(12) Department of Evidence-Based Cardiovascular Medicine
The application of evidence-based medicine (EBM) has become indispensable in recent years. The establishment of a foundation for EBM in Japan is lagging far behind that in Europe and the United States, however. Department of Evidence-Based Cardiovascular Medicine was established in October 2007 to construct a large quantity of scientific evidence for treatment of cardiovascular disease in Japanese (See Figure 1). (Department of Evidence-Based Cardiovascular Medicine)
Fig. 1: Evidence-Based Medicine
Major Research Themes Currently in Progress
1.The CHART-2 Study and SUPPORT Trial
Chronic heart failure(CHF) is the final phase of cardiovascular disease and the prognosis of patients with CHF is poor. Japan is now one of the countries in which the population is again rapidly, so we anticipate an marked increase in chronic heart failure due to its high occurrence in the elderly. In 2000 we began Chronic Heart Failure Analysis and Registry in the Tohoku District (CHART-1 Study) as prospective cohort study on chronic heart failure to identify the characteristics of and prognosis for chronic heart failure in Japan and much knowledge from this research has been already presented. This was followed in October 2006 with the organization of the Tohoku Heart Failure Association with approximately 20 affiliated institutions in the Tohoku Region and the start of CHART-2 Study (NCT00418041) as a new cohort study. This cohort will enroll 10,000 cases of continuously monitored heart failure patients (ACC/AHA Guidelines Stage B to D) and we will prospectively follow these cases, for at least three years which makes this the largest scale of cohort research in Japan.
At the same time, the SUPPORT Trial (NCT00417222), a randomized clinical trial, for evaluating the event suppression effect of adding angiotensin II receptor blocker treatment to 1,000 chronic heart failure patients also suffering from hypertension who were selected from this cohort was started. This trial is expected to provide the world's first evidence for use of this medicine in Japanese. Those interested in this research can learn more from the Department's website.
2.Other Research in Progress
As the Ministry of Health, Labour and Welfare Scientific Research Grant Adoption Study, "The role of Metabolic Syndrome in the development of Chronic Heart failure," a joint research project with two other facilities in other parts of the country. Coronary Spasm Association(CSA) was launched in August 2006 to conduct the research on the coronary spasms from the basic and clinical perspectives. Under the direction of Tohoku University (Professor Hiroaki Shimokawa) and Kumamoto University (Professor Hisao Ogawa), 68 facilities are participating nationwide in this research. The CSA is operated receiving research grants from the Japan Heart Foundation and its office is located in our department.
Fig. 4: Block diagram of "The role of Metabolic Syndrome in the development of Chronic Heart failure"
Fig. 5: Coronary Spasm Association Website
Publications (since 2000)
- Shiba N, Shimokawa H. Chronic heart failure in Japan: Implications of the CHART studies. Vascular Health and Risk Management 2008;4:103-113.
- Shiba N, Matsuki M, Takahashi J, Tada T, Watanabe J, Shimokawa H. Prognostic importance of chronic kidney disease in Japanese patients with chronic heart failure. Circ J. 2008 Feb;72(2):173-8.
- Tada T, Shiba N, Watanabe J, Matsuki M, Kagaya Y, Shinozaki T, Shirato K, Shimokawa H. Prognostic value of anemia in predicting sudden death of patients with diastolic heart failure. Int J Cardiol. 2007 Jul 20. [Epub ahead of print]
- Shirato K, Shiba N, Shimokawa H. Chronic Heart Failure Analysis and Registry in the Tohoku District: the CHART study Nippon Rinsho. 2007 Apr 28;65 Suppl 4:74-8.
- Watanabe J, Shinozaki T, Shiba N, Fukahori K, Koseki Y, Karibe A, Sakuma M, Miura M, Kagaya Y, Shirato K. Accumulation of risk markers predicts the incidence of sudden death in patients with chronic heart failure .Eur J Heart Fail. 2006;8:237-242.
- Watanabe J, Shiba N, Shinozaki T, Koseki Y, Karibe A, Komaru T, Miura M, Fukuchi M, Fukahori K, Sakuma M, Kagaya Y, Shirato K. Prognostic value of plasma brain natriuretic peptide combined with left ventricular dimensions in predicting sudden death of patients with chronic heart failure. J Card Fail. 2005;11:50-55.
- Shiba N, Watanabe J, Shinozaki T, Koseki Y, Sakuma M, Kagaya Y, Shirato K. Poor prognosis of Japanese patients with chronic heart failure following myocardial infarction--comparison with nonischemic cardiomyopathy. Circ J. 2005;69:143-149.
- Shiba N, Watanabe J, Shinozaki T, Koseki Y, Sakuma M, Kagaya Y, Shirato K; CHART Investigators. Analysis of chronic heart failure registry in the Tohoku district: third year follow-up. Circ J. 2004;68:427-434.
( Text by Nobuyuki Shiba )