HEROES

Habitual physical activity is beneficial for cardiovascular health. Yet, many patients with cardiovascular disease are sedentary, and current physical activity programs often fail to achieve lasting improvements. At the extreme end of the activity spectrum, more athletes engage in long-term, high-volume, high-intensity training.  Emerging evidence suggests that there may be an upper limit of exercise for heart health and exceeding this threshold may attenuate the benefits of an active lifestyle. The FIT-HEART consortium seeks to develop tailored physical activity interventions for cardiovascular disease patients and to investigate safe exercise limits for recreational and elite athletes. The research FIT-HEART has three main goals: Co-create, implement and evaluate an innovative program that promotes physical activity by integrating incentives from the individual’s (social) environment tailored to the needs of specific subgroups, which can be seamlessly integrated into healthcare systems across the Netherlands, with potential for future expansion to other patient groups and the broader population. Assess the upper limits of exercise on heart health in recreational and professional athletes by conducting prospective studies in unique cohorts. This approach integrates extensive cardiac phenotyping, wearable monitoring, novel AI technologies, digital twinning, immunophenotyping, and long-term evaluation of clinical outcomes. Establish and expand a multidisciplinary, synergistic consortium focused on sports, exercise, and heart health. Our mission is to nurture young talent, foster innovative cross-domain collaborations, and secure funding for ongoing and future research. In partnership with end-users, we will disseminate outcomes to professionals, patients, and the public, while raising awareness of the wide-ranging health benefits of an active lifestyle. The origin The FIT-HEART consortium emerged from a shared ambition among academic institutions, healthcare partners, patient organizations, and policymakers to address sedentary lifestyles in cardiovascular disease patients and to investigate the cardiac effects of extreme exercise in both elite and recreational athletes. This interdisciplinary initiative builds upon prior collaborative research in sports cardiology, preventive medicine, and behavioral interventions aimed at promoting physical activity. FIT-HEART is well-aligned with the strategic agendas of the Dutch Heart Foundation and the Dutch CardioVascular Alliance (DCVA), both of which prioritize innovative solutions to reduce the burden of cardiovascular disease. By integrating incentives from people’s social environment, the consortium aims to create personalized treatment options that encourage lasting physical activity, while taking into account subgroup-specific needs. In parallel, the integration of advanced cardiovascular methodologies enables FIT-HEART to identify recreational and professional athletes at an early stage who are at risk for adverse cardiovascular health outcomes.

Atherosclerotic cardiovascular disease (ASCVD) is the main cause of mortality in Europe. During the last decades, successful strategies have been developed to treat ASCVD targeting traditional and novel risk factors leading to an unprecedented arsenal to reduce the cardiovascular disease burden. Unfortunately, current strategies are all aimed at adding novel therapeutic agents on top of the standard therapeutic moieties, adopting the one-size-fits-all dogma. This strategy has major limitations including unaddressed heterogeneity of patients, ignoring patients’ side-effects, lack of response to therapy and decreased compliance. With ATHERONETH, we aim to bring forward stratification tools that help to improve the prediction of the actual cardiovascular risk of individual patients, and in particular the pathophysiological mechanisms the contribute to this risk in the individual patient. This will allow clinicians to better tailor their therapeutic regimens. The Research Our main objective is to identify biological parameters that can be utilized to better stratify patients with atherosclerotic cardiovascular disease for improved and personalized prevention and treatment. Utilization can be reached by finding circulating biomarkers or imaging characteristics that reflect plaque phenotypes, underlying pathophysiology, and ASCVD incidence. By combining frontline knowledge, clinical data resources and multimodal technologies, the consortium members will execute the following workplan. 1 - In ATHERONETH we will fine-tune the local phenotypic diversity of human plaques on a multi-omics level and define plaque types that associate with biology and clinical events. These plaque types will be associated with systemic read-outs (biomarkers). 2 - We will define systemic inflammatory and lipid metabolism related determinants of heterogeneity in plaque phenotype and ASCVD. 3 - We will utilise existing data from (large) cohorts to determine (epi)genetic, lipidomic/proteomic, and microbiome-related biomarkers of ASCVD and build algorithms that define subgroups of patients. 4 -We will study imaging parameters of plaque characteristics and inflammation that point to differential disease progression and potential treatment benefit. The Origin AtheroNeth leverages scientific power that was generated over the past decade by (inter)national research consortia. This consortium resulted from the DCVA exploration on atherosclerosis. Our vision for the future is to achieve a reduction in ASCVD-associated morbidity and mortality, an improvement in the quality of life for patients, and a reduction of the associated healthcare burden and costs. Our program has a strong match with the challenges as reported in the “Nationale Hart en Vaat agenda” (National Cardiovascular Agenda) of the Dutch Heart Foundation. It is evident that the current proposal addresses the challenges “Oog voor verschillen” (Eye for differences) and “Behandel op maat” (Tailored treatment).