Check@Home

2022

In the Netherlands, there is no national approach for early detection of cardiovascular disease, kidney disease and type 2-diabetes in the general population, despite the social and economic impact of these disorders. The Check@Home consortium was founded to fill this gap and aims to lower the morbidity and mortality of cardiovascular disease, chronic kidney disease and type 2 diabetes by 25% in the next ten years, and thereby decrease the burden of these chronic diseases.

The Focus

Due to common risk factors such as high blood pressure, obesity and the aging population, the number of people suffering from cardiovascular disease, chronic kidney disease or type 2-diabetes is expected to increase excessively in 2030. A large proportion of people are not aware of having these diseases, as it is often present without overt symptoms. Fortunately, these chronic conditions can be detected at an early stage, allowing for adequate and early treatment to prevent (the progression of) these conditions and their complications. Check@Home aims to do so by developing a (cost-)effective national program that is accessible to all socio-economic groups and takes place in the citizen's own living environment, making it comfortable for citizens to do. It will also reduce the burden on primary care and contribute to the affordability and sustainability of healthcare. The program is designed and implemented in close collaboration with citizens, patients, and local citizen initiatives, to make sure that this program is a durable solution for all groups of society.

The Research

In total 160,000 people aged 50-75 years and living in Breda, Arnhem and Groningen, will be invited to participate in the study with a home-based test using the Check@Home digital platform. In case of early signs of cardiovascular disease, kidney damage or diabetes type 2, a targeted work-up will follow in a regional diagnostic center. If necessary, lifestyle advice and initiation of medication will be provided to relieve regular care as much as possible.

The Origin

At the request of several DCVA partners, including the Dutch Heart Foundation, which has earlier recognition of cardiovascular disease highly prioritized on its national research agenda, which was drawn up at the initiative of the Dutch Heart Foundation in 2014 and revised in 2020, the DCVA explored the potential for a national initiative to develop the first population screening for cardiovascular disease in 2020. The Check@Home study builds on previous studies, including the KidneyCheck study. To achieve a national approach to the early detection of diabetes, cardiovascular disease and chronic kidney damage, the DCVA, Dutch Heart Foundation, Dutch Kidney Foundation and Dutch Diabetes Fund established the Check@Home consortium. This is a collaboration of multiple research groups, private parties, and research funders: NWO, the Dutch Heart Foundation, the Dutch Kidney Foundation and the Dutch Diabetes Fund.

The projectcoördinators are Dr. Lyanne Kieneker and Dr. Stephanie van der Voorn.

Funded

Contact person:

Dr. Lyanne Kieneker

l.kieneker@dcvalliance.nl

Principal investigators

Prof. dr. Folkert Asselbergs

f.w.asselbergs@amsterdamumc.nl

Prof. dr. Ron Gansevoort

r.t.gansevoort@umcg.nl

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The SARS-CoV-2 pandemic has a high burden of morbidity and mortality due to development of the acute respiratory distress syndrome (ARDS). The reninangiotensin-system (RAS) plays an important role in the development of ARDS, with ACE2 (angiotensin-converting enzyme 2) being a key enzyme within this. The virus's spike protein binds to ACE2, facillitating cellular internalization. Downregulation of ACE2 results in the excessive accumulation of angiotensin II, which in turn increases pulmonary vascular permeability through stimulation of the angiotensin II type 1a receptor (AT1R), thereby exacerbating lung pathology associated with decreased ACE2 activity. Currently available AT1R blockers (ARBs) such as valsartan, have shown potential to block this pathological process mediated by angiotensin II.
The Focus
The primary aim of the PRAETORIAN-COVID trial is to investigate the effect of the ARB valsartan compared to placebo on the composite end point of admission to an intensive care unit, mechanical ventilation, or death of COVID-19 patients.
The Research
Participants receiving active treatment are administered valsartan at a dosage titrated to blood pressure, with a maximum of 160 mg twice daily. Participants receiving placebo are provided with a matching placebo. The treatment duration was 14 days or until reaching the primary endpoint, or until hospital discharge, if applicable within 14 days.Two complementary mechanisms underpin the potential efficacy of angiotensin II type 1 receptor blockers (ARBs) in preventing acute respiratory distress syndrome (ARDS) and reducing morbidity and mortality:

ARBs block excessive angiotensin-mediated activation of the AT1R.
ARBs upregulate ACE2 expression, leading to reduced angiotensin II levels and increased production of the protective vasodilator angiotensin 1–7.

Given these mechanisms, ARBs show promise in preventing ARDS development, potentially reducing the need for intensive care unit (ICU) admission and mechanical ventilation, and ultimately lowering mortality rates associated with SARS-CoV-2 infection.

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EMBRACE

2023

Atrial fibrillation (AF) is not benign. It commonly progresses from paroxysmal AF (PAF) to permanent AF. AF progression is associated with major adverse cardiovascular/cerebral events (MACCE). Cardiovascular risk factors and comorbidities (CVR) are present long before the first AF episode, causing a progressive atrial cardiomyopathy (ACM). The mechanisms of ACM vary between patients hindering effective AF management. The EmbRACE network now aims to unravel the diversity of mechanisms underlying ACM, identify simple diagnostic tools to identify them, and develop a therapeutic approach to prevent ACM progression.
The Research
Early rhythm-control therapy is one promising intervention to potentially interfere with ACM progression next to CVR management. For a sustained impact we aim to develop care pathways to prevent ACM and AF progression and MACCE. Therefore, we will

identify and validate relevant cellular and molecular determinants of ACM and AF and their clinical surrogate parameters;
develop an in-silico platform to simulate identified mechanisms of ACM and AF and their effects on AF progression and, based on these data, make suggestions for future refinement of ACM therapy;
explore the variety of temporal patterns of PAF as markers of ACM subtypes, demonstrate their prognostic relevance and identify surrogate markers available in clinical practice, based on AI and machine learning;
test in a randomized trial stratified for sex the hypothesis that early AF ablation and optimal CVR management in AF patients with ACM delays ACM progression and reduces MACCE;
explore whether lifestyle management reduces ACM progression, whereas with only rate control ACM progresses;
validate the RACE V AF progression score in real life cohorts and translate this and other knowledge into novel care pathways for AF.

The origin
Atrial fibrillation is the most common cardiac arrhythmia and can lead to a variety of complications, such as stroke. Currently, there are limited treatment options for this cardiac arrhythmia. Moreover, the disease is often noticed late, which makes proper treatment even more difficult. Therefore, the Dutch Heart Foundation funded the RACE V consortium. Afterwards, the Dutch Heart Foundation guided an exploration to form a national consortium as a follow-up around this theme. This led to the EmbRACE consortium, which is a national network of six university medical centers, UMC Groningen, Maastricht UMC+, UMC Utrecht, Amsterdam UMC and LUMC and Erasmus MC, and hospitals in Arnhem and Eindhoven. The Dutch Heart Foundation funds the research.

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