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Celebrating International Women’s Day with Prof. Valeria Caso

March 8th marks International Women’s Day, a day to celebrate the achievements of women around the world and recognise the areas where improvements can be made.

Prof. Valeria Caso, MD, PhD is work package leader (WP9), responsible for ‘Understanding Gender-related differences’ for the PRESTIGE-AF research project.

It is widely understood that women have been under-represented in studies on overall cardiovascular disease, surgery, and cancer. This underrepresentation is problematic, as it causes generalisations about the impact of how these health conditions affect women to be made without suitable evidence.

Prof. Caso’s work focuses on how to increase the awareness of physicians in raising the participation of women to appropriate levels for randomised clinical trials, as well as how to increase the awareness among female patients to participate in clinical trials, investigate for biological differences in both sexes in intracerebral haemorrhages, AF and stroke outcomes and investigate social-cultural influences in both sexes in stroke outcome.

We spoke with Prof. Caso in anticipation of this year’s International Women’s Day to see what inspires her to do the work she does and in line with this year’s theme of #InspireInclusion, what we can all do to ensure inclusion in regards to stroke research and prevention.

What inspired you to follow a career in health and science?

“Since an early age, I have been thoroughly intrigued by the complexities of the human mind. This interest has led me on a lifelong journey to understand myself and help others. Initially, I wanted to become a neuropsychiatrist for children. This aim accompanied me throughout medical school when my fascination with the human brain deepened.“

How did this experience impact your decision to go specifically into stroke research?

“My path took a significant turn during my specialisation period for neurology. The neurology department director at the time offered me an opportunity that would inspire my career. He offered to send me to a stroke unit in Germany. I chose to go to the city of Kiel, where I had been born.

My time at the Stroke Unit in Kiel was eye-opening, as I was as able to see first-hand how a stroke could swiftly, and often most devastatingly, negatively impact a person’s life – it was profoundly moving to witness. The exposure to stroke medicine marked a pivotal point in my career. Later, while a Ph.D. candidate, I spent time at a stroke unit in Heidelberg, Germany, where I saw, for the first time, the positive effects of thrombolysis therapy, lost or compromised motor functions were restored after treatment delivery. I knew that this was a game changer.

Every day in Heidelberg, I learned of the challenges associated with treatment, as each patient was unique. The successes and setbacks highlighted the intricacies involved in treating and preventing stroke.”

What does inspiring inclusion mean to you?

“Inspiring inclusion means guaranteeing an environment that values, respects and supports all persons, regardless of their background, identity, or circumstances. It is about actively fostering a culture that acknowledges and embraces diversity to achieve the fullest possible participation and contribution from everyone.”

How do we become more inclusive of women regarding stroke research, prevention, and treatment?

“Inspiring inclusion, especially in stroke research, prevention, and treatment, can be significantly enhanced through active mentoring. However, this needs to begin early on for people considering a future in medicine. In fact, continuous guidance throughout the early phases of a woman’s medical career is crucial, as establishing oneself in the medical field requires years of dedication and perseverance. Guidance that is community-centric and highly personalized might also see greater participation of women in stroke prevention and treatment programs.

Specifically, we should focus on engaging with women in familiar neighbourhood settings, where trust has already been established among the members. Here, in-person communication and education, akin to continuous mentoring, could be highly impactful. Likewise, tailored approaches based on the habits and customs of individual groups could also lead to significant improvements in how women perceive and engage with healthcare related to stroke.”

Thank you Prof. Caso for your tireless dedication to create positive change and improve outcomes for women impacted by stroke. You can learn more about the work Prof. Caso does with the PRESTIGE-AF project on the our Partner page.

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Prestige-AF Annual Meeting – London 2023

On 17th November, the PRESTIGE-AF consortium met in London, UK for the project’s sixth annual meeting – the first in-person annual meeting since 2019.

