What is CVD?
Cardiovascular Diseases are a group of conditions affecting the heart or blood vessels and are a major factor of mortality and morbidity, making up to 18 million deaths globally which represents 32% of deaths. The crude death rates due to heart disease were 68.5 for male and 37.4 for female per 100000 population of respective sex in 2020 in Hong Kong, causing an average of 53.4 deaths per 100,000 standard population in 2022-2023.
In Hong Kong, CVDs are also among the top causes of mortality. Nearly half of the Hong Kong population aged 40 or above are at high risk and require drug therapy and counseling, posing a significant socioeconomic burden on the territory.
In 2022, Hong Kong saw 31,334 inpatient discharges and deaths related to coronary heart diseases, accounting for 1.6% of all inpatient discharges and deaths that year. Additionally, there were 3,995 deaths due to cardiovascular diseases in 2022, representing 6.5% of all registered deaths. The crude death rates were 75.5 per 100,000 population for males and 36.7 per 100,000 for females.
Atherosclerosis begins with artery damage and inflammation which gradually results in the accumulation of cholesterol, fats, blood cells and other substances, causing the formation of plaque. Plaque will narrow arteries, lowering oxygenated-blood supply to tissues.
Thrombosis refers to the formation of thrombus (blood clots) inside arteries, which leads to blockage to blood vessels, disrupting the blood flow to organs and tissues. Thrombosis is the primary cause of heart attacks and strokes, causing an estimated 300,000 deaths per year in the European Union.
Unhealthy lifestyle choices, such as poor diet, lack of exercise, smoking, and excessive drinking, can significantly increase the risk of high blood pressure, high cholesterol, and obesity, leading to potentially devastating heart attacks, even in people under 70 years old.
What is concerning is that there are nearly 600 000 everyday smokers in Hong Kong currently, accounting for 9.5% of the total population.
Fig 1.Number of smokers in different age groups in 2000,2010 and 2021 by hong kong health bureau
Many people in Hong Kong have an unhealthy lifestyle. In the past, the Hong Kong government conducted a citywide health survey that shows more than 75% of respondents consume too much salt. Besides, 50% of respondents have high cholesterol.
Source: https://www.pacificprime.hk/blog/obesity-in-hong-kong-reports/
A recent survey conducted by the Hong Kong Special government and the Chinese University of Hong Kong, over 8,000 residents covering different age groups were interviewed between July 2021 and December 2022. It was found that over 53% of Hong Kong adults do not meet the level of physical exercise recommended by the World Health Organization (WHO), which is at least 150 minutes per week of moderate to vigorous exercise.53.8% of Hong Kong adults did not meet the level of physical activity recommended by the WHO (150mins of exercise every week)
Fig 3.Result of street interview conducted by PPVIC among 159 response
We focused on exploring the lifestyle of Hongkongers through street interviews. As shown in the above street interviews, over 50% of people seldom have regular exercise. About a quarter of people never have a regular exercise routine a week, which is one of the risk factors for developing CVDs. Moreover, 8.7% of the population aged 15 or above drank alcoholic beverages regularly in the 12 months. 94.4% of persons aged 15 or above reported consuming an average of less than five servings of fruit and vegetables per day.
Team HK-United is committed to addressing the growing concern of cardiovascular disease (CVD), a major health issue that affects millions worldwide. Our human practice team, consisting of students from PPVIC, WYK and SKSS, plays a vital role in community engagement and collaboration. Here,we will explore the urgency of handling CVD, emphasizing on the factors resulting in CVD and their current situations. Furthermore, we will present the significance of human practice to the whole project, followed by the insights from interviews conducted with professionals and the public, capturing their perspective and thoughts on CVD and how we constantly improve our project based on the responses.
As our team project comprises different elements and categories, we have decided to identify the stakeholders in (i) their influences in the community and (ii) their interest in our project. We hope to get as much vital feedback as we can, so as to get a full view of the situation and maximize the impacts which is contributed to our project.
