Have you ever wondered why no one has yet come up with the crystal ball? A genial idea that haunted the human kind ever since it reached the awareness of self-limiting existence. Not only for what is there hereafter, but also as a dread of the unforeseen consequences of the paths in life less well taken. Foreseeing the future. Predicting disasters. Welcome to the world of atherosclerosis where predicting the events, like heart attacks, is the key instrument in the battle of survival. Ever since we can deal with the heart attacks, physicians are trying to recognise the obvious patterns of signs prompting them to imminent disaster. For sure, at times disease process allows enough time to reveal itself in a recognisable picture, however, many times it presents as a silent disease with little give away of forthcoming blow.
Many of the molecules present in the bloodstream at the time of the heart attacks have been explored for that purpose. In many instances, these merely confirm that disaster is taking place. These may be the expression of offensive front or may constitute part of counteracting self-protecting mechanisms. In both instances, little is gained on the quest of predicting the events, as neither would be present before the actual insult. Even less is gained in understanding their actual role and whether modifying it would make a difference.
Preventing disasters therefore seems even less palpable goal. True, we know some of the major causes, like high blood pressure, diabetes, cholesterol and smoking and we fiercely fight against them. Many times we need to admit our defeat in spite of our best efforts. It seems that disease process reaches a new balance at another level and relentlessly progresses further.
Faced with so many obstacles to fight the disease, one thought crystallizes without a need for the crystal ball. Knowing your enemy well is the key first step. Understanding the underlying process through meticulous homework seems to be the next step in spite of an unhappy thought of immensity of the work ahead of us. The third step in the battle is therefore a wise strategy. Some pieces of the puzzle are available and setting them together we can project at least a crude picture. Atherosclerosis involves inflammation within vessel wall that starts at very early age and progresses ever since. Looking at the groups where particular mechanisms may predominate may yield more insight as to its contribution and the role. Our research thus looks at the populations at risk and tries to understand what makes them vulnerable.
We will produce pictures of the vessels and the heart using imaging techniques that constitute every day clinical practice, ultrasound and magnetic resonance imaging. Whatever observed with the imaging, we will try to draw in a common pattern and look whether these patterns differ among different groups of diseases and from healthy people. Similarly, we will look at the blood and try to draw the signatures from there.
There is little to argue against a meticulous approach that we are attempting by having a good look to understand better. This may not give us the crystal ball imminently. It may, however, fill in some of the crucially missing pieces in the atherosclerosis puzzle.
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Many thanks for your support.
Dr Valentina Puntmann, Imperial College London