The meeting was a welcome opportunity to reconnect and hear how each of the twelve work packages are progressing, encouraging collaborative learning and exchange of information. The day began bright and early, as members of the consortium arrived at the beautiful 58 Prince’s Gate building at Imperial College London.

Coordinator of PRESTIGE-AF and Chair of Stroke Medicine at Imperial College London (UK), Professor Veltkamp kicked off the meeting by welcoming everyone and providing an overview of the full day of presentations ahead.

Prof Veltkamp welcoming the consortium at Imperial College London

Dr Eleni Korompoki addressed the consortium by providing a scientific update to attendees both in the room and those joining virtually. After hearing updates from several work packages, the group paused for a well-deserved lunch break.

Members of the consortium trying out the PRESTIGE-AF escape room
Communications Manager, Harry Jenkins, discussing future plans for the project’s dissemination activities

During this break, Communications Manager for the project, Harry Jenkins, ran a session of the PRESTIGE-AF escape room, which had been created to communicate aspects of the project to external audiences. This was the first time members of the consortium were able to try out the experience for themselves. The session was met with much enthusiasm and positive feedback, with the team managing to escape with four minutes to spare!

After lunch, the consortium had the opportunity to break into working groups to discuss a range of topics and encourage collaboration across teams. The consortium reconvened to share key takeaways from their respective working groups and continue to hear from work group leaders on their research progress from the past year.

Prof Valeria Caso discussing participation of female patients in trials

To round off the day, the consortium heard feedback from the Executive Committee, who commended the team for their progress and expressed their interest in how the upcoming twelve months will unfold. Prof Veltkamp provided his final remarks and closed the meeting, with an optimistic outlook on the months ahead.

It was a great day and we already look forward to seeing each other again next year (in a soon to be decided location), for our final meeting and celebration of the project!

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Live Stream of PRESTIGE-AF trial in Italy

PRESTIGE-AF researchers, Prof Valeria Caso and Dr Fracesco Corea live-streamed (in Italian) on March 4th about the PRESTIGE-AF trial in Italy. They presented on the full operation for the study of secondary prophylaxis of cardioembolic stroke in patients suffering from atrial fibrillation and after-effects of cerebral haemorrhage. Coordinated by Prof, Valeria Caso of the Perugia Hospital with about 15 participating centres in Italy. In Umbria, the hospitals of Branca, Citta di Castello, Foligno and Perugia are in fact authorized to recruit candidates. Tune-in!

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Event: Life After Stroke Series of Interactive Webinars for 2021

PRESTIGE-AF partner, Stroke Alliance for Europe launches Life After Stroke Series of Interactive Webinars for 2021 

Stroke Alliance for Europe has launched a series of free interactive events to build the life after stroke healthcare, research and stroke survivor community, to stimulate debate, improve life after stroke care and build interest for SAFE’s 1st European Life After Stroke Forum on 12 March 2021. 

The opening session on Friday 12 March 10.00-11.30 CET is titled Life after stroke: priorities, challenges and ways forward. The session would be of interest to neurologists, therapists, physicians, allied health professionals and nurses, social care practitioners and stroke survivors.

Registration is FREE and welcome to all. Register via the EventBrite event page

The event includes updates from Sweden, the UK, Ireland and Italy on people’s experiences of the impact of stroke before and during the pandemic, and how healthcare and support services have adapted to meet the challenges of post-pandemic stroke care. All attending will learn about new and creative ways of offering support such as using telemedicine and telerehabilitation and remote methods of looking after stroke survivors.   

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Women in stroke: closing the gap for equitable prevention and treatment

pile of coloured pill capsules

For World Stroke Day, we speak with Prof Valeria Caso, stroke neurologist and former president of ESO (European Stroke Organisation) on the gender and sex disparities between current stroke research and the reality.

