Home » Heart attack, so you can predict the risk in advance

Heart attack, so you can predict the risk in advance

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How do you know if people with no symptoms, but with initial coronary artery injuries, will develop a heart attack? Forecasts on the evolution of atherosclerosis are practically impossible today and it is not possible to know in advance who is at greater risk of developing a heart attack in the medium to long term. Tomorrow, perhaps, with a tailor-made cocktail of controls, it will be possible to discover who, in the presence of atherosclerosis of the coronary arteries that may not cause any problems, runs the highest risk of suffering a heart attack.

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A “mixture of information”, put in order also thanks to the support of artificial intelligence, to reveal the future of cardiac health. It is not a utopia, but the promise that opens up for research thanks to the Intestrat-Cad study, coordinated by the Monzino Cardiology Center and which opens the second phase of recruitment for volunteers who intend to be studied.

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The investigation will search in the blood of people without previous heart attacks or angioplasty treatments to revascularize the arteries that supply the heart – but for which the CT scan has shown an initial coronary atherosclerotic disease – one or more biomarkers to be associated with the picture highlighted by the same Tac. Thanks to these “signalers”, identifiable thanks to a simple blood test, the aim is to identify patients at greater risk with a simple blood test. In short: the research aims to identify how to “build” the cocktail of controls for subjects who have no problems, but with atherosclerosis that attacks the coronary arteries, and therefore discover in advance, in the absence of symptoms, what will be the first clinical manifestation in the course of life of a person with coronary atherosclerosis (that is, if they will have an acute event or a chronic stable form of heart disease).

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Obviously, it will then be possible to carry out a much more careful monitoring on these subjects and perhaps it will be possible to study treatment paths for risk factors and targeted treatments for the most dangerous plaques.

“The original idea of ​​the research starts from the assumption of the Epiphany study, launched at Monzino 4 years ago: not all coronary plaques are the same and above all not all lead to a cardiovascular event – he explains Gualtiero Colombo, Head of the Monzino Functional Genomics and Immunology Unit – we therefore set ourselves the goal of classifying the different risk of coronary events in patients with initial plaques, based on personalized molecular prognostic indicators. The partnership with some of the best excellences of Lombardy allows important evolutions compared to Epiphany. We will use artificial intelligence to generate risk prediction models, we will study new molecular aspects of the disease, such as the structure of the immune / inflammatory response at the cellular level “.

Precisely from the preliminary data of the first study, however, it is confirmed that atherosclerotic plaques are not all the same and that the forms of atherosclerosis can therefore be different from a molecular point of view: consequently, specific parameters could exist for different subtypes of coronary heart disease. “Now we can broaden our horizons and our ambitions and find a greater number of these parameters, to define the predisposition to heart attack at the level of a single subject – continues the expert – phase two of the project is now starting: to recall patients for which there is an indication to perform a second coronary CT scan, in order to evaluate the progression of the disease. “

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The study is important because, although starting from an apparently identical basis, the atherosclerotic process of the coronary arteries, which leads to their progressive occlusion, can last decades and clinically manifest itself in very different ways. There are individuals, even of an advanced age, who have never experienced and never will experience symptoms. In other cases, the disease develops progressively until it causes angina, that is, a chronic but relatively benign disease. Other patients, on the other hand, face serious events, such as a heart attack, or even fatal, such as sudden death. With this study, perhaps, tomorrow it will be possible to identify who is at risk and how to behave. The Interstrat-Cad research is funded by the Regional Foundation for Biomedical Research (FRRB) and unites in partnership the Humanitas Clinical Institute, IFOM (FIRC Institute of Molecular Oncology), the University of Pavia and the Policlinico San Matteo of Pavia. , with Monzino as coordinator and recruiter center.

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