Research in Progress 2008-09
Grant No. 1016
A tailored intervention to increase New Zealander’s fruit and vegetable consumption
Dr Caroline Horwath
An innovative computer programme, 5+Your Way®, has been created to motivate and enable
New Zealand adults to eat more fruit and vegetables. The programme attempts to mimic a personalised consultation with a dietitian trained in behavioural psychology. Each participant completes a questionnaire, which the computer “reads” and uses to select appropriate text and graphic messages from the Message Library to appear in his/her individually tailored booklet. In Phase I, ~ 150 New Zealanders were interviewed to improve these novel print materials. In Phase II, 1050 New Zealanders, aged 25 to 60 years, participated in a 12-month randomised controlled trial to test the effectiveness of tailored and generic communications.
Grant No. 1059
Research Fellowship
Dr Carlene Lawes
This fellowship comprises several projects that investigate modifiable risk factors for cardiovascular disease. Projects have estimated how much cardiovascular disease is due to high blood pressure, and examined the combined effect of blood pressure and smoking on cardiovascular disease. Project work has also reviewed evidence on different methods to manage obesity, and analysed trends in strokes worldwide over the last four decades. Several new research initiatives are aiming to focus on smoking cessation as smoking is another important risk factor for cardiovascular disease.
Grant No. 1090
Betaine, diet and homocysteine
Professor Peter George
Some people lose large amounts of betaine in their urine. These people are more likely to develop heart disease or have strokes. Many common foods are rich in betaine (for example, many cereals and vegetables such as silverbeet and spinach), and natural betaine (‘trimethylglycine’ or TMG) can be purchased as a dietary supplement. It has been shown that it is possible to replace the lost betaine, and natural betaine supplied as a supplement is just as good as dietary betaine. Betaine is used by animal farmers to decrease body fat and increase lean muscle, and is likely to affect human obesity similarly.
Grant closed.
Grant No. 1091
New Zealand Women’s Lifestyle Study
Dr Beverley Lawton
Lack of exercise is a major risk factor for diabetes and heart disease. Increasing numbers of New Zealanders are being diagnosed with type 2 diabetes. Recent research shows that diabetes can be prevented in some people by increasing exercise and/or by dietary change. This study showed that an extended green prescription was successful in increasing exercise levels in mid-life women over a 24-month period. Women in the intervention group increased their exercise (and sustained the increase) over 24 months, significantly more than women in the control group. These increases in exercise corresponded to improvements in some measures of quality of life but also in more falls and injuries. Biochemical and clinical measures (such as weight, blood pressure and cholesterol) did not differ significantly between groups. These results are the first to show that a primary care referral to an exercise on prescription programme with follow-up nurse support can produce increases in exercise and improvements in quality of life for up to two years.
Grant closed.
Grant No. 1092
Dual vent cardiopulmonary bypass to reduce ischemic brain injury in cardiac surgery
Dr Paget Milsom
A small number of people sustain brain injury as a complication of open heart surgery. The investigators have developed a new heart bypass technique that aims to reduce this brain injury. Magnetic resonance imaging (MRI) brain scans are being used to show if any brain injury has occurred. The amount of brain injury sustained in people with the new heart bypass technique is being compared with those having conventional heart bypass. Blinded viewing of the MRI scans shows clear evidence of new cerebral ischemic lesions in a significant proportion of the participants and that this is associated with measurable cognitive decline. Knowledge that the cognitive decline that follows open heart surgery is at least in part due to embolic ischemic damage means that ways of trying to reduce this damage may have promise in improving outcomes following surgery.
Grant No. 1094
Coenzyme Q10: Potential for improving cardiovascular risk
Professor Russell Scott
Coenzyme Q10 is an increasingly used complementary medicine for prevention of heart attack and stroke, and thus requires investigation. Statins are indicated for people with cholesterol disorders to reduce cardiovascular events. 14% of statin-treated subjects develop muscle-aches (myalgia), possibly due to depletion of coenzyme Q10 levels. The investigators have found no improvement in myalgia symptoms with coenzyme Q10 supplementation in subjects previously intolerant to statin therapy. Reductions in coenzyme Q10 in statin-treated subjects have been associated with improvements in vascular function. The investigators will examine whether coenzyme Q10 supplementation in statin-treated subjects further improves vascular function, giving additional benefit to CVD reduction.
Grant No. 1097
Senior Fellowship
Dr Gillian Whalley
Cardiac ultrasound (echocardiography) is performed to evaluate the structure and function of the heart and to determine the cause of heart failure. Traditionally, echocardiography has focused on the heart’s ability to pump blood forward, but increasingly there is interest in the ability of the heart muscle to relax in between muscular contractions. Using advanced ultrasound imaging, the degree of heart relaxation and how this may affect both diagnosis and management of patients with heart failure can be estimated. By putting together a large number of patients from hospitals around the world, it has been shown that measuring how well the heart relaxes may help to identify patients who are more likely to suffer further complications.
Grant closed.
Grant No. 1103
Research Fellowship, and
Grant No. 1171
A longitudinal study of the role of anti- and pro-smoking media on adolescents’ smoking attitude and intentions
Dr Judith McCool
Results from the analysis provide strong evidence of an association between higher exposure to media, permissive media consumption environment, positive perception of smokers in media, and positive appraisals of smoking in media and intention to smoke. Results from the study show that having clear and consistent anti-smoking rules and expectations within the household effectively establishes the norms from which media imagery is appraised. If the message challenges expectation, an active negotiation with the images/messages is more likely to occur. For example, with stereotypical images that depict familiar, reliable and largely unchallenged representations of individuals, social groups and norms, the images are appraised as intended (ie the cheerleaders are depicted as pretty, popular and sporty) however, when this stereotypical representation is challenged, (eg a tough, tattooed smoking cheerleader joins) this unexpected and inconsistent representation is renegotiated.
Grant closed.