Profile image of Prof Valeria Caso smiling at camera
Prof Valeria Caso’s personal scientific focus has been stroke in women and tackling the gender and sex imbalances in stroke research, prevention and treatment

Thursday 29th October every year, is World Stroke Day. A day to foreground discussions on stroke prevention and treatment and emphasise how many sufferers and survivors there are around the globe. This all culminates in serving the mission to ensure better care and support for survivors and their families and reduce the risk of stroke; new and recurring. There are identifiable factors that influence the possibility of the onset of a new stroke and that of a recurring stroke for survivors. Lifestyle, family history, and other health indications (such as atrial fibrillation) all can play a role, but another element that is hardly known and spoken about is one of the biggest factors; sex and gender.

Stroke is a leading cause of mortality among non-communicable diseases (NCDs) for both sexes however, research shows that stroke is more detrimental to women. We speak with Prof Valeria Caso, stroke neurologist at the University of Perugia Stroke Unit (Italy) and former president of ESO (European Stroke Organisation) about the gender disparities related to stroke and how through studies such as PRESTIGE-AF, the work that is being done to reduce the gap, and ensure equitable treatment and prevention.

Women at higher risk

“Specifically, women have higher overall lifetime risks of stroke along with higher rates of mortality and disabilities”, says Prof Caso whose personal scientific focus has been stroke in women.  “In terms of risk factors for stroke, atrial fibrillation leads to higher incidence and more severe thromboembolic events (blood clotting) for women.  Moreover, women tend to seek medical attention later than men as they are more likely to be living alone.”

Women are at increased risk with more detrimental outcomes but surprisingly, as Prof Caso tells us, their presence in scientific research is marginalised. “To date, women have been under-represented in major randomised clinical trials. The surrounding  safety and efficacy results for women is not an accurate reflection of reality and this in turn, stroke prevention and treatment recommendations and guidelines are severely distorted.” 

Prof Caso goes further to say that this under-representation has been suggested as a reason why women having more drug-related adverse events. “Specifically, most randomised controlled trials (RCTs) and meta-analyses on the use of antithrombotic agents (anti blood clotting drugs, for example) in cerebrovascular disease have neither performed sub-analyses on sex-related differences nor adequately represented women in their sample size. In 2005, the European Society of Cardiology, and the European Medicines Agency recommended a significant representation of women in clinical trials.”

“In 2016, the Motion for a European Parliament Resolution on promoting gender equality in mental health and clinical research underlined the fact that clinical trials of pharmaceutical products on both men and women are necessary and that these should be inclusive, non-discriminatory and performed under conditions of equality, and inclusion.”

Inclusion – easier said than done

The male-female ratio in stroke trial today still does not reflect the real world situation. Women may be more difficult to include in RCTs because they tend to be older at stroke onset, have more comorbidities, and are more likely to have pre-existing functional impairment. The work Prof Caso and her team will be doing in the PRESTIGE-AF Horizon2020 project is to identify sex-and gender related barriers that may be an undercurrent in the marginalised representation of women in clinical trials of stroke prevention. One of the main goals is to  develop strategies on how to promote gender equality in stroke trial participation. 

Prof Caso says the main objectives to address gender and sex disparities are clear. We need to “understand the attitudes of female and male physicians regarding the participation of women as opposed to men in RCTs of stroke prevention and we need to understand the differential attitudes of female and male stroke patients in such RCTs. This extends to identifying the psychosocial factors underlying the differences. Finally, we will develop strategies to increase awareness of physicians and of patients for the importance of participation of women in RCTs.”

The work of Prof Caso in the PRESTIGE-AF project is summarised on the PRESTIGE-AF website.

Feature image by Joshua Coleman (@joshstyle) on Unsplash

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Researchers in Focus: Elena Palà and Olga Sánchez-Maroto Carrizo from VHIR (Spain)

It is often we hear about the research going on in the lab but rarely do we shine a spotlight on the researchers behind the work. Here in this series called ‘PRESTIGE-AF researchers in focus’ we will learn more about who is behind the groundbreaking research into ICH stroke survivors’ who have atrial fibrillation and their ongoing treatment.