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The timeline has shown about what we have done throughout the year in different categories. Different interviews, research or events that we held, have a huge meaning to our project that lead us to implement and improve so as to strive for excellence.
Dr. Chow Tak Hau, Cyrus
- Clinical cardiologist
- Specialist in cardiology
Why interview him?
In order to grasp a more thorough understanding of cardiovascular diseases and atherosclerosis, we consulted Dr. Chow Tak Hau Cyrus for a brief concept of heart diseases. Dr. Chow is a practical cardiologist with various experience on treating patients with cardiovascular disease and he focuses on biological investigation and heart disease treatment
What we learnt
Dr.Chow provided us with valuable information, including the reasons resulting in the decreasing rate of death caused by CVD are majorly higher success rate of surgery and reducing number of smokers. In addition, he emphasised the downside of modern treatments which includes high costs and a number of side effects and the irreversibility of atherosclerosis
Reflection
We identified that current treatments for heart disease are pricey and we were inspired to produce a product that is able to effectively reduce the possibility of getting heart disease.We believe that creating more accessible and affordable solutions to improve patient outcomes.
- Chairperson of the Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong
- Chief of the Cardiology Division, Honorary Consultant and Chief of Service of the Department of Medicine, Queen Mary Hospital
Professor Tze Hung Fat is a specialist in cardiology who is fully-experienced and well known with cardiovascular diseases. We hope to interview with him so as to get more details on the cause of atherosclerosis and thrombosis, and also get vital feedback for us to implement into our product.
We learned the mechanism of atherosclerosis and thrombosis. He also mentioned that the relationship between atherosclerosis and cholesterol is significant. But he emphasized that if the cholesterol level is too low, it will cause cancer. So he gave us vital feedback that if we want to lower the organ’s cholesterol level, we can’t target it.
We decided to discover solutions which can lower cholesterol level but not to directly target the organs which may cause the cholesterol level to become too low. Also we started to do more research on the causes of atherosclerosis and thrombosis and learned the background of “Low-density lipoprotein” and “High-density lipoprotein”.
1. Dr. Gao Xue Quan
- Lecturer of the School of Chinese Medicine, The University of Hong Kong
- Clinic Manager (Medical)
With a view to seek further advice on the potential direction of our product development, we interviewed Dr. Gao, an experienced chinese medicine practitioner and a lecturer of chinese medicine in the University of Hong Kong, for advice and suggestions.
Dr.Gao gave us precious insights into our project. He mentioned chinese medicine could be a more efficient method of solving the problem in spite of the fact that it is not suitable for everyone, highlighting that ginseng is effective in treating cardiovascular diseases and has a significantly lower cost and less side effects.
Listening to Dr. Gao’s suggestions, we decided to focus our path on Chinese medicine, specifically investigating the impact of ginseng on treating cardiovascular diseases.
- Chinese Medicine Practitioner
- TY Healthcare Chinese Medicine
Concerning the information on Ginseng from the Chinese medicine perspective, we interviewed Ms Lo, a Chinese medicine practitioner for suggestions on treating patients with cardiovascular disease with ginseng.
Ms Lo indicated that Chinese medicine focuses on restoring balance and addressing root causes of cardiovascular diseases rather than just treating symptoms. Combining Chinese herbal remedies with Western medical treatments can accelerate the recovery of the patients. In order to have a better medical effect, ginseng can be mixed with other herbs or materials. As a result, we have decided to mix ginsentide TP1 with lupin peptide P5 to further reduce the risks of cardiovascular diseases from prevention.
From the perspective of Chinese medicine, we understood the significance of the prevention of cardiovascular diseases and decided to use ginsentide from ginseng as one of the components of our product.
Fig: Interview with Chinese medicine practitioner Ms. Lo Siu Ching
1. Ms.May Lee
- Scientific Officer (Medical)
- Hong Kong Department of Health
To explore our direction for the usage and production of our product, we consulted Ms. May Lee, a Scientific Officer from the Department of Health with expertise in biochemistry and pharmacy.