Grant No. 1115
Clinical and neurohormonal predictors of outcome post-DC cardioversion for atrial fibrillation
Professor A Mark Richards
Atrial fibrillation is the most common cardiac arrhythmia. There are two different strategies when treating this condition: restoring normal rhythm or controlling the heart’s ventricular rate. Cardioversion, a procedure done to restore normal rhythm, has an initial success rate of 80-90%. Most of the patients with initial successful outcome will revert back to atrial fibrillation (only one third of those who had successful cardioversion initially will remain in normal sinus rhythm a year later). A combination of plasma hormone measurements together with clinical characteristics will help accurately identify those patients most likely to enjoy sustained return to normal rhythm after cardioversion.
Grant No. 1141
A randomised controlled trial of pre-quitting nicotine replacement therapy
Dr Christopher Bullen
The PQNIQ study tested whether taking nicotine replacement therapy (NRT) patches or gum for two weeks before quitting improved the likelihood that a smoker would stop smoking and remain a non-smoker for at least six months. Around 1100 callers to the New Zealand Quitline took part and 80% were still in contact at the last follow up call six months after making the quit attempt. It was found that this approach was no more effective than standard treatment to a person’s chances of staying quit over six months. Further work is being done to pool these results with those from similar studies to see if a small benefit is likely, in which case it may be a strategy some smokers wish to take.
Grant closed.
Grant No 1143
Effect of pulmonary valve replacement in tetralogy of Fallot
Dr Brett Cowan
A large number of New Zealand children are born with abnormalities in their hearts. Magnetic resonance imaging (MRI) is used to make the correct diagnosis and plan surgery for those that require it. This project has allowed the successful development of software to create a mathematical representation of both pumping chambers of the heart to greatly improve the diagnostic information available from the MRI scan. This software will be used at the Centre for Advanced MRI at the University of Auckland, in clinical trials looking at new treatments for heart disease and in international research projects.
Grant No. 1144
Role of NT-proBNP in screening for left ventricular hypertropy in patients with type 2 diabetes in the community: 2nd Natriuretic Peptides in the Community Study (NPC II)
Associate Professor Robert Doughty
Patients with diabetes are at high risk of heart disease. Thickening of the heart muscle, called hypertrophy, is an important risk factor for development of heart disease. Detection of hypertrophy of the heart is difficult in the community. This study evaluated whether a simple blood test for a hormone released from the heart would allow early detection of hypertrophy of the heart. The results from the study showed that hypertrophy of the heart muscle was common, affecting more than half of the patients with diabetes in this study. However, the simple blood test was not a suitable test to detect this heart abnormality. Further work is required to determine the most suitable test to screen for heart disease among patients with diabetes in New Zealand.
Grant closed.
Grant No. 1145
Metabolic variation and response to nicotine replacement therapy
Dr Rod Lea
Transdermal nicotine is widely used for smoking cessation, but only 20% of smokers quit successfully with this medication. Interindividual variability in nicotine metabolism rate may influence treatment response. This study sought to validate, and extend in a larger sample, previous findings that the ratio of plasma nicotine metabolites 3’-hydroxycotinine (3-HC)/cotinine, a measure of nicotine metabolism rate, predicted response to nicotine patch. A sample of 568 smokers was enrolled in a study that provided counselling and eight weeks of 21mg nicotine patch. Pretreatment 3-HC/cotinine ratio was examined as a predictor of 7-day point prevalence abstinence, verified with breath carbon monoxide (CO), 8 weeks after the quite date. Controlling for sex, race, age and nicotine dependence, smokers in the upper 3 quartiles of 3-HC/cotinine ration (faster metabolizers) were 50% less likely to be abstinent vs smokers in the first quartile (slow metabolizers). Among abstainers, plasma nicotine levels decreased linearly across the 3-HC/cotinine ratio. These data support the value of the 3-HC/cotinine ratio as a biomarker to predict success with transdermal nicotine for smoking cessation.
Grant closed.
Grant No. 1147
C-ghrelin links metabolism and heart disease?
Dr Christopher Pemberton
The investigators have identified a new peptide secreted from the stomach, called C-Ghrelin. C-Ghrelin is a sibling of a hormone called Ghrelin which stimulates feeding, yet also protects the heart. The work completed suggests that C-Ghrelin may also provide a link between diet-related obesity and cardiovascular disease. The investigators have characterised the biochemical structure of C-Ghrelin and studied its effect on the heart and vasculature. This work suggests C-Ghrelin is cardioprotective in vitro, independent of growth hormone actions. In vivo infusions identified no significant effects of C-Ghrelin upon global cardiovascular haemodynamics, suggesting that haemodynamic/bioactive effects of C-Ghrelin may be localised and tissue specific.
Grant closed.
Grant No. 1148
Ucn-II in heart failure and interactions with existing therapies
Associate Professor Miriam Rademaker
Urocortin 2 (Ucn2) is a new hormone that has been shown to have beneficial actions short-term in heart failure. In this project the effects of long-term administration of Ucn2 were investigated (since responses to prolonged treatment can differ from those of brief exposure), and interactions between Ucn2 and existing heart failure therapies were assessed, given that any new treatment will likely be used in conjunction with established medicines. The findings indicated that chronic Ucn2 administration produced sustained improvements in heart failure status, and that co-treatment with Ucn2 resulted in additional haemodynamic, hormonal and renal benefits in heart failure beyond those achieved by standard therapies alone.
Grant closed.
Grant No. 1149
Improvement of ischaemic cardiac outcomes by carbon monoxide treatment
Dr Ivan Sammut
Both coronary artery disease and cardiac surgical interventions can cause considerable damage to heart tissue by reducing the amount of oxygen reaching the heart. It has been established that following obstruction of a major blood vessel to the heart, the infarct size can be reduced and heart function can be protected by treatment with very low levels of carbon monoxide gas over a sustained period without producing any adverse effects. This protection has been shown to act through several molecular mechanisms which protect the energetic processes within the heart’s cells whilst reduce inflammation and cell death.
Grant closed.
