Professor of Vascular Medicine and Tayside R&D Director
Division of Cardiovascular and Diabetes Medicine
Medical Research Institute
Dundee DD1 9SY
+(44) 01382 632457
Professor Belch graduated as a Doctor from the University of Glasgow (MBChB), becoming a Lecturer within the University Department of Medicine, where she completed her Research MD degree (Honours, winner of Belahouston Gold Medal) in 1987. She was appointed Senior Lecturer with Honorary Consultant status at the University Department of Medicine in Ninewells Hospital, Dundee, also in 1987, and became Professor of Vascular Medicine in 1995. She was Director of the Tayside Clinical Trails Centre before becoming the Director of the Tayside Medical Science Centre (TASC) and the Tayside R&D Director. She is a founder Fellow of the Academy of Medical Science, and a Fellow of the Royal Society, Edinburgh.
Professor Belch research interests include:
- Vascular Medicine especially Peripheral Arterial Disease
- Vascular Risk especially inflammatory aspects
- 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
- Scottish Heart and Arterial Risk (SHARP) 20 year study of Cardiovascular Risk. National Study. Chairman of Research Committee. 1988-current.
- Medical Research Council Clinical Trials Programme Grant. Prevention of Progression of Peripheral Arterial Disease (POPADAD) National Multicentre Trial. Principal Investigator. 1997-2008.
- Raynaud’s and Scleroderma Association, Systemic Sclerosis Trial of CV Events & Progression (SSTEP) Principal Investigator. National Multicentre Trial. 2002-current.
- British Heart Foundation. Mild to Moderate Intermittent Claudication and Exercise (MIMIC) National Multicentre Trial. Management Committee. 2002-2007.
- European Systemic Sclerosis Study Group, European DELPHI exercise. Trial Steering Committee. 1995-2006.
- Oral iloprost in Raynaud’s Phenomenon Study Group. Chairman of Trial Steering Committee. International Multicentre Trial (Schering Chemicals Ltd). 1995-2001.
- UK/Finnish PARTNER Trial. International Multicentre Trial in Critical Ischaemia. Principal Investigator and Chairman of Trial Steering Committee (Grunenthal Ltd). 1989-1994.
- VASOGEN. National Multicentre Trial in intermittent claudication. Chairman of Trial Steering Committee and Principal Investigator. (Vasocare Inc) 1998-2002
- CASPAR (Clopidogrel and aspirin in Peripheral Arterial Grafts). International Steering Committee Chairman (BMS/Sanofi Synthelabo). 2002-current.
- Intermittent Claudication Trial Steering Committee UK Principal Investigator and member of Trial Steering Committee (Sigma Tau). 1999-2003.
- Serotonin Inhibition in Claudication. International Multicentre Trial. Clinical Endpoints Committee (Mitsubishi Pharma Europe Ltd). 2003-2005.
- MASCOT. International Multicentre Trial. Co-Chairman (with Dr Mark Creager, USA) of Steering Committee (Bristol-Myers Squibb). 2005-2008.
- WALK Trial. International Multicentre Trial of Genetically modified growth factor, European Chairman of Steering Committee, Member of International Steering Committee (Genzyme Inc). 2004-current.
- TAMARIS. International Multicentre Trial of genetically modified growth factor in critical limb ischemia. Chairman of Trial Steering Committee (Sanofi Aventis) 2007- current.
- 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.
- TRACE RA Biobank. National multicentre Trial. Principal Investigator (Pfizer Inc). 2007-current.
- 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).
She has over 300 publications in peer reviewed Scientific Journals (with 4Videos/DVDs, 2 Books, 42 Book Chapters, 40 Commissioned Reviews, 32 Editorials/Guidelines) and grant funding amounting to 23.4 million pounds over 20 years (£12M in past 5yrs). She has been cited more than 6.600 times and had a personal ‘H’ index of 43 in 2011. A selection of publications showing the breadth of work is listed below:
- Belch, JJF
, McKay A, McArdle B, Lowe GDO, Pollock JG, Leiberman P, Forbes CD, Prentice CRM. A double blind study of the effect of prostacyclin infusion in severe peripheral vascular disease. Lancet 1983; 1 (8320): 315-317.
