Obesity and diabetes: it’s not about how much fat you haveFor a long time, it was thought that excess fat led to metabolic dysfunction and obesity, which in turn, led to vascular disease. In 2008, we introduced the concept of fat tissue dysfunction and its relationship to vascular risk factors and disease. Being obese is no longer about how much fat someone has, but about the quality and function of fat (we use fat for energy and insulation). Fat cells that become functionally flawed can contribute to disease by the production of adipokines, inflammation and coagulation factors. Also, obese people are at higher risk for diabetes by the same process of adipokine production as a result of adipose tissue dysfunction.
Personalizing treatment for prevention of vascular diseases by predicting individual treatment effectsPatients with high risk for first or recurrent vascular events, such as patients with vascular disease and patients with diabetes receive medication that lowers blood pressure, lowers cholesterol and anticoagulants. However, not every patient will respond in the same way to the medication. We’re using data from large randomized clinical trials and from various cohorts to make prediction models for risk and for treatment effects in individual patients. We can now even predict lifetime risk and from there, also lifetime benefit from blood pressure lowering or cholesterol lowering therapy or from anticoagulants in terms of vascular disease-free life years gained. This information can be used to discuss with a patient (‘shared decision making’) whether or not to start or intensify treatment.
Vaatrisico app and U-Prevent website/appMany patients fall into the gray zone of risk – they may be at risk – and they often ask me why they need to take medication. Several years ago, we developed the vaatrisico app, available free of charge in App and Android stores. With the risk calculators in these apps, an individual’s vascular risk can be calculated, and this information can be easily communicated to patients.
Based on research in collaboration with various research groups world-wide, we’ve created U-Prevent, a website and app to calculate individual lifetime benefit of cholesterol lowering and blood pressure lowering and anticoagulant therapy. This is a real paradigm shift. U-Prevent helps patients and their doctors to choose wisely with shared decision-making based on data from big data research. We have the ambition to further improve the prediction algorithms and tools in close collaboration with our colleagues from Harvard Medical School in Boston.
Principal InvestigatorFrank Visseren, MD, PhD
Jannick Dorresteijn, MD, MSc, PhD
Administrative staffMargie Pinas
Nicole Jaspers, MD
Monique van Kleef, MD
Cilie van het klooster, MD
Tamar de Vries, MD
Jean-Paul Vendeville, MD
Britt Heideman, MD
Steven Hageman, MD
Research nursesCorina Joosten
Nursing specialistsCorien Flint