In this iteration, we meet Elena Palà, PhD student and Olga Sánchez-Maroto Carrizo, project manager who are two researchers from PRESTIGE-AF partner institute, Vall d’Hebrón Institute of Research (VHIR) Neurovascular Research Laboratory.

Elena Palà – PhD student

Elena Palà in a lab coat
  • If you were to explain to a person without any medical background, what is your research about?

Our research is focused on discovering biomarkers in the stroke field. Biomarkers are molecules that can be measured in the blood of patients and may help the physicians in the diagnostic and prognosis of a disease. For example, in the PRESTIGE-AF, we look for biomarkers that give us information about the risk of a patient to have a haemorrhage or an ischaemic stroke in the future.

  • What drew you to this field?

I became a scientist as I like to think that what I am doing will help patients and I think that without science, medicine would not advance. I studied genetics and as I was more interested in translational research than basic research and I ended up doing my PhD on stroke biomarkers.

  • What is your role in PRESTIGE-AF?

In the Neurovascular Research Laboratory, we are responsible for the central biobank of the study. At the moment, and before the clinical trial ends, a lot of work consists of preparing material to be sent to all the sites in Europe participating in the study. Also, we have been in charge of creating a harmonized protocol in order that all the sites process the blood in the same way, and we are in constant contact with the sites to solve doubts. Once the clinical trial ends we will receive the blood from all the included participants and we will perform several experiments analysing biomarkers in order to find the most interesting candidates.

  • Has there been a turning point or defining moment in your career so far?

I imagine that one important moment will be the day I present my PhD.

  • Briefly, what excites you about your work?

What I like most about working in science is learning new things every day. Also, I like being part of interesting projects like the PRESTIGE-AF, in which I found the opportunity to work with an international multidisciplinary team of experts.

  • Tell me what you like to do when you aren’t working on research.

In my free time I like travelling. Also, I like reading, watching series and doing some sport.

  • What are your professional goals in the next five, and ten years?

I would like to continue working in a position linked to research and science, learning every day and feeling useful in my job.

Olga Sánchez-Maroto Carrizo – Project Manager

  • If you were to explain to a person without any medical background, what is your research about?

My role is to help investigators and Sponsors to conduct clinical investigations, helping them in the design, logistics and management of trials.

  • What drew you to this field?

I have a degree in Biology, but I am not a scientist as people usually think. I am part of the administrative team that each scientist needs for conducting investigations. Investigators focus on their experiments which tend to have them forgetting all the paperwork and logistics that all investigations have.

What is your role in PRESTIGE-AF?

My role is to oversee the clinical trial in Spain, helping the Sponsor and Investigators in the management of the investigation.

  • What excites you about your work?

To try to improve the health and quality of life of patients.

  • Tell me what you like to do when you aren’t working on research.

In my free time, you can find me cooking, reading or practising yoga.

  • What are your professional goals in the next five, and ten years?

I hope, let’s cross the fingers, to stay as today, helping investigators to achieve their objectives for improving the health and quality of life of people.

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PRESTIGE-AF Study resumes

Stethoscope and Laptop Computer. Laptop computers and other kinds of mobile devices and communications technologies are of increasing importance in the delivery of health care. Photographer Daniel Sone

After almost 3 months of suspension due to COVID-19, the PRESTIGE-AF Study has resumed recruitment of participants

After almost 3 months of suspension, recruitment of participants into the PRESTIGE-AF Study is resuming. In Germany and Spain there are seven and three sites open respectively, with many new sites due to open over the next few weeks. Italy, Austria and France have been given permission to start recruitment into the study for the first time and sites will begin to open from 1st July.   Participant recruitment is still paused in the UK but is expected to resume in the next two months.

