Clinical epidemiology

The research within our LUMC departments is conducted within departmental research programmes. The research programme below is embedded within the department of Clinical Epidemiology.

Aim and focus

Clinical epidemiology consists of the application of general epidemiologic principles in clinical research. The research of the department can be categorised over three axes: first, the population to which the research is directed; second, the disease content, and third, methodology of data science. Invariably,  the research concerns questions which necessitate a numerical approach, and in which the human individual is the unit of observation. Specifically, the programme focuses on the general population to understand disease development and prevent disease, and to patients to improve treatment and understand disease mechanisms. The key words in the approach to research is that it is new, relevant, collaborative and methodologically sound. Disease content in which the department is structurally active includes haemostasis and thrombosis, obesity-related disease, chronic kidney disease, osteoarthritis and transfusion medicine.

Position in international context

The department is among the world leaders in Epidemiology, as well as in several of the content-defined fields, such as haemostasis and thrombosis, osteoarthritis and metabolic disorders. Much of the research is performed in international collaborations, amongst others with universities in Milan, Seattle, Tromsø, Burlington (Vermont), Tehran, Aarhus, Stockholm and Copenhagen, with frequent exchanges of personnel and affiliate appointments. Notably, Prof. Rosendaal is Visiting Professor at the universities of Tromsø and Milan, Prof. Dekkers as well as emeritus Prof. Vandenbroucke at the university of Aarhus, and Prof van der Bom in Belo Horizonte, while Prof. Cannegieter leads a research twinning programme from the International Society on Thrombosis and Haemostasis (ISTH), also with the university of Belo Horizonte.

Content / highlights / achievements

Research themes, the current studies and their principal investigators:

  • Venous thrombosis (LETS, MEGA, VTE, AT-AGE, PODCAST): Prof. dr S.C. Cannegieter, Dr A. van Hylckama Vlieg, Dr W.M. Lijfering, Prof. dr F.R. Rosendaal
  • Bleeding disorders (HIN-6, SIPPET, TeMpOH, BITE, ATTACH): Prof. dr J.G. van der Bom, Prof. dr F.R. Rosendaal
  • Chronic kidney disease (NECOSAD, PREPARE, EQUAL): Prof. dr F.W. Dekker, Dr M. van Diepen
  • Transfusion medicine (RFACT, Prepares, INOX-ICU): Prof. dr J.G. van der Bom, Dr R. Middelburg
  • Osteoarthritis (HOSTAS, NEO, GARP, ECHO, geMstoan): Prof. dr M. Kloppenburg, Prof. dr F.R. Rosendaal
  • Metabolic disorders (NEO): Prof.  dr F.R. Rosendaal, Dr R. de Mutsert, Dr D.O. Mook-Kanamori 
  • Methodology: Prof. dr S. le Cessie, Prof. dr O.M. Dekkers, Dr R. Groenwold

During the last five years (2013-2017) we consistently published in the major medical journals (well over 600 articles), with 43 publications in the highest ranking journals (IF>10).

In the area of thrombosis research, we recently established in two large, multicentre randomised controlled trials that routine anticoagulant treatment given to patients after knee arthroscopy or during lower leg plaster cast is not effective in preventing venous thrombosis.

In the area of haemophilia, the department was in a leading role in the first international randomised trial comparing two classes of FVIII concentrates in haemophilia, leading to several publications. Moreover, we obtained  a grant for a national study of haemophilia, which project currently includes all haemophilia centres, and led to the foundation of a haemophilia ‘pearl’ in the ‘Parelsnoer’ biobank.

For  chronic kidney disease, we recently started to develop and validate instruments to assess patient reported outcomes (PROMs) specific for patients with renal disease. This project is in close collaboration with the Dutch Kidney Patients . In addition, in a large study in all Stockholm citizens we showed  that using proton pump inhibitors is associated with an accelerated decline in renal function (Klatte, Gastroenterol 2017).

In the field of osteoarthritis we showed that obesity, a strong risk factors for osteoarthritis, acts mechanically in knee osteoarthritis, but via metabolic pathways in hand osteoarthritis (Visser, Ann Rheum Dis 2015). This led to laboratory studies  where the role of lipid mediators is unravelled, supported by a NWO  ‘Zwaartekracht’ (Gravity) consortium (Institute for Chemical Immunology).  

For our studies of metabolic disorders, we acquired a large consortium grant (CVON, Netherlands Heart Foundation) to start the ‘Energise’ consortium. In this framework we will extend analyses in the NEO study, of which the 100th paper proposal was submitted in 2017. Since all 6700 individuals have been genotyped with an exome- and GWAS-chip, the collaboration in multinational genetic consortia has led to many publications in high-ranking  

In the area of transfusion medicine we previously  uncovered negative effects of blood from female donors on severe side effects of transfusion and this was recently extended to the finding that red blood cells from parous female donors increase mortality of red blood cells recipients.

The methodologic work is focusing on methods for epidemiological research. We have developed new methodology for instrumental variable analyses, sensitivity methods for mediation analysis, meta-analysis, and competing risks.  

In 2016, the LUMC founded a group on medical education research, which is supported by our department;  one  of the focus areas   is to study outcomes of extra scientific training to medical students, which enables them to discover their talents and grow as future physician-researchers.

Future themes

In the coming years, existing research lines will be continued and expanded, focussing both on population health and patient’s health. Besides disease-oriented themes, a major focus will be the NEO study that assesses all common disorders, and in which we included 6700 predominantly overweight and obese individuals from the general population, where a second visit of the participants is in the development stage. In addition, we will strengthen our collaboration with other methodological departments (e.g,. Medical Statistics) to create a Centre for Quantitative Medicine, for which a unilocation for both departments will be created.

Cohesion within LUMC

The department has strong ties with many departments in the LUMC, as evidenced by the joint positions of the staff members Cannegieter, Dekkers, van der Bom, Kloppenburg, le Cessie and Groenwold. Most projects are performed in close collaboration with LUMC departments, such as Thrombosis and Haemostasis (thrombosis), Rheumatology (osteoarthritis), Orthopaedics (thrombosis prevention, outcome research), Medical Statistics (methodology) and Nephrology (chronic kidney disease). In addition, there is a close collaboration with Sanquin (blood management) and all LUMC departments transfusing significant amounts of blood products (ICU, hematology, NICU, Obstetrics) and the University of Milan (haemophilia). In the NEO study, ten departments from the LUMC work together, as well as researchers from the Free University and Maastricht University.