Grant No. 1153
Overseas Training Fellowship
Dr Martin Stiles
This fellowship was undertaken at the Royal Adelaide Hospital and consisted of clinical training in Cardiac Electrophysiology and research on abnormal heart rhythms: Atrial Flutter and Atrial Fibrillation. Patients presenting for catheter treatment of these rhythms consented to additional testing during their procedure, including 3D mapping techniques. This fellowship funded the initial year of a PhD at the University of Adelaide. The PhD thesis has been assessed and accepted without changes. Detailed characterisation of the electrical changes accompanying these abnormal rhythms has been published.
Grant closed.
Grant No. 1155
Research Fellowship
Dr Sarah Molyneux
This fellowship involved exploring some of the many possible ways that coenzyme Q10 (CoQ10), a compound that is essential for energy production and which has antioxidant activity, was involved in heart disease. CoQ10 supplementation is becoming increasingly popular, and may be beneficial for patients with heart failure, or those on statin (cholesterol lowering) therapy ? which lowers CoQ10 as well as cholesterol. It has been found that low plasma CoQ10 concentrations were associated with more deaths in patients with chronic heart failure. This important finding suggests that supplementation with CoQ10 may decrease mortality in this population.
Grant closed.
Grant No. 1156
Research Fellowship
Dr Natasha Rafter
Cardiovascular disease is our leading cause of hospitalisation and premature death. Guidelines recommend people at high risk (e.g. those who have had a heart attack or stroke) receive long-term treatment with aspirin and medication to lower blood pressure and cholesterol. Most New Zealanders do not continue to take these medicines long-term. The IMPACT trial would assess whether a combination pill improved uptake of these medicines compared to standard practice (multiple pills). The PILL pilot trial would show how much the combination pill lowered blood pressure and cholesterol and whether it was well tolerated.
Grant No. 1159
Systemic ventricular remodelling after cardiac surgery in early infancy: pilot study
Dr Tom Gentles
This study aimed to enrol 24 patients and involved MRI study of ventricular mechanics before, immediately after and 10 weeks after neonatal cardiac surgery. Enrolment has been competed in patients with 2 ventricle repair and in patients with a Norwood procedure. Six patients have been recruited in the shunt group. Patients with this procedure have reduced substantially over the past two years. The investigators have begun image analysis and this should be completed in the next few months.
Grant No. 1160
CoQ10 in cardiovascular disease
Dr Sarah Molyneux
This funding was used to explore some of the many ways that coenzyme Q10 (CoQ10), a compound that is essential for energy production in the body and has antioxidant activity, was involved in heart disease. CoQ10 supplementation is becoming increasingly popular, and may benefit patients with heart failure, or those on statin (cholesterol lowering) therapy by eliminating muscle fatigue side effects. It has been found that the most efficient single oral dose of CoQ10 is 200 mg, and that patients with heart failure and low CoQ10 concentrations have more deaths than those with higher CoQ10, therefore supplementation may be warranted.
Grant closed.
Grant No. 1170
Evaluation of Manaaki Manawa, a kaupapa Maori cardiac rehabilitation programme
Ms Leonie Gallaher/ Ms Wendy Henwood
The broad purpose of Manaaki Manawa is to improve the health outcomes for Maori with heart disease within the two participating PHO catchment areas. It aimed to be complementary to, and co-ordinated with, existing Northland Health DHB rehabilitation services. The evaluation of the programme funded partly by the Heart Foundation, demonstrated that the Manaaki Manawa kaupapa was appropriate for the group it was developed for. It was providing a valued choice for Maori needing cardiac rehabilitation. The evaluation highlighted a number of extremely positive aspects of the programme that contributed to health gains for most clients. The programme content could be tailored and responsive to individual needs. The process was conducive to increasing client understanding of their heart condition, management and control. There were four broad linked areas that clients attributed to the programme ? increased confidence and wellbeing, increased knowledge and better understanding of their heart condition, the ability to make some lifestyle changes and support and learning for whanau.
Grant closed.
Grant No. 1199
Genotype and gene expression in heart failure
Dr Anna Pilbrow
Coronary heart disease is the greatest killer in the western world and our genes are estimated to account for up to half of our cardiovascular risk. This study was part of a world-wide effort to understand why heart disease runs in some families. The investigators documented activity levels of all the genes in the human heart, in patients and healthy people, to find the mechanisms by which genetic variants contributed to heart risk. This work aimed to help identify people at risk of heart disease and to allow doctors to determine which treatments would be more suitable for particular heart patients.
Grant closed.
Grant No. 1202
Seasonal patterns of cardiovascular disease in New Zealand
Dr Simon Hales
The investigators analysed information about average seasonal patterns of diseases of the heart and circulation between 1988 and 2004 in New Zealand, in relation to individual characteristics (eg. age, sex, ethnicity, income) and factors in the physical environment, such as the amount of air pollution, housing and weather conditions. In New Zealand, living in a region with high outdoor air pollution or high social deprivation increased the risk of dying from cardiovascular disease in winter. Low income or living in rented accommodation also appeared to increase the risk at the individual level. All of these effects are small, but nevertheless potentially important since the whole population is affected to some degree.
Grant closed.
Grant No. 1203
Renal impairment in decompensated heart failure
Professor A Mark Richards
Impaired kidney junction is common in heart failure. The research assessed methods for rapid detection of kidney disease in acute and chronic heart failure. Biomarkers of kidney injury, using new blood and urine tests, were measured in people with acute heart failure. A urine test (NGAL) detected kidney injury sooner than currently available tests and represented a tool to assess kidney function rapidly ? paving the way for future research to assess specific therapy for kidney protection in heart failure. Magnetic resonance imaging in chronic heart failure provided easily-available integrated assessment of kidney function and was potentially a new method for understanding the causes of kidney failure in this condition.
Grant No. 1204
Nicotine replacement therapy selection box trial
Dr Natalie Walker
Smoking is a major cause of death and disease. Nicotine replacement therapy (NRT) is an effective aid to stopping smoking, however only the patch and gum forms are subsidised. New ways are urgently needed to get more people to use NRT when quitting. This trial will find out whether 1,410 smokers are more likely to quit smoking if they are given more choice over which NRT they use, as opposed to being given no choice. The trial has been recruiting smokers since June 2007 through the national Quitline cessation support service.
