capability is used to develop better treatments for stabilising plaque, and we can identify who has vulnerable plaque, then there is the potential to prevent well over 50% of all strokes and myocardial infarcts.”

Dr Anderson’s Heart Foundation Project Grant allows him to extend his research to image 31 surgical specimens of plaque from neck arteries and 10 mice with atherosclerosis, and measure the markers of unstable plaque within the plaque itself.

“We will employ a methodology which can be directly translated to human imaging when a human MARS scanner is built. Then people who really are at risk might avoid the devastating consequences of stroke and heart attack.” *For more on this research subject, see our story about Associate Professor Steven Gieseg on Page 19.

These markers include macrophages, fibrous cap, haemorrhage, activated platelets, lipid, and calcium.

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Quest for new genetic markers With the first sign of cardiovascular disease often being sudden cardiac death, identifying new genetic markers could be pivotal in saving lives.

Miss Nikki Earle’s Research Fellowship will allow her to use DNA-and RNA-based technologies to increase the accuracy of estimating an individual’s risk of morbidity and mortality from coronary artery disease.

Her first small research project will involve looking at circulating microRNAs as markers of arrhythmia risk in survivors of myocardial infarction.

“We aim to perform a microRNA screening study to investigate whether circulating microRNAs can predict future cardiac arrest or sudden cardiac

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death events in people surviving admission to hospital for an acute coronary syndrome.”

The Coronary Disease Cohort Study – conceived and led by Professor Mark Richards (Heart Foundation Chair of Cardiovascular Studies) and carried out in collaboration with Professor Rob Doughty (Heart Foundation Chair of Heart Health) – comprises more than 2000 patients surviving acute coronary syndrome, of whom 5% have experienced CA/SCD events.

Miss Earle says the cohort is well characterised with extensive clinical, echocardiographic and neurohormonal data available.

She will perform all analyses under the guidance of Dr Anna Pilbrow (current Senior Heart Foundation Fellow) who has considerable experience in analysis of circulating microRNAs.

Improving treatments for heart failure Despite significant advances in care, heart failure remains a major cause of morbidity and mortality in New Zealand.

In the two-year IMPERATIVE-ECHO study, jointly funded by the Heart Foundation and Cardiac Society of Australia and New Zealand, Dr Sarah Fitzsimons aims to provide us with insight into the use of NT pro-BNP and echo to optimise therapy, which will hopefully result in improved patient outcomes.

“Several studies have suggested they may have utility in guiding treatment once a patient is discharged, however ‘when it is best’ and ‘how often testing is needed’ hasn’t been determined yet,” she explains.

“In the IMPERATIVE study we’re looking at whether regular ‘intensive’ monitoring of NT proBNP helps patients stay well and out of hospital.”

The study will be undertaken in both Auckland and Christchurch hospitals and she hopes to have the results published in three years.

Dr Fitzsimons, from the University of Auckland, also received an Overseas Fellowship in this year’s funding round, enabling her to work at Papworth Hospital in Cambridge, UK, where she will broaden her clinical experience in the management of heart transplant patients.

Since 1970 we’ve awarded: 200

Fellowships and Scholarships

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project grants, small project grants, grants in aid, travel grants and summer studentships

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The power of interpersonal connection Do empathy and compassion in healthcare delivery affect a patient’s ability to look after themselves?

That’s a question Simona Inkrot hopes to answer over the next 18 months, through her research project titled ‘Person-centred care in the context of chronic heart failure management in the community’.

Funded by the Heart Foundation, Ms Inkrot will try to unravel which actions are most effective in improving a patient’s ability and willingness to self-care.

“I am hoping to raise awareness among clinicians that if a patient feels empathy during healthcare consultations, they are more likely to feel empowered to engage in behaviours that benefit their health and wellbeing.”

Ms Inkrot, a Heart Failure Clinical Nurse Specialist from Waikato Hospital’s Department of Cardiology, will use a questionnaire to measure the amount of empathy patients feel they have received during their consultation.

“We aim to analyse which person-centred care factors correlate most with and predict good self-care and self-rated health, and use this information to further shape and guide our practice within the Waikato Integrated Heart Failure Service (WIHFS) to improve health outcomes.

“In addition, we propose to compare the patients’ perceptions of their self-care skills against the Heart Failure Clinical Nurse Specialists’ assessment.

“We shall then analyse for congruency between the two assessments to help us identify gaps in understanding and further develop individualised self-care support plans for patients.”

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Aims of the study: To assess and analyse person-centred factors affecting HF management To analyse which personcentred care factors correlate most with and predict good self-care and self-related health To use this information to further shape and guide practice within the WIHSF to improve health outcomes

Focus turns to Canterbury Pasifika Most of what we know about the cardiovascular health profile of Pacific people in New Zealand is based on data from Auckland.

