FACT/F-CRIN takes stock of advances in cardiovascular disease

A few weeks before the next World Heart Day on September 29th, the French Alliance for Cardiovascular Clinical Trials FACT/F-CRIN takes stock of the progress of treatments and ongoing trials. Interview with Prof. Ph. Gabriel Steg, President of FACT (F-CRIN Labeled Network), Head of the Cardiology Department at Bichat Hospital (AP-HP), expert in myocardial infarction and one of the few French specialists to conduct large international clinical trials.

How common is cardiovascular disease?

Myocardial infarction is one of the leading causes of death worldwide. In France it is the second leading cause of cancer. About 100,000 myocardial infarctions occur in France every year. A man is at higher risk from the age of 55, while a woman may have a later heart attack, from the age of 65 to 70. Before menopause, the risk is 4 times lower than in men, although the risk of early heart attack in women tends to increase because of female smoking.

What are the current treatments and solutions?

Cardiology is rich in drug, interventional and surgical treatments, both for curative treatment and for prevention. There have been tremendous advances, from drugs (antiarrhythmics for abnormal heart rhythms, anticoagulants and antiplatelet drugs to prevent blood clots, beta-blockers that lower heart rate and blood pressure, to statins that prevent plaque build-up in the arteries and reduce the long-term risk of heart attack reduce stroke, etc.) or more or less invasive procedures (angioplasty and stenting to widen the arteries, electroshock and endocavity ablation to restore the heart’s rhythm, coronary artery bypass graft surgery to improve the blood supply to the heart, valvular procedures to repair or replace one or more heart valves , sometimes without surgery, implantable pacemaker and defibrillator, to control heart rate, etc.). For example, thanks to all of these techniques, we have gone from a myocardial infarction mortality rate of 25% in the 1980s to 4% today.

What are the latest advances in clinical research from FACT in cardiovascular disease? How innovative are they?

The mission of FACT, the French Alliance for Cardiovascular Clinical Trials, is to design, conduct and conduct clinical trials. Since its inception in 2012, we have conducted numerous clinical trials, most of which are in phase 3 (at the stage of testing drugs or interventional techniques). For example, on anticoagulant drugs, which are very important in the treatment of heart attacks, or even drugs originally intended for diabetes that we are repositioning, we published two particularly important publications last year: Reality, led by Pr. Grégory Ducrocq (Bichat, Paris) the world’s first study to compare different blood transfusion strategies for the treatment of myocardial infarction in the case of anemia, and Flower MI (study led by Pr Étienne Puymirat, HEGP, Paris): the comparison of several strategies for coronary artery control Post-infarction angioplasty in patients with complex coronary lesions.

What other ongoing cardiovascular disease clinical trials is the FACT network involved in?

At the same time, we take part in several tests and studies:

  • EVAOLD led by Prof. Gilles BARONE-ROCHETTE (CHU Grenoble Alpes), who is investigating the best strategy to treat myocardial infarction in people aged 80 and over.
  • AQUATIC, coordinated in particular by Pr. Gilles LEMESLE (CHRU Lille) to define the best antithrombotic treatment for coronary patients with atrial fibrillation (the most common cardiac arrhythmia).
  • RITA 2 MI, a European-funded study to test a French discovery by Pr. Ziad MALLAT (PARCC/HEGP INSERM Paris and University of Cambridge), aimed at assessing the impact of a new therapeutic strategy targeting the immune response of patients after a myocardial infarction (MI).

What are the advances/benefits of these studies for patients and their families?

We have seen a huge increase in preventive and curative treatments in recent years, resulting in a 10-15% reduction in heart attacks. We are also interested in new risk factors, in particular the FRENCHIE registry, a French prospective observational registry of myocardial infarction, which investigates the importance of these new risk factors, such as poor dental hygiene and infections, periodontal disease or even obstructive sleep disorders such as sleep apnea, which seem to be factors that increase the likelihood of myocardial infarction. By treating these factors, heart attacks could be avoided. We are also investigating the abnormalities of a specific cholesterol fraction: Lp(a) and the impact of these abnormalities on the risk of myocardial infarction in patients and their families.

How can patients participate in ongoing or future studies?

All patients interested in participating in ongoing studies should speak to their doctor who can put them in touch with the FACT network. There is also a register of clinical trials at the AP-HP (available online: https://www.aphp.fr/registre-des-essais-cliniques), with the possibility of volunteering. We are particularly interested in people with abnormal Lp(a) elevations and coronary diseases: these patients can contact us (https://www.fact-trials.eu/fr/contact)

What contribution does the F-CRIN network make to the disease?

In order to carry out clinical studies, we need large numbers of patients: often several thousand, sometimes several tens of thousands. It is therefore important to belong to dynamic and organized networks such as the F-CRIN networks. It is also important that the network represents France in international collaborations and is sometimes able to initiate and manage these large international studies.

What message would you like to convey to the patients and families who read us?

I want to emphasize the importance of prevention. Even if the situation in France is more favorable than in other countries, myocardial infarction remains the second leading cause of death, with a large proportion of accidents being preventable. Prevention is therefore not effective enough. People with high blood pressure need to be better identified and treated; People with cholesterol need to change their lifestyle and take medication if necessary; Smokers need to be aware of the risk of cardiovascular accidents from tobacco… We are working on that, but there is still progress to be made in this area.

About F-CRIN
Founded in 2012, supported by INSERM and funded by the ANR and the Ministry of Health, F-CRIN (French Clinical Research Infrastructure Network) is an organization of excellence in French clinical research. Its objective is to strengthen the international competitiveness of French clinical research, to identify and label research networks, to facilitate the implementation of academic or industrial clinical trials and to develop the expertise of clinical research players by pooling know-how, objectives and resources. The organisation, which has a national coordination unit based in Toulouse, has already designated and pooled 16 clinical investigation networks for diseases of general international interest (severe asthma, stroke, cardiology, cardio-nephrology, atopic dermatitis, autoimmune and autoinflammatory diseases). currently , cardio-kidney diseases, cardiovascular diseases, motor neuron disease/Charcot disease, obesity, retinal pathologies, Parkinson’s disease and movement disorders, pediatrics, multiple sclerosis, sepsis, thrombosis, psychotic diseases, vaccinology), 3 competence and method networks (rare diseases , medical devices, epidemiology) and a tailor-made support platform that offers all the services needed to conduct clinical trials. Overall, F-CRIN represents a clout of more than 1,400 clinical research professionals. F-CRIN benefits from the support of several university hospitals, universities and foundations. More information: https://www.fcrin.org/

Founded by Prs. Ph. Gabriel Steg, Nicolas Danchin and Tabassome Simon, supported by a scientific committee of 3 members (Prs. Patrice Jaillon, Jean-Pierre Bassand, Pascal Gueret), the F-CRIN-labelled FACT network brings together excellent hospitals, cardiology teams, public (academic and non-academic) and private clinics, invested in cardiovascular clinical research and in particular in clinical studies in the field of coronary diseases. The objectives of this network are to conduct high-performing clinical trials in the field of coronary diseases, particularly coronary atherothrombosis and the cardiovascular complications of diabetes; promoting quality clinical research; professionalize clinical research in the field of coronary artery disease by training investigators in good clinical practice and facilitating patient recruitment for drug trials; to create a “single stop” for cardiovascular drug and medical device testing, allowing industrial sponsors to save time and avoid lengthy procedures involving all investigators; and to increase the visibility of coronary clinical research in France and abroad. More information : https://www.fact-trials.eu/en

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