“Progress lies not in enhancing what is, but in advancing toward what will be.”
- Khalil Gibran
“At the Wheel of Research” is the title of Dr. Soumya Swaminathan’s biography, an inspiring portrait of the inaugural Chief Scientist at the World Health Organization (WHO) who served during the COVID-19 pandemic. Noting that “Ultimately, it is science that saved us,” she highlights the large investments made in research globally and the “…superhuman effort put in by thousands of scientists and healthcare personnel…” As cardiovascular (CV) disease remains the leading cause of morbidity and mortality worldwide, the concept of the wheels of research in motion has emerged as the theme of the 2024 Canadian VIGOUR Centre (CVC) Annual Report.
This report highlights numerous accomplishments of the CVC and its’ greatest resource—our people. A timeline of 2024: welcomes Dr. Jacob Udell as a Senior Associate Faculty Member; congratulates Faculty Members Drs. Roopinder Sandhu on her new roles as the Director of the Libin CV Institute’s Women’s CV Health Initiative and Chair in Women’s CV Health Research (University of Calgary), and Dr. David Collister for receipt of the Canadian Society of Nephrology New Investigator Lectureship Award; also featured is a $5-million donation from the CVC Cardiovascular Health Foundation (CVCF) to fund a new research chair in CV science at the University of Alberta, and the inaugural year of the CVCF-supported CVC Scholar Program.
The CVC was pleased to host Dr. Michael Gibson (Harvard Medical School) as a Distinguished Visiting Speaker. As Study Chair, his Cardiology Rounds presentation highlighted the results of the AEGIS-II trial (published in the New England Journal of Medicine), a collaborative effort with the CVC, led by Drs. Kevin Bainey and Shaun Goodman, supporting Canadian hospital enrollment.
Several studies were initiated in 2024, including the Alberta Diabetes Institute (ADI) grant-supported ULTIMA study of insulin pump therapy in type 1 diabetes mellitus led by Dr. Padma Kaul; the ARTEMIS trial of anti-inflammatory therapy (ziltivekimab) in acute myocardial infarction patients led by Dr. Bainey and supported in Canada by Drs. Mina Madan (University of Toronto) and Christopher Fordyce (University of British Columbia); the CONTEMP-ICD study, COMET-HF trial, and the MOONRAKER series of trials of heart failure (HF) treatments (implantable cardioverter defibrillator for associated arrhythmias, omecamtiv mecarbil, and finerenone, respectively) led in Canada by Dr. Justin Ezekowitz (and Dr. Sandhu in CONTEMP-ICD). Canadian site management and support for most of these trials is provided by the CVC Clinical Operations team, led by Associate Director Tracy Temple.
Additional research highlighted within includes the Canadian Institutes of Health Research (CIHR) grant-supported ECG-SAFE Study employing artificial intelligence algorithms that utilize the electrocardiogram to diagnose heart issues (led by Drs. Kaul, Sandhu, and Sunil Vasu Kalmady), and the Healthy Pregnancy Hub online platform providing evidence-based information about the safety of prescription medications during pregnancy (co-led by Dr. Kaul), together with a number of featured publications from our CVC faculty, staff, and trainees.
We greatly appreciate the support and enthusiasm of our outstanding partners and collaborators who help us to keep the research wheels in perpetual motion as we strive to generate, translate, and disseminate knowledge to enhance the health of the citizens of Alberta, Canada, and the world.
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, and is supported by accomplished administrative and clinical operations teams, as well as experienced biostatisticians, data and machine analysts, and core laboratories 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.
Jan. 2024
The CVC was pleased to welcome long-time collaborator Dr. Jacob Udell to our team in early 2024. Dr. Udell is the Division Head of Cardiology at the Women’s College Hospital, the Director of the Peter Munk Clinical Trials and Translation Unit at Toronto General Hospital, and an Associate Professor of Medicine at the University of Toronto. His research interests include risk assessment in patients with or at risk for ischemic heart disease and heart failure, use of population health data and clinical registries for patient-oriented research, and use of pragmatic/streamlined trial design for investigation of novel strategies and interventions in patients with or at risk for ischemic heart disease and heart failure. Dr. Udell (Coordinating Investigator) and the CVC worked closely together on the EMPACT-MI trial that was presented and published in March 2024.