Grant No. 1205
Does a high salt diet lead to a rapid deterioration in vascular compliance?
Dr Rob MacGinley
This study examined the impact of salt loading on the blood pressure and blood vessel tone in hypertensive individuals. Following a period on a low salt diet (NHF recommendation 60 mmol/day), individuals received additional salt by way of tomato juice typical of a New Zealand diet (150 mmol/day) or an American diet (250 mmol/day) for four weeks. The low salt diet reduced blood pressure to a normal value, the NZ average dietary salt intake increased blood pressure by 6 mmHg and the American average dietary salt intake increased blood pressure by 8 mmHg. This was associated with an increase in the tone of the blood vessels. This study clearly demonstrated the impact that salt had on blood pressure control. Lowering the dietary intake of salt must be a major part of the management of high blood pressure to reduce the risk of cardiovascular disease.
Grant closed.
Grant No. 1207
Overseas Training Fellowship
Dr Nicolaas van Pelt
Dr van Pelt was a fellow in cardiac imaging at the Erasmus MC in Rotterdam, the Netherlands in 2006-2007. He learned how to perform and interpret a technique known as CT coronary angiography. This uses the latest ultra fast CT scanners to image the coronary arteries in great detail. The Cardiac imaging group at the Erasmus MC have been one of the pioneers of this new technology. The experience and research conducted on this fellowship has allowed Dr van Pelt to use this technology in New Zealand. As a cardiologist at Middlemore Hospital, Auckland, he has set up a cardiac CT programme and is involved in research to further develop this test.
Grant closed.
Grant No. 1208
Overseas Training Fellowship
Dr Madhav Menon
The research year at the Minneapolis Heart Institute and the University of Minnesota programme was conducted in the clinical use of CT coronary angiography which is an evolving technology to image the arteries of the heart without an invasive procedure by using CT scans. Experience was gained in performing and reporting this procedure. Severe angina is a problem in patients who have significant blockages in the coronary arteries who are not candidates for bypass surgery or stent treatment for various reasons. These patients have a poor quality of life. Research work was undertaken in improving quality of life for these patients, using various modalities including STEM cell injections into the heart where it is aimed to grow new vessels and muscles in the heart.
Grant closed.
Grant No. 1210
Research Fellowship
Dr Hannah Badland
There is increasing evidence that sustainable solutions to increasing habitual physical activity and reducing obesity at the population-level may be related to design aspects of the neighbourhood environment. The URBAN (Understanding the Relationship between Activity and Neighbourhoods) Study explores the associations between body size and physical activity engagement in adults and children with built environment variables. Body size and physical activity levels will be measured over neighbourhoods in four New Zealand cities using objective measures and self-report survey methods. Built environment characteristics of study neighbourhoods will be measured using Geographic Information Systems (GIS), observation, and self-report. The study outcomes will directly inform national urban design policy and interventions to sustainably improve health outcomes by supporting population physical activity engagement and reducing obesity. The research is part of an eight-country study.
Grant No.1211
Research Fellowship
Dr Ralph Maddison
This fellowship is comprised of several projects that investigate novel technologies to increase or to better measure physical activity. Projects have investigated novel strategies such as active video games and TV time watching monitors to respectively decrease body mass and increase activity in children. One study investigated the environmental influences on nutrition and activity in children, while a fourth compared three different measures of activity in the general population. The results from the first three studies will provide New Zealand parents, doctors and policy makers with evidence on potentially effective strategies to increase activity in children. Two recent studies will measure the physical activity and nutrition behaviours in a sample of NZ children and young people; and assess wider influences such as the economy and social factors on food, security and physical activity in Maori, Pacific and low-income families. These research projects all have the aim of identifying ways to improve participation in activity and ultimately improving health for all New Zealanders.
Grant No. 1212
Research Fellowship
Dr Jay Ritzema-Carter
Heart failure readmission rates continue to increase despite the increasing number of therapies which improve symptoms and survival. This first-in-man trial assessed the feasibility of a pressure monitoring device that was implanted into the hearts of patients with severe heart failure. Using this device, cardiac pressures were measured by patients at home twice-daily and heart failure medications were adjusted accordingly. Adjustment of medication dosing in this way was safe and feasible and has been associated with reduction in heart failure related hospital admissions in this group. Data analysis has been completed and it is hoped that the results will be published later this year.
Grant closed.
Grant No. 1213
Postgraduate Scholarship
Ms Katrina Poppe
Type 2 diabetes increases the risk of cardiovascular disease and can cause changes in the heart muscle itself which adversely affects the way the heart contracts and relaxes. The aim of this research is to develop equations specifically for diabetics that can be used to estimate their individual level of cardiovascular risk. Different equations will be developed for different situations depending on the level of information available. For instance, the information available to a GP is different to that which is available to a Cardiologist after specialist tests. The earlier a person is identified at being of increased risk, the greater the chance that risk can be reduced.
Grant No. 1214
Postgraduate Scholarship
Mr Christopher Booker
Inflammation is part of the body’s natural immune response to infection, but in obesity, diabetes and heart disease, this response is chronically overactive and may be a causative link between these three diseases. This research will examine the effect of a recommended diet on levels of inflammation in people with diabetes. In addition, it will examine the actions of one particular inflammatory factor called interleukin-18 on pathways in the brain which influence appetite, body weight, and blood glucose control. Previous studies suggest this inflammatory factor may contribute to the development of heart disease.
Grant No. 1216
Postgraduate Scholarship
Ms Katrina Ellis
In addition to the much reported ‘lifestyle’ risk factors for heart disease, such as smoking and obesity, up to half of the risk of developing heart disease is inherited. Genetic factors play an important role in the progression of coronary artery disease. This project is studying gene variants from pathways involved in blood pressure regulation and lipid metabolism to identify those associated with outcome in coronary disease patients recruited from Christchurch and Auckland Hospitals. Identifying genes that influence disease susceptibility and the ability to recover after a coronary event may provide significant improvements in patient management and care.
