The Center for Interdisciplinary Studies of Diabetic Cardiovascular Disease

Jean E. Schaffer, M.D., Director, and Daniel S. Ory, M.D., Co-Director

By focusing on cardiovascular disease in people with diabetes, the researchers of the Center for Interdisciplinary Studies of Diabetic Cardiovascular Disease address a health problem affecting about two-thirds of the over 20 million people in the United States who have diabetes. Heart disease and stroke are the leading causes of complications and death in people with diabetes.

At present, the way heart and vascular disease develops in people with diabetes is not completely understood. Evidence is emerging that how cardiovascular disease develops in people with diabetes is different from that of nondiabetic patients. For example, cardiomyopathy (unhealthy change in heart muscle tissue) is common even in diabetic patients who don't have high blood pressure and high cholesterol, and atherosclerosis (hardening and narrowing of arteries) in diabetic patients tends to be more aggressive and diffuse.

Researchers now believe that a central factor affecting the diabetic heart is that it adopts a unique metabolism. Because it's always pumping, the heart needs a large, constant supply of fuel, and ordinarily it gets it by adeptly switching between burning sugar or fat as the composition of its blood supply changes throughout the day. But the diabetic heart can't do this and relies mainly on fat for energy. Scientists have recently found that this strongly contributes to the eventual onset of cardiovascular disease.

"First and foremost, diabetes is a metabolic disease," says center director Jean Schafer, M.D., professor of medicine and of molecular biology and pharmacology. "So one of our goals is to find metabolic products in the blood or other tissues that can serve as biomarkers of cardiovascular complications in diabetic patients."

To do this, the new center will form a team of scientists with expertise in multiple disciplines including metabolism and cardiovascular pathobiology.

Physical changes in the heart or even particular genes that predispose for disease can also be biomarkers of diabetic cardiovascular disease. Once confirmed, these biomarkers will serve as early warning signs of impending cardiovascular disease in diabetes and will allow physicians to implement preventative measures before the disease becomes unmanageable.

"We know that the sooner we intervene in diabetic patients and make the appropriate modifications in lifestyle, such as exercise or dietary changes, or introduce the appropriate medications, the more likely we are to change the course of cardiovascular disease," says co-director Daniel S. Ory, M.D., associate professor of medicine and of cell biology and physiology. "The ability to recognize the markers of disease early would provide a very powerful benefit."

Noninvasive methods of imaging the heart will also be an important research focus of the center. Researchers who have joined the center previously discovered sensitive methods for measuring structural changes in the diabetic heart using echocardiographic techniques. "As we characterize these changes better and more fully understand their significance, that should translate into improving diagnosis in clinical echocardiography labs around the country," Schaffer says.

Changes in metabolism or in the physical appearance of the heart may stem in part from an underlying genetic component. Certain inherited tendencies may play a role in the severity or onset of cardiovascular disease in diabetic patients, so the center will also look for genetic markers. "The potential is there that before a patient displays any cardiac abnormalities, a genetic predisposition could be spotted, and this would open up a whole new area of preventative strategies," Ory says.

Finding the full range of biomarkers for cardiovascular disease in diabetes will require the expertise of several different research fields. Naturally, some of the center's researchers will hail from cardiology, but there will also be scientists who specialize in endocrinology, nutrition, molecular biology, chemistry, radiology, physics and more.

"As a physician scientist, I dream that something our team discovers in a culture dish or a mouse will someday help us take care of patients," Schaffer says. "It's an incredible privilege to be in a position now where we can to move from what we discover in our laboratories into applications that will affect the clinical population."