Our Team Research encompassing 1,500,000 participants on 6 continents in 102 countries 70 scientists, investigators and research fellows 300 100 study team staff studies led by PHRI Messages from the Leadership Contents Vital Signs 8 Ahead of the Curve 10 Entering its third decade, this joint Extraordinary science, consistently institute of McMaster University high-quality research, is happening Governance of PHRI 11 and Hamilton Health Sciences at Population Health Research Setting the COMPASS 12 embodies a strong culture of inquiry, Institute. Their innovative and Reducing Bleeding collaboration and innovation. fundamentally important projects 14 The high standards maintained are key to the future health of Silent But Deadly 16 by PHRI draw gifted researchers Canadians, and indeed to all Reversing Type 2 Diabetes 18 from around the world citizens of the world.” to Hamilton.” Halving Perioperative Risk 20 Paul O’Byrne Patrick Deane Dean & Vice-President, Brain Health 22 President and Chancellor, Faculty of Health McMaster University Sciences, Preventing Deaths After Heart Attacks 24 McMaster University PURE World 26 Dietary Dialogue 28 Global Health 30 Research into Action 32 Health Starts Early 34 The research by PHRI has improved I am proud of the impact on health Nature or Nurture? 36 clinical practice and disease of our studies and of our scientists.” prevention in Hamilton Many Minds, One Goal 38 Salim Yusuf and Canada.” Executive Director, Learning from International Experts 40 Population Health Rob MacIsaac Research Institute The Next Generation 42 President, Hamilton Health Sciences Early-Career Scientists 44 Optimized Operations 46 Our Research Community 48 Helping Those in Need 50 Our continued gratitude to David Braley for his generous donation to help fund Mission Forward 52 the David Braley Cardiac Vascular Stroke Research Institute building. 6 7 Vital Signs PHRI PAPERS WITH MORE THAN 1,000 CITATIONS HOPE Ramipril, NEJM 2000 REGULATORY APPROVALS BASED ON PHRI TRIALS RE-LY, NEJM 2009 PHRI TRIAL DRUG INDICATION INTERHEART, Lancet 2004 CURE, NEJM 2001 COMPASS Rivaroxaban Coronary Artery Disease / ACCORD, NEJM, 2008 Peripheral Artery Disease PCI-CURE, Lancet 2001 ACTIVE Clopidogrel Prevention of Vascular Events ONTARGET, NEJM 2008 in Atrial Fibrillation MICRO-HOPE, Lancet 2000 AVERROES Apixaban Prevention of Stroke in Atrial Fibrillation INTERHEART Obesity, Lancet 2005 RE-LY Dabigatran Prevention of Stroke in Atrial Fibrillation Global Burden of CVD Part 1, Circulation 2001 HOPE Albuminuria, JAMA 2001 ONTARGET / Telmisartan Prevention of Cardiovascular Disease CHARM-Preserved, Lancet 2003 TRANSCEND AVERROES, NEJM 2011 OASIS-6 Fondaparinux ST Elevation Myocardial Infarction HOPE Vitamin E, NEJM 2000 OASIS-5 Fondaparinux Unstable Angina/Non-ST Elevation INTERSTROKE, Lancet 2010 Myocardial Infarction ACTIVE-W, Lancet 2003 OASIS-4 Clopidogrel Unstable Angina/Non-ST Elevation CHARM-Added, Lancet 2003 Myocardial Infarction CHARM-Overall, Lancet 2003 DREAM Rosiglitazone, Lancet 2006 RESOLVD / Candesartan Heart Failure HOPE-2, NEJM 2006 CHARM Metoprolol CR INTERHEART Psychosocial, Lancet 2004 HOPE Ramipril Secondary Prevention POISE, Lancet 2008 HOPE Renal, Ann Int. Med 2001 PHRI IN PUBLICATIONS: 1993 THROUGH 2018 CHARM-Alternative, Lancet 2008 ONTARGET Renal, Lancer 2008 500 0 1,000 2,000 3,000 4,000 5,000 6,000 400 300 HOPE-3 was named by the New England Journal of Medicine as one of the most influential studies of 2016, concluding that heart disease could be prevented by giving healthy seniors a pill to lower their cholesterol. The article was one of the NEJM articles 200 deemed “the most meaningful in improving medical practice and patient care.” A paper on fat intake from the PURE study was number one on Altmetric in 2017, 100 and the physical activity paper related to PURE was in the top 100 in 2017. The PURE dairy paper was in the top 10 for 2018. 0 2011 8 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2012 2013 2014 2015 2016 2017 2018 9 Ahead of the Curve Governance of PHRI Our goal is to conduct research that can improve the world’s health through PHRI has two founding organizations, McMaster University, and Hamilton Health transformative discoveries. After first leading the preventive cardiology and Sciences (HHS). As a joint research institute, the Executive Director is responsible therapeutic program for seven years, Salim Yusuf founded PHRI in 1999 to broaden to a governing body comprising representatives of PHRI, McMaster and HHS. the research agenda. Key factors behind PHRI’s success include an extensive international network In addition, the International Scientific Advisory Board provides scientific and of committed collaborators and the wide range of the types of studies