Atherosclerosis & Genetics
Atherosclerosis is, by inducing ischemic cardiac syndromes, the main driver of cardiac disease and of cardiac mortality and morbidity. The department of Cardiology at the Heart Center Leiden has a large dedicated department involved in treating patients with atherosclerosis as well as doing research how to treat and prevent it.
Treatment of atherosclerosis is performed firstly by counselling, advice, and medication. However in many cases this is not sufficient on its own and mechanical revascularisation is needed by percutaneous coronary angioplasty of coronary bypass operations. To this end large and well equipped catheterization laboratories and operation theatres are available with cutting edge and state of the art technologies. Extensive research (e.g. innovative medication, novel (drug eluting) stents, renal denervation and percutaneous heart valves) is performed to get more insights in the basic processes of atherosclerosis and its treatment. This is performed in the basic laboratory, transgenic animal models and in patient care. A true translational model is used here, from bench to bedside and back. Furthermore an intensive patient tracking and monitoring system, with regional involvement, has been developed (MISSION! care tracks, such as the acute myocardial infarction care track) to optimally implement latest guideline and evidence based therapy.
Pharmacogentic studies search for heritable genetic variations (polymorphisms) that influence disease like atherosclerosis and responses to drug therapy. Pharmacogenetics has many possible applications in cardiovascular pharmacotherapy, including screening for polymorphisms, to choose for the right patient the right drug, with the greatest potential for efficacy and least risk of toxicity. Pharmacogenetics also informs dose adaptations for specific drugs in patients with aberrant metabolism. The department of Cardiology of the LUMC has a long and extensive track record in doing pharmacogenetic research and bringing the results into practise.
In recent years it has become apparent that an increasing number of cardiac diseases are caused by specific genetic defects. Afflicted patients may have for example structural heart disease like hypertrophic or dilated cardiomyopathies, but also channelopathies like Long QT syndrome or Brugada syndrome. For these patients, the Department of Cardiology of the LUMC provides dedicated cardiogenetic out-patient clinics aimed at counseling, (cascade) screening and guideline-driven patient care. This latter includes medical management, but also invasive therapeutic options like (surgical or alcohol) septum ablation in HCM and implantation of Implantable Cardioverter Defibrillators (ICDs) in arrhythmic disease. Also, clinical and basic research into disease mechanisms is performed by studying genotype-phenotype relations and modeling of disease using patient-specific induced Pluripotent Stem cell (iPS) generation.