The progressive life-long ageing of the cardiovascular system is markedly involved in the maintenance of health on the one hand and in the high incidence of cardiovascular (CV) morbidity on the other, as shown by the occurrence of hypertension, heart failure, coronary artery disease, cerebrovascular disease and chronic kidney disease. These diseases are the leading causes of preventable high premature mortality, iterative hospitalizations, reduced physical and physiological adaptation, loss of autonomy and decline in quality of life.
The scopes of FHU-CARTAGE are:
- The appraisal of the evolution in time - from infancy to the very elderly - of cardiovascular disease. The proposed concept being that the current approach of accepting the population after having reached sexual maturity as a homogenous collective up to the occurrence of death is too simplistic and perfectible.
- The assessment of different biological time-clocks involved in the maintenance and the progression of cardiovascular disease both on a population-based approach as well as on an individual-based approach allowing the development of diagnostic, preventive and therapeutic strategies targeting both the population as well as the individual (population medicine and individualized medicine).
- A particular focus will be devoted to old frail subjects with CV diseases in order to apply personalized diagnostic and therapeutic strategies taking into account their biological rather than chronological age.
The Lorraine region is one of the French regions with the highest prevalence of cardiovascular disease. To date, CV prevention has primarily targeted classical CV risk factors and generic interventions on environmental and social factors applied mostly in a non-systematic manner and without systematic longitudinal follow-up.
The integration of more sophisticated diagnostic analyses including genomics and proteomics as well as novel imaging technologies will allow studying the population as well as individuals in a more specific manner to guide and evaluate therapeutic interventions.
We believe that the “ageing” dimension is still very sparsely integrated in both the research and the clinical management of common cardiovascular diseases. This can be easily illustrated through an example from clinical research in the field of hypertension: it is generally considered that the difficulties in identifying genetic variants related to arterial hypertension in the general population is related to the polygenic character of this disease and to multiple gene-gene and gene-environment interactions.
However, this classical approach does not integrate the fact that the increase in blood pressure– and particularly in systolic pressure - is largely age-dependent and primarily an index of vascular ageing.
Interestingly, looking for genes that cause human diseases is based on the principle that gene segregation in a population follows the principles of evolution by natural selection. However, such a principle can only occur during the reproductive years, while essential hypertension, and particularly systolic hypertension, occurs by far much later during the post-reproductive period. It is necessary, therefore, to incorporate the “ageing” dimension into models of essential hypertension and search for biomarkers able to identify individual variations in the degree of biological ageing.
The main objective of FHU – CARTAGE is to fully integrate the concept of the “ageing process” in order to elaborate innovative patient-centered strategies for the prevention, monitoring and treatment of age-related CV diseases. This involves the further development of not only specific programs of basic, translational and clinical research, but also of implementation and dissemination programs including innovative disease management programs and dedicated training plans.
KEY WORDS: ageing, cardiovascular, patient-centered, translational research, frailty, innovation.