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551. Alcohol consumption in England and Wales

Author: Derek G Cook, A G Shaper, and Peter H. Whincup
Subjects: Data collection, Wales, Alcohol Drinking, business.industry, Data Collection, General Engineering, General Medicine, England, Environmental health, General Earth and Planetary Sciences, Medicine, Humans, Telecommunications, business, Alcohol consumption, General Environmental Science, Research Article
Published: 1987

552. Is the prevalence of coronary heart disease falling in British men?

Author: Shah Ebrahim, Peter H. Whincup, Fiona C Lampe, A G Shaper, Richard W Morris, and M Walker
Subjects: Adult, Male, Gerontology, medicine.medical_specialty, Age adjustment, Coronary Disease, Cardiovascular Medicine, Cohort Studies, Angina, Age Distribution, Recurrence, Case fatality rate, Epidemiology, Prevalence, medicine, Humans, Longitudinal Studies, Prospective Studies, cardiovascular diseases, Myocardial infarction, Prospective cohort study, business.industry, Middle Aged, medicine.disease, United Kingdom, Logistic Models, Social Class, Cohort, Cardiology and Cardiovascular Medicine, business, Follow-Up Studies, Demography, Cohort study
Abstract: OBJECTIVE—To assess whether long term trends over time in acute coronary heart disease (CHD) event rates have influenced the burden of prevalent CHD in British men. DESIGN—Longitudinal cohort study. PARTICIPANTS—7735 men, aged 40-59 at entry (1978-80), selected from 24 British towns. METHODS—The prevalences of current angina symptoms and history of diagnosed CHD were ascertained by questionnaire in 1978-80, 1983-85, 1992, and 1996. New major CHD events (fatal and non-fatal) were ascertained throughout the study from National Health Service central registers and general practice record reviews. Age adjusted trends in CHD prevalence were compared with trends in major CHD event rates. RESULTS—From 1978-1996 there was a clear decline in the prevalence of current angina symptoms: the age adjusted annual percentage change in odds was -1.8% (95% confidence interval (CI) -2.8% to -0.8%). However, there was no evidence of a trend in the prevalence of history of diagnosed CHD (annual change in odds 0.1%, 95% CI -1.0% to 1.2%). Over the same period, the CHD mortality rate fell substantially (annual change -4.1%, 95% CI -6.5% to -1.6%); rates of non-fatal myocardial infarction, all major CHD events, and first major CHD event fell by -1.7% (95% CI -3.9% to 0.5%), -2.5% (95% CI -4.1% to -0.8%), and -2.4% (95% CI% -4.3 to -0.4%), respectively. CONCLUSIONS—These results suggest that middle aged British men are less likely to experience symptoms of angina than in previous decades but are just as likely to have a history of diagnosed CHD. Despite falling rates of new major events and falling symptom prevalence, the need for secondary prevention among middle aged men with established CHD is as great as ever. Keywords: coronary heart disease; angina; prevalence; trends

553. Birth weight and blood pressure: Cross sectional and longitudinal relations in childhood

Author: Derek G Cook, Olia Papacosta, Peter H. Whincup, and M Walker
Subjects: Male, medicine.medical_specialty, Pediatrics, Aging, Cross-sectional study, Birth weight, Placenta, Blood Pressure, Body Mass Index, Linear regression, Medicine, Birth Weight, Humans, Longitudinal Studies, Child, General Environmental Science, business.industry, Obstetrics, General Engineering, General Medicine, Organ Size, Confidence interval, Body Height, Blood pressure, Cross-Sectional Studies, El Niño, England, Child, Preschool, General Earth and Planetary Sciences, Body Constitution, Female, Birth records, business, Body mass index, Research Article
Abstract: Objective: To examine cross sectional and longitudinal relations between birth weight and blood pressure in childhood. Design: Cross sectional study of primary school children aged 9-11 years, with analysis in relation to previous measurements at 5-7 years in a subgroup. Setting: 20 primary schools in Guildford and Carlisle. Subjects: 1511 children measured at 9-11 years (response rate 79%), including 549 who had been measured at 5-7 years. Main outcome measures: Blood pressure at 9-11 years, change in blood pressure between 5-7 and 9-11 years, birth weight (based on maternal recall), and placental weight (based on birth records). Results: At 9-11 years birth weight was inversely related both to systolic blood pressure (regression coefficient −2.80 mm Hg/kg; 95% confidence interval −3.84 to −1.76) and to diastolic blood pressure (regression coefficient −1.42 mm Hg/kg; −2.14 to −0.70) once current height and body mass index were taken into account. Placental weight was inversely related to blood pressure after adjustment for current height and body mass index but placental ratio (placental weight to birth weight) was unrelated to blood pressure. Between 5–7 and 9–11 years systolic blood pressure rose more rapidly in children of lower birth weight (regression coefficient −1.71 mm Hg/kg; −3.35 to −0.07). This effect seemed to be stronger in girls. Conclusions: Birth weight rather than placental ratio is the early life factor most importantly related to blood pressure in childhood. The results support the possibility of “amplification” of the relation between birth weight and blood pressure, particularly in girls.

