Transforming the way patients with cardiovascular disease are treated worldwide

This is part of a continuing series showcasing some of Ontario’s many clinical trial strengths and assets.

Dr. Michael Farkouh served for more than 12 years as founding Director of the Mount Sinai Cardiovascular Clinical Trials Unit in New York City, and developed one of the first diabetes and heart disease units in North America.

Today, the Canadian cardiologist is back home as Chair of the Peter Munk Centre of Excellence in Multinational Clinical Trials at the Peter Munk Cardiac Centre, University Health Network, in Toronto, Ontario. His mandate: to find global solutions to the global problem of cardiovascular disease.

Launched in 2012, the Centre of Excellence is ideally positioned to “study the world,” says Dr. Farkouh. “We have a platform of highly innovative clinical programs in some of the most complex cardiac conditions—congenital heart disease, hypertrophic cardiomyopathy, and heart failure advanced therapies including transplant and left ventricular assist device—and we have the best technology.”

Cardiovascular disease, including heart disease and stroke, is the number one cause of death worldwide—claiming more than 17.5 million lives in 2012, representing 31% of deaths.

The Peter Munk Centre of Excellence in Multinational Clinical Trials has an ethnically and socio-economically diverse population in the Toronto area that is enthusiastic to participate in clinical trials for their own benefit and to help others, says Dr. Farkouh. Ontario’s other advantages include a single-payer health care system that makes it easier to recruit patients for trials, and “an administrative database across the province that allows us to do trials cost effectively.”

Dr. Farkouh and his team of investigators “focus on innovation and translation. We aim to shorten the time from discovery to its application to patients. Although mortality from heart attack and heart failure has been reduced considerably through clinical trials—many of them led from Ontario—we still have a long way to go to improve quantity of life, and most importantly, quality of life.”

The Peter Munk Centre of Excellence in Multinational Clinical Trials is a leader of more than 20 international trials (mainly Phases IIb to IV) involving over 400 physicians, scientists and researchers at about 100 sites in 20 countries. The centre is also participating in another 70 global clinical trials in heart failure, vascular surgery, adult congenital heart disease, echocardiography, electrophysiology, cardiac imaging and interventional cardiology.

The FREEDOM Trial, co-led by New York’s Mount Sinai Hospital and the Peter Munk Centre of Excellence, attracted considerable media attention recently. It is an example of how clinical trials advance patient care. The trial showed that patients with diabetes whose multi-vessel coronary artery disease is treated with bypass surgery live longer and are less likely to suffer severe complications than those who undergo angioplasty.

Many other clinical trials are underway including a study on genomics in the management of patients with coronary disease, leveraging the strength of the Mayo Clinic in genetic testing and the expertise of the Peter Munk Centre of Excellence in clinical trials methodology.

Another clinical trial involving 25 centres worldwide is assessing two cardiac imaging strategies for following patients with cancer at high risk for cardio toxicity (heart dysfunction or muscle damage) during their cancer therapy.

While most of the centre’s multinational clinical trials are investigator-initiated, others involve partnering with pharmaceutical or medical device companies, and Dr. Farkouh believes this is a potential area for future growth.

Dr. Farkouh is also Chair of the Heart and Stroke/Richard Lewar Centre of Excellence, the University of Toronto’s cardiovascular centre that unites all 10 hospitals in the university network. The Peter Munk Centre of Excellence is the lead for this group, which will serve as an international model for collaboration.

Partnership is the hallmark of the Peter Munk Centre of Excellence in Multinational Clinical Trials. The centre is home base to the Worldwide Network for Innovation in Clinical Research (WNICR) with Dr. Farkouh as Chair. Through the WNICR, 10 leading clinical trial hubs of similar size and scope on five continents are working together to rapidly advance cardiovascular research, and to share discoveries with other nations and developing countries.

“We roll out our discoveries to developing countries because they have such a burden of disease,” says Dr. Farkouh. Over 75% of all cardiovascular deaths take place in low- and middle-income countries, according to the World Health Organization.

Dr. Carlos Serrano, Director of the Atherosclerosis Clinical Unit of the Heart Institute (InCor) and Associate Professor at the School of Medicine, University of Sao Paulo, Brazil, works closely with Dr. Farkouh through WNICR and on a series of 10 cardiovascular disease clinical trial initiatives between the Peter Munk Centre of Excellence and InCor.

“The possibility to share knowledge with the Peter Munk Centre, a worldwide-recognized centre of excellence that currently plays a critical role in leading multinational clinical trials, is very rewarding and scientifically enriching. This partnership also means the possibility to cooperate with approaches that will impact the way we treat patients with heart disease in the near future,” says Dr. Serrano.

Dr. Farkouh is proud of the progress of the Peter Munk Centre of Excellence in Multinational Clinical Trials in its first five years. “Whenever we do a trial, we are poised to answer an important question but we often raise many more questions. That leads to the next set of trials—it’s a continuous flow.”

For more information, visit the Peter Munk Centre of Excellence in Multinational Clinical Trials

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