However, as Dr Allamanda Faatoese points out, Pacific communities in Auckland live in vastly different environments than those in the South Island.

“We currently know little about the heart health profile of Pasifika in Christchurch.”

Dr Faatoese’s Pasifika Heart Study will, for the first time, look at the cardiovascular and metabolic risk profiles of Pasifika in Christchurch.

“Our primary aim is to document current cardiovascular risk profiles for a South Islandbased cohort. Secondly, we aim to establish the normal ranges of lipoprotein biomarkers (circulating and genetic) and determine whether these are candidate markers of cardiovascular risk,” she explains.

Recruitment for the study began in June this year. Screening of the 200 adult participants – including both healthy individuals and those who suffer from illness – involves personal and family medical history, measures of blood pressure and body composition, and blood tests.

“We will also incorporate a short food questionnaire to enhance the comprehensive cardiovascular and metabolic risk profile of this unique Pacific cohort.”

Dr Faatoese, from the University of Otago, Christchurch, is co-leading the project with Tony Fakahau (Pacific Trust Health Clinic) and Professor Vicky Cameron (Christchurch Heart Institute).

Her $78,834 Project Grant from the Heart Foundation will provide a research assistant and pay the cost of laboratory tests for 50 participants.

Aims of the Pasifika Heart Study: To recruit a South Islandbased Pacific Island adult cohort to determine current cardiovascular and metabolic risk factor profiles and cardiovascular scores To determine levels of circulating biomarkers and associations with cardiovascular risk in a Pacific cohort To investigate associations of lipoprotein genetic variants and their effects on lipoprotein levels among Maori and Pacific cohorts

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Grants Awarded in July 2015 At the July meeting of the Heart Foundation’s Scientific Advisory Group, a total of 29 grants were awarded. The awards include seven Project Grants, ten Fellowships, seven Small Project Grants and five Travel Grants. Five Summer Studentships were also awarded to the Medical Schools at the University of Otago and the University of Auckland.

Project grants Associate Professor Nigel Anderson Department of Radiology, University of Otago, Christchurch High resolution multi-energy CT imaging of vulnerable atherosclerotic plaque. $107,768 over 2 years.

Dr Allamanda Faatoese Department of Medicine, University of Otago, Christchurch Cardiovascular and lipoprotein profiles of Pacific in Canterbury – the Pasifika Heart Study. $78,834 over 1 year.

Dr Sarah Fitzsimons Department of Medicine, University of Auckland IMPERATIVE-ECHO. $144,640 over 2 years.

Associate Professor Helen Pilmore Department of Renal Medicine, Auckland City Hospital Canadian-Australasian randomised trial of screening kidney transplant recipients for coronary artery disease (CARSK study). $150,000 over 2 years.

Dr Anna Rolleston The Cardiac Clinic, Tauranga The effect of a 12-week exercise and lifestyle management programme on cardiac risk reduction: A controlled trial using a kaupapa M¯aori philosophy. $150,000 over 3 years.

Dr Anna Pilbrow Christchurch Heart Institute, University of Otago, Christchurch Improving cardiovascular risk prediction in the general population. $77,949 over 2 years.

Professor Ralph Stewart Green Lane Cardiovascular Services, Auckland City Hospital Oxygen therapy in acute coronary syndromes. $150,000 over 3 years.

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Fellowships Dr Nikki Moreland A 0.3 Heart Foundation Senior Fellowship (for 2 years) was awarded to Dr Nikki Moreland, School of Biological Science, University of Auckland.

Dr Sarah Fitzsimons An Overseas Training & Research Fellowship (for 1 year) was awarded to Dr Sarah Fitzsimons. Dr Fitzsimons will work in advanced heart failure management and heart transplantation at Papworth Hospital, Cambridge, UK. Dr Kerryanne Johnson A 0.5 Overseas Training & Research Fellowship (for 1 year) was awarded to Dr Kerryanne Johnson. Dr Johnson will work in multimodality cardiac imaging at Leeds General Infirmary, Leeds, UK. Dr Kashif Khokhar A 0.5 Overseas Training & Research Fellowship (for 1 year) was awarded to Dr Kashif Khokhar.

Dr Khokhar will work as an Electrophysiology Fellow at Royal Adelaide Hospital, Australia.

Dr Gnalini Sathananthan An Overseas Training & Research Fellowship (for 1 year) was awarded to Gnalini Sathananthan. Dr Sathananthan will work as an ACHD (adult congenital heart disease) Fellow at Toronto General Hospital, Canada.