554. Social class and height

Author: Derek G Cook, A G Shaper, and Peter H. Whincup
Subjects: Male, Letter, Body height, business.industry, General Engineering, General Medicine, Social class, Body Height, Social Class, Child, Preschool, Mathematics education, General Earth and Planetary Sciences, Medicine, Humans, Female, business, Child, General Environmental Science

555. Geographic variation in incidence of coronary heart disease in Britain: The contribution of established risk factors

Author: S. G. Wannamethee, F C Lampe, M Walker, Richard W Morris, A G Shaper, and Peter H. Whincup
Subjects: Adult, Male, Gerontology, medicine.medical_specialty, Age adjustment, Coronary Disease, Cardiovascular Medicine, Social class, Residence Characteristics, Risk Factors, Epidemiology, Humans, Medicine, Prospective Studies, Risk factor, Prospective cohort study, business.industry, Incidence, Incidence (epidemiology), Urban Health, Middle Aged, United Kingdom, Logistic Models, Blood pressure, Cardiology and Cardiovascular Medicine, business, Body mass index, Demography
Abstract: OBJECTIVE—To determine the extent to which geographic variation in the incidence of major coronary heart disease (CHD) in Great Britain may be explained by established risk factors. DESIGN—Prospective study. SETTING—24 British towns with widely differing CHD mortality. SUBJECTS—7735 men followed up from screening in 1978-80 for 15 years. MAIN OUTCOME MEASURES—Percentage of variance between the towns in major CHD incidence that can be explained by individual characteristics of men in the towns. RESULTS—Age standardised incidence rates over a 15 year period varied from 0.52% per annum in Maidstone to 1.07% per annum in Dewsbury and tended to follow the known pattern of higher rates in Scottish and northern English towns and lower rates in southern English towns ("north-south gradient"). Higher town incidence rates were related to prevalence of current cigarette smoking, low physical activity, and low alcohol consumption, and to mean body mass index, mean systolic blood pressure, low mean height, and prevalence of manual social class, but not to mean serum total cholesterol. The 95% range for true age adjusted CHD incidence (over 15 years) was estimated as 0.58-1.03% per annum among British towns. After adjustment for baseline smoking status, physical activity, body mass index, alcohol consumption, systolic blood pressure, serum total cholesterol, occupational social class, and height, this variation was reduced by 50%. A model based on these eight variables accounted for the major part of the north-south gradient. CONCLUSIONS—Much of the variation in CHD incidence among British towns was accounted for by established risk variables. The remaining unexplained variation may be related to measurement error in the established risk variables, to environmental factors such as climate, or to the combined effect of a wide range of minor risk factors. Keywords: geographic variation; established risk factors; coronary heart disease; multilevel modelling