- Belch, JJF, Newman P, Drury JK, McKenzie F, Leiberman P, Capell HA, Forbes CD, Prentice CRM. Intermittent prostacyclin infusions in patients with Raynaud's syndrome: a double blind trial. Lancet 1983; 1 (8320): 313-315.
- Belch, JJF, Madhok R, Shaw, B, Leiberman P, Forbes CD, Sturrock RD. Double-blind trial of CL115,347, a transdermally absorbed prostaglandin E2 analogue, as a treatment for Raynaud's phenomenon. Lancet 1985; 1 (8439): 1180-1183.
- McKenzie J, Belch, JJF, Land D, Park R, McKillop J. Oesophageal ischaemia in motility disorders associated with chest pain. The Lancet 1988; 2 (8611): 592-595.
- McMurray J, McLay J, Chopra M, Bridges A, Belch, JJF. Evidence for enhanced free radical activity in chronic congestive heart failure secondary to coronary artery disease. American Journal of Cardiology 1990; 65 (18): 1261-1262.
- Taylor JE, Henderson IS, Stewart WK, Belch, JJF. Erythropoietin and spontaneous platelet aggregation in haemodialysis patients. The Lancet 1991; 338 (8779): 1361-1362.
- Belch JJF, Shaw JW, Kirk G, McLaren M, Robb R, Maple C, Morse P. The white blood cell adhesion molecule E-selectin predicts restenosis in patients with intermittent claudication undergoing percutaneous transluminal angioplasty. Circulation 1997; 95 (8): 2027-2031.
- Belch JJF, Bell PRF, Coleridge-Smith P, Creissen D, Dormandy JA, Kester RC, McCollum RD, Mizushima Y, Ruckley CV, Scurr JH, Wolfe JHN. A randomized double-blind placebo controlled study evaluating the efficacy and safety of AS-013, a PGE1 prodrug in patients with intermittent claudication. Circulation 1997; 95 (9): 2298-2302.
- Khan F, Greig IR, Newton DJ, Butler A, Belch JJF. Skin blood flow after transdermal S-nitrosothio-acetylglucose. The Lancet 1997; 350 (9075): 410-411.
- Ho M, Veale JD, Eastmond C, Nuki G, Belch JJF. Macrovascular disease and systemic sclerosis. Annals of Rheumatic Diseases 2000; 59 (1): 39-43.
- Belch JJF, Topol EJ, Agnelli G, Bertrand M, Califf RM, Clement DL, Creager MA, Easton JD, Gavin III JR, Greenland P, Hankey G, Hanrath P, Hirsch AT, Meyer J, Smith SC, Sullivan F, Weber MA. Prevention of Atherothrombotic Disease Network. Critical issues in peripheral arterial disease detection and management: a call to action. (Editorial) Archives of Internal Medicine 2003; 163 (8): 884-92.
- Alkaabi JK, Ho M, Levison R, Pullar T, Belch JJF. Rheumatoid arthritis and macrovascular disease. Rheumatology 2003; 42 (2): 292-297.
- Khan F, Belch JJF MacLeod M, Mires G. Changes in endothelial function precede the clinical disease in women in whom pre-eclampsia develops. Hypertension 2005; 46: 1123-1128.
- George J, Carr E, Davies J, Belch JJF, Struthers A. High-dose allopurinol improves endothelial function by profoundly reducing vascular oxidative stress and not by lowering uric acid. Circulation 2006; 114 (23): 2508-2516.
- Galarraga B, Ho M, Youssef HM, Hill A, McMahon H, Hall C, Ogston S, Nuki G, Belch JJF. Cod liver oil (N-3 fatty acids) as a non-steroidal anti-inflammatory drug sparing agent in rheumatoid arthritis. Rheumatology 2008; 47 (5): 665-669.
