What if we had a better way to predict heart attacks and other cardiovascular events?

Three Cedars-Sinai investigators—Dr. Brennan Spiegel, director of Cedars-Sinai Health Services Research, and Dr. Noel Bairey Merz and Jennifer Van Eyk, PhD, of the Barbra Streisand Women's Heart Center—are studying the earliest warning signs of heart disease, hoping to find innovative ways to intervene and prevent a health crisis.

The goal is to stop heart attacks and strokes before they happen, a potential game-changer in the battle against cardiovascular disease.

"We want to do a better job of predicting who is a candidate for a heart attack or heart failure, but the challenge is that we as doctors don't see people frequently enough in the clinic to always know the instant that things are changing in their lives or their bodies," says Dr. Bairey Merz.

As a result, despite effective medical therapies and lifestyle interventions, many heart disease patients get worse due to undertreatment, poor adherence to medications, or missed clues that may have warned of heart attacks, strokes, or heart failure.

This new project observes patients where they live, work, and play by using cutting-edge digital health technologies along with patient reporting. It's part of a brewing healthcare revolution that recognizes that every individual is different—not just socially and culturally but also on a molecular level.

The 18-month study, which is funded by the California Initiative to Advance Precision Medicine and launched in spring 2017, enrolled 200 individuals at mid-risk of a major advanced cardiac event, such as a heart attack, or hospital readmission due to worsening heart failure.

Each study participant wears a biosensor—think a Fitbit on steroids—24 hours a day. It measures activity, sleep, heart rate, and stress. Participants also keep a health diary and report their levels of anxiety, depression, and quality of life via a smartphone or computer.

Once a month, patients mail researchers blood samples they have gathered with a microsampling home collection device developed by industry partner Neoteryx.

The samples are tested for cardiac biomarkers including a protein released when the heart muscle has been damaged, the protein marker for heart failure, and a marker of inflammation. Also analyzed are 72 blood proteins identified by Van Eyk’s team as early markers of atherosclerosis, a hardening or narrowing of the arteries.

"With advances in remote-sampling devices, we're now able to get quality data," says Van Eyk. "If we can use this data to start to predict cardiac events, this will be a breakthrough that has been a dream for all of us for a long time." By integrating the data with each patient's medical record, doctors hope to intervene with intensive medical approaches or lifestyle changes.

Exactly what the cumulative data will show is still unknown, but the potential seems clear—and vast.

"What if Dr. Van Eyk's biomarker results and Dr. Spiegel's biosensor monitoring could tell me that a patient is in a period of instability?" says Dr. Bairey Merz. "If you could see that unfolding, patients could take proactive measures, intensify treatment, and try to 'cool off' that unstable period."

The Cedars-Sinai team also wants to be sure this blend of technology, personal reporting, and precision medicine will be feasible and cost effective. "We want to know if all this will applicable to a larger population," Dr. Bairey Merz explains. "Ideally, that's what we would want."