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, Utrecht, Arnhem and Eindhoven, 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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IMPRESS

2021

In the past decade, there has been significant progress in understanding sex- and gender-based differences in cardiovascular diseases (CVD). However, this knowledge remains scattered across medical literature, highlighting the need for a centralized platform accessible to healthcare professionals, scientists, policymakers, and patients. The IMPRESS consortium aims to establish a knowledge platform focused on gathering, summarizing, and prioritizing existing knowledge related to sex- and gender-specific aspects of CVD. This initiative seeks to promote the implementation of existing knowledge into clinical practice, identify knowledge gaps, and inform policymakers about areas requiring additional attention.
In substantial portions of women with symptoms of myocardial ischemia, obstructive disease in the epicardial coronary arteries is absent. Currently, such women undergo multiple diagnostic tests, which do not always result in a conclusive diagnosis. IMPRESS seeks to reduce missed and delayed diagnoses of heart diseases in women, improving cardiovascular care outcomes nationwide. The knowledge platform will serve as a national resource, fostering collaboration and supporting the adoption of sex- and gender-sensitive practices in cardiovascular medicine.

The Research
IMPRESS consolidates existing knowledge, fosters research, and implements findings into practice wherever possible (for example by creating a Decision Support Tool for primary care and for cardiologists). Within the IMPRESS consortium, the following studies are being conducted:

Delphi study: delayed or missed diagnosis of heart disease
Silent heart attacks: causes, symptoms, and risk factors of silent myocardial infarctions
UMCU-IMPRESS pilot study: undetected coronary microvascular disease (CMD)
Peripheral-Flow: LASCA technique in CMD
Dutch registry of coronary function tests

 
The origin
In the past decade, the understanding of sex- and gender differences in CVD has considerably improved. However, relevant evidence is scattered throughout the medical literature. There is a need to make this information easily accessible to health care professionals, scientists, policy makers and patients. Implementation of existing knowledge in clinical practice will then be promoted, knowledge gaps identified, and policy makers informed on the areas that need additional attention. This is also of high importance to the Dutch Heart Foundation, which therefore funded the IMPRESS consortium; a collaboration between several DCVA partners; the Nederlandse Vereniging voor Cardiologie (NVVC), WCN, Netherlands Heart Institute (NLHI), ZonMw and the Dutch Heart Foundation, supported by the DCVA.
 

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