It goes without saying that PRESTIGE-AF investigators are proceeding with utmost caution and are regularly reassessing and evaluating for the health and safety of their patients. That being said, this is great news for the consortium, the research and the PRESTIGE-AF project as a whole. Now, work can resume to fulfil the aims of the project; a randomised controlled trial to gather evidence around recommended anticoagulation medication for stroke prevention in patients with atrial fibrillation. With stroke being one of the largest public health challenges around the world albeit a growing challenge with increased ageing population estimates, the PRESTIGE-AF work is crucial to help stroke prevention and bettering the treatment and care for brain stroke survivors with atrial fibrillation.

The consortium hope to see a flurry of participant recruitment activity and it has kicked-off to a good start. In Essen, Germany, the first participant was recruited soon after the Study resumed.

It feels as if the world has been in a state of dormancy and COVID-19 has and will continue to impact our lives, professionally and personally. However, with the Study resuming we are slowly coming out of a surreal reality and the team feel uplifted and charged to continue their work on PRESTIGE-AF.

Article photo by National Cancer Institute on Unsplash

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COVID update

We wanted to provide a quick update on how PRESTIGE-AF is progressing at the moment in regard to COVID-19. To ensure the safety and well-being of all participants, the clinical steering committee and the sponsor of the prestige-AF trial have decided to temporarily suspend the recruitment of further participants. For those participants already enrolled in the trials, mitigating measures have been put in place and their safety and health is assured.

This is not a unique circumstance, many research programmes across Europe are also in similar situations and are impacted by the containment measures.

We are closely monitoring the situation and will provide another update when there are any changes.

For further information, the European Commission has placed up-to-date information on their website regarding COVID-19 response and action.

Yours sincerely,
Prof Roland Veltkamp
Imperial College London
PRESTIGE-AF coordinator and on behalf of the PRESTIGE-AF consortium

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Should patients with a brain bleed be given anticoagulant medication?

First published on SAFE’s website.

SAFE is a non-profit-making organisation that represents a range of stroke patient groups from across Europe. Their goal is to drive stroke prevention up the European political agenda and prevent the incidence of stroke through education.

Stroke is one of the largest public health challenges around the world, and occur when the blood supply to the brain is interrupted, such as through a clot or a brain bleed. It is the most common cause of adult-acquired disability, the second leading cause of death globally and the second most frequent cause of dementia. In addition, its impact is expected to further increase in the coming decades due to the ageing population.

We spoke with Dr Eleni Korompoki, MD, PhD, FESO, about a €6.9m worth EU funded research project, aimed at patients with atrial fibrillation (AF), a common heart condition which causes irregular and abnormally fast heartbeat, who have previously had a stroke caused by bleeding in the brain (termed intracerebral hemorrhage or ICH). The Prevention of Stroke in intracerebral hemorrhage survivor with Atrial Fibrillation (PRESTIGE-AF) brings together scientists and clinicians across Europe with the goal of reducing the risk of further stroke in this group of patients. Dr Korompoki is a Clinical Research Fellow in Stroke Medicine at Division of Brain Sciences, Imperial College London.

Dr Eleni Korompoki, MD, PhD, FESO, PRESTIGE AF researcher
Dr Eleni Korompoki, MD, PhD, FESO, PRESTIGE AF researcher

SAFE: If you were to explain the project’s aim to a person without any medical background, what would you say?
EK: We are conducting a research study to show whether or not patients who have had a brain hemorrhage should be given anticoagulant medication to prevent blood clots that can be caused by a heart arrhythmia called atrial fibrillation. Currently we do not know the best way to prevent strokes in these patients.

SAFE: What types of partner do you need to carry out a project like this?
EK: This project is covering many specialties, so we need to have partners with experts in stroke, cardiology, genetics, biomarkers, neuroimaging and predictive modelling to name just a few!

SAFE: Can you briefly describe your role in the project?
EK: I am part of the central clinical trial team who assist all of the (70!) hospitals who recruit to our clinical trial. I am available to provide medical support, answer questions about patient eligibility and review the safety reports (called adverse events) as we closely monitor all health complaints that patients have whilst they are in the study. Towards the end of the project I will be involved with data analysis and writing up the results of the trial.

