ECC 2015
What is the AMORIS study?
Prof Mieke van Hemelrijck - Kings College London, London, UK
Can you summarise the AMORIS study?
The AMORIS study, or the Apolipoprotein Mortality Risk Study, was initiated by colleagues at the Karolinska Institute in Stockholm. So between 1985 and 1996 there was a central laboratory in Stockholm who did most of the lab tests for general health check-ups. They collected blot samples, they analysed them for up to over 500 blot biomarkers, so they did that from 1985 to 1996. So they have all this information for over 800,000 men and women. Then in 2007 they decided actually that they could also look into that study into markers for cancer. They already previously looked at how all these biomarkers can be useful for risk of cardiovascular disease but in 2007 they also linked it to the cancer register. The reason they can do that is because in Sweden everybody has a personal identification number so all the results from the blot tests could be linked to data from the cause of death register, the national cancer register, the in-patient register. So basically the AMORIS database at baseline has information on a lot of biomarkers and then that can be linked to different outcomes in terms of cancer but also other diseases as well, cause of death. We also have information on socioeconomic status and several other national healthcare registers and research registers that are linked to this. So it’s really driven by Gunnar and Ingmar Jungner who had their lab back in the ‘80s in Stockholm.
Why is it important to find biomarkers to predict risk?
The reason we are looking at biomarkers in relation to risk of cancer is not necessarily to come up with a marker that we can prevent someone from getting cancer but it’s really to get an understanding of the etiology of cancer because it can give us new ideas for hypotheses in how different metabolisms are linked to cancer. On the other hand, of course, if people come up with certain symptoms we could potentially then use these biomarkers and then look for whether there are any other symptoms related to a potential cancer diagnosis. But I think the reason we are looking specifically in AMORIS at serum biomarkers and cancer is it’s very much from an etiological point of view, trying to understand how different metabolisms, like the glucose metabolism or the lipid metabolism, are associated with risk of getting cancer and that can then drive the new hypotheses which we can take back to the lab to see whether there are other markers related. We can also do more lifestyle related studies because it’s not because one marker of the lipid metabolism is particularly high that you’re going to have cancer but it does give us an idea of what may potentially be driving the development of a certain cancer.
What can you do if a patient’s serum lipid profile looks bad?
There are many things one can do because if your serum lipid profile is bad that doesn’t necessarily mean that you have a higher risk of getting cancer because we already know that that’s associated with a higher risk of cardiovascular disease, it may be linked if someone has metabolic syndrome. But we do know that all these risk factors are also associated with certain types of cancer. So I think the first thing one can do is… well, obviously what a clinician can do is to help the patient get their lipid profile back to normal and that can be through medication or it could be through lifestyle alterations. By doing that you improve your overall health status, I would say, and by that you may then also reduce your risk of getting cancer. But I think it has an effect on many different types of potential diseases.