Ms. Lee emphasised the critical role of factors such as pH and temperature in influencing the efficacy of our product. She highlighted that proper dosing is essential to avoid adverse effects while maximising therapeutic benefits. Additionally, she reassured us that natural foods, like ginseng, are generally safe for consumption, which can enhance the product's appeal. Furthermore, she underscores the necessity of conducting thorough safety assessments to ensure compliance with regulatory standards for health products.
Based on her response, we recognize the importance of ensuring both safety and efficacy in our product development. Since producing a supplement typically involves less stringent regulatory requirements compared to pharmaceuticals, we have decided to pursue this route. By incorporating natural ingredients like ginseng, which is classified as Generally Recognized As Safe(GRAS), we effectively distinguish our product from pharmaceuticals that often rely on synthetic chemicals.Additionally, in the aftermath of the COVID-19 pandemic, there has been a notable increase in the number of consumers who are more concerned about their health and prefer natural, holistic, and preventative solutions. Therefore, we have chosen to develop our product as a supplement.
Fig: Interview with Scientific Officer Ms. May Lee
1. Ms. Slyvia Tang
- Quality Assurance Officer
- A local restaurant
With the aim to collect advices for the product(supplement) produce,we interviewed Ms Tang,a quality assurance officer of a food company called Tam Jai,to observe the trend and suitable ways to further extend our product in order to favor the interest of HongKongers and seek for advice on our future production.
She suggested the incorporation of ginseng and lupine-based supplements in a convenient form,such as capsules or powder to meet and benefit the hectic lifestyle of HongKongers,and she also highlighted the significance of clinical trials and scientific evidence which provides certification to the specific certification standard to our dietary supplements so as to convinced the customers and enhance their confidence in taking our supplement.
We realised the potential of producing a supplement in a simpler way such as capsule to meet public’s needs and the significance of monitoring safety of our production.We realise the potential of producing a supplement in a simpler way such as capsule to meet public’s needs and the significance of monitoring safety of our production.
Fig: Interview with Quality Assurance Officer Ms. Sylvia Tang
1. Mr Tim Chan (Retired grandfather)
In order to grasp a better understanding of the difficulties that CVD patients are facing, and their confidence in our product to prevent CVD.
Mr Chan agrees that prevention is better than cure. As a CVD patient, he appreciates a supplement that helps preventing CVD with an affordable price. He is confident towards our supplement only if there are certifications from food safety assurance companies. However, when it comes to synthetic biology, he remains sceptical about the use of bacteria in the production of the supplement.
We discovered that CVD patients have the same goal with us, that is to prevent CVD from relapsing. However, CVD patients may be concerned about the use of bacteria during the production of our supplement as they may have inadequate knowledge on synthetic biology. In view of this, we should deliver a bright idea of synthetic biology through education.
We strive to reduce the risk of CVDs among Hongkongers. As Hong Kong is recognized as one of the busiest cities in the world, Hongkongers usually have an unhealthy lifestyle, including their diet, exercise routine, and mental burden. In view of this, we focus on exploring the lifestyle of Hongkongers, especially on having supplements, as well as their exercise habits.
We discovered that most citizens have a routine of consuming supplements, and the reasons for interviewees to consume supplements are mainly improving their health, especially intensifying their immune system, and gaining more nutrients.
All of the interviewees agree that supplements are beneficial to our health. They are confident in our supplement, too.
Other than that, we realized that consumers usually consume capsule supplements, and they prefer consuming them in a more convenient method.
Hence, we strive to develop our supplements in capsule form, as citizens usually prefer capsules due to its convenience.
Figure : Result of 1st street interview among 40 respons
Fig: 1st Street Interview in Shek Lei Shopping Center
Fig:1st street interview in Tseung Kwan O
Since suffering from CVDs are really common among Hong Kong people, we decided to design a questionnaire in order to check their acknowledgment of CVDs. At the same time, our product is a supplement to alleviate CVDs, we also want to know more about their preferences for this product.
