ORCID Profile
0000-0002-7937-304X
Current Organisations
University of Cambridge Darwin College
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University of Cambridge
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Sociology | Consumption and Everyday Life | Environmental Sociology | Sociology and Social Studies of Science and Technology
Expanding Knowledge through Studies of Human Society | Residential Energy Conservation and Efficiency |
Publisher: BMJ
Date: 29-05-2018
DOI: 10.1136/BMJ.K934
Abstract: To investigate the association between alcohol consumption (at baseline and over lifetime) and non-fatal and fatal coronary heart disease (CHD) and stroke. Multicentre case-cohort study. A study of cardiovascular disease (CVD) determinants within the European Prospective Investigation into Cancer and nutrition cohort (EPIC-CVD) from eight European countries. 32 549 participants without baseline CVD, comprised of incident CVD cases and a subcohort for comparison. Non-fatal and fatal CHD and stroke (including ischaemic and haemorrhagic stroke). There were 9307 non-fatal CHD events, 1699 fatal CHD, 5855 non-fatal stroke, and 733 fatal stroke. Baseline alcohol intake was inversely associated with non-fatal CHD, with a hazard ratio of 0.94 (95% confidence interval 0.92 to 0.96) per 12 g/day higher intake. There was a J shaped association between baseline alcohol intake and risk of fatal CHD. The hazard ratios were 0.83 (0.70 to 0.98), 0.65 (0.53 to 0.81), and 0.82 (0.65 to 1.03) for categories 5.0-14.9 g/day, 15.0-29.9 g/day, and 30.0-59.9 g/day of total alcohol intake, respectively, compared with 0.1-4.9 g/day. In contrast, hazard ratios for non-fatal and fatal stroke risk were 1.04 (1.02 to 1.07), and 1.05 (0.98 to 1.13) per 12 g/day increase in baseline alcohol intake, respectively, including broadly similar findings for ischaemic and haemorrhagic stroke. Associations with cardiovascular outcomes were broadly similar with average lifetime alcohol consumption as for baseline alcohol intake, and across the eight countries studied. There was no strong evidence for interactions of alcohol consumption with smoking status on the risk of CVD events. Alcohol intake was inversely associated with non-fatal CHD risk but positively associated with the risk of different stroke subtypes. This highlights the opposing associations of alcohol intake with different CVD types and strengthens the evidence for policies to reduce alcohol consumption.
Publisher: Elsevier BV
Date: 03-2011
Publisher: Massachusetts Medical Society
Date: 04-10-2012
Publisher: Springer Science and Business Media LLC
Date: 10-2021
DOI: 10.1038/S41588-021-00944-6
Abstract: Telomeres, the end fragments of chromosomes, play key roles in cellular proliferation and senescence. Here we characterize the genetic architecture of naturally occurring variation in leukocyte telomere length (LTL) and identify causal links between LTL and biomedical phenotypes in 472,174 well-characterized UK Biobank participants. We identified 197 independent sentinel variants associated with LTL at 138 genomic loci (108 new). Genetically determined differences in LTL were associated with multiple biological traits, ranging from height to bone marrow function, as well as several diseases spanning neoplastic, vascular and inflammatory pathologies. Finally, we estimated that, at the age of 40 years, people with an LTL s.d. shorter than the population mean had a 2.5-year-lower life expectancy compared with the group with ≥1 s.d. longer LDL. Overall, we furnish new insights into the genetic regulation of LTL, reveal wide-ranging influences of LTL on physiological traits, diseases and longevity, and provide a powerful resource available to the global research community.