Feb. 2024
CVC faculty member Dr. Roopinder Sandhu joined the University of Calgary as the new Director of the Libin Cardiovascular Institute’s Women’s Cardiovascular Health Initiative and Clinic, and as the Martha Brauer Chair in Women’s Cardiovascular Health Research.
Mar. 2024
A $5-million donation from the CVC Cardiovascular Health Foundation (CVCF) funded a new research chair in cardiovascular science in the University of Alberta’s Faculty of Medicine & Dentistry (FoMD). This initiative will support critical advancements in research and health outcomes for patients, and foster collaborative engagement across disciplines within the FoMD, College of Health Sciences, and other agencies. The new chair will bring a fresh perspective and unique talents to help advance the CVC’s ongoing work in cardiovascular research and clinical trials both nationally and internationally.
Apr. 2024
The CVC is pleased to be collaborating with the University of Rochester Medical Center and Patient-Centered Outcomes Research Institute on the CONTEMP-ICD study, which compares optimal guideline-directed medical therapy to implantable cardioverter defibrillators in patients with heart failure with reduced ejection fraction who have low predicted arrhythmic risk. The study aims to enroll 2,740 patients from sites in both the United States and Canada. Drs. Justin Ezekowitz and Roopinder Sandhu are co-investigators and spearheading the Canadian involvement.
Apr. 2024
Dr. Padma Kaul received an Alberta Diabetes Institute (ADI) Catalyst Grant for the ULTIMA study, which seeks to better understand the accessibility and long-term outcomes of insulin pump therapy (IPT) use in individuals with Type 1 diabetes mellitus in Alberta. IPT involves a wearable medical device that provides continuous insulin infusion underneath the skin. Compared to multiple daily injections, IPT is shown to be associated with superior glucose control and an improved patient experience.
May. 2024
The CVC is pleased to be collaborating with Duke Clinical Research Institute and Novo Nordisk to conduct ARTEMIS, a Phase 3 cardiovascular outcomes trial in participants with acute myocardial infarction testing a novel once-monthly monoclonal antibody that inhibits Interleukin 6 activity, thus providing anti-inflammatory effects in patients with atherosclerotic cardiovascular disease. The study will be conducted in 24 countries and enroll 10,000 patients over a period of 20 months. 25 sites have been selected to participate in Canada, where the CVC team is managing operations with leadership from Drs. Kevin Bainey (Steering Committee), Mina Madan (University of Toronto; National Leader), Christopher Fordyce (University of British Columbia; National Leader), and Shaun Goodman.
May. 2024
As part of the CVC’s ongoing Distinguished Visitor Series, the CVC welcomed Dr. C. Michael Gibson of the Beth Israel Deaconess Medical Center and Harvard Medical School. Dr. Gibson’s Cardiology Rounds highlighted insights from the AEGIS-II trial, while his Research Rounds Seminar examined the future of factor Xia inhibitor therapy in acute coronary syndromes. Together with Drs. Kevin Bainey and Shaun Goodman, Dr. Gibson cheered on the Edmonton Oilers during a National Hockey League playoff game!
May. 2024
CVC Faculty Member Dr. David Collister was the recipient of the Canadian Society of Nephrology (CSN) New Investigator Lectureship Award. This award highlights the important work being conducted by future leaders in Canadian kidney research.
Jun. 2024
The American Heart Association and the McKinsey Health Institute released a notable new report about the current state of women’s heart health in the United States. The report referenced a CVC-led research study, which demonstrated that women are at greater risk than men of dying or developing heart failure in the five years following their first heart attack.
Jul. 2024
Principal Investigator Dr. Padma Kaul and her team of Co-Investigators (including the CVC’s Drs. Sunil Vasu Kalmady and Roopinder Sandhu) received a Spring 2024 Canadian Institutes of Health Research (CIHR) grant for the ECG-SAFE study. The primary goal of the study is to improve artificial intelligence algorithms that use the electrocardiogram to diagnose heart issues and predict future problems. The study team will determine if the algorithms they developed in acute care environments work well for community settings, and they will also develop new algorithms to identify individuals at a higher risk of future adverse events.