Nearly 80% of the individuals stated that they have a general understanding on CVD,such that they have a brief concept on how to regulate their lives to prevent the disease starting on avoiding the popular factors(The three-highs).In view of this,the public are actually alert of this disease.Nevertheless,some of them reflected that by living in the fast lane contributes to less time on focusing health habits. Therefore, they demand a solution that is more effective for them to prevent CVD.
In general, people aren’t willing to try our products and we can tell the reason is people are not confident about synthetic biology since they don’t know much about it and they have concerns about the bacteria being used while producing our product. We decided to let different professionals and organizations prove that our product is used and efficient.
Over 50% of them have a habit of purchasing health supplements. That shows that Hong Kong people are willing to purchase supplements since they have a need for being healthier.
However,Over 40% of them think supplements are a kind of financial burden for them. It is because they are mostly expensive and they need to consume various supplements within a day.
In conclusion, this questionnaire shows us that people have basic knowledge of CVDs and they also can keep a healthy lifestyle in general. However, our product needs to get recommended by different professionals in order to increase the trust of people.
Fig: 2nd Street Interview in Shek Lei, Kwai Chung
Fig:2nd Street Interview in Tseung Kwan OOur Human Practice Team tends to make our project impacts to the society and work with different people in the community. We worked on the engagement with different stakeholders, hoping to receive vital feedback and do reflections so as to implement the suggestions or advice to our project for huge improvements.
With the early stages’ research and interviews, we started our project on the treatment of cardiovascular diseases at first due to the causes of high mortality and seriousness, and so on targeted atherosclerosis and thrombosis.
Hence, our HP gives opportunities for the development of our project, giving directions to the wet lab, dry lab to operate.
To start our project, we planned to know more about atherosclerosis and thrombosis. We interviewed some cardiologists, talking about the modern treatments/side effects on atherosclerosis and thrombosis and its side effects. We hence know that there are many side effects in modern medicine. For example, Statin, which can decrease the rate of cholesterol level produced by the liver. Statin will cause common side effects like muscle pain, headache, dizziness; or rare side effects like inflammation of pancreas, hair loss. We discovered that intake of Statin for a long period will cause the cholesterol level to become too low which will cause Cancer occurs.
The main point is that Atherosclerosis is irreversible. We can only prevent or slow down the process of Atherosclerosis. Hence, our project's initial idea has burgeoned: Rather than intaking medicine with many side effects, or surgeries with high cost and risk, why don’t we try to make some product that can slow down the process of Atherosclerosis with lower cost and less side effects? In other words, not to cure the disease, but to prevent or slow down the process of the disease.
We began to continue our project as the direction of prevention. We discovered that Chinese medicine emphasizes prevention. Furthermore, traditional Chinese medicines have a strong focus on using treatments that have minimal side effects which is precisely applicable on our project.
Traditional Chinese medicine such as Ginseng, which is a medicinal plant that has been used for centuries in traditional medicine systems. It is commonly known for its adaptogenic properties and functions on prevention of atherosclerosis. Besides, Ginseng has shown promising functions on atherosclerosis and thrombosis. Such as the improvement of endothelial function, inhibiting platelet aggregation.
Moreover, it is important to control the dosage, as there are clinical tests that using too much ginseng to treat patients will exacerbate their condition.
To solve the problem, we decided to extract part of ginseng so as to lower the dosage while maintaining its function to atherosclerosis and thrombosis. Following, we discovered Ginsentide TP1, which is a bioactive peptide potential on cardiovascular benefits and contains most of the functions of Ginseng that can be active on prevention of atherosclerosis and thrombosis.
As we extracted Ginsentide TP1 from Ginseng, which TP1 can induce the production of Nitric Oxide in the endothelial cells and causes smooth muscle cell relaxation. It will cause the lumen size to increase and hence decrease the blood pressure so as to reduce damage in endothelial cells and reduce atherosclerosis process. But it’s not enough to slow down the process of Atherosclerosis only with the functions of Ginsentide TP1. Hence, we thirst for discovering more possibilities to improve our project.