Grant No. 1217
Postgraduate Scholarship
Ms Shirin Foroughian
Obesity is a rapidly escalating, worldwide epidemic, which rates among the top 10 causes of the global burden of ill health. Whilst the topic of obesity has been widely studied, there have been few studies undertaken on Asian adolescents. The aim of this research is to investigate the nutritional and exercise behaviours of young New Zealand Asians that are likely to affect their weight and the factors influencing these behaviours. The study sample is adolescents aged 13-17 years who were interviewed at their schools where they answered a questionnaire about their lifestyle behaviour patterns and measurements were done to determine their weight status, followed by some participating in one of the 12 focus groups. The data shows that Asian adolescents are not less likely to be overweight/obese than European adolescents, and have poorer health knowledge. Family and friends, media and advertisements, food availability, convenience, money, and knowledge all play a major role in Asian adolescents’ eating patterns and exercise habits. Problematic nutritional behaviour and incorrect knowledge, in addition to exposure and contact with New Zealand’s ‘obesogenic’ environment, can lead to weight concerns and its related health issues later on in their lives. The population in this study welcomes support from the government, school, and family to help tackle the issue. These measures include the monitoring of the media and school canteens, offering enjoyable and interactive educational health and nutrition programmes and activities at schools, and involvement of the family.
Grant No. 1218
Postgraduate Scholarship
Mr Hamish Prosser
The enzyme ACE1 converts the inactive hormone Angiotensin 1 to active Angiotensin 11 Ang. (Ang11), Ang11 elevates blood pressure to homeostatic levels in healthy persons. Cardiac disease can elevate Ang11 levels, resulting in chronic high blood pressure. Pharmaceutical agents designed to combat this all target ACE1, reducing its activity, minimising Ang11 generation. It has been shown that a newly identified hormone ‘PA12’, with similar attributes to Angiotensin É can produce Ang11 independent of ACE1 activity, instead using an alternate enzyme called Chymase. This finding may provide alternate targets in the battle to reduce blood pressure in those suffering high blood pressure.
Grant No. 1221
Sex steroids and secretion of vasoactive peptides
Associate Professor John Evans
It is known that males and females are differently at risk of cardiovascular disease. The risks change with age in a manner that seems to parallel the levels of sex steroids. It was demonstrated that the sex steroids may affect peptides that are in the inner lining of bloods vessels. The peptides seem to be part of a complex network that is co-ordinated so that some peptides will respond while others do not to particular conditions. By obtaining information on which compounds were stimulated in a given circumstance, treatments of vascular disease and prevention strategies may be developed.
Grant closed.
Grant No. 1234
Fatty acids, lipids and sensory properties of hazelnuts (The FLASH Study)
Dr Alexandra Chisholm
In a study carried out at Otago University, NZ grown hazelnuts were tested for their acceptability and effect on blood cholesterol. Twenty eight women and 20 men aged from 25 to 64 years, and with a mean total cholesterol level of 5.86 mmol/L took part in the study. Ground, sliced and whole hazelnuts were tested over three periods of four weeks. Participants were asked to eat 30 gm hazelnuts on five days each week. All forms reduced total cholesterol and LDL (‘bad’) cholesterol, and increased HDL (‘good’) cholesterol without causing any increase in the participants’ weight or BMI. The participants also enjoyed eating hazelnuts regularly thus these nuts could contribute to cardiovascular health.
Grant closed.
Grant No. 1237
Pilot study to develop a new clinical test to measure insulin sensitivity
Dr Kirsten McAuley
Insulin resistance is a major risk factor for type 2 diabetes, heart disease and perhaps many other diseases. Currently only crude measures are available to estimate insulin sensitivity in the general population. Only very sensitive, very complicated tests are available for use in small research trials. This project aimed to develop methodology for a new 30 minute test to measure insulin sensitivity, which could be used in large research trials and in general clinical practice. Now that this has been successfully completed the investigators are currently validating the new test against the gold standard measures.
Grant closed.
Grant No. 1239
Streptokinase antibodies in rural New Zealand populations
Dr Garry Nixon
Streptokinase, because of its ability to dissolve clots (fibrinolysis), is a widely used treatment for patients who are having a heart attack. It is not uncommon for people to have high antibody levels to streptokinase, on the basis of previous streptococcal infections. Maori are known to have high levels of these infections. This study has confirmed that cardiac patients in a predominantly Maori rural community have significantly higher anti-Streptokinase antibody levels than do patients in a predominantly NZ European rural community. It may be better to use an alternative fibrinolytic agent in predominantly Maori rural communities.
Grant closed.
Grant No. 1248
A randomised trial to improve patient understanding of cardiac risk
Dr Elizabeth Broadbent
This trial investigates whether a nurse can help heart attack patients to understand their cardiac risk better by using the information generated by the Predict risk management programme. Patients were randomised to either receive the Predict information or not and were followed up immediately and at 3-months to assess understanding and health behaviours.
Grant No. 1249
Reaching advanced age: older hearts and health
Associate Professor Ngaire Kerse
This project aims to determine inflammatory markers, body composition, lipid profile, physical activity, nutritional status, and cardiac function in elderly subjects; and to determine the association of these parameters to past cardiovascular events. The research began in 2007 and is now nearing completion having enrolled 70 people aged 85 years and 33 people of 75-79 years (Maori) to undertake comprehensive cardiac assessments, including cardiac history, cardiac imaging, body composition and blood tests. The data collection phase is finished and the study is currently engaged in data entry and analysis.
Grant No. 1251
In vitro triethylenetetramine metabolism in cytosol of liver and heart of humans and rats
Dr Jun Lu
The aim of this project was to understand the metabolism of triethylenetetramine, a drug used for the treatment of diabetic heart failure, in rat and human. The investigators have successfully carried out proposed experiments and are in the process of collecting and analysing data. New methods for drug analysis were developed and published in a prestigious scientific journal. Data analysis is being completed and the findings will be submitted for publication in a few months. The funds supplied by the National Heart Foundation enabled the purchase of much needed reagents, and that support was instrumental for the success of this project.
Grant closed.