Sep. 2024
September marked the first full year of the CVC Scholar Program, a training initiative that 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.
"My first year in the Scholar Program has been transformative,
allowing me to immerse myself in research and to develop critical
skills. I am incredibly grateful and honoured to learn from
leading researchers in the field, whose expertise and guidance
have greatly enriched my understanding and passion.”
- Yuliia Smereka
MSc Student, Medicine
Nov. 2024
The Healthy Pregnancy Hub is a new Canada-wide online platform that provides evidence-based information about the safety of prescription medications during pregnancy. Although almost 70% of those who are pregnant take medication, there is limited information available on the impact and safety for this population. For this reason, the hub aims to equip pregnant individuals with reliable and accessible resources to support them in making informed choices about medications alongside their healthcare providers. This initiative is part of the Canadian Mother-Child Cohort, for which Dr. Padma Kaul is the Alberta Principal Investigator.
Nov. 2024
The CVC is pleased to be collaborating with Duke Clinical Research Institute and Cytokinetics, Inc. on COMET-HF, a Phase 3 trial assessing the efficacy and safety of omecamtiv mecarbil, a selective cardiac myosin activator, in patients with symptomatic heart failure with severely reduced ejection fraction. The CVC team is leading operations in Canada with faculty leadership from Dr. Justin Ezekowitz.
Dec. 2024
The CVC is pleased to be collaborating with Colorado Prevention Center (CPC) Clinical Research and Bayer AG on three trials (REDEFINE-HF, CONFIRMATION-HF, and FINALITY-HF), which are part of a large international heart failure program called MOONRAKER. These studies are evaluating the efficacy and safety of finerenone, a non-steroidal mineralocorticoid receptor antagonist (MRA), in heart failure patients with reduced, mildly reduced, and/or preserved ejection fraction. The CVC team is leading operations in Canada with faculty leadership from Dr. Justin Ezekowitz.
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Active sites participating in CVC-managed trials
ECGs analyzed by the CVC Core Laboratory
Citations generated from CVC-authored papers published between 2020 – 2024
Digital ECGs evaluated in CVC AI/ML studies
Canadians included in CVC studies using real world data
Randomized Clinical Trial
Empagliflozin, a treatment for type 2 diabetes, can improve cardiovascular outcomes in certain high-risk patients. The EMPACT-MI trial found that when compared to placebo, empagliflozin did not significantly lower the risk of a first hospitalization for heart failure or death from any cause in patients with an acute myocardial infarction. While the study did not meet its primary endpoint, two simultaneous secondary analyses suggest that empagliflozin could potentially be beneficial in a more targeted group of patients.
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Randomized Clinical Trial
CSL112 is an apolipoprotein A1 derived from human plasma, and is a component of high-density lipoprotein (also known as “good”) cholesterol. The AEGIS-II trial found that when compared to placebo, CSL112 did not significantly reduce recurrent cardiovascular events in patients with an acute myocardial infarction. A secondary analysis of the trial outcomes showed a reduced incidence of heart attacks at six months in the CSL112 group, suggesting potential benefits that warrant further investigation.
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Randomized Clinical Trial
This study examined whether pharmacist-led prescriptions of oral anticoagulation therapy (OAC) could improve delivery of stroke risk reduction treatment in atrial fibrillation (AF) patients. After three months, guideline-concordant OAC use was significantly higher in the pharmacist intervention group compared to usual care, with a 34% absolute increase. These findings demonstrate the potential of pharmacist-led care to address gaps in OAC delivery and improve stroke risk reduction therapy in AF patients through innovative, community-based interventions.
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Randomized Clinical Trial
Two secondary analyses of the STREAM-2 trial further investigate the efficacy and safety of half-dose tenecteplase in ST-segment elevation myocardial infarction patients who cannot access timely primary percutaneous coronary intervention.