Publisher: Springer Science and Business Media LLC
Date: 10-08-2023
DOI: 10.1186/S13063-023-07473-Z
Abstract: Vasovagal reactions (VVRs) are the most common acute complications of blood donation. Responsible for substantial morbidity, they also reduce the likelihood of repeated donations and are disruptive and costly for blood services. Although blood establishments worldwide have adopted different strategies to prevent VVRs (including water loading and applied muscle tension [AMT]), robust evidence is limited. The Strategies to Improve Donor Experiences (STRIDES) trial aims to reliably assess the impact of four different interventions to prevent VVRs among blood donors. STRIDES is a cluster-randomised cross-over/stepped-wedge factorial trial of four interventions to reduce VVRs involving about 1.4 million whole blood donors enrolled from all 73 blood donation sites (mobile teams and donor centres) of National Health Service Blood and Transplant (NHSBT) in England. Each site (“cluster”) has been randomly allocated to receive one or more interventions during a 36-month period, using principles of cross-over, stepped-wedge and factorial trial design to assign the sequence of interventions. Each of the four interventions is compared to NHSBT’s current practices: (i) 500-ml isotonic drink before donation ( vs current 500-ml plain water) (ii) 3-min rest on donation chair after donation ( vs current 2 min) (iii) new modified AMT ( vs current practice of AMT) and (iv) psychosocial intervention using preparatory materials ( vs current practice of nothing). The primary outcome is the number of in-session VVRs with loss of consciousness (i.e. episodes involving loss of consciousness of any duration, with or without additional complications). Secondary outcomes include all in-session VVRs (i.e. with and without loss of consciousness), all delayed VVRs (i.e. those occurring after leaving the venue) and any in-session non-VVR adverse events or reactions. The STRIDES trial should yield novel information about interventions, singly and in combination, for the prevention of VVRs, with the aim of generating policy-shaping evidence to help inform blood services to improve donor health, donor experience, and service efficiency. ISRCTN: 10412338. Registration date: October 24, 2019.
Publisher: Cold Spring Harbor Laboratory
Date: 22-10-2022
DOI: 10.1101/2022.10.20.22281120
Abstract: To provide quantitative evidence of the use of polygenic risk scores (PRS) for systematically identifying in iduals for invitation for full formal cardiovascular disease (CVD) risk assessment. 108,685 participants aged 40-69, with measured biomarkers, linked primary care records and genetic data in UK Biobank were used for model derivation and population health modelling. Prioritisation tools using age, PRS for coronary artery disease and stroke, and conventional risk factors for CVD available within longitudinal primary care records were derived using sex-specific Cox models. Rescaling to account for the healthy cohort effect, we modelled the implications of initiating guideline-recommended statin therapy after prioritising in iduals for invitation to a formal CVD risk assessment. 1,838 CVD events were observed over median follow up of 8.2 years. If primary care records were used to prioritise in iduals for formal risk assessment using age- and sex-specific thresholds corresponding to 5% false negative rates then we would capture 65% and 43% events amongst men and women respectively. The numbers of men and women needed to be screened to prevent one CVD event (NNS) are 74 and 140 respectively. In contrast, adding PRS to both prioritisation and formal assessments, and selecting thresholds to capture the same number of events resulted in a NNS of 60 for men and 90 for women. The use of PRS together with primary care records to prioritise in iduals at highest risk of a CVD event for a formal CVD risk assessment can more efficiently prioritise those who need interventions the most than using primary care records alone. This could lead to better allocation of resources by reducing the number of formal risk assessments in primary care while still preventing the same number CVD events.
