Courtois Cardiovascular Biorepository

What is heart disease?

Heart disease is any condition which affects the structure and/or function of the heart. There are different types of conditions. Some of the more common conditions are:

  • disease of the blood vessels (known as coronary artery disease);
  • disease of the valves (known as valvular disease);
  • disease of the heart muscle (known as cardiomyopathy);
  • heart rhythm problems (known as arrhythmias); and
  • heart disease that you are born with (known as congenital heart disease).
What is a heart attack?

A myocardial infarction, also known as a heart attack, occurs when a blood vessel is blocked. The blocked area stops the flow of blood and oxygen to the heart muscle of the affected area. If the blood flow is not restored quickly, that area of the heart muscle can be damaged or destroyed.

What are examples of cardiovascular risk factors?

There are several examples of risk factors that lead to heart disease and stroke.

First, there are risk factors that can be controlled by simply changing your lifestyle and habits. These lifestyle risks include:

  • Smoking
  • Unhealthy diet
  • Stress
  • Physical inactivity
  • Excessive alcohol and drug use
  • Unhealthy weight

Second, there are medical conditions that you may have been diagnosed with that are risk factors. Some of these conditions include:

  • High cholesterol
  • High blood pressure
  • Diabetes
  • Sleep apnea

Third, there are risk factors that you cannot be changed, such as your:

  • Age
  • Sex
  • Family and medical history
  • Ethnicity

Remember, prevention is key to decreasing your risk of developing cardiovascular heart disease. Get or stay active, eat healthy, and do not smoke!

What is a stroke?

A stroke occurs when the blood vessels flowing up to the brain are blocked or ruptured. When this happens, the brain cannot get the blood and oxygen it needs and, consequently, brain cells die. Atrial fibrillation of the heart is a known risk factor for stroke.

Why is nutrition important?

Our nutrition is critical because every meal we eat provides us with the nutrients (e.g., proteins, vitamins and minerals) that we require to survive. A healthy diet increases energy and improves our mood. It also controls weight and can reduce the risk of certain diseases.

It is recommended that individuals follow “Canada’s Food Guide – Eating Well.” This guide allows you to make smart food choices from the different food groups. A well-balanced healthy diet helps fuel your body, enjoy the activities you love, complete everyday tasks and achieve overall good health.

Am I overweight?

In order to determine if you are at a healthy body weight, your doctor may use a calculation known as the Body Mass Index (BMI). The goal of the BMI is to use your weight and height to estimate body fat.
A high BMI is associated with an increased risk for chronic diseases, such as heart disease, high blood pressure, and type 2 diabetes in adults. If your BMI is higher than 25, you are likely overweight, so you should make some changes to your diet and exercise routine to help improve your health and reduce your risk of heart disease.

It is also important to note that although the BMI calculation is a good estimate of body fat for most people, it does have some limitations. For example, a person who is very muscular and physically fit, may have a high BMI due to muscle mass, which would be an overestimate of body fat.

Lipoprotein(a) Information

I was told my lipoprotein(a) was high. What does this mean?

Although testing for lipoprotein(a) (Lp(a)) levels is now recommended in Canada since 2021, Lp(a) is not normally measured as part of a routine lipid profile and your doctor may have not previously requested this test, even if you have had your “cholesterol” checked in the past.

What is a lipoprotein?

In order to dissolve in the blood and allow their transport to cells, certain lipids (fats) combine with proteins. It is this association that constitutes the lipoprotein. There are several types of lipoproteins, each of which has a different function. HDL (“good” cholesterol), for example, helps control excess blood cholesterol, while LDL (“bad” cholesterol) is a waste product that also delivers some cholesterol to tissues. Lp(a)is a particle that is similar to LDL, but has a more complex structure.

What is the link between cardiovascular disease (CVD) and lipoprotein(a)?

It is well known that excess LDL is bad for cardiovascular health. It contributes to the buildup of plaque in our arteries (atherosclerosis) and can ultimately lead to a blockage causing a heart attack or stroke. Lp(a) is also one of the lipoproteins that can accelerate atherosclerosis and cause other heart diseases, including aortic stenosis (a disease affecting the aortic valve of the heart). In addition to LDL and other risk factors for heart disease (for example, cigarette smoking, high blood pressure, high blood sugar), Lp(a) is an independent cardiovascular risk factor. Several studies have demonstrated this link between Lp(a) and increased risk of cardiovascular disease.

Lifestyle habits (poor diet, weight gain, and low physical activity) can partly explain high cholesterol levels, but genetics also plays a big role. Some people simply produce more cholesterol than others. Unlike other forms of cholesterol, Lp(a) levels are determined predominantly by genetic factors and are not influenced by age, gender or lifestyle habits. Simply put, our genetics determine the levels of Lp(a) we live with. These levels are also stable throughout life, with a few exceptions.

What can I do to reduce my cardiovascular risk?

While LDL levels can be controlled through medication and lifestyle changes, this is not the case for Lp(a). However, reducing LDL levels, controlling other risk factors, as well as making heart healthy lifestyle choices can reduce the associated cardiovascular risk.

In short…

Each person is different and elevated Lp(a) levels must be put in context depending on their individual case. Also, bear in mind that a high Lp(a) level does not signal a diagnosis of cardiovascular disease or put you at imminent danger. It only indicates a higher risk than the population average of someone like you from developing cardiovascular disease in the future. It is important to remember that it is possible to reduce your risk by taking control of your lifestyle, instituting heart healthy habits and controlling your LDL levels and other risk factors such as blood pressure and blood sugar with medications, when necessary.