Dr Woo Bin (Tiffany) Voss A 0.5 Overseas Training & Research Fellowship (for 1 year) was awarded to Dr Woo Bin (Tiffany) Voss.

Dr Voss will undertake an Echocardiography Research Fellowship at Northwestern Memorial Hospital, Chicago, USA. Miss Nikki Earle A Research Fellowship (for 3 years) was awarded to Miss Nikki Earle, Department of Medicine, University of Auckland.

Dr Corina Grey A Research Fellowship (for 3 years) was awarded to Dr Corina Grey, Section of Epidemiology and Biostatistics, University of Auckland.

Dr Vicky Yang Wang A Research Fellowship (for 2 years) was awarded to Dr Vicky Yang Wang, Auckland Bioengineering Institute, University of Auckland.

Dr Anthony (Shaw Hua) Kueh An Overseas Training & Research Fellowship (for 1 year) was awarded to Dr Anthony (Shaw Hua) Kueh. Dr Kueh’s imaging fellowship will focus on cardiac CT and cardiac MRI at St Paul’s Hospital, Vancouver, Canada.

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Small project grants Professor Vicky Cameron Department of Medicine, University of Otago, Christchurch Heart disease risk markers in Canterbury healthy volunteers. $14,818 over 1 year.

Miss Nikki Earle Department of Medicine, University of Auckland Circulating microRNAs as markers of arrhythmia risk in survivors of myocardial infarction. $15,000 over 1 year.

Ms Simona Inkrot Department of Cardiology, Waikato Hospital Person-centred care in the context of chronic heart failure management in the community. $9,890 over 18 months.

Travel grants Dr Sarah Fitzsimons Department of Cardiology, Auckland Hospital European Society of Cardiology Congress, London, UK. Dr Rajesh Katare Department of Physiology, University of Otago American Heart Association Annual Scientific Session, Orlando, USA. Dr Regis Lamberts Department of Physiology, University of Otago European Society for Cardiology Congress, London, UK. Dr Pau Medrano-Gracia

Associate Professor Johanna Montgomery Department of Physiology, University of Auckland Examining the role of synapse function and plasticity in the little brains of the heart. $14,900 over 1 year.

Dr John Pickering Department of Medicine, University of Otago, Christchurch Time course profiles of high sensitive troponin in patients at risk of acute myocardial infarction. $15,000 over 1 year.

Dr Daryl Schwenke Department of Physiology, University of Otago A PILOT study – identifying the physiological relevance of acyl vs non-acyl ghrelin for modulating cardiac sympathetic nerve activity following acute myocardial infarction. $14,805 over 9 months.

Dr Jichao Zhao Auckland Bioengineering Institution, University of Auckland Structural characterisation of explanted intact human atria. $15,000 over 1 year.

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School of Medical Sciences, University of Auckland MICCAI 18th International Conference, Munich, Germany.

Ms Shruti Rawal Department of Physiology, University of Otago American Heart Association Annual Scientific Session, Orlando, USA.

Alumni Updates In this section, we catch up with a group of our alumni to see how their research has progressed since they received Heart Foundation grants in recent years.

Search for new cardiac stem cell therapy Dr Rajesh Katare is trying to develop a new stem cell therapy that will help mend damaged hearts in people with diabetes.

Based at the University of Otago’s Department of Physiology in Dunedin, he aims to work out why complications arise in stem cell therapy for people with diabetes, and find a solution to this problem.

He proposes that early molecular alterations in diabetic stem cells could play a critical role in impairing the regenerative potential of diabetic stem cells.

“Stem cell therapy has recently emerged as a new treatment option, added to current medications in patients with severe heart failure.

“However, stem cell therapy is ineffective in patients with diabetes, because diabetes directly affects the survival and functional ability of stem cells by altering the molecular signalling cascade.”

Dr Katare says a micromolecule called MicroRNA appears to be responsible for this problem and it may be possible to restore normal function to diabetic stem cells by genetically engineering the microRNAs.

He says diabetes is being used as the disease model because people with diabetes are more prone to develop heart disease, but this therapy is applicable to any form of heart disease.

Part of the work involves collaborating with cardiac surgeons at Dunedin Hospital, who can provide right atrial appendage tissue samples collected from people – both with and without diabetes – who are undergoing coronary artery bypass graft surgery.

“These tissues are used to isolate the stem cells from the heart, which can then be expanded and used for required experiments to determine the changes in the expression pattern of microRNAs.” Dr Katare received a two-year Project Grant from the Heart Foundation in last year’s funding round.