Grant No. 1252
Individual patient meta-analysis of restrictive diastolic filling in patients with heart failure and post myocardial infarction sub-analyses
Dr Gillian Whalley
Patients with chronic heart failure and those suffering heart attacks are at higher risk of death. We know that if the heart is not pumping effectively, the risk of death is much higher. However, the relaxation of the heart after each pumping action may be equally important ? patients with very poor relaxation have very high rates of death. Previously, it was unclear whether poor heart relaxation itself was a bad sign or whether it simply leads to poor pump function or occurs in the presence of other risk factors and symptoms, such as diabetes and breathlessness. Many studies have tried to answer this, but many have had too few patients to answer this question clearly. The investigators formed a collaborative group to bring together data on 7000 patients previously collected in 30 different studies from 16 countries to determine the role of ultrasound assessment of the heart’s relaxation in terms of predicting death. This has allowed the investigators to clearly demonstrate that not only is the relaxation important in predicting outcome, it may be more important than pump action.
Grant closed.
Grant Nos. 1253 and 1276
Prevalence of rheumatic heart disease in South Auckland children
Dr Nigel Wilson
Screening in schools was completed at the end of August 2008. 1142 students attending 7 different schools in Counties Manukau underwent cardiac auscultation and echocardiography. 93 children were identified with changes suspicious for rheumatic heart disease on their screening echocardiogram and were referred for assessment at Starship Children’s Heart Clinic. Interim analysis indicated the prevalence of rheumatic heart disease in the study population was approximately 20-25 per 1000. 6-12 month follow-up assessments will be completed on students found to have “possible” RHD during their initial SSH assessments. In 2009, screening is planned in a low risk group of children in order to assess the prevalence of pathologic mitral regurgitation and morphologic valve changes in this group.
Grant closed.
Grant No. 1269
Inhibition of cardiac sympathetic nerve activity: novel therapies post-MI
Dr Chris Charles
Nerve activity going to the heart is of major importance in the control of heart function and is likely to be involved in the cause of heart failure and sudden death from heart attacks. The objectives of this project are to (1) assess changes in this nerve activity in response to commonly prescribed â-blockers both before and following a heart attack; (2) to assess the therapeutic potential of agents which inhibit nerve activity immediately after a heart attack; and (3) to measure interaction of novel hormones with this nerve activity. This project is likely to produce important and unique information likely to improve our understanding of this important aspect of heart function. Such insight has the potential to lead to new or improved treatments for these common, often devastating disorders.
Grant No. 1271
Determinants of obesity and cardiovascular risk factors at 11 years of age
Professor Ed Mitchell
The Auckland Birthweight Collaborative study is investigating factors including diet, and physical activity in childhood and how these factors are related to children becoming overweight and obese as they grow up. The study is also looking at how such factors affect the cardiovascular health of these children. The investigators have now collected data on these children at birth, 1, 3.5, 7 and 11 years of age and are therefore able to track how these factors and changes in lifestyle might affect children as they grow up both in terms of their physical size and body make up, and risk of them developing disease as they grow older.
Grant No. 1272
Genotype and gene expression in heart failure using Affymetrix technology
Dr Anna Pilbrow
Coronary heart disease is the greatest killer in the western world and our genes are estimated to account for up to half of our cardiovascular risk. This study was part of a world-wide effort to understand why heart disease runs in some families. Activity levels of all the genes in the human heart, in patients and healthy people, have been documented to find the mechanisms by which genetic variants contribute to heart risk. This work aimed to help identify people at risk of heart disease and to allow doctors to determine which treatments were more suitable for particular heart patients.
Grant closed.
Grant No. 1273
The Maori Community Heart Study ? Non-Maori Cohort
Ms Suzanne Pitama
There is a major disparity in heart disease mortality between Maori and non-Maori, but how many Maori are living with cardiovascular disease in the community is not well documented. The study is documenting current levels of established heart disease, levels of previously-undiagnosed diabetes, cardiovascular disease and risk factors in a rural Maori community at Wairoa (Hawkes Bay), and urban Maori in Christchurch, as well as evaluating the implementation of treatment programmes, interventions, and outcomes for study participants. The current project is documenting cardiovascular disease and risk factors in a non-Maori comparator group, matched to the Christchurch Maori cohort.
Grant No. 1274
Regional secretion and clearance of novel peptides in health and heart disease
Professor A Mark Richards
Numerous small proteins (peptides) are important measures of cardiac health. Blood levels represent biomarkers of cardiac function, yet sources of peptide release and removal are poorly understood. The study confirmed that natriuretic peptides are produced by the heart and that removal from the circulation occurs in multiple different tissues suggesting a common but as yet unknown clearance mechanism. The study demonstrates for the first time that newly discovered peptides (BNP signal peptide and other related signal peptides) are released by heart tissue confirming their potential as new markers of cardiac injury.
Grant No. 1275
Promoting healthy childhood nutrition through primary schools: a study of barriers, supports, and effective policy options
Dr Louise Signal
Primary schools are seen as key sites to promote healthy nutrition practices to students, and as a result, are being required by government to make changes to the food available in school and how foods are promoted. Through working with five case study schools, a number of barriers to promoting healthy nutrition practices have been identified. Common to all schools is the limited influence schools have on childrens’ food preferences and diets. Different barriers are faced by schools located in more or less economically deprived neighbourhoods, such as requirements to fundraise or involvement of parents.
Grant No. 1278
Overseas Training & Research Fellowship (White-Parsons)
Dr Judith MacCormick
This Fellowship is based at the Children’s Hospital Boston, Massachusetts. The fellowship programme offers many structured teaching sessions with immense learning opportunities. On the cardiac ward, the fellow is responsible for care of the cardiology inpatients under the medical and cardiac transplant services. Time has been spent in the cardiac catheter laboratory with training in diagnostic and interventional skills. Dr MacCormick is undertaking a study to assess prognostic echocardiographic factors in newborn babies with congenital diaphragmatic hernia. The planned research project is a retrospective view to assess whether newborn echocardiographic features, such as the left ventricular volume, can help with predicting outcomes in these children.