Publisher: American Society for Clinical Investigation
Date: 12-07-2018
Publisher: American Medical Association (AMA)
Date: 22-07-2009
Publisher: Elsevier BV
Date: 2010
Publisher: Springer Science and Business Media LLC
Date: 2021
Publisher: Oxford University Press (OUP)
Date: 23-07-2012
DOI: 10.1093/IJE/DYS086
Publisher: Oxford University Press (OUP)
Date: 03-05-2010
DOI: 10.1093/IJE/DYQ063
Publisher: BMJ
Date: 29-06-2009
DOI: 10.1136/BMJ.B2393
Publisher: Oxford University Press (OUP)
Date: 20-09-2018
DOI: 10.1093/NAR/GKY837
Publisher: Wiley
Date: 20-12-2014
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 18-06-2019
DOI: 10.1161/CIRCULATIONAHA.118.038813
Abstract: There is uncertainty about the relevance of animal foods to the pathogenesis of ischemic heart disease (IHD). We examined meat, fish, dairy products, and eggs and risk for IHD in the pan-European EPIC cohort (European Prospective Investigation Into Cancer and Nutrition). In this prospective study of 409 885 men and women in 9 European countries, diet was assessed with validated questionnaires and calibrated with 24-hour recalls. Lipids and blood pressure were measured in a subs le. During a mean of 12.6 years of follow-up, 7198 participants had a myocardial infarction or died of IHD. The relationships of animal foods with risk were examined with Cox regression with adjustment for other animal foods and relevant covariates. The hazard ratio (HR) for IHD was 1.19 (95% CI, 1.06–1.33) for a 100-g/d increment in intake of red and processed meat, and this remained significant after exclusion of the first 4 years of follow-up (HR, 1.25 [95% CI, 1.09–1.42]). Risk was inversely associated with intakes of yogurt (HR, 0.93 [95% CI, 0.89–0.98] per 100-g/d increment), cheese (HR, 0.92 [95% CI, 0.86–0.98] per 30-g/d increment), and eggs (HR, 0.93 [95% CI, 0.88–0.99] per 20-g/d increment) the associations with yogurt and eggs were attenuated and nonsignificant after exclusion of the first 4 years of follow-up. Risk was not significantly associated with intakes of poultry, fish, or milk. In analyses modeling dietary substitutions, replacement of 100 kcal/d from red and processed meat with 100 kcal/d from fatty fish, yogurt, cheese, or eggs was associated with ≈20% lower risk of IHD. Consumption of red and processed meat was positively associated with serum non–high-density lipoprotein cholesterol concentration and systolic blood pressure, and consumption of cheese was inversely associated with serum non–high-density lipoprotein cholesterol. Risk for IHD was positively associated with consumption of red and processed meat and inversely associated with consumption of yogurt, cheese, and eggs, although the associations with yogurt and eggs may be influenced by reverse causation bias. It is not clear whether the associations with red and processed meat and cheese reflect causality, but they were consistent with the associations of these foods with plasma non–high-density lipoprotein cholesterol and for red and processed meat with systolic blood pressure, which could mediate such effects.
Publisher: JMIR Publications Inc.
Date: 10-02-2022
DOI: 10.2196/31885
Abstract: Although the burden of premature myocardial infarction (MI) is high in Malaysia, direct evidence on the determinants of MI in this multi-ethnic population remains sparse. The Malaysian Acute Vascular Events Risk (MAVERIK) study is a retrospective case-control study established to investigate the genomic, lipid-related, and other determinants of acute MI in Malaysia. In this paper, we report the study protocol and early results. By June 2019, we had enrolled approximately 2500 patients with their first MI and 2500 controls without cardiovascular disease, who were frequency-matched by age, sex, and ethnicity, from 17 hospitals in Malaysia. For each participant, serum and whole blood have been collected and stored. Clinical, demographic, and behavioral information has been obtained using a 200-item questionnaire. Tobacco consumption, a history of diabetes, hypertension, markers of visceral adiposity, indicators of lower socioeconomic status, and a family history of coronary disease were more prevalent in cases than in controls. Adjusted (age and sex) logistic regression models for traditional risk factors indicated that current smoking (odds ratio [OR] 4.11, 95% CI 3.56-4.75 P .001), previous smoking (OR 1.34, 95% CI 