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Boosting M¯ aori uptake of cardiac rehab

Historically, M¯ aori have been less likely to attend cardiac rehabilitation programmes than non-M¯ aori, which is something Dr Geoff Kira wants to change.

solution would be to pick patients up in a van.

“The purpose of my research is to modify current or develop new cardiac rehabilitation programmes to improve the uptake and attendance of M¯ aori patients.”

Dr Kira also discovered that the first time many patients learn about cardiac rehabilitation is when they’ve just come out of surgery.

Massey University’s Dr Kira, named the Heart Foundation’s M¯ aori Cardiovascular Research Fellow in 2013, has spent the past year interviewing 32 M¯ aori patients and 12 M¯ aori and non-M¯ aori health professionals.

He found many M¯ aori are unable to attend cardiac rehabilitation because they don’t have transport and can’t take time off work.

“They don’t have salary insurance so they have to go back to work after having a heart attack.

And there’s also a M¯ aori obligation to provide for their family, particularly the men – they’re very staunch about that.”

One answer to that problem would be to run programmes in the evening, online or by DVD, so the working person doesn’t miss out. Another

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“Offering healthy kai at the meetings would also be beneficial. Things as simple as that could help improve attendance rates.”

“In the midst of being drugged up, operated on and a little shocked, how can you expect people to remember they’ve been told to go to cardiac rehab?”

A common complaint was that information about cardiac rehabilitation needs to be simpler and clearer, rather than being buried in a lengthy flyer.

Dr Kira’s next step is to carry out feasibility studies, trialling new kinds of cardiac rehabilitation based on his interviewees’ recommendations.

Vision for an active youth Dr Sandra Mandic knows the best way to beat heart disease is to prevent it, starting from a young age.

That’s why she’s investigating the inactive lifestyles of today’s youth, through a three-year study called BEATS (Built Environment and Active Transport to School).

“The lack of physical activity and increase of sedentary lifestyles in adolescents are a global health problem. Active transport to school, such as walking or cycling, is a convenient way to integrate physical activity into everyday life.”

Dr Mandic, from the University of Otago’s School of Physical Education, Sport and Exercise Sciences in Dunedin, is exploring transport to school habits, neighbourhood environment, and physical activity in Dunedin adolescents.

“This information will be used for designing future interventions to promote active transport to school, increase physical activity and improve health in adolescents.”

The BEATS study uses the most contemporary and comprehensive ecological model for active transport. This model takes into account characteristics of an individual; social factors such as influence of parents and peers; as well as built environment and policy factors.

“It is founded on a multidisciplinary approach and multi-sector collaborations, involving the University of Otago, Dunedin Secondary Schools’ Partnership and Dunedin City Council,” says Dr Mandic.

The study method includes both quantitative (surveys, maps, accelerometers) and qualitative (focus groups/interviews) approaches with students, parents, teachers and school principals.

Dr Mandic and her team have so far surveyed more than 1700 adolescents from all 12 secondary schools in Dunedin, and are now surveying their parents.

Understanding the factors that influence how adolescents get to school will enable health promoters, policy makers, city planners, and scientists to address barriers to active transport to school, encourage active transport, and create supportive built environments.

Dr Mandic received a three-year project grant from the Heart Foundation in 2014.

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Giving babies the best start in life Poor development and function of the placenta can have long-lasting harmful effects on both the mother and baby.

As Dr Anna Ponnampalam explains, the first nine months of baby’s life in the womb is a vital stage influencing disease risk for a range of disorders that develop later in life.

That’s why she is seeking to understand the causes and consequences of a serious pregnancy complication called preeclampsia.

“Preeclampsia predisposes women and their babies to significantly increased risk of metabolic and heart diseases later in life.”

In preeclamptic pregnancies, blood supply to the placenta, along with the structure and function of both the placenta and blood vessels within the placenta, are inadequate.

“The placenta acts as a life support system for every baby in the womb by delivering nutrients and oxygen to create an ideal environment for baby’s growth. The placenta is key to the development of the disease.”

Dr Ponnampalam, from the Liggins Institute at the University of Auckland, says the only current cure for preeclampsia is the delivery of the placenta and the baby.

“Removal of the placenta eliminates immediate risk of disease, however, long-term consequences for the mother and the baby remain, making preeclampsia an independent long-term risk factor for high blood pressure and heart disease for both the mother and the baby.”

Her ultimate aim is to identify new forms of therapy.

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“Greater understanding of the cause of preeclampsia and gestational diabetes will provide the basis for future novel therapies to prevent heart disease in this high-risk group of women and their babies.”

Dr Ponnampalam received the Heart Foundation-Gravida Fellowship (for 3 years) in 2013 and will most likely be publishing her first set of results later this year.

