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Q&A with Dr James Nadel
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Q&A with Dr James Nadel

The role of inflammation in the development, identification and treatment of unstable blood vessel plaque

Dr James Nadel received a Heart Foundation Health Professional Scholarship in 2020. His PhD at the University of New South Wales will examine the role of the enzyme myeloperoxidase in plaques that cause heart attack and stroke. 

What are you currently researching?

Atherosclerosis is a condition where the arteries supplying the heart, brain and body build-up plaque. Plaques are made of cholesterol, inflammatory cells and other materials. They build up inside artery walls and can cause the arteries to narrow and stiffen. This can reduce the flow of blood and oxygen to vital organs like the heart and brain. In some cases, the plaque can rupture, and a blood clot can form. The blood clot can then block the artery and cause a heart attack or stroke.

We now know that inflammation of blood vessels can cause plaques to become unstable and more likely to rupture. Although there are ways of identifying unstable plaque, existing diagnostic techniques do not specifically examine inflammation. This means inflammatory risk can go undetected and untreated.

Myeloperoxidase is a protein that causes inflammation. Recent research has demonstrated that there are high levels of myeloperoxidase in unstable and ruptured plaques. This means that myeloperoxidase may offer a ground-breaking way to diagnose and treat people who are at higher risk of a heart attack because of unstable plaque.

My research will explore how useful myeloperoxidase is in diagnosing and treating people with unstable plaque. To start with, I will aim to confirm the link between myeloperoxidase activity and unstable plaque. Then, I will explore the role of myeloperoxidase as a non-invasive way of identifying and treating people with unstable plaque. This is exciting research, as it could identify people who are at high risk of a heart attack or stroke earlier, before symptoms and irreversible damage have occurred.

What difference will your research make to people’s cardiovascular health in Australia?

Currently, the diagnosis and treatment of coronary heart disease is based on how narrow or blocked the arteries are. This can be detected with tests like a coronary angiogram.

While this is a useful test, it is also important to know which people have plaques that are predisposed to rupture and cause a heart attack or stroke.  My research has the potential to identify these people, so they can be treated and monitored to reduce their risk. This research could change the way doctors diagnose, monitor and treat atherosclerosis in Australia.

What motivated you to do your research?

Coming from a background of philosophy, I have always been intrigued by the pursuit of new knowledge. We learn in medical school about the disease processes underlying heart attack and stroke.  As I progressed through my early career, I was surprised to find that our treatments for atherosclerosis do not reflect the disease process itself. For example, we often treat people based on how narrow their blood vessels are. But we know that the vast majority of strokes and heart attacks occur because of plaque rupture and blood clot formation, which can occur in blood vessels that are not critically narrowed. My research into the role of myeloperoxidase may provide a way to diagnose and treat people at higher risk of a heart attack or stroke earlier. In the longer term, this could save more lives and reduce the devastating impacts these events can have on people and their loved ones.

Do you have a message for Heart Foundation supporters?

I am committed to improving the lives of those with cardiovascular disease. I would like to sincerely thank the Heart Foundation and its donors for the ability to continue to give back to a society that has given me so much opportunity.

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