Program brings together clinical care and research to further understanding of vascular conditions and prevention.
The Vascular Disease Prevention Program at the Brigham and Women’s Hospital (BWH) Cardiovascular Center combines clinical care and research focused on understanding and preventing vascular disease.
Patient care
Jorge Plutzky, MD, Director of the Vascular Disease Prevention Program, and his colleague Frank Sacks, MD, run the weekly Lipid/Prevention Clinic. The clinic is a resource for referring physicians who have patients with:
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Premature onset of atherosclerosis;
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A strong family history of cardiovascular disease;
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Interests in maximizing their personal prevention efforts;
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Abnormal lipid values;
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Intolerance or unresponsiveness to lipid-lowering therapy, including statins
The Lipid/Prevention Clinic that Dr. Plutzky directs has seen a significant increase in the number of patients complaining of being unable to tolerate statins, a drug commonly prescribed for lowering cholersterol. Although most patients can tolerate statins, a small subgroup cannot take the medication. Dr. Plutzky says, “Often, through a combination of approaches including closer investigation of the nature of the reported statin-related symptoms, an adjustment in statin dosage, or a change to a different statin, we are able to design a regimen that allows the patient to benefit from this potentially lifesaving therapy.”
Clinical research
The Vascular Disease Prevention Program also includes a robust roster of basic and clinical research activities. Trials focus on emerging issues in prevention. Soon, Dr. Plutzky will begin to enroll selected patients in a trial of a weight loss drug, rimonabant, that has been shown to improve weight and lipid profiles. This trial is designed to assess whether it also confers cardiovascular benefits.
Basic research
Some of the most promising molecular research concerns the connection between abnormal metabolism (high glucose, diabetes and insulin resistance) and atherosclerosis. The molecular nexus between diabetes and heart disease remains elusive. One of the most promising possibilities is a class of chemical receptors known as peroxisome proliferator-activated receptors (PPARs) – especially PPAR gamma – that regulate metabolic processes.
Dr. Plutzky is an international leader in the connection between diabetes and atherosclerosis, including his research on understanding the effects of PPAR drugs and the search for the natural partners for these receptors. “Research into PPARs may lead to agents that can have a significant impact into understanding the connection between diabetes and cardiovascular disease and perhaps reducing the vascular complications associated with these metabolic issues,” says Dr. Plutzky. He continues, “In the meantime, as clinicians, we need to remain aware of the association between the two diseases and of the fact that the same lifestyle modifications may prevent both diabetes and heart disease. Prevention is often the place where clinical medicine meets leading-edge science.”
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