Grant No. 1279
Research Fellowship
Dr Jade Hollis-Moffatt
This collaborative study, between the University of Otago and Ngati Porou Hauora, will advance knowledge on the underlying genetic cause(s) of gout. Gout mainly affects Maori (10%) and Pacific (15%) men. Gout is caused by high levels of serum uric acid (hyperuricaemia), which is also an independent risk factor for cardiovascular disease (CVD) and hypertension (HT). To date, recruitment of a clinical cohort has been established and genetic variants within one urate transport gene that contribute significantly to the development of gout in Maori and Pacific New Zealanders has been identified.
Grant No. 1280
Research Fellowship
Dr Melody Oliver
Almost a third of New Zealand children are overweight or obese. Physical activity is fundamental to obesity prevention and treatment in children, and may be strongly influenced by the physical and social environments that children are exposed to. Greater understanding of these environmental influences on activity behaviours and obesity is required to develop effective solutions to reverse obesity and insufficient physical activity levels in children. The focus of this research is thus to objectively assess physical activity in New Zealand children, and to identify factors within children’s built and social environmental contexts that are related to activity behaviours and body size.
Grant No. 1282
Research Fellowship
Ms Nicola Scott
The metabolic syndrome is a risk factor for developing diabetes and heart disease. The syndrome is characterised by increased body weight, high blood pressure, abnormal cholesterol levels and insulin resistance. The number of people being diagnosed with the metabolic syndrome every year is increasing and although it is a very common disorder, little is known about how it develops or why it increases the chance of developing other diseases. A novel model has been developed that mimics human metabolic syndrome by crossing two mouse strains, each carrying some of the characteristics of the syndrome. This will allow further understanding of this disorder.
Grant No. 1284
Research Fellowship
Dr Shieak Tzeng
Impaired neural regulation of cardiac function and blood pressure is a major risk factor for sudden death from established cardiovascular disease. The current fellowship consists of several projects investigating the fundamental relationships between respiratory activity and cardiovascular control, with a special focus on determining whether interventions directed at reducing breathing rate enhances cardiovascular regulation. Results from these ongoing projects will guide the development of respiratory pattern training as a non-invasive adjunct in the management of cardiovascular disease.
Grant No. 1285
Postgraduate Scholarship
Ms Helen Eyles
Unhealthy diet plays a role in approximately 11,000 deaths in New Zealand each year, and healthier diets are important in preventing common diseases such as heart disease, stroke and diabetes. Information and knowledge are important in improving dietary habits, and automated, tailored nutrition education is a promising strategy for providing relevant, personalised nutrition advice to large numbers of individuals. The Supermarket Healthy Options Project (SHOP) is a large trial assessing tailored nutrition education and price discounts for the promotion of healthier supermarket food purchases. Funding from the National Heart Foundation is being used to support PhD research within the framework of the SHOP trial, including the following specific objectives: (1) a systematic review of the long-term effect of tailored nutrition education; (2) assessment of whether household supermarket sales data is a good proxy measure of individual food consumption; (3) an examination of the association of ethnicity and income with supermarket food and nutrient purchases; and (4) an examination of nutrient profiling systems currently used to categorise foods in New Zealand. Objectives (1) and (2) have been completed, and objectives (3) and (4) are underway.
Grant No. 1287
Can an antioxidant targeted to mitochondria inhibit lesion development and proinflammatory signalling in a mouse model of atherosclerosis?
Ms Elizabeth Ledgerwood
Antioxidants are widely touted as being able to prevent heart disease, however clinical testing of antioxidants such as Vitamin E has had disappointing results. This may be because the antioxidant is not in the right place within cells. MitoE is a new version of Vitamin E that is ‘targeted’ to the major site of oxidant (free radical) production within cells. It is hoped that MitoE will effectively block steps necessary for the development of heart disease. The investigators have undertaken a pilot study in mice that are susceptible to heart disease, and are currently analysing the results of the study to determine if their hypothesis is correct.
Grant No. 1289
Establishing a mouse model of the human metabolic syndrome
Ms Nicola Scott
The metabolic syndrome is a risk factor for developing diabetes and heart disease. The syndrome is characterised by increased body weight, high blood pressure, abnormal cholesterol levels and insulin resistance. The number of people being diagnosed with the metabolic syndrome every year is increasing and although it is a very common disorder, little is known about how it develops or why it increases the chance of developing other diseases. A novel model has been developed that mimics human metabolic syndrome by crossing two mouse strains, each carrying some of the characteristics of the syndrome. This will allow further understanding of this disorder.
Grant closed.
Grant No. 1290
Awareness of cardiovascular disease risk factors among adult New Zealanders
Professor David Thomas
Cardiovascular disease (CVD) is New Zealand’s biggest killer. Effective community-based educational and preventive programmes rely on accurate assessment of the current levels of knowledge about CVD risk factors and warning signs and symptoms in a population. In addition, periodic measurement of knowledge of CVD risk factors is needed to assess the impact of CVD educational campaigns over time. However, no assessment of knowledge about CVD risk factors and warning signs and symptoms among population groups has yet been reported for New Zealand. This study aimed to complete the first step in filling this knowledge gap. A review of the literature on surveys relating to knowledge about heart disease and stroke was conducted. Subsequently a questionnaire was developed measuring knowledge and awareness about CVD. The survey questionnaire was pilot tested as a telephone survey. The results of the pilot testing indicated that only minor modifications to the survey were required prior to its being used on a national level. There was no evidence of ethnic differences in item acceptability or comprehension. Piloting the survey allowed information to be obtained on likely hit rates when using the telephone survey methodology which has informed plans to conduct the survey on a national level.
Grant closed.
Grant No. 1298
Maori CV Research Fellowship
Ms Amy Norman
This project investigates the influence of maternal nutrition during pregnancy on the development of obesity in the offspring. A nutrient poor environment during development has been shown to make the offspring susceptible to obesity and metabolic disorders in adulthood. Metabolic flexibility describes the ability to match energy fuels to energy demands and the primary aim of this research is to investigate how this is established from birth. The composition of skeletal muscle is assessed in order to understand the influence of developmental nutrition on exercise capacity later in life. In addition, the pathways of insulin sensitivity in these prenatally-induced obese offspring is investigated.