1.12-1.60 P=.001), a history of high blood pressure (OR 2.13, 95% CI 1.86-2.44 P .001), a history of diabetes mellitus (OR 2.72, 95% CI 2.34-3.17 P .001), a family history of coronary heart disease (OR 1.28, 95% CI 1.07-1.55 P=.009), and obesity (BMI kg/m2 OR 1.19, 95% CI 1.05-1.34 P=.009) were associated with MI in age- and sex-adjusted models. The MAVERIK study can serve as a useful platform to investigate genetic and other risk factors for MI in an understudied Southeast Asian population. It should help to hasten the discovery of disease-causing pathways and inform regionally appropriate strategies that optimize public health action. RR1-10.2196/31885
Publisher: American Medical Association (AMA)
Date: 20-06-2012
Publisher: Wiley
Date: 30-03-2009
DOI: 10.1002/SIM.3530
Publisher: Wiley
Date: 10-02-2009
DOI: 10.1002/SIM.3378
Abstract: Many measures have been proposed to summarize the prognostic ability of the Cox proportional hazards (CPH) survival model, although none is universally accepted for general use. By contrast, little work has been done to summarize the prognostic ability of the stratified CPH model such measures would be useful in analyses of in idual participant data from multiple studies, data from multi-centre studies, and in single study analysis where stratification is used to avoid making assumptions of proportional hazards. We have chosen three measures developed for the unstratified CPH model (Schemper and Henderson's V , Harrell's C-index and Royston and Sauerbrei's D), adapted them for use with the stratified CPH model and demonstrated how their values can be represented over time. Although each of these measures is promising in principle, we found the measure of explained variation V very difficult to apply when data are combined from several studies with differing durations of participant follow-up. The two other measures considered, D and the C-index, were more applicable under such circumstances. We illustrate the methods using in idual participant data from several prospective epidemiological studies of chronic disease outcomes.
Publisher: Oxford University Press (OUP)
Date: 13-06-2017
DOI: 10.1093/AJE/KWX149
Publisher: American Chemical Society (ACS)
Date: 19-03-2019
Publisher: Public Library of Science (PLoS)
Date: 30-07-2013
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 12-2010
Publisher: American Medical Association (AMA)
Date: 12-08-2009
Publisher: Elsevier BV
Date: 04-2018
Publisher: Elsevier BV
Date: 07-2022
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 08-2023
Abstract: The aim of this study was to provide quantitative evidence of the use of polygenic risk scores for systematically identifying in iduals for invitation for full formal cardiovascular disease (CVD) risk assessment. A total of 108 685 participants aged 40 to 69 years, with measured biomarkers, linked primary care records, and genetic data in UK Biobank were used for model derivation and population health modeling. Prioritization tools using age, polygenic risk scores for coronary artery disease and stroke, and conventional risk factors for CVD available within longitudinal primary care records were derived using sex‐specific Cox models. We modeled the implications of initiating guideline‐recommended statin therapy after prioritizing in iduals for invitation to a formal CVD risk assessment. If primary care records were used to prioritize in iduals for formal risk assessment using age‐ and sex‐specific thresholds corresponding to 5% false‐negative rates, then the numbers of men and women needed to be screened to prevent 1 CVD event are 149 and 280, respectively. In contrast, adding polygenic risk scores to both prioritization and formal assessments, and selecting thresholds to capture the same number of events, resulted in a number needed to screen of 116 for men and 180 for women. Using both polygenic risk scores and primary care records to prioritize in iduals at highest risk of a CVD event for a formal CVD risk assessment can efficiently prioritize those who need interventions the most than using primary care records alone. This could lead to better allocation of resources by reducing the number of risk assessments in primary care while still preventing the same number of CVD events.
Publisher: Oxford University Press (OUP)
Date: 22-11-2018
Publisher: Elsevier BV
Date: 10-2018
Publisher: JMIR Publications Inc.