Artery plaques – what’s really going on inside them?

To cure and detect cardiovascular disease at a preclinical stage, we need a better understanding of what’s happening deep within the artery wall.

Cell culture and mouse studies have brought researchers a long way, but these models are only approximations of the complex inflammatory process driving the disease.

Associate Professor Steven Gieseg’s research team at the University of Canterbury, in collaboration with Professor Justin Roake’s surgical team at Christchurch Hospital, are attempting to shed light on this process by developing a live plaque culture model.

Using atheroma cut from patients’ carotid arteries, the team is culturing the live tissue in the laboratory at the University’s School of Biological Sciences.

“We’re using the data generated from these cultures to further model the cellular behaviour in more easily manipulated cultures of human monocytes, macrophages and human monocyte like cell lines,” Associate Professor Gieseg explains.

One of the team’s primary goals is to understand how and why immune cells die within the plaques when exposed to oxidised low density lipoproteins (oxLDL). LDL is the main cholesterol-carrying particle in the blood but can get trapped inside the artery wall, where it slowly oxidises.

Death of the plaques’ cells by oxLDL destabilises the tissue, triggering plaque rupture, clot formation, and blockage of the artery.

immune macrophage cells to overreact and generate lethal levels of oxidants within the cell.

This rapid production of oxidants wipes out key metabolic enzymes, killing the cells.

His team will also be determining the composition of plaque specimens using a MARS-CT X-ray machine newly developed by Canterbury and Otago Universities in collaboration with CERN, with funding from the NZ Government and Heart Foundation.

Associate Professor Gieseg says the MARS-CT generates histology level images of the plaque composition without damaging the plaque tissues or cells by measuring the spectrum of the X-rays.

“These key developments in tissue culture and imaging will allow our team to ask fundamental questions about plaque biology with the goal of developing better therapies and preclinical detection systems.”

Associate Professor Gieseg’s team has recently shown oxLDL is toxic because it causes the

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Thanks to our expert panel This year, the Heart Foundation received 88 applications for funding – the highest number ever.

Assessing these applications is never easy, and we rely heavily on our Scientific Advisory Group for their shared experience and expertise. Their rigorous approach to considering each application ensures our funding is allocated in the most strategic way possible.

The Scientific Advisory Group comprises highlyrespected individuals from New Zealand’s medical and scientific community, and toplevel Heart Foundation representatives. Current members are: Associate Professor Merv Merrilees (Chairperson) Department of Anatomy with Radiology University of Auckland Associate Professor Gerry Devlin Medical Director of the Heart Foundation Cardiologist at Waikato Hospital, Hamilton Professor Rob Doughty Chair of Heart Health Department of Medicine, University of Auckland

Mr Tony Duncan Executive Director, Heart Foundation Professor Alison Heather Department of Physiology University of Otago, Dunedin Professor Murray Skeaff Department of Human Nutrition University of Otago, Dunedin Professor Tim Stokes Elaine Gurr Professor of General Practice Dunedin School of Medicine, University of Otago Professor Richard Troughton Christchurch Heart Institute, Department of Medicine University of Otago, Christchurch Associate Professor Mark Webster Senior Cardiologist, Green Lane Cardiovascular Service Auckland City Hospital Associate Professor Sue Wells School of Population Health, University of Auckland Dr Jinny Willis Scientist, Lipid and Diabetes Research Group Christchurch Hospital

Paying it Forward

We need your help! There are many ways you can help us. Please indicate your preferred method of supporting the Heart Foundation:

The Heart Foundation’s vision is to stop New Zealanders dying prematurely from heart disease, and to help people with heart disease live full and productive lives. But as a charity, we rely on the generous support of our alumni community, donors and sponsors to continue the fight. Please help us keep funding world-class research and cardiology training, so New Zealanders can benefit from improving levels of heart healthcare and treatment.

I would be interested in sharing, in public or through other media, about the grant I received from the Heart Foundation and how that has influenced me

Please post this form to: Heart Foundation, PO Box 17160, Greenlane, Auckland 1546.

I would like to consider giving a monthly donation towards the work of the Heart Foundation I would like some information about leaving a gift in my will I would like to receive some information about joining the Heart Foundation Lottery programme Name: Address:

Or scan and email to Jo Dalton, jod@heartfoundation.org.nz Phone 09 571 9191

Phone:

ISBN 978-1-927263-44-0

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©2015 National Heart Foundation of New Zealand. All rights reserved. If you wish to reproduce or have any queries, please contact info@heartfoundation.org.nz. The Heart Foundation of New Zealand is a registered charity (CC23052) under the ISSUE FOUR Charities Act 2005.

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