556. Low prevalence of lipid lowering drug use in older men with established coronary heart disease

Author: A Thomson, M Walker, Lucy T. Lennon, Jonathan Emberson, Peter H. Whincup, and Olia Papacosta
Subjects: Male, medicine.medical_specialty, Statin, medicine.drug_class, Cross-sectional study, Myocardial Infarction, Cardiovascular Medicine, Angina Pectoris, Cohort Studies, Angina, Internal medicine, Epidemiology, Prevalence, medicine, Humans, Prospective Studies, cardiovascular diseases, Myocardial infarction, Aged, Hypolipidemic Agents, Response rate (survey), business.industry, Middle Aged, medicine.disease, United Kingdom, Surgery, Cholesterol, Cross-Sectional Studies, lipids (amino acids, peptides, and proteins), Cardiology and Cardiovascular Medicine, business, Pravastatin, Follow-Up Studies, Cohort study, medicine.drug
Abstract: Objective: To determine the prevalence and correlates of lipid lowering drug use among older British men with established coronary heart disease (CHD). Design: Cross sectional survey within a cohort study (British regional heart study) carried out at 20 years of follow up in 1998–2000. Setting: General practices in 24 British towns. Participants: 3689 men aged 60–75 years (response rate 76%). Main outcome measures: Diagnoses of myocardial infarction and angina based on detailed review of general practice records. Lipid lowering drug use and blood cholesterol concentrations ascertained at 20 year follow up examination. Results: Among 286 men with definite myocardial infarction, 102 (36%) were taking a lipid lowering drug (93 (33%) a statin); among 360 men with definite angina without myocardial infarction, 84 (23%) were taking a lipid lowering drug (78 (21%) a statin). Most men with documented CHD who were not receiving a lipid lowering drug had a total cholesterol concentration of 5.0 mmol/l or more (87% of those with myocardial infarction, 82% with angina). Fewer than half of men with CHD receiving a statin had a total cholesterol concentration below 5.0 mmol/l (45% of those with myocardial infarction and 47% of those with angina). Only one third of the men taking a statin were receiving trial validated dosages. Among men with CHD, a history of revascularisation, more recent diagnosis, and younger age at diagnosis were associated with a higher probability of receiving lipid lowering drug treatment. Conclusion: Among patients with established CHD, the prevalence of lipid lowering drug use remains low and statin regimens suboptimal. Major improvements in secondary prevention are essential if the benefits of statins are to be realised.

557. Cardiovascular risk factors in British children from towns with widely differing adult cardiovascular mortality

Author: Peter H. Whincup, Derek G Cook, Stephanie Taylor, Valerie Wilson, Olia Papacosta, Fiona Adshead, and Mary Walker
Subjects: Adult, Male, medicine.medical_specialty, Waist, Birth weight, Hemodynamics, Blood Pressure, Residence Characteristics, Risk Factors, Epidemiology, Medicine, Birth Weight, Humans, Risk factor, Child, General Environmental Science, Aged, Wales, business.industry, General Engineering, General Medicine, Middle Aged, Health Surveys, Confidence interval, Body Height, Surgery, Survival Rate, Blood pressure, Standardized mortality ratio, England, Cardiovascular Diseases, Child, Preschool, General Earth and Planetary Sciences, Female, business, Demography, Research Article
Abstract: Objective: To examine whether cardiovascular risk factors differ in children from towns in England and Wales with widely differing adult cardiovascular death rates. Design: School based survey conducted during 1994 in 10 towns, five with exceptionally high adult cardiovascular mortality (standardised mortality ratio 131-143) and five with exceptionally low adult cardiovascular mortality (64-75). Towns were surveyed in high-low pairs. Subjects: 3415 white children aged 8-11 years with physical measurements (response rate 75%), including 1287 with blood samples (response rate 64%), of whom 515 had blood samples taken 30 minutes after a glucose load. Results: Children in towns with high cardiovascular mortality were on average shorter than those in towns with low mortality (mean difference 1.2 cm; 95% confidence interval 0.3 to 2.1 cm; P = 0.02) and had a higher ponderal index (0.34 kg/m3; 0.16 to 0.52 kg/m3; P = 0.006). Mean systolic pressure was higher in high mortality towns, particularly after adjustment for height (2.0 mm Hg; 0.8 to 3.2 mm Hg; P = 0.009). Mean waist:hip ratio, total cholesterol concentration, and 30 minute post-load glucose measurements were similar in high and low mortality towns. The differences in height and blood pressure between high and low mortality towns were unaffected by standardisation for birth weight. Conclusions: The differences in height, ponderal index, and blood pressure between towns with high and low cardiovascular mortality, if persistent, may have important future public health implications. Their independence of birth weight suggests that the childhood environment rather than the intrauterine environment is involved in their development. Key messages Development of cardiovascular risk factors in British children living in areas with widely different adult cardiovascular mortality has been little stud- ied Children in areas of high mortality are on average shorter and have higher ponderal indices and higher blood pressures (particularly when height differences are taken into account) than those in areas of low mortality Total cholesterol concentration, waist:hip ratio, and post-load glucose/glucose tolerance are very similar in high and low mortality areas The differences in height, ponderal index, and blood pressure are independent of birth weight, suggesting that childhood rather than intrauterine factors may be important in their development