- Galarraga B, Khan F, Kumar P, Pullar T, Belch JJF. C-reactive protein: the underlying cause of microvascular dysfunction in rheumatoid arthritis. Rheumatology 2008; 47 (12): 1780-4.
- Belch JJF, MacCuish A, Campbell I, Cobbe S, Taylor R, Prescott R, Lee R, Bancroft J, MacEwan S, Shepherd J, Macfarlane P, Morris A, Jung R, Kelly C, Connacher A, Peden N, Jamieson A, Matthews D, Leese G, McKnight J, O'Brien I, Semple C, Petrie J, Gordon D, Pringle S, MacWalter R: Prevention of Progression of Arterial Disease and Diabetes Study Group, Diabetes Registry Group, Royal College of Physicians Edinburgh. The prevention of progression of arterial disease and diabetes (POPADAD) trial: factorial randomised placebo controlled trial of aspirin and antioxidants in patients with diabetes and asymptomatic peripheral arterial disease. British Medical Journal 2008; 337: 1030-1033.
- Greenhalgh RM, Belch JJF, Brown LC, Gaines PA, Gao L, Reise JA, Thompson SG: Mimic Trial Participants. The adjuvant benefit of angioplasty in patients with mild to moderate intermittent claudication (MIMIC) managed by supervised exercise, smoking cessation advice and best medical therapy: results from two randomised trials for stenotic femoropopliteal and aortoiliac arterial disease. European Journal of Vascular & Endovascular Surgery 2008; 36 (6): 680-688.
- Galarraga B, Belch JJF, Pullar T, Ogston S, Khan F. Clinical improvement in Rheumatoid Arthritis is associated with healthier microvascular function in patients who respond to antirheumatic therapy. Journal of Rheumatology 2010; 37(3): 521-528.
- Rothwell PM, Fowkes FGR, Belch JJF, Ogawa H, Chew E, Warlow CP, Peto R, Meade TW. Effect of daily aspirin on long-term risk of death due to cancer: analysis of individual patient data from randomized trials. Lancet 2011 (Jan 1); 377 (No. 9759): 3-4
- Belch JJF, Dormandy J, Biasi GM, Cairols M, Diehm C, Eikelboom B, Golledge J, Jawien A, Lepantalo M, Norgen L, Hiatt WR, Becquemin JP, Berqvist D, Clement D, Baumgartner I, Minar E, Stonebridge P, Vermassen F, Matyas L, Leizorovicz A. Clopidogrel and Acetylsalicylic acid in bypass Surgery for Peripheral ARterial disease: Results of the randomized, placebo-controlled CASPAR Trial. Journal of Vascular Surgery 2010 Oct;52(4):825-33, 833.e1-2. Epub 2010 Aug 1.
- Belch JJF, Hiatt WR, Baumgartner MD I, Driver IV, Nikol S, Norgren L, Van Belle E, on behalf of the TAMARIS Committees and Investigators. Effect of fibroblast growth factor NV1FGF on amputation and death: a randomised placebo-controlled trial of gene therapy in critical limb ischaemia. The Lancet, 2011, Vol. 377 No. 9781 pp 1929-1937
Teaching involves both undergraduate and postgraduate students, and covers areas including Peripheral Arterial Disease, Connective Tissue Disease and Governance of Clinical Trials.
- 30 invited postgraduate primary care (both national and international)
- 29 Invited lectures to the Pharmaceutical Industry (at senior R&D level, both national and international)
- 20 Invited lectures, Royal Colleges
- 96 National plenary lectures
- 124 International plenary lectures
- 25 invited Lay lectures
- 7 International ‘Meet the Expert’ sessions eg The Patients’ Path: Interdisciplinary Management of Peripheral Arterial Disease to Improve Outcomes – Meet the Experts Session. European Society of Vascular Surgery. Nice 2008. Optimising Antiplatelet therapy in Peripheral Arterial Disease and Poly-vascular Disease. CASCADE IV Expert Meeting. Berlin 2008.
In the main these relate to her research interests as above, but also include lectures to the Lay public, and Lectures on Research Governance within Clinical Trials.