Date: 09-07-2021
Abstract: lthough the burden of premature myocardial infarction (MI) is high in Malaysia, direct evidence on the determinants of MI in this multi-ethnic population remains sparse. he Malaysian Acute Vascular Events Risk (MAVERIK) study is a retrospective case-control study established to investigate the genomic, lipid-related, and other determinants of acute MI in Malaysia. In this paper, we report the study protocol and early results. y June 2019, we had enrolled approximately 2500 patients with their first MI and 2500 controls without cardiovascular disease, who were frequency-matched by age, sex, and ethnicity, from 17 hospitals in Malaysia. For each participant, serum and whole blood have been collected and stored. Clinical, demographic, and behavioral information has been obtained using a 200-item questionnaire. obacco consumption, a history of diabetes, hypertension, markers of visceral adiposity, indicators of lower socioeconomic status, and a family history of coronary disease were more prevalent in cases than in controls. Adjusted (age and sex) logistic regression models for traditional risk factors indicated that current smoking (odds ratio [OR] 4.11, 95% CI 3.56-4.75 i P /i & .001), previous smoking (OR 1.34, 95% CI 1.12-1.60 i P /i =.001), a history of high blood pressure (OR 2.13, 95% CI 1.86-2.44 i P /i & .001), a history of diabetes mellitus (OR 2.72, 95% CI 2.34-3.17 i P /i & .001), a family history of coronary heart disease (OR 1.28, 95% CI 1.07-1.55 i P /i =.009), and obesity (BMI & kg/m sup /sup OR 1.19, 95% CI 1.05-1.34 i P /i =.009) were associated with MI in age- and sex-adjusted models. he MAVERIK study can serve as a useful platform to investigate genetic and other risk factors for MI in an understudied Southeast Asian population. It should help to hasten the discovery of disease-causing pathways and inform regionally appropriate strategies that optimize public health action. R1-10.2196/31885
Publisher: Springer Science and Business Media LLC
Date: 18-09-2007
DOI: 10.1007/S10654-007-9165-7
Abstract: Many long-term prospective studies have reported on associations of cardiovascular diseases with circulating lipid markers and/or inflammatory markers. Studies have not, however, generally been designed to provide reliable estimates under different circumstances and to correct for within-person variability. The Emerging Risk Factors Collaboration has established a central database on over 1.1 million participants from 104 prospective population-based studies, in which subsets have information on lipid and inflammatory markers, other characteristics, as well as major cardiovascular morbidity and cause-specific mortality. Information on repeat measurements on relevant characteristics has been collected in approximately 340,000 participants to enable estimation of and correction for within-person variability. Re-analysis of in idual data will yield up to approximately 69,000 incident fatal or nonfatal first ever major cardiovascular outcomes recorded during about 11.7 million person years at risk. The primary analyses will involve age-specific regression models in people without known baseline cardiovascular disease in relation to fatal or nonfatal first ever coronary heart disease outcomes. This initiative will characterize more precisely and in greater detail than has previously been possible the shape and strength of the age- and sex-specific associations of several lipid and inflammatory markers with incident coronary heart disease outcomes (and, secondarily, with other incident cardiovascular outcomes) under a wide range of circumstances. It will, therefore, help to determine to what extent such associations are independent from possible confounding factors and to what extent such markers (separately and in combination) provide incremental predictive value.
