UNSW held its inaugural Cardiovascular Symposium on 5 April 2022 to launch the newly established Cardiac, Vascular and Metabolic Medicine (CVMM) Research Theme. Several researchers from The George Institute presented at the Symposium, with PhD Candidate Jeffrey Ha receiving a runner-up award for his presentation on medications to prevent stroke in adults with atrial fibrillation and reduced kidney function.

Dr Jeffrey Ha is a clinician-researcher and the focus of his research at The George Institute has been investigating the role of blood thinning medications to address the high burden of cardiovascular disease in patients with poor kidney function.

“Patients with moderate to advanced kidney disease are at a much higher risk for heart disease and stroke and have been largely excluded from clinical trials with limited treatment options. Through a large international cohort study, we are providing more evidence to support effective and safe treatment options to prevent stroke in this high-risk population with atrial fibrillation and chronic kidney disease.”

Professor Alta Schutte, Professorial Fellow at The George Institute, leads the CVMM Theme at UNSW. At the Symposium, she introduced the Theme and talked about why it was a critically important focus for the nation’s health.

“Heart disease, stroke and diabetes remain the leading causes of death in Australia and account for the greatest healthcare costs. The Theme covers the spectrum of discovery research to implementation science, covering also primary health care, population health, intensive and critical care, big data in health and clinical trials.”

Prof Schutte, who has served as the President of the International Society of Hypertension, is a leading global researcher in hypertension and cardiovascular health. She has been the Chief Investigator of several multidisciplinary studies and is involved in numerous international consortia, such as the Global Burden of Disease study, the NCD Risk Factor Collaboration, the May Measurement Month initiative of the International Society of Hypertension, World Health Organization Blood Pressure Device working groups and the Lancet Commission on Hypertension.

In her latest publications, she has joined leading experts in Australia in calling for urgent action to tackle high blood pressure in Australia to achieve better cardiovascular, and related health outcomes.

“Globally, raised blood pressure is the leading risk factor for major adverse outcomes such as coronary heart disease, stroke and dementia. Given these conditions are the top three killers of Australians, raised blood pressure should be front and centre of the national health agenda.”

Under her guidance, the CVMM Theme and Steering Committee brings together expertise across Schools, affiliated Medical Research Institutes, allied Hospitals and Local Health Districts. It positions the faculty and researchers across the Institute as innovative leaders in this domain, both nationally and internationally. The George Institute has made significant contributions to this program of work through its ground-breaking research in blood pressure lowering therapies and novel treatments for diabetes. Other researchers from the Institute who presented their work at the Symposium include Assoc Prof Clare Arnott, Assoc Prof Sunil Badve, Prof Clara Chow, Prof Bruce Neal, Dr Cheryl Carcel and Dr Brendon Neuen.

This year discussions covered basic to clinical science, with talks ranging from genetics and imaging in new cardiometabolic therapies, to a polypill blood pressure control trial to congenital heart disease.

An annual event that will feature prominently on the UNSW calendar, the Symposium will showcase new networking opportunities and research covering a cross-section of fields under the overall Theme in response to broad interest from across the research network.

Dapagliflozin in advanced chronic kidney disease and kidney failure: The RENAL LIFECYCLE trial

A team of researchers from The George Institute for Global Health have been awarded over $2.2 million to conduct a new trial to see if a drug used to treat diabetes can improve outcomes for people with advanced stages of kidney disease.

Currently, almost 27,000 Australians are living with kidney failure with nearly 14,000 receiving dialysis and 12,800 living with a kidney transplant. Death rates are high in patients with advanced chronic kidney disease (CKD) and in those that have progressed to kidney failure and need dialysis or transplantation, and treatment options are limited. Kidney failure rates are also high in patients with advanced stages of CKD and in those living with a kidney transplant.

A class of drugs called SGLT2 inhibitors have already been shown to improve heart, circulatory and kidney outcomes in patients with mild and moderate stages of chronic kidney disease (CKD), but they haven’t been studied in people who are in the advanced stages of the disease or in kidney failure.

The new international trial will evaluate whether the SGLT2 inhibitor dapagliflozin can also reduce risk of death, heart failure and kidney failure in people with advanced stages of the disease or in kidney failure. The Australian arm of this trial will be led by Professor Sunil Badve and Associate Professor Clare Arnott. In this world-first study, the Australian team will also study the effect of dapagliflozin on structural abnormalities of heart and if this in turn contributes to their cardiovascular benefits in people with advanced kidney disease and kidney failure.

Australia to join large multicentre Enhanced Control of Hypertension and Thrombectomy Stroke Study (ENCHANTED-MT) being conducted in China

Professor Craig Anderson, Director of Global Brain Health at The George Institute and Professor of Neurology and Epidemiology in the Faculty of Medicine at UNSW Sydney will receive just over $2m to help improve outcomes for people who have experienced an ischaemic stroke.

Mechanical removal of clots blocking large blood vessels to restore blood flow to the affected area of the brain has become standard treatment for acute ischaemic stroke. Despite this, many patients still have a poor outcome.

Blood pressure (BP) is a powerful predictor of how well patients do, but there is uncertainty around what the ideal level should be during and after this procedure, known as mechanical thrombectomy (MT). Recommendations in current treatment guidelines are not based on strong evidence and there are variations on how this is managed in clinical practice.

The George Institute established the Enhanced Control of Hypertension and Thrombectomy Stroke Study in China to compare more- or less-intensive blood pressure management on outcomes for patients after successful MT. The MRFF funding will now allow Prof Anderson and his team to enrol and conduct brain imaging analysis on 400 Australian patients as part of the larger trial.

Over 50,000 Australians are living with the effects of stroke, resulting in over $6 million in direct health care costs and $26 billion in indirect costs through loss of life and suffering.

It is estimated that over 2000 patients undergo the MT procedure at 18 hospitals across the country each year. The researchers estimate that this funding has the potential to improve the function and wellbeing of at least 150 of these patients each year, as well as many hundreds of thousands elsewhere in the world, reduce the burden on health systems, community care, and society.