- Alan Kay
MBBCh, MSc
MD, MSc
PhD
In 2015, the CVC, along with our U.S. clinical research colleagues at Duke and Stanford Universities, published a paper in the American Heart Journal entitled “The Future of Cardiovascular Clinical Research in North America and Beyond”. Focusing on numerous opportunities to disrupt the previously established paradigm to guide the future of cardiovascular research in the global research environment we outlined the many obstacles facing randomized clinical trials in North America, highlighted the evolving roles of stakeholders in cardiovascular clinical research, identified novel research and operational approaches, and proposed forward-looking academic research organization (ARO) collaborations. Fast-forward to almost 9 years later, and we can see that the future is now! Hence, the theme of the CVC’s 2023 Annual Report: “Building Blocks: Shaping Our Future”.
The Canadian VIGOUR Centre (CVC) was established in 1997 as an academic research organization (ARO) at the University of Alberta, and has since been committed to the enhancement of cardiovascular health. The CVC is recognized for its pioneering research in cardiovascular medicine, which embraces the translation of research through thought leadership and management of innovative clinical trials. Furthermore, the CVC is focused on the generation of new knowledge from patient registries and population outcome studies, which inform the direction of future pathways.
As an ARO, the CVC is committed to the scholarly value of scientific inquiry and truth, and believes knowledge should be shared openly in an ethical research environment. The CVC’s dedication to lifelong learning has also inspired one of our central tenets –engaging the next generation of health professionals in a research culture that embraces curiosity, welcomes new ideas, and seeks to address key unanswered questions in health care. Learn more about the CVC’s vision, mission, and core values here.
The CVC is anchored by a dedicated group of internationally recognized thought leaders in cardiovascular medicine and clinical investigation. It is supported by accomplished administrative and clinical operations teams, as well as experienced biostatisticians, data and machine learning analysts and core laboratory personnel. Research is a team sport, and our diverse and multidimensional group is committed to continuous innovation that has an impact on informing health policy.
The CVC relaunched the Distinguished Visitor Series in 2023, and had the opportunity to host three internationally renowned academics:
In early 2023, the Canadian Institutes of Health Research (CIHR) made a landmark-funding announcement for the Accelerating Clinical Trials (ACT) Consortium with the aim to optimize, grow, and facilitate clinical trials performance in Canada.
The ACT brings together hundreds of researchers from 28 networks and 11 clinical trial units across Canada. In addition to the involvement of the University of Alberta as a major partner, the CVC is also a founding member of the ACT, with several of our members holding positions to support and guide outcomes. Many of the innovative activities that the CVC is currently undertaking, including trial design, analysis, and operations, will be facilitated through collaboration with the ACT.
CVC’s Founding Director, Dr. Paul W. Armstrong, was the recipient of the American College of Cardiology (ACC) 2023 Lifetime Achievement Award, in recognition of his more than 50 years of outstanding contributions in the field of cardiovascular disease.
ABBREVIATE is an Alberta-based, multi-centre vanguard project that aims to determine whether the continuation or discontinuation of beta-blocker therapy will affect long-term cardiovascular outcomes in patients with stable ischemic heart disease. The CVC team is supporting operations with faculty leadership from Dr. Sean van Diepen.
The Government of Canada announced a $125 million dollar investment in the University of Calgary’s One Child Every Child initiative, which will focus on children’s health and wellness research. Dr. Padma Kaul, alongside Dr. Amy Metcalfe from the University of Calgary, will facilitate one of the project’s three key research themes — “Better Beginnings” — investigating the health and well–being of pregnant people and their infants.
The Canadian Cardiovascular Research Collaboratory (C3) held its first in-person meeting since 2019 in Toronto, Ontario. The C3 is a virtual clinical research network blending the two fundamental elements of collaboration and the clinical laboratory, and provides opportunities for researchers to identify and study important unanswered questions and address unmet cardiovascular health care needs that would be challenging for a single centre to undertake. Learn more about the C3 here.
Dr. Padma Kaul and her team were awarded a Spring 2023 CIHR Project Grant for the DISCOURSE study. Cancer is becoming a major cause of hospitalization and death among people with diabetes, and this study aims to better understand the linkages between these conditions.
The Canadian Right Ventricular Failure AdaptiVE (CRAVE) program will test novel and repurposed therapies for improving right ventricular (RV) function and outcomes for patients with pulmonary hypertension (PH) and RV dysfunction and failure. A planning meeting was held in Edmonton in September, and engaged patients, caregivers, and PH experts in the design of the program.