Publisher: Oxford University Press (OUP)
Date: 22-12-2013
DOI: 10.1093/AJE/KWT298
Publisher: Elsevier BV
Date: 12-2021
Publisher: Springer Science and Business Media LLC
Date: 06-2018
Publisher: Oxford University Press (OUP)
Date: 31-10-2009
DOI: 10.1093/IJE/DYN225
Publisher: Springer Science and Business Media LLC
Date: 10-09-2021
DOI: 10.1186/S12916-021-02087-1
Abstract: Genetic, lifestyle, and environmental factors can lead to perturbations in circulating lipid levels and increase the risk of cardiovascular and metabolic diseases. However, how changes in in idual lipid species contribute to disease risk is often unclear. Moreover, little is known about the role of lipids on cardiovascular disease in Pakistan, a population historically underrepresented in cardiovascular studies. We characterised the genetic architecture of the human blood lipidome in 5662 hospital controls from the Pakistan Risk of Myocardial Infarction Study (PROMIS) and 13,814 healthy British blood donors from the INTERVAL study. We applied a candidate causal gene prioritisation tool to link the genetic variants associated with each lipid to the most likely causal genes, and Gaussian Graphical Modelling network analysis to identify and illustrate relationships between lipids and genetic loci. We identified 253 genetic associations with 181 lipids measured using direct infusion high-resolution mass spectrometry in PROMIS, and 502 genetic associations with 244 lipids in INTERVAL. Our analyses revealed new biological insights at genetic loci associated with cardiometabolic diseases, including novel lipid associations at the LPL , MBOAT7 , LIPC , APOE-C1-C2-C4 , SGPP1 , and SPTLC3 loci. Our findings, generated using a distinctive lipidomics platform in an understudied South Asian population, strengthen and expand the knowledge base of the genetic determinants of lipids and their association with cardiometabolic disease-related loci.
Publisher: Elsevier BV
Date: 11-2018
Publisher: Oxford University Press (OUP)
Date: 29-05-2023
DOI: 10.1093/EURHEARTJ/EHAD260
Abstract: To develop and validate a recalibrated prediction model (SCORE2-Diabetes) to estimate the 10-year risk of cardiovascular disease (CVD) in in iduals with type 2 diabetes in Europe. SCORE2-Diabetes was developed by extending SCORE2 algorithms using in idual-participant data from four large-scale datasets comprising 229 460 participants (43 706 CVD events) with type 2 diabetes and without previous CVD. Sex-specific competing risk-adjusted models were used including conventional risk factors (i.e. age, smoking, systolic blood pressure, total, and HDL-cholesterol), as well as diabetes-related variables (i.e. age at diabetes diagnosis, glycated haemoglobin [HbA1c] and creatinine-based estimated glomerular filtration rate [eGFR]). Models were recalibrated to CVD incidence in four European risk regions. External validation included 217 036 further in iduals (38 602 CVD events), and showed good discrimination, and improvement over SCORE2 (C-index change from 0.009 to 0.031). Regional calibration was satisfactory. SCORE2-Diabetes risk predictions varied several-fold, depending on in iduals’ levels of diabetes-related factors. For ex le, in the moderate-risk region, the estimated 10-year CVD risk was 11% for a 60-year-old man, non-smoker, with type 2 diabetes, average conventional risk factors, HbA1c of 50 mmol/mol, eGFR of 90 mL/min/1.73 m2, and age at diabetes diagnosis of 60 years. By contrast, the estimated risk was 17% in a similar man, with HbA1c of 70 mmol/mol, eGFR of 60 mL/min/1.73 m2, and age at diabetes diagnosis of 50 years. For a woman with the same characteristics, the risk was 8% and 13%, respectively. SCORE2-Diabetes, a new algorithm developed, calibrated, and validated to predict 10-year risk of CVD in in iduals with type 2 diabetes, enhances identification of in iduals at higher risk of developing CVD across Europe.
Publisher: Oxford University Press (OUP)
Date: 13-06-2021
DOI: 10.1093/EURHEARTJ/EHAB309
Abstract: The aim of this study was to develop, validate, and illustrate an updated prediction model (SCORE2) to estimate 10-year fatal and non-fatal cardiovascular disease (CVD) risk in in iduals without previous CVD or diabetes aged 40–69 years in Europe. We derived risk prediction models using in idual-participant data from 45 cohorts in 13 countries (677 684 in iduals, 30 121 CVD events). We used sex-specific and competing risk-adjusted models, including age, smoking status, systolic blood pressure, and total- and HDL-cholesterol. We defined four risk regions in Europe according to country-specific CVD mortality, recalibrating models to each region using expected incidences and risk factor distributions. Region-specific incidence was estimated using CVD mortality and incidence data on 10 776 466 in iduals. For external validation, we analysed data from 25 additional cohorts in 15 European countries (1 133 181 in iduals, 43 492 CVD events). After applying the derived risk prediction models to external validation cohorts, C-indices ranged from 0.67 (0.65–0.68) to 0.81 (0.76–0.86). Predicted CVD risk varied several-fold across European regions. For ex le, the estimated 10-year CVD risk for a 50-year-old smoker, with a systolic blood pressure of 140 mmHg, total cholesterol of 5.5 mmol/L, and HDL-cholesterol of 1.3 mmol/L, ranged from 5.9% for men in low-risk countries to 14.0% for men in very high-risk countries, and from 4.2% for women in low-risk countries to 13.7% for women in very high-risk countries. SCORE2—a new algorithm derived, calibrated, and validated to predict 10-year risk of first-onset CVD in European populations—enhances the identification of in iduals at higher risk of developing CVD across Europe.