Registry/Cohort
Researchers evaluated a pharmacoinvasive strategy in ST-elevation myocardial infarction patients with cardiogenic shock who were unable to receive timely primary percutaneous coronary intervention due to prolonged transport times. They found this strategy was associated with improved electrocardiographic reperfusion, reduced death, dialysis, and mechanical circulatory support, as well as no increase in major bleeding, making it a potentially safe and effective treatment option for this patient population.
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Registry/Cohort
This study analyzed the impact of running a sub-4 minute mile on longevity using a public database of the first 200 athletes to achieve this feat. Despite the common perception that extreme exercise can be detrimental, the runners lived an average of 4.7 years longer than expected. While the study focused on elite athletes, researchers suggest that moderate to vigorous exercise can still provide longevity benefits for the general population.
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Registry/Cohort
In this retrospective analysis of the COMPASS trial, researchers assessed the potential clinical impact of low-dose rivaroxaban with aspirin on Canadian patients with atherosclerotic cardiovascular disease. The study identified 20,000 new cases annually among 3.3 million adults, with 40% eligible for the therapy. The expected net clinical benefit was 5.6 fewer events per 1000 person-years, suggesting that low-dose rivaroxaban with aspirin could significantly reduce cardiovascular morbidity and mortality.
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Population Health
This study found low rates of iron deficiency (ID) and ID anemia (IDA) testing in heart failure patients, despite well-established links to poor outcomes and readily available testing and treatment options. When patients were tested, ID and IDA were common, but iron supplementation was rarely used. These findings underscore the importance of aligning current practices with guideline standards, and the need for innovative strategies to improve iron screening and therapy in heart failure patients.
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Population Health
This study examined whether sex differences were present among high-cost users (HCUs) with atrial fibrillation (AF), who account for the top 10% of total healthcare costs. Despite a lower number of females with AF, they represented an equal portion of HCUs and almost half of total costs. Researchers suggest that enhanced strategies for prevention and early treatment of AF HCUs could potentially lessen the financial strain placed on the healthcare system.
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Artificial Intelligence and Machine Learning
This study employed machine learning to predict 30-day and 1-year risks of emergency visits, readmissions, or death in heart failure patients. Researchers integrated data from multiple sources and tested several machine learning algorithms, finding that a model employing deep feature synthesis delivered enhanced risk stratification. This model could be a valuable tool for addressing longstanding challenges in risk assessment and healthcare resource utilization.
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Artificial Intelligence and Machine Learning
Machine learning-based electrocardiogram (ECG) algorithms can detect early signs of cardiovascular (CV) disease, including conditions beyond conventional ECG interpretations. This study developed and validated two models to predict 15 common CV diagnoses, and found that both models exhibited good-to-excellent prediction performance. These findings highlight the potential of pairing machine learning models with the widely accessible 12-lead ECG to accurately predict a range of CV conditions and other disorders.
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Systematic Review
This international task force summary explores the evolution of pulmonary arterial hypertension (PAH) clinical trial end-points and highlights how emerging technologies and innovative trial designs can potentially facilitate new PAH drug development. Researchers emphasize the need to optimize trial designs, improve efficiency, and create meaningful, innovative end-points in order to successfully implement novel therapies for PAH.
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Systematic Review
In this commissioned article for the American Heart Association Journals Centennial Collection, Dr. Paul Armstrong discusses how large international randomized clinical trials, driven by advances in information technology, have transformed cardiovascular research over the past century, leading to significant improvements in the outcomes of patients with cardiovascular disease.
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Meta-Analysis
Heart failure is common in kidney failure patients undergoing dialysis, but distinguishing it from other conditions with similar symptoms can be challenging. This study found that only a smaller percentage of randomized clinical trials reported heart failure events, with varied diagnostic criteria and limited event adjudication. These findings emphasize the need for a standardized heart failure event definition in dialysis trials that will benefit patients, healthcare providers, researchers, and regulators.
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Health Economics
Coronary artery calcium (CAC) testing is not widely used in Canada, and its cost-effectiveness compared to other treatments for patients at intermediate risk of cardiovascular disease is unclear. This study found that CAC score-guided treatment was marginally cost-neutral at 5 years and cost-effective at 10 years compared to universal statin use. The researchers advocate for greater access to low-cost CAC screening to improve decision-making for statin therapy.
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