We learned about the mechanisms and process of atherosclerosis also what cholesterol is. Cholesterol is a type of lipid that is essential for building cells and producing certain hormones. It travels through the bloodstream in particles called lipoproteins. There are two main types of lipoproteins that carry cholesterol: low-density lipoprotein (LDL) and high-density lipoprotein (HDL).
HDL can help remove cholesterol from the bloodstream by carrying it back to the liver, where it can be processed and eliminated from the body, so it’s known to be good cholesterol.
LDL carries cholesterol to the arteries, where it can form plaque, this plaque buildup can narrow the arteries and cause atherosclerosis and thrombosis. So it’s known to be bad cholesterol.
Our refinement is to focus on how to decrease the cholesterol level and hence decrease the rate of LDL carries cholesterol to arteries to form plaque so as to slow down the process of atherosclerosis.
With some research, we discovered lupin beans, which is a super bean beneficial to heart health by lowering cholesterol levels, and hence discovered Lupin Peptide P5. Lupin Peptide P5 can inhibit PCSK9 to increase LDL uptake and inhibit HMG-CoA Reductase to increase synthesis of LDLr.
So why did we decide to fuse TP1 and P5 together but not just make 2 peptides? As different proteins will denature in different pH values or temperatures, we want to ensure that both TP1 and P5 won’t be denatured so as to maintain their functions.
Secondly, TP1 and P5 have different functions, but both can be involved in cardiovascular disease. We want the two peptides to be delivered to the blood vessels at the same time, so as to increase the rate of treating atherosclerosis by addressing various underlying mechanisms.
People due to busy lifestyles often ignore their health situation, which greatly increases risk of cardiovascular diseases. Hence, we aim to provide a reliable and user-friendly solution for preventing atherosclerosis, helping people maintain their cardiovascular health without disrupting their daily routines.
Combining with feedback from the community, we decided to make our product in the form of a supplement. And with more interviews with the specialist, we finally decided to implement our peptide into a capsule.
Capsules can ensure dosage precision, avoiding overdose or underdose by handling errors. On the other hand capsules can easily control dosage to different age ranges. Most importantly, it’s easy to take, which is user-friendly to people with busy schedules.
The future of ginseng cultivation and its role in treating cardiovascular disease (CVD) looks promising, with innovative solutions on the horizon that could revolutionize healthcare.
iGEM teams are actively investigating ways to enhance ginseng through genetic modification. Their goal is to develop resilient strains capable of improving medicinal properties.
Techniques such as biofortification are being employed to enrich ginseng with essential nutrients and bioactive compounds, thereby amplifying its health benefits.
A significant breakthrough anticipated in this field is Ginsentide TP1, a compound derived from ginseng. This potential therapy has the capacity to dramatically reduce mortality rates associated with CVD, improve quality of life, and lower hospitalizations and healthcare expenses.
With the introduction of Ginsentide TP1, healthcare providers may shift their focus towards prevention and personalized care, customizing treatments based on individual genetic profiles.
This transition could encourage collaboration among healthcare professionals, fostering a comprehensive approach to cardiovascular health.
Moreover, public health initiatives will be crucial in raising awareness about heart health and promoting healthier lifestyle choices.
Collectively, these advancements in ginseng research, alongside effective public health strategies, could lead to a more efficient and holistic method for preventing and managing cardiovascular disease in the future.
In summary, HP has played a critical role in our project. We have worked with people on different perspectives and they kept proposing solutions for improvements. Fortunately with the help of HP, we at last designed a fusion peptide which can slow down the process of atherosclerosis.
Furthermore, we are fervent in educating the public about the importance of a good lifestyle modification. We also aim to produce supplement with less side effects, so as to reduce the pain while withstanding the cardiovascular disease. To sum up, we are striving to make benefits to the society, so as to make an impact in our community.