Leading this program are CVC faculty member, Dr. Jason Weatherald, and Dr. Lisa Mielniczuk (University of Ottawa Heart Institute), with operational support provided by the CVC team.
In its inaugural year, the CVC Scholar Program selected two students to join this new training initiative, which provides supportive mentorship, research opportunities, and a collaborative environment for early–stage investigators looking to enhance both their research expertise and careers in cardiovascular medicine. Learn more about the Scholar Program here.
“We are excited to launch the CVC Scholar Program, which is fostering the next generation of researchers focused on the discovery and translation of different cardiovascular conditions in a tailored program with strong mentorship.” – Drs. Roopinder Sandhu and Sean van Diepen (Program Co-Leads)
The 10th annual CVC Clinical Trials Colloquium (and first in-person event since 2020) was hosted at the University of Alberta in Edmonton. The theme for this year’s meeting was “Shaping the Future of Cardiovascular Clinical Research in Canada”. Learn more about the Colloquium here.
The REDISCOVER study was selected as a featured research project for the CIHR 100 Years of Insulin: Accelerating Canadian Discoveries to Defeat Diabetes initiative. REDISCOVER seeks to provide new insights into the relationships between sex and diabetes and cardiovascular disease outcomes. The study is led by Dr. Padma Kaul as part of her role as the CIHR Sex and Gender Science Chair.
The Re-PHIRE study is a Phase 2b, randomized, double-blind, placebo-controlled, multi-centre, dose-ranging study assessing the impact of the drug called AZD3427 in patients with heart failure and pulmonary hypertension due to left heart disease. More than 60 clinical trial sites have been selected in over a dozen countries, including 7 in Canada. The CVC team is supporting operations in Canada with faculty leadership from Drs. Justin Ezekowitz and Jason Weatherald.
COgnitioN with VERiciGuat Evaluation in Heart Failure (CONVERGE-HF) is a new Phase 2b, randomized, double-blind, placebo-controlled trial examining the treatment effect of vericiguat, an oral soluble guanylate cyclase (sGC) stimulator, on imaging and blood markers of cerebral and coronary small vessel diseases, as well as function and cognitive status, quality of life, and clinical events in participants with heart failure and mild to moderate cognitive impairment. The CVC team is supporting operations with faculty leadership from Dr. Justin Ezekowitz.
ST-elevation myocardial infarction (STEMI) occurs when a coronary artery is completely blocked, and it is often the most dangerous and severe type of heart attack. Results from the STREAM-2 trial provide new data supporting a reasonable alternative treatment strategy for the large population of older STEMI patients worldwide who have high rates of morbidity and death.
Read More
The HEART-FID trial verified the safety of ferric carboxymaltose, an intravenous iron supplementation, and demonstrated modest improvements in cardiovascular outcomes in patients who have heart failure with a reduced ejection fraction and iron deficiency.
Read More
Growing evidence suggests that the gut microbiome plays an important role in understanding the origins and development of heart failure. The FEAST-HF trial sought to examine the effect of fermentable dietary fiber acacia gum in patients with heart failure.
Read More
This secondary analysis of the ODYSSEY OUTCOMES trial showed that alirocumab appears to be a safe, well-tolerated, and effective lipid-modifying and outcome-improving treatment when used for up to 5 years in patients with a recent acute coronary syndrome.
Read More
Since the publication of the VICTORIA primary trial results in 2020, the VICTORIA study group has published over 20 secondary analyses. These publications constitute an important body of work on worsening heart failure, and provide mechanistic and prognostic insights into a relatively understudied, but increasingly important heart failure patient subset.
Read More
Frailty is a state of reduced physiological capacity across multiple body systems that increases vulnerability and adverse health outcomes in older adults. In this secondary analysis of the VITALITY-HFpEF trial, researchers examined the link between frailty and health status in patients who have heart failure with preserved ejection fraction.
Read More
Findings from this study illustrate how artificial intelligence and machine learning models can be used to translate routinely collected clinical data into knowledge that will improve the delivery of healthcare.
Read More
The current system for classifying patients with heart failure is dependent upon the confirmation of left ventricular ejection fraction (LVEF), a measurement of the heart’s ability to pump blood from the left ventricle. This study demonstrated that in the absence of LVEF data, administrative data-based prediction models are a viable option for identifying patients with heart failure.
