Cholesterol bis? Polish scientists are looking for new risk factors
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Thanks to the Białystok PLUS study, we can already see what diseases are undiagnosed in society. We hope to discover new markers, thanks to which it will be possible to diagnose earlier, for example, heart diseases, cancers – says Prof. Karol Kamiński from the Medical University of Białystok, head of Białystok PLUS: an epidemiological study on a European scale.
Katarzyna Pinkosz, Wprost: A unique project on a European scale: this is the name of the Białystok PLUS project (Polish Longitudinal University Study). What distinguishes it from other epidemiological studies?
Prof. Karol Kaminski: We want to invite 10,000 residents of Białystok between 20 and 80 years of age, selected by lottery. The study is conducted in cooperation with the City Office. After drawing people, we receive their addresses and send invitations to the study. So far, we have invited over 8,000 people and examined almost 3,000.
Previous epidemiological studies usually covered one section; they concerned, for example, the circulatory system, respiratory system, neoplastic diseases. Meanwhile, the patient is one and we want to examine residents in terms of the respiratory system, circulatory system, possible neoplastic diseases or metabolic disorders, in order to obtain a comprehensive picture of their health. We are modelling ourselves on the SHIP study (Study of Health in Pomerania) conducted for a dozen or so years by the University of Greifswald, which is our official partner.
Do I understand correctly: you are examining healthy people very carefully? Not patients? What is the purpose of the study?
We want to find out what are the causes of development and course of the most common diseases of civilization. They result mainly from lifestyle, but they can also be conditioned by genetics or environmental factors. Our goal is to investigate factors that have “eluded” previous epidemiological studies.
Medicine has become extremely specialized, many researchers deal with a very narrow scope – e.g. one organ, disease. Much less research concerns a holistic approach to the person being examined. We examine the people we draw very broadly.
We start with a detailed medical interview, past procedures, but also mental and psychological problems. We perform basic tests (height, weight, BMI, body composition), check how the respiratory system is functioning, perform a spirometric test. We also examine the functions of the circulatory system – in various ways, starting with echocardiography, we perform carotid artery ultrasound, we examine the pulse wave velocity. We perform ophthalmological tests (fundus of the eye, pressure in the eyeball, transparency of the lens), thyroid ultrasound, liver. We assess the condition of the oral cavity, because it correlates very well with multi-morbidity.
Is every person examined from head to toe?
Yes, we also perform whole-body MRI scans: for people who decide to do so. Each person also has a general urine test, morphology, immunochemical and hormonal tests, and tests for some markers, such as troponin. Thanks to this, we collect a very rich range of data that we can assess both from a medical and social perspective – we cooperate in this area with the Institute of Sociology at the University of Białystok, which analyzes social data.
This year we received an ABM grant for an epidemiological study of multimorbidity, which will allow us to reassess the people studied after 6 years. So these people, whom we studied for the first time in 2018, we will study again this year. Thanks to this, we will be able to assess how the factors we assessed in 2018 influenced the development of individual diseases. It will show us what may happen (in terms of diseases) in the population of Białystok in the following years.
It will be possible to predict what diseases residents will suffer from in 10 years…
We use large-scale methods for this purpose, genetic methods that reveal polymorphisms present in the entire genome; metabolomic and proteomic studies that currently define about 400 proteins circulating in the blood. We want to see how they are related to existing disorders, and whether they will allow us to predict, for example, the occurrence of a heart attack, stroke, diabetes, or cancer.
We are collecting many elements to be able to use them in the next analysis after 6 years, and then after 4 years. We will have a 10-year observation, thanks to which we will be able to assess what the threats are in the population of Białystok, but also what new disease markers may be.
We are also very open to cooperation, which is why we have projects on voice analysis, how it can predict the development of specific diseases.
How is voice analysis used to predict disease progression?
One doctorate has already been defended on this topic: it turns out that young women suffering from polycystic ovary syndrome have a changed voice. Some parameters can be detected, for example, to suggest that it is worth being tested for a specific purpose. We have conducted similar studies for diabetes, atherosclerosis; they are very promising.
The people who are selected are examined very carefully. If the results are abnormal: are they referred to a doctor?
First, we ask if the person wants to know what the results of our tests are. If so, we always end the test with a conversation with the doctor. He or she provides information about the pathological results that we know need to be looked at. Please note that we are looking at many factors that we do not yet know about today, what their impact is and what role they will play in diagnostics.
The study participant receives a complete set of results from us with a detailed description of what to do. But there have also been cases where a patient went straight from us to the emergency room because we detected, for example, very severe anemia.
It is still too early to sum up, but can we already lift the veil of secrecy after these first research results?
Yes, we see that there is a large group of people who do not know that they are sick: they have, for example, pre-diabetes, diabetes, hyperlipidemia, thyroid nodules. We see that we should pay more attention to diagnostics to detect diseases earlier.
Just as it was once discovered that high LDL cholesterol is a risk factor for atherosclerosis, so thanks to Białystok PLUS it will be possible to detect a new marker that will suggest early on that a given disease is beginning to develop? Is there a chance for such a breakthrough discovery?
We hope so! Perhaps this type of marker will be used in early diagnostics or screening. Thanks to our multidirectional assessments, we may also be able to say that, for example, a person with lung disease, with the presence of certain markers, is also at risk for intestinal disease and intervene earlier.
We see medicine moving away from a holistic view of the patient. We believe it is worth looking at how different organs and systems interact with each other.
Will it be possible to extrapolate the results from Białystok to the whole of Poland?
I think so; the population of Białystok is not very different from the population of the rest of Poland.
In medicine, we often rely on research results from other countries, e.g. the Framingham Study, which examines the impact of various factors on the incidence of heart disease, is conducted in the US and used worldwide. So, when it comes to risk factors and markers of the development of individual diseases, the population we study seems to be representative.
Based on the results of our research, we want to develop a calculator for the risk of multiple diseases. We will verify it in the national population – thanks to this, we will be able to assess the frequency of multiple diseases: both conscious and unconscious in the population of the entire country. In particular, unconscious multiple diseases are a very serious risk factor for death.
Prof. dr hab. Karol Kamiński is a cardiologist and heads the Department of Population Medicine and Prevention of Civilization Diseases at the Medical University of Białystok.