conducted, strategic advice. Its members include: including large and small randomized trials with various designs and large population-based epidemiologic studies in more than 100 countries. These studies • Sir Rory Collins, (Chair), University of Oxford, UK have enabled us to answer several questions rigorously. • Dr. Alan Bernstein, (Co-Chair), Canadian Institute for Advanced Research Our unique Prospective Urban and Rural Epidemiological (PURE) study involves • Dr. Robert Califf, Duke University, USA studying 200,000 participants in detail, and 500,000 with simple information, • Dr. Mark Lathrop, McGill University, Canada from more than 1,000 urban and rural communities in 26 high, middle and low • Lord Ajay Kakkar, University College London, UK income countries. PURE is investigating the impact of modernization, urbanization • Dr. Alan Lopez, University of Melbourne, Australia and globalization on health behaviours, how risk factors develop and influence • Dr. Sudha Seshadri, UT Health San Antonio, USA cardiovascular disease, diabetes, lung diseases, cancers, kidney disease, brain health and injuries. New ambitious studies document the health status of one million The board of Hamilton Health Sciences Research Institute (HHSRI) provides people in Asia. stewardship of the PHRI Research Endowment. HHSRI is comprised of: • Craig Laviolette, (Chair), VP, Siemens Canada Reach of participation • Rob MacIsaac, CEO, Hamilton Health Sciences • Paul O’Byrne, Dean and VP, Faculty of Health Sciences, McMaster University Studying health systems • Marvin Ryder, Asst. Prof., Marketing, McMaster University and environmental knowledge • Akbar Panju, Professor, Medicine, McMaster University implementation • Robert Jones, former Chair of Board, HHS Observational studies in 6 continents with 1,000 urban & rural Clinical trials in communities North America Dean, Faculty of Health Sciences, and Europe McMaster University Exploring new CEO, Hamilton Health Sciences disease pathways through genomics, proteomics, Expanding to dementia, metabolomics Hamilton Health Sciences International renal, stroke, perioperative Executive Committee Research Institute Scientific Advisory Foundational work in medicine, CV surgery, of PHRI Board (ISAB) important health-related cancer, thrombosis, (HHSRI) Board research, serving as a childhood risk factors model for similar efforts in other countries Scope of studies 10 11 Use of rivaroxaban, a new antithrombotic treatment, reduces heart attacks, strokes, amputations and death in patients with coronary artery disease or peripheral artery disease.” Setting the COMPASS – Stuart Connolly, Senior Scientific Lead The COMPASS trial, involving 26,997 COMPASS co-investigators patients with coronary artery disease Stuart Connolly, Jackie Bosch, or peripheral artery disease, showed John Eikelboom, Sonia Anand and that rivaroxaban plus aspirin lowered Salim Yusuf, were joined by stroke the risk of serious vascular events, researchers Robert Hart and including stroke, limb amputation Mike Sharma on COMPASS-MIND. and death — three of the most feared That study’s results found that complications of atherosclerotic low-dose rivaroxaban plus aspirin is vascular disease. These findings effective for primary and secondary represent major advances for patients. stroke prevention in patients with clinical atherosclerosis. • Rapid approval of rivaroxaban by regulators around the world • 602 hospitals and clinics in 33 countries 12 13 • Approvals by regulatory agencies worldwide of the use of apixaban and dabigatran for the prevention of stroke in patients with atrial fibrillation • Thrombosis and Atherosclerosis Research Institute (TaARI) • Canadian Venous Thromboembolism and Outcomes Research Network (CanVECTOR) Reducing Bleeding • COMPASS network of cardiologists, internists, hospitalists, vascular physicians and surgeons • INTERBLEED Network of Gastroenterologists In the ACTIVE-A study, Stuart Connolly and Salim Yusuf Can we prevent clots without found that giving clopidogrel plus aspirin to patients with atrial fibrillation, increasing bleeding?” for whom vitamin-K antagonist therapy – John Eikelboom, Senior Scientist was unsuitable, reduced major vascular events, especially stroke, but increased major hemorrhage. Thrombosis causes one in four deaths In the subsequent RE-LY and in Canada, and kills about 10 million AVERROES studies, Connolly, people a year globally. Antithrombotic Eikelboom and Yusuf proved that the drugs prevent and treat venous new oral anticoagulants, dabigatran thromboembolism, acute coronary and apixaban, were more effective than syndromes and stroke. Not all patients conventional anticoagulation (warfarin) benefit equally from drug treatment; or aspirin in preventing strokes