Professor Belch research interests include:

1.  Vascular Medicine especially Peripheral Arterial Disease
2. Vascular Risk especially inflammatory aspects
3. Connective tissue disease with a focus on Systemic Sclerosis

 

This work was key in the discovery of the contribution of inflammation to cardiovascular disease (CVD), and she was first to report oxidative stress and impaired endothelial function in many CVDs through her biomarker laboratory. She has developed, with her team, state of-the-art equipment microvascular imaging, and the laboratory is among the best-equipped in the UK, facilitating the original research into small vessel disease in the connective tissue disorders (CTDs). This microvascular imaging is further enhanced by the collaborative development of vascular MRI scanning (she obtained funds for a dedicated MRI scanner), allowing her work access to state of the art MRI and CT measures of blood flow, perfusion, arterial stenoses in relation to peripheral arterial disease (PAD).

There are 2 further inter-related study areas within her research portfolio: In the first she has explored and developed novel surrogate markers for vascular risk (biomarkers) within a normal or at risk population. This work is then translated into clinical trials to validate hypotheses or develop interventions.

 

These two areas cover major trials within the normal population such as the MRC funded Dundee Infant Feeding Study (Howie/Forsyth) where she detected vascular risk in 20% of normal children throughout  Tayside, and TASCFORCE (funded by Chest Heart and Stroke, Scotland), a 10,000 population screening study for novel risk factors using MRI in 3,300 subjects within a specified sub-group. This complements the earlier work of 20,000 volunteers (Scottish Heart and Arterial Risk Prevention, SHARP) which has documented CV risk in a cross section of the Scottish workforce through a 10 year follow up. This latter risk factor study provided data for novel MAFF/FSA funded dietary studies in essential fatty acids, and in saturated fats, the results of which contributed to FSA recommendations regarding fat in diet for the UK population.

In peripheral arterial disease (PAD) she was first to link adhesion molecules & restenosis in diabetes (CHS/CSO funded), facilitating an 8 year CV endpoint study of patients with diabetes and asymptomatic PAD (7,900 in screening and 1,300 in therapy) (POPADAD, MRC funded clinical trial programme grant). This trial of eight years duration, published in the British Medical Journal (2008;337:a1840),has been cited by 155 subsequent scientific papers. It has changed clinical practise world-wide.

 

This approach of detecting abnormalities, linking them to outcome, then planning and expediting clinical trials has also been a feature of her rheumatological work. As a result of novel laboratory work documenting risk in these inflammatory diseases (arc funded), she has obtained funds for two further 6 year CV event and mortality studies in both Systemic Sclerosis & Rheumatoid arthritis (BHF/arc clinical trials programme grant). Both of these trials are the largest of their kind in the UK and are may change patient management when the results are available. Her work has supported 13 PhD students (3 current), 11 MD (one current), and 5 MSc (1 current). The major impact of this work has been in two areas: 1. to change attitudes and behaviour in the detection and management of vascular risk in PAD; and 2. Raise awareness of CVD in the rheumatic diseases.

 

She has had a major contribution to the clinical trials summarised below:

Major National and International Multicentre Clinical Trials

1. Scottish Heart and Arterial Risk (SHARP) 20 year study of Cardiovascular Risk. National Study. Chairman of Research Committee. 1988-current.
2. Medical Research Council Clinical Trials Programme Grant. Prevention of Progression of Peripheral Arterial Disease (POPADAD) National Multicentre Trial. Principal Investigator. 1997-2008.
3. Raynaud’s and Scleroderma Association, Systemic Sclerosis Trial of CV Events & Progression (SSTEP) Principal Investigator. National Multicentre Trial. 2002-current.
4. British Heart Foundation. Mild to Moderate Intermittent Claudication and Exercise (MIMIC) National Multicentre Trial. Management Committee. 2002-2007.
5. European Systemic Sclerosis Study Group, European DELPHI exercise. Trial Steering Committee. 1995-2006.
6. Oral iloprost in Raynaud’s Phenomenon Study Group. Chairman of Trial Steering Committee. International Multicentre Trial (Schering Chemicals Ltd). 1995-2001.
7. UK/Finnish PARTNER Trial. International Multicentre Trial in Critical Ischaemia. Principal Investigator and Chairman of Trial Steering Committee (Grunenthal Ltd). 1989-1994.
8. VASOGEN. National Multicentre Trial in intermittent claudication. Chairman of Trial Steering Committee and Principal Investigator. (Vasocare Inc) 1998-2002
9. CASPAR (Clopidogrel and aspirin in Peripheral Arterial Grafts). International Steering Committee Chairman (BMS/Sanofi Synthelabo). 2002-current.
10. Intermittent Claudication Trial Steering Committee UK Principal Investigator and member of Trial Steering Committee (Sigma Tau). 1999-2003.
11. Serotonin Inhibition in Claudication. International Multicentre Trial. Clinical Endpoints Committee (Mitsubishi Pharma Europe Ltd). 2003-2005.
12. MASCOT. International Multicentre Trial. Co-Chairman (with Dr Mark Creager, USA) of Steering Committee (Bristol-Myers Squibb). 2005-2008.
13. WALK Trial. International Multicentre Trial of Genetically modified growth factor, European Chairman of Steering Committee, Member of International Steering Committee (Genzyme Inc). 2004-current.
14. TAMARIS. International Multicentre Trial of genetically modified growth factor in critical limb ischemia. Chairman of Trial Steering Committee (Sanofi Aventis) 2007- current.
15. British Heart Foundation/ Arthritis and Rheumatism Council. Trial of Atorvastatin in preventing CV Events in Rheumatoid Arthritis. (TRACE RA). National Multicentre Trial. Co-Principal Investigator. 2006-current.
16. TRACE RA Biobank. National multicentre Trial. Principal Investigator (Pfizer Inc). 2007-current.
17. Chest Heart & Stroke (Scotland) TASCFORCE. Tayside multicentre trial (n=10,000/3500). Early detection of risk. Principal Investigator 2009-current

 

The detection of CV risk in PAD has allowed both national and international recognition that risk factor management must be undertaken. She was involved in the first Royal College of Physicians, Edinburgh, PAD Guideline (Medical management of peripheral arterial diseases 1998), leading to a second one in 2007 (Management of peripheral arterial disease). Through this work she has contributed to the Quality and Outcomes Framework (QoF) process, introducing risk factor screening for PAD as local quality measure for Primary Care in the UK. Her work is contributed to the current NICE Guidelines on PAD, currently just completed its scoping phase.

Further, the POPADAD study has implications for all patients with diabetes who have not yet had a vascular event, changing practice world wide.

In addition, within the rheumatological field, her vascular work has allowed new treatments for both microvascular and macrovascular disease, bringing change of medical practice to the benefit of these patient groups.

Finally, her work in trial design within PAD has allowed Guidelines to be developed in this area, which have been used by both EMEA, and FDA in developing regulations for drug registration in PAD (Study design options for clinical trials in PAOD patients. Transatlantic Conference on Clinical Trial Guidelines in PAOD. Basle 1997).