SAFE: What (if any) are the difficulties with carrying out the work?
EK: Stroke is the leading cause of disability in Europe and strokes caused by bleeding tend to be more disabling. Therefore it can be a challenge to identify patients who are willing and able to take part in a study like this.

SAFE: What personally attracted you to be in this project?
EK: I have been involved in stroke research for more than 10 years, focusing on stroke prevention and heart-brain connection. As a physician and researcher, I strongly believe that prevention is the key element for well- being. PRESTIGE-AF is a prevention trial targeting an individualised approach and better quality of life after stroke. The trial will also address important aspects such as gender differences, and patients’ attitudes and preferences.

As part of PRESTIGE-AF consortium I have plenty opportunity to interact with internationally recognised experts of ten leading European academic institutions, to work together with a multidisciplinary team from different European countries gaining a lot of experience and improving my scientific skills.

SAFE: When this project ends, what do you expect to change, i.e. how it will reflect on stroke treatment?
EK: We expect to be able to provide evidence based treatment to patients who have had a brain hemorrhage and have atrial fibrillation, the most common cardiac arrhythmia. In addition we hope that we will be able to start using a more person centered approach with these patients using information learnt from looking at brain scans, blood tests, gender differences and psychological aspects.

PRESTIGE-AF has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No. 754517.

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PRESTIGE-AF second annual meeting held in Graz, Austria on 6th December

Another year, another successful annual meeting. Hosted by PRESTIGE-AF partners, Medizinische Universitat Graz (MUG), the PRESTIGE-AF consortium convened in the idyllic and picturesque town of Graz in Austria on the 6th December for one full day of intense presentations, parallel session discussions and Scientific Advisory Board feedback.

The day started early at 8am, inviting the medical students of MUG to a seminar on the PRESTIGE-AF project. Dr Thomas Gattringer who is Additive Specialist Neurological Intensive Care at MUG, focussed his talk on the diagnosis and treatment of haemorrhagic stroke. With final remarks discussing the identified gaps in treatment guidelines, Dr Gattringer provided a smooth segue for Prof Roland Veltkamp to speak about the PRESTIGE-AF study. Coordinator of PRESTIGE-AF and Chair of Stroke Medicine at Imperial College London (UK), Prof Veltkamp explained to the students what PRESTIGE-AF, as an EU-funded, international collaborative research study, hopes to achieve in closing these gaps in stroke treatment guidelines and the expected research and patient impacts.

people in a lecture theatre listening to Prof Roland Velktamp present
Prof. Roland Veltkamp explaining to medical students of MUG the importance of the PRESTIGE-AF Study. The PRESTIGE-AF Study aims to bolster treatment guidelines for patients with atrial fibrillation (AF) who have suffered an intracerebral haemorrhage (ICH)

After these talks, the PRESTIGE-AF consortium gathered and work group leaders provided updates on their research progress from the past year. A well-deserved lunch brought in the afternoon parallel sessions. With one group discussing predictive modelling and the other clinical trial coordination, partners used the time to ask each other questions and clarify the particulars around the PRESTIGE-AF clinical trials including protocols, responsibilities and technical requirements.

people in a lecture theatre listening to Prof Roland Velktamp present
Dr Kathrin Foerster presenting the work package (WP) 13 update on behalf of PRESTIGE-AF partners, Heidelberg University Hospital (Germany).

The penultimate agenda item was the Scientific Advisory Board feedback presented to the Consortium. The Board commended the Consortium for all their efforts and progress over the year and this left good stead for Prof. Veltkamp to give his final remarks and closed the meeting on positive notes as we lead into the holiday season.

Overall, the meeting wonderfully prepared, organised and delivered by MUG was a huge success and plans are already underway for deciding which partner will host the next annual meeting.