Cardiovascular
 Prof Tom Marwick
Centre of Clinical Research Excellence
Cardiovascular exercise and prevention program for diabetic patients
Current guidelines suggest that the cardiovascular risk in patients with TIIDM is such that they should be managed as though they have established cardiac disease. This reflects both subclinical vascular and myocardial disease. A diet/exercise program can reduce the progression from impaired glucose tolerance to TIIDM and can reduce insulin resistance. Its role on subclinical complications of TIIDM is undefined.
We aim to develop an exercise and diet program specifically directed to reduce CV complications of TIIDM and examine outcomes at 4 years, to establish a sustainable home-based program using telemedicine methods and to assess the role of insulin resistance in development of abnormal cardiac and vascular function, and assess the metabolic effects of this program on insulin resistance.
Cardiac and vascular disease in renal transplant recipients
Cardiovascular disease accounts for 46% of deaths in patients with a functioning renal transplant (RTx) and is the most common cause of morbidity. Princess Alexandra Hospital has the largest renal transplant unit in the southern hemisphere with nearly 600 patients with functioning transplants and over 100 new transplants each year. Our preliminary data shows that disordered myocardial and vascular structure and function are apparent before the appearance of overt atherosclerosis and systolic dysfunction in transplant recipients.
We aim to confirm and extend these findings by studying a large cohort of these patients in which we will perform a multiple risk factor intervention study to try to reduce the progression of cardiovascular disease in RTx recipients (using carotid intima-medial thickness [IMT], brachial artery reactivity [BAR], arterial compliance and myocardial Doppler as surrogate end-points).
Heart Disease of Obesity
Obesity is an important correlate of cardiac disease, renal disease and proteinuria), independent of its association with coronary artery disease. Right ventricular dysfunction and edema are particularly frequent, and often ascribed to obstructive sleep apnea.
An alternative explanation is that adverse metabolic effects of obesity, including insulin resistance, mediate these changes. If so, these complications should be responsive to a lifestyle/prevention program.
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