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CVCD Alliance

Official Title

Cardiac, Vascular, and Cognitive Dysfunction Cohort Alliance

Status

Ongoing

Overview

Cardiac, vascular, and cognitive dysfunction have a strong impact on the quality of life, longevity and health care costs, in Canada and globally. It is of paramount importance to understand the early determinants of such dysfunction and its progression to clinical events, especially given the increasing prevalence of known cardiovascular (CV) risk factors, which result in organ dysfunction including atrial fibrillation, congestive heart failure and dementia, threatening the financial sustainability of health care systems. Furthermore, two important knowledge gaps remain: First, the “causes of the causes”, specifically the influence of contextual factors such as environmental conditions on risk factors are not well understood. Their precise characterization in communities across Canada will aid policy development and inform population health interventions aimed at reducing the risk for cardiac, vascular and cognitive dysfunction. Second, there is a lack of sensitive predictors and markers for early, subclinical stages on a systematic (blood) or regional (tissue) level.

The Canadian Parternership Against Cancer (CPAC) has requested proposals to build in cardiovascular phenoytping into their 5 Canadian Partnership for Tomorrow Project (CPTP) cohorts from British Columbia, Alberta, Ontario, Quebec and Atlantic Canada (NS, NB, NFLD, PEI). Our research team “the Canadian CVCD Cohort Alliance” has proposed to build on the existing strengths of and closely collaborate with and leveraging established Canadian cohorts, i.e. the Canadian Longitudinal Study on Aging (CLSA), the Prospective Urban Rural Evaluation (PURE), and the Montreal Heart Institute (MHI) Biobank, and to additionally recruit 2,000 Reserve-based Aboriginal people from across Canada who are a high-risk group for CVD and cancer.

The objectives of the CVCD Alliance are:

  • To understand the role of socio-environmental and health system contextual factors (societal structure, built environment, nutrition environment, tobacco environment, access to and quality of health services) on individual CV risk factors, subclinical vascular disease, and clinical CV events.
  • To identify early markers for sub-clinical dysfunction in the brain, heart and abdomen using magnetic resonance imaging, and to investigate the contextual and individual level determinants (i.e. biologic factors such as genetic and molecular signatures) of this dysfunction, as well as to assess the predictive value of sub-clinical dysfunction on the development of clinical CV events.

Study Design

Prospective cohort study which includes men and women aged 35-69 years who will be recruited from all participating cohorts, as described above. Number of participants to be included from each existing cohort will be based on the population variability in location (communities from which the participants being recruited) and ethnicity, and the number of participants with completed clinical assessment including physical measures.

Primary Endpoint

Baseline assessment: After completing informed consent, detailed information on individuals’ cancer and cardiovascular risk factors will be obtained using questionnaire and where required, physical measures and biological samples. This includes blood pressure, anthropometrics, lipids, diabetes assessment, health behaviors’ including dietary assessment, physical fitness and smoking, social factors, mental health assessment, and measures of cognitive function, plus biologics (including DNA, urine and serum blood samples).

MRI Scan at Baseline: In a standardized, comprehensive and cost-efficient multi-parametric MRI scan will be attempted in all subjects. This includes the brain (ischemic white matter disease, covert strokes, cerebral atrophy and cerebral connectivity), heart (morphology, volumes and mass, global and regional wall motion, pericardial fat, covert myocardial infarction, non-ischemic fibrosis, infiltration, perfusion and oxygenation), blood vessels (plaque volume) and abdomen (visceral adipose tissue and liver fat). The proposed MRI protocol that combines several techniques in a single scan is efficient and tolerable.

Follow-up Assessment: We plan to follow-up all participants prospectively every 3 years by conducting a face-to-face visit. In the interim, contact will be maintained by telephone, email, and the internet. We will also seek permission to collect health card numbers to enable record linkage with the health outcomes databases in the province of origin.

Number of Patients

9700

Number of Countries

1

Study Period

2013–2018

Principal Investigator

Sonia Anand

Program Manager

Dipika Desai

Collaborators

Canadian Partnerships Against Cancer; Heart and Stroke Foundation of Canada