He CNIC. Located in Madrid, the Carlos III National Cardiovascular Research Center is an iPioneering institution led by one of the most relevant cardiologists in the world, Valentí Fusterwho, according to the last ranking from the Cybermetrics Lab research group, He is the most cited Spanish scientist in history. It is not surprising: just take a look at its milestones to realize that has laid the foundations of current cardiology. We owe something to him that seems so truism today that prevention is better than cure.
Walking through the CNIC is Discover the world of precision medicine of the future. In one of the laboratories develops RNA therapies that block cholesterol synthesis; one of them, already on the market, It is administered twice a year. In another, they are investigating CRISPR gene editing technologies to treat alive hereditary heart diseases. And among the latest findings of this center is the having discovered how a metabolite of the intestinal microbiota is behind arteriosclerosis. Some images look like something out of science fiction movies.
The cardiologist appointments us at 7:30 in the morning in his office. He arrived an hour ago from New York, where he has resided and directed the prestigious Cardiovascular Institute at Mount Sinai Hospital since 1994.
For 20 years now, every week he has taken a plane on Thursday afternoon to wake up on Friday at the CNIC, where a marathon day awaits him alongside the center’s researchers and in which he also reserves time for his two “obsessions”, young people, who “are the future”, and health dissemination.
His 82 years of age, constant trips to both sides of the pond and a scientific and clinical agenda impossible for any other human do not seem to exhaust his energy. “It’s because what I do motivates me,” he says. Truly, Fuster is exceptional.
A group of CNIC researchers led by Dr. Sara González discovered a protein that participates in the maturation of heart vessels during embryonic development and whose deficiency would affect the coronary arteries. With high-resolution microscopic techniques, unprecedented detail of coronary vascularization has been achieved, in this case in the heart of a mouse.
“I’ve been studying the heart all my life and I still don’t understand how it can contract so efficiently all my life without breaking down,” he confesses candidly as soon as he begins to chat. Reviewing some data on this organ, which weighs just 300 grams, is like catching Fuster’s fascination: it beats an average of 60 times per minute – 30 in the case of outstanding athletes like Miguel Induráin or Kilian Jornet. about 3,000 million times throughout a lifetime; Its valves open and close constantly and last for decades working perfectlydespite the fact that their cells barely regenerate. With age, obviously, they can deteriorate and need replacement.
But despite how competent this organ is, cardiovascular diseases are since A few decades ago the leading cause of mortality on the planet, even ahead of cancer. According to estimates by the main international cardiology associations, Every year at least 17 million people die from heart disease, a figure that is increasing and is closely linked to an inadequate diet with a high content of sugars and fats. to a sedentary lifestyle, smoking, pollution, overweight and obesity.
The lymphatic vasculature of the heart, which performs functions such as protecting this organ against infections or recovery after a heart attack, is still very unknown. The study by doctors Miguel Torres and Ghislaine Lixoux revealed that cells from different tissues participate in its formation.
“I began my research career delving into the causes of heart disease, how, when and why the disease occurred, until I realized that most are caused by human behavior,” says Fuster. “That made me change my focus and focus on promoting health through prevention.”
This change of direction largely explains the two projects that he implemented at the CNIC when he assumed leadership in 2004 and that continue to be the center’s flagship: la polypildorawhich The WHO has recently recognized it as an essential medicine, and the PESA CNIC-Santander study, on atherosclerosis.
polypill: the prescribed medication
The polypill was born from another obsession of Fuster’s: adherence to treatment, or in other words, the need for the patient to take the prescribed medication, something that surprised him that did not happen, not even when people had suffered a heart attack. Hence I would like to simplify the treatment and reduce the daily prescription from three or four pills to just one.
This is the genesis of the polypill, which has taken more than 20 years to develop and at least 30 prototypes to find the formula for success. Today This drug is marketed in 25 European countries and is taking the final steps to also be launched in the United States. Its low cost, Fuster highlights hopefully, can make it decisive in developing countries, where cardiovascular disease has been skyrocketing in recent decades.
“High cholesterol is much more harmful to the arteries at age 40 than at age 60.”
Cardiovascular disease starts in the legs
Another of the CNIC’s great discoveries has come thanks to the PESA CNIC-Santander study, which has confirmed that cardiovascular diseases, as with neurodegenerative diseases, begin decades before they appear. The study followed 4,000 volunteer workers from Banco de Santander between 40 and 55 years old for 10 years to discover that cardiovascular disease started in the legswhere the large arteries are, without giving symptoms and that It later advanced, affecting the smaller arteries.. “It was a revelation,” Fuster emphasizes. We saw that Risk factors have a much greater impact on younger people: high cholesterol is much more damaging to arteries at 40 than at 60».
These findings have led the CNIC to initiate, with the Pascual Maragall Foundation, the PESA Brain study, which scrutinizes the relationship between cardiovascular and neurodegenerative disease within the same population of Santander volunteers. And the fact that arterial blood flow is affected by cholesterol plaques reduces the amount of irrigation that the brain receives, which implies less glucose in this organ and the death of nerve cells.