Publisher: Elsevier BV
Date: 10-2019
Publisher: BMJ
Date: 18-08-2011
Publisher: Public Library of Science (PLoS)
Date: 14-01-2021
DOI: 10.1371/JOURNAL.PMED.1003498
Abstract: Polygenic risk scores (PRSs) can stratify populations into cardiovascular disease (CVD) risk groups. We aimed to quantify the potential advantage of adding information on PRSs to conventional risk factors in the primary prevention of CVD. Using data from UK Biobank on 306,654 in iduals without a history of CVD and not on lipid-lowering treatments (mean age [SD]: 56.0 [8.0] years females: 57% median follow-up: 8.1 years), we calculated measures of risk discrimination and reclassification upon addition of PRSs to risk factors in a conventional risk prediction model (i.e., age, sex, systolic blood pressure, smoking status, history of diabetes, and total and high-density lipoprotein cholesterol). We then modelled the implications of initiating guideline-recommended statin therapy in a primary care setting using incidence rates from 2.1 million in iduals from the Clinical Practice Research Datalink. The C-index, a measure of risk discrimination, was 0.710 (95% CI 0.703–0.717) for a CVD prediction model containing conventional risk predictors alone. Addition of information on PRSs increased the C-index by 0.012 (95% CI 0.009–0.015), and resulted in continuous net reclassification improvements of about 10% and 12% in cases and non-cases, respectively. If a PRS were assessed in the entire UK primary care population aged 40–75 years, assuming that statin therapy would be initiated in accordance with the UK National Institute for Health and Care Excellence guidelines (i.e., for persons with a predicted risk of ≥10% and for those with certain other risk factors, such as diabetes, irrespective of their 10-year predicted risk), then it could help prevent 1 additional CVD event for approximately every 5,750 in iduals screened. By contrast, targeted assessment only among people at intermediate (i.e., 5% to %) 10-year CVD risk could help prevent 1 additional CVD event for approximately every 340 in iduals screened. Such a targeted strategy could help prevent 7% more CVD events than conventional risk prediction alone. Potential gains afforded by assessment of PRSs on top of conventional risk factors would be about 1.5-fold greater than those provided by assessment of C-reactive protein, a plasma biomarker included in some risk prediction guidelines. Potential limitations of this study include its restriction to European ancestry participants and a lack of health economic evaluation. Our results suggest that addition of PRSs to conventional risk factors can modestly enhance prediction of first-onset CVD and could translate into population health benefits if used at scale.