Knowing that your Lp(a) is high, might make you concerned about your health, which is a normal reaction for some people. However, consider this an opportunity to focus your efforts on leading a more healthy lifestyle and speaking to your doctor about ways to reduce your cardiovascular risk.

Here are some resources that can help you take control of your cardiovascular risk:

How long will my blood be stored?

Your blood samples will be stored for as long as the research team continues to conduct research studies. The samples will be stored in -80°C freezers which will keep them in good condition, meaning that your blood derivatives will be preserved and remain intact for many years to come.

How long will my data be stored?

The data will be kept for as long as the research is ongoing at the McGill University Health Centre.

What does “storing my data on the cloud” mean?

Storing your data “on the cloud” means that all your de-identified study data that we collect will be kept and saved off-site (not at the MUHC), on a remote storage system, which is accessed via the internet. The data is maintained, managed, backed up and made available ONLY to our research team members who are responsible for managing the data.

Your data will be hosted in a commercial cloud located in Montreal, which follows all Canadian legal requirements in terms of personal information protection.

What is the goal of these scientific databases?

A scientific database is used to store and share research information. To speed up research and validate new discoveries, it is often helpful for researchers to share information among each other and to compare data from other studies. By sharing information, researchers can learn even more about human health and disease.

Why is my waist being measured?

It has been proven that excessive fat around your waist (which includes your belly) may put you at risk for heart disease. Even if you are a person with a healthy weight and carry some excess fat around your waist, this can increase your risk of high blood pressure, high cholesterol, heart disease and diabetes.

What is a “biorepository”?

Our biorepository is a collection of biological samples (e.g., blood/tissue) medical images (e.g., heart scans), and medical information. This collection is called the Courtois Cardiovascular Biorepository and will assist with future cardiovascular research.

What is “DNA”?

DNA stands for deoxyribonucleic acid.

DNA is a molecule that contains all the genetic information transmissible from one generation to the next. It provides a series of instructions that determines the unique characteristics of an individual, such as one’s eye colour or blood group. For the purpose of this biorepository, your DNA will be obtained from your blood sample.

What are “genes”?

Genes are segments of DNA that have the information required to make the body work. For example, they provide instructions to build all the proteins that make our body function. Genes carry information that is passed on to future generations e.g., your children. Genes essentially define who you are.

What is “RNA”?

RNA stands for ribonucleic acid.

RNA is a molecule that contains all the genetic information transmissible from one generation to the next. RNA is responsible for delivering DNA’s genetic message to the part of a cell that makes the proteins. For the purpose of this biorepository, your RNA will be obtained from blood.

What is microbiome?

The body is composed of bacteria, fungi and viruses that live on and inside the human body (e.g., in your stomach and on our skin). A microbiome is all the genetic material found in all these microbes.

These bacteria are extremely important as they help protect us against disease, help build our immunity, digest food, produce certain vitamins and keep us healthy. It will be studied through stool samples.

What is an MRI?

An MRI, or magnetic resonance imaging, is a non-invasive (meaning no needles or catheters required) imaging method that produces a 3-D image of your body without damaging radiation. This procedure can produce an image of your heart, carotid arteries and your brain. For a healthcare professional to perform this scan, you will need to lay down inside a large machine, remaining very still so that the image is not blurry. You will be given earphones to block out the sound of the scanner.

What is digital health?

Digital health is the use of technological devices such as your fitness watch, which can be used to improve healthcare delivery. These devices when worn can continuously collect data such as; personal, physical, environmental as well as sleep patterns. The compiled data can help us understand the effect of these factors on cardiovascular diseases.

Digital health is receiving a lot of attention and of growing interest to researchers. It is being used to assist with personalizing medicine. The data collected will also be stored on the cloud.

Your participation
Why should I participate?

Your participation in this study will help us develop new ways of managing and treating individuals with or at risk of developing heart conditions in the future. The future of medicine, as we see it, is not to treat the average person; instead, we hope to treat each person as a unique individual with personalized cardiovascular health management.

Will I receive immediate benefits?

The goal of this research study is to gain knowledge and, through this knowledge, develop signatures to help people in the future. Therefore, you will not receive immediate benefits from this study, but you may receive long term benefit when your research personalized signature is defined. In addition, this research will benefit future generations, which may include your children or grandchildren.

Will I get my data?

You will have access to a video of your heart and brain following the review of MRI scan, your calculated interheart score which categorizes you as; low, medium or high risk of developing heart disease in the future, and electrocardiogram (ECG) without interpretation, laboratory results and digital health data.

As this is a research study, we require data from many participants, such as yourself, in order to be able to perform our analysis and define individual signatures. We will share information when it becomes available.

Why would researchers want to study my blood?

Researchers often study the blood of people with a medical condition and compare it to the blood from people who do not have this condition. Researchers will use your samples, along with samples from thousands of other patients, to look for ways to prevent, diagnose, and/or treat health problems. Your blood can help researchers make discoveries that can advance medicine and improve treatments.

What will you get from my blood?

From your blood sample, we may extract plasma, serum, blood cells, DNA and RNA.

What if something bad is found?

If, during the study, your MRI scans or blood tests reveal a serious life-threatening concern, you and your treating physician will be contacted by phone and informed of the finding. As these tests are done as part of a research study, your doctor will need to repeat the test in clinic or hospital. Your physician will then recommend how to best manage the problem.