Grant: Foundation Grant

Cardiovascular disease, which includes coronary heart disease and stroke, affects more than 1 million Canadians and 300 million persons worldwide, and results in 18 million death each year. One of the most effective and widely used approaches to prevent cardiovascular disease is antithrombotic treatment (e.g., aspirin, clopidogrel, warfarin, newer direct acting oral anticoagulants) that prevent potentially harmful blood clots from forming at the site of atherosclerotic plaques. The most important side-effect of these treatments is bleeding. The importance of bleeding has been vastly under-rated. We paid little attention to bleeding, thinking that for the most part this was easily treatable, and much less important than heart attack and stroke. We now know that bleeding is not only common, affecting thousands of Canadians with cardiovascular disease each year, but is also a powerful risk factor for heart attack and stroke, the very events that these treatments aim to prevent. My research program focuses on determining why persons with cardiovascular disease develop bleeding, and why those who bleed are at such high risk of attack and stroke after bleeding. Having identified the risk factors and mechanisms, my subsequent studies will evaluate whether targeted interventions can prevent cardiovascular events and mortality related to bleeding.