Combating the ace of spades

Money in the right places

One British adult dies of heart disease every four minutes. That's a grim statistic. And the sad thing is that many of those deaths could be prevented. Cardiovascular research units in many of Scotland's universities are committed to changing the future with generous help from powerful medical foundations and trusts.

The University of Glasgow was supported by the British Heart Foundation to the tune of £5 million to build the BHF Glasgow Cardiovascular Research Centre which provides a state-of-the-art experimental and clinical facility to further vital research into the disease.

The University of Dundee's Institute of Cardiovascular Research (TICR) is part of a centre of excellence at the city's Ninewells Hospital. A massive grant from the London-based Wolfson Foundation added to a generous donation from Dundee's Leng Trust to establish the institute. Six groups were brought together in one research facility: the Peripheral Vascular Diseases Research Unit; the Cardiovascular Epidemiology Unit; the Centre for Public Health Nutrition Research; the Department of Clinical Pharmacology; Molecular Cardiovascular Biomedical Research; and the Angiogenesis and Tissue Repair Unit.

Cardiovascular biology

Over the last ten years cardiovascular biology has emerged as a major research strength within the University of Edinburgh. This spans gene manipulation, cell and molecular biology, integrative biology and clinical research. The university has a track record of establishing successful interdisciplinary centres for research in the biomedical sciences and in 1995 the Faculty of Medicine indicated its intention to create a Centre for Research in Cardiovascular Biology as a major new interdisciplinary centre. The first step is a major new research initiative funded by the Wellcome Trust the Edinburgh Cardiovascular Research Initiative (CVRI) which has provided an unprecedented opportunity to focus on key aspects of the pathogenesis of cardiac and vascular diseases by way of both local and international collaborations. The Edinburgh CVRI is comprised of five main research groups: Endothelial Cell and Molecular Cardiology, Molecular Physiology, Inflammation Research, Vascular Injury and Molecular Endocrinology.

A collaborative analysis of high blood pressure

Collaborative programmes offer the chance of a broad range of exceptional minds working on a common problem and the Wellcome Trust is behind another innovative project involving two Scottish universities Glasgow and Edinburgh. This is the Functional Genomics Development Initiative, to which the Wellcome Trust has put £5.4 million.

High blood pressure affects 25% of adults in western societies and is the major cause of heart attacks, strokes and kidney failures. It is genetically determined and elucidation of the causative genes and biological mechanisms responsible for high blood pressure will have a profound bearing on new methods of detection, prevention and treatment of common diseases of the heart and blood vessels.

The project partners outwith Scotland are Oxford, Leicester and Maastricht Universities and Imperial/MRC Clinical Sciences Centre: this consortium makes UK research internationally competitive in cardiovascular functional genomics.

Independently, the University of Edinburgh is also studying the risk to women who were small babies at birth of developing heart disease later in life. With funding from the British Heart Foundation the research team is looking into whether women who were small babies produce more stress hormones in adult life, as it is thought that increased risk of cardiovascular disease is largely pre-determined by impaired growth of the foetus caused by poor nutrition or exposure to other stressful factors.

Keep taking the drugs please

All the research and medical breakthroughs in the world are to no avail if, at the end of the day, patients don't take the prescribed medication. A staggering 50% of patients in Scotland with chronic conditions such as high blood pressure and cardiovascular disease who are prescribed potentially life saving drugs decide, for whatever reason, not to take their medicine.

The way in which drugs are prescribed is seen as one possible reason for non-co-operation on the patient's part. And with new legislation on the way that will allow a greater range of health professionals, such as nurses and pharmacists, to prescribe drugs, the health industry sees the opportunity to test new models of delivery.

The Robert Gordon University in Aberdeen has responded to this by setting up the Centre for Partnerships in Medicines for Health which aims to be the UK leader for teaching and research in methods of prescription. The NHS could save a lot of money if more people who have been dealt the ace of spades would swap it for the queen of hearts, rather than resolutely hanging onto the killer card for dear life. Which poses another question: is, as so often, the human mind with all its contrariness at the heart of the matter?