Read More
These guidelines help clinicians navigate the use of contemporary antiplatelet therapy, a group of medicines that prevent the formation of blood clots after a heart attack, and/or following a stent procedure, or open-heart bypass surgery. Dr. Kevin Bainey was a key contributor as both the guideline panel co-chair and lead author.
Read More
The first in a series of three papers about pulmonary hypertension, this research provides a comprehensive summary of advances in pulmonary arterial hypertension (PAH) pathophysiology, current therapeutic approaches, and emerging treatment options, along with a forward-looking dialogue on innovative solutions for future PAH trials.
Read More
Current guidelines recommend quadruple therapy for patients with heart failure and reduced ejection fraction, however, triple therapy still remains underutilized in this patient population. This study sought to identify existing barriers to timely initiation of triple therapy and examined a new metric that could be utilized by clinicians to evaluate quality of care and develop strategies for better implementation.
Read More
It is important to account for sex and gender in randomized clinical trials (RCTs), as these factors can directly impact how individuals experience health conditions and respond to treatment. In this analysis of past RCTs of adults with kidney failure who receive maintenance dialysis, researchers found that while women and female participants are appropriately represented, much work is still required to properly document and distinguish between sex and gender.
Read More
Since March 2020, the CVC has undertaken a number of research projects investigating the long-term burdens of COVID-19 on patient outcomes and the health care system. These selected highlights from 2023 help shed light on how the pandemic impacted hospitalized patients with non-COVID-19 conditions, whether there is a correlation between vaccination status and outcomes in patients with COVID-19-related critical illness, and how sex-based differences in patients who tested positive for SARS-CoV-2 inform risk-levels for cardiovascular hospitalizations.
Assessing the Impact of the Pandemic on Outcomes for Hospitalized Patients Association Between Vaccination Status and Outcomes in Patients Admitted to the ICU with COVID-19 Younger Men at Higher Risk for Cardiovascular Hospitalization Following COVID-19
MD
This year’s annual report is bursting with the collective activities and progress of our splendid research team at the CVC. The addition of new faculty has enriched our diversity, expanded our reach and enhanced our productivity. Our team of project leaders, biostatisticians and administrative/business personnel, who facilitate what we do, has done a terrific job ensuring that the emerging research work has achieved the high quality of presentations and publications we expect, and the subsequent dissemination it deserves.
As one reflects on this year’s theme, “Building Blocks: Shaping Our Future,” it is germane to contemplate upon one of the challenges the CVC has faced in recent years. There have been remarkable changes in the clinical research environment since the CVC became an official research centre of the University of Alberta (U of A) over 20 years ago. Our recent challenge pertains to functioning as an academic research organization within a bicameral healthcare system governed by the U of A and the single provincial health care provider, namely Alberta Health Services (AHS). Operating as a not-for-profit entity within these two overarching systems became progressively more complex as each evolved to face changing leadership, resource constraints and differing priorities and needs
As a result, it became clear that we needed to invent our own future based on what was happening around us, lest it be shaped by others. Fortunately, there were “receptors” at high levels in both the AHS and U of A, to whom we could relate and make the case to create a new “building block” foundational to our preferred future in the form of the CVC Cardiovascular Health Foundation (CVCF). This was accomplished in 2021 with the outstanding support of Ms. Karen Mellor, our head of operations and finance.
The CVCF is a not-for-profit foundation that supports the core mission of the CVC, namely to generate, translate and disseminate knowledge gained through the conduct of innovative research of cardiovascular disease. Importantly, it is governed by a Board of Directors representing the U of A and the Northern Alberta Clinical Trials and Research Centre, which provides oversight and transparency of its operations.
It became evident that—unlike many other research centres in our university—the CVC essentially operates as a small business. We must recognize and compete within the marketplace. Importantly, the existence of the CVCF now allows unexpended revenues generated from the thought leadership and our other organizational work to be securely transferred from the CVC to the Foundation. This entity has been crucial in providing a more secure future by allowing us to reinvest in our human and other resource needs. In addition, we can now be more nimble and responsive in supporting interesting pilot projects that—while showing promise—often benefit from a needed “kick-start.”
Finally, in the last quarter of 2023, we established an endowed CVC Chair in Cardiovascular Science. This exciting position, to which we will externally recruit, will advance the academic mission of the U of A and catalyze new research initiatives in cardiovascular science. This endowment will support the Chair holder in building a robust cardiovascular research program in conjunction with the CVC at the U of A.
The future also belongs to those who can see it coming, and I am confident we can enhance our mission in the times ahead.
Paul W. Armstrong
MD