Publisher: BMJ
Date: 16-03-2012
DOI: 10.1136/BMJ.E1552
Publisher: American Medical Association (AMA)
Date: 07-07-2015
Publisher: American Medical Association (AMA)
Date: 11-11-2009
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2010
Publisher: Elsevier BV
Date: 06-2010
Publisher: Oxford University Press (OUP)
Date: 23-05-2018
DOI: 10.1093/CVR/CVY120
Abstract: In the last decade, over 175 genetic loci have robustly been associated to levels of major circulating blood lipids. Most loci are specific to one or two lipids, whereas some (SUGP1, ZPR1, TRIB1, HERPUD1, and FADS1) are associated to all. While exposing the polygenic architecture of circulating lipids and the underpinnings of dyslipidaemia, these genome-wide association studies (GWAS) have provided further evidence of the critical role that lipids play in coronary heart disease (CHD) risk, as indicated by the 2.7-fold enrichment for macrophage gene expression in atherosclerotic plaques and the association of 25 loci (such as PCSK9, APOB, ABCG5-G8, KCNK5, LPL, HMGCR, NPC1L1, CETP, TRIB1, ABO, PMAIP1-MC4R, and LDLR) with CHD. These GWAS also confirmed known and commonly used therapeutic targets, including HMGCR (statins), PCSK9 (antibodies), and NPC1L1 (ezetimibe). As we head into the post-GWAS era, we offer suggestions for how to move forward beyond genetic risk loci, towards refining the biology behind the associations and identifying causal genes and therapeutic targets. Deep phenotyping through lipidomics and metabolomics will refine and increase the resolution to find causal and druggable targets, and studies aimed at demonstrating gene transcriptional and regulatory effects of lipid associated loci will further aid in identifying these targets. Thus, we argue the need for deeply phenotyped, large genetic association studies to reduce costs and failures and increase the efficiency of the drug discovery pipeline. We conjecture that in the next decade a paradigm shift will tip the balance towards a data-driven approach to therapeutic target development and the application of precision medicine where human genomics takes centre stage.
Publisher: Oxford University Press (OUP)
Date: 23-03-2018
DOI: 10.1093/AJE/KWY018
Publisher: Wiley
Date: 09-09-2011
DOI: 10.1002/SIM.4362
Publisher: BMJ
Date: 15-07-2010
DOI: 10.1136/BMJ.C3498
Publisher: American Medical Association (AMA)
Date: 02-2019
Publisher: Elsevier BV
Date: 04-2015
Publisher: Oxford University Press (OUP)
Date: 13-06-2021
DOI: 10.1093/EURHEARTJ/EHAB312
Abstract: The aim of this study was to derive and validate the SCORE2-Older Persons (SCORE2-OP) risk model to estimate 5- and 10-year risk of cardiovascular disease (CVD) in in iduals aged over 70 years in four geographical risk regions. Sex-specific competing risk-adjusted models for estimating CVD risk (CVD mortality, myocardial infarction, or stroke) were derived in in iduals aged over 65 without pre-existing atherosclerotic CVD from the Cohort of Norway (28 503 in iduals, 10 089 CVD events). Models included age, smoking status, diabetes, systolic blood pressure, and total- and high-density lipoprotein cholesterol. Four geographical risk regions were defined based on country-specific CVD mortality rates. Models were recalibrated to each region using region-specific estimated CVD incidence rates and risk factor distributions. For external validation, we analysed data from 6 additional study populations {338 615 in iduals, 33 219 CVD validation cohorts, C-indices ranged between 0.63 [95% confidence interval (CI) 0.61–0.65] and 0.67 (0.64–0.69)}. Regional calibration of expected-vs.-observed risks was satisfactory. For given risk factor profiles, there was substantial variation across the four risk regions in the estimated 10-year CVD event risk. The competing risk-adjusted SCORE2-OP model was derived, recalibrated, and externally validated to estimate 5- and 10-year CVD risk in older adults (aged 70 years or older) in four geographical risk regions. These models can be used for communicating the risk of CVD and potential benefit from risk factor treatment and may facilitate shared decision-making between clinicians and patients in CVD risk management in older persons.
Location: United Kingdom of Great Britain and Northern Ireland
Location: United Kingdom of Great Britain and Northern Ireland
Location: United Kingdom of Great Britain and Northern Ireland
Location: United Kingdom of Great Britain and Northern Ireland
Start Date: 2015
End Date: 06-2018
Amount: $370,000.00
Funder: Australian Research Council
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