Grant No. 1299
Moving through the built environment: where, how and why
Dr Hannah Badland
The built environment is increasingly being linked to overall physical activity engagement and population health outcomes. Despite this growing focus, much of this research has been based on subjective self-report measures. This study sought to overcome this by using objective measures of the built environment (geographical information systems (GIS)), travel behaviours (global positioning systems (GPS)), and physical activity engagement (accelerometers) in the adult population. Specifically, the pilot study determined: strengths and limitations of using GPS in population health research, where, when, and how adults accumulated physical activity, provided further evidence of the relationship between commute distance, transport mode(s), and commute time, and examined the objective associations between physical activity, travel behaviours, and the built environment. Findings from this study will likely influence future practice in this field.
Grant closed.
Grant No. 1300
Different ways of expressing cardiovascular treatment benefits
Associate Professor Felicity Goodyear-Smith
The way information is expressed influences patients’ decisions about their health care. 1000 patients whose cardiovascular disease (CVD) risk is assessed complete questionnaires tailored to their individual risk asking their preferences for different formats of risk expression (relative risk, absolute risk, odds, numbers needed to treat, natural frequencies); numerical versus pictorial formats and whether the doctor or patients should make management decisions. Information on patients’ age, gender, education, ethnicity and numeracy ability is collected. This study should assist health professionals better explain benefits and risks in CVD and other health-related situations, in a helpful and meaningful manner for patients.
Grant No. 1301
An MRI compatible exercise ergometer
Associate Professor Paul Hofman
The funding generously donated by the Heart Foundation has enabled the research group to build an exercise machine that can be used in an MRI. Because of the large magnetic field in an MRI scanner this has to be made out of materials not affected by magnetic fields. The exercise also has to be lying down and not cause movement of the chest (which would blur the heart images). A cycling machine has been successfully developed in collaboration with the Bioengineering Institute. This will help in uncovering heart abnormalities that are exacerbated by exercise or only observed at higher heart rate.
Grant closed.
Grant No. 1302
Understanding clinician and consumer perspectives of obesity: expanding knowledge of the causation and treatment of obesity
Professor Doug Sellman
Given the qualitative nature of this study, the small sample size and the restricted professional and consumer groups consulted, the findings of this study cannot be applied to all people with obesity or all clinicians treating obesity. The findings do, however, provide a unique insight into a range of ‘experts’ thoughts about obesity. This has been useful to increase understanding about the phenomenological aspects of obesity that have been missing from the existing literature. Such information is useful in highlighting ways for obesity treatment. In particular, findings from this study, in conjunction with the existing literature, support the need to further explore the role addiction may play in overweight and obesity. There is sufficient evidence to suggest that aspects of addiction models of treatment may be useful in assisting at least some people with obesity.
Grant closed.
Grant No. 1303
Feasibility of an intervention to decrease television watching in children
Ms Enid Dorey
A study of an intervention to decrease TV watching in children was conducted by the Clinical Trials Research Unit (University of Auckland). A Grant-in-aid from the National Heart Foundation contributed to equipment and focus group costs for the study. Focus groups with parents identified several barriers to reducing children’s TV watching. A pilot study examining the effectiveness of electronic TV time restriction monitors to reduce TV viewing found no differences between those who received a monitor and those who did not for TV viewing hours. Future research needs to address the barriers identified and focus on multi-component family based interventions to reduce TV viewing.
Grant closed.
Grant No. 1307
Markers of pulmonary artery hypertension
Dr Adrienne Edwards
Pulmonary arterial hypertension (PAH) is a rare condition caused by high blood pressure in the arteries running from the heart to the lungs. Increases in blood pressure puts strain on the heart, and eventually cause the right side to stop working. Although modern therapies improve symptoms and outcomes there is still no cure for PAH which is devastating in this young patient group. This study aims to identify protein markers in the blood of participants with PAH. This will lead to a better understanding of PAH which may lead to earlier diagnosis and curative treatments.
Grant No. 1308
Characteristics of induced and spontaneous ventricular fibrillation during myocardial ischaemia
Dr Nigel Lever
Ventricular fibrillation (VF) is the most common mechanism of sudden cardiac death but the mechanisms that trigger and maintain VF remain unclear. The majority of early deaths from myocardial infarction are due to VF often occurring in the pre-hospital phase but many deaths from late effects of infarction or other cardiomyopathies are also due to VF. The aim of this project is to determine whether VF during ischaemic events is fundamentally different from events induced electrically in an animal infarct model and to determine whether there is a relationship between VF characteristics and defibrillation thresholds. Experimental work on this project has commenced with four studies undertaken so far. The remainder of the experiments will be completed during 2009. The analysis and interpretation will follow.
Grant No. 1309
CoQ10: Potential to reduce cardiovascular risk ? extension study
Ms Joanna Young
Coenzyme Q10 (CoQ10) is an increasingly used complementary medicine for prevention of heart attack and stroke. Statins are indicated for people with cholesterol disorders to reduce cardiovascular events. Reductions in CoQ10 in statin-treated subjects have been associated with improvements in vascular function. The investigators will examine if CoQ10 supplementation in statin-treated subjects further improves vascular function, giving additional benefit to CVD reduction. Fourteen percent of statin-treated subjects cannot tolerate an appropriate dose of statin therapy due to muscle aches, facilitating the selection of optimal drug therapy.
Grant No. 1335
Revco -80 C Freezer for archiving clinical study examples
Associate Professor Vicky Cameron
A grant was received from the National Heart Foundation for an ultra-cold freezer for archiving blood samples for on-going research into heart disease. New ways are being investigated of improving diagnosis, monitoring and treatment for both the onset and progression of heart disease, studying hospital patients with coronary heart disease compared with a group of heart-healthy people from the community. Blood samples collected from the study need to be stored at ultra-cold temperatures prior to measuring markers of cardiovascular disease risk and progression. The purchase of this freezer will allow the safeguarding of this valuable resource.
Grant closed.