558. Cigarette smoking in British men and selection for coronary artery bypass surgery

Author: Peter H. Whincup, A G Shaper, Alison McCallum, M Walker, Richard W Morris, and S Ebrahim
Subjects: medicine.medical_specialty, Heart disease, business.industry, Incidence (epidemiology), Patient Selection, Hazard ratio, Smoking, medicine.disease, Coronary artery bypass surgery, medicine.anatomical_structure, Treatment Outcome, Risk Factors, Internal medicine, Cardiology, behavior and behavior mechanisms, Medicine, Humans, Derivation, Coronary Artery Bypass, Cardiology and Cardiovascular Medicine, business, Prospective cohort study, Survival rate, Artery, Research Article
Abstract: OBJECTIVE: To examine the relation between smoking status, clinical need, and likelihood of coronary artery bypass grafting in middle aged men. DESIGN: A prospective study of cardiovascular disease in British men aged 40 to 59 years, screened in 1978-80 and followed until December 1991. SUBJECTS AND SETTING: 7735 men drawn from one general practice in each of 24 British towns. MAIN OUTCOME MEASURE: Coronary artery bypass graft surgery. RESULTS: Of the 3185 current smokers, 38 (1.03/1000/year) underwent coronary artery bypass surgery compared with 47 of 2715 (1.45/1000/year) ex-smokers, and 19 of 1817 (0.85/1000/year) never-smokers. Ex-smokers had a lower incidence of major ischaemic heart disease during follow up than current smokers. After adjustment for incidence of ischaemic heart disease during follow up, the hazard ratio of coronary artery bypass surgery for ex-smokers compared with smokers was 1.52 (95% confidence interval 0.99 to 2.34). Ex-smokers were more likely at screening to recall a doctor diagnosis of ischaemic heart disease than smokers (7.1% v 5.3%), but among those who recalled a doctor diagnosis, smokers were less likely to undergo coronary artery bypass surgery than ex-smokers (9.4% v 3.5%, P = 0.026). By 1992, men defined as smokers at screening were no less likely than ex-smokers to have been referred to a cardiologist (18.5% v 18.8%), nor to report having undergone coronary angiography less frequently than ex-smokers (12.7% v 11.4%). CONCLUSION: Even allowing for the strong relation between coronary artery bypass surgery and clinical need, continuing smokers were less likely to undergo coronary artery bypass surgery than ex-smokers. A complex interplay exists between the men's experience of heart disease, the decision to stop smoking, and the willingness of doctors to consider coronary artery bypass surgery.

559. Resting electrocardiogram and risk of coronary heart disease in middle-aged british men

Author: Goya Wannamethee, P W Macfarlane, A G Shaper, Peter H. Whincup, and M Walker
Subjects: medicine.medical_specialty, medicine.diagnostic_test, Epidemiology, business.industry, Chest pain, medicine.disease, Coronary heart disease, Angina, Internal medicine, Predictive value of tests, medicine, Cardiology, Medical history, cardiovascular diseases, Myocardial infarction, medicine.symptom, Cardiology and Cardiovascular Medicine, business, Prospective cohort study, Electrocardiography
Abstract: Objective: To examine the relation between resting electrocardiographic (ECG) abnormalities and risk of coronary heart disease (CHD).Design and setting: This was a prospective study of 7735 middle-aged men aged 40–59 years at entry (British Regional Heart Study). At baseline assessment each man completed a modified World Health Organization (WHO) (Rose) chest-pain questionnaire, gave details of his medical history and had a three-lead orthogonal electrocardiogram recorded. ‘Symptomatic CHD’ refers to a history of anginal chest pain and/or a prolonged episode of central chest pain on WHO questionnaire and/or recall of a doctor diagnosis of CHD (angina or myocardial infarction).Main outcome measures: These were the first major CHD events, i.e. fatal CHD and non-fatal myocardial infarction, occurring during 9.5 years of follow-up.Results: Of 611 first major CHD events during follow-up, 243 (40%) were fatal. After adjustment for age, other ECG abnormalities and symptomatic CHD, the ECG abnormalities most stro...

560. Re: 'Height and the risk of cardiovascular disease in women'

Author: M Walker, A. G. Shaper, Peter H. Whincup, and Andrew N. Phillips
Subjects: Pediatrics, medicine.medical_specialty, Epidemiology, business.industry, medicine, Disease, business

561. Locomotor disability in a cohort of British men: The impact of lifestyle and disease

Author: SG Wannamethee, A G Shaper, Shah Ebrahim, Peter H. Whincup, and M Walker
Subjects: Gerontology, Longitudinal study, Epidemiology, business.industry, Physical fitness, Weight change, General Medicine, Middle age, Years of potential life lost, Cohort, Medicine, Risk factor, business, Cohort study
Abstract: BACKGROUND: Increasing life expectancy has brought public health concern about the increase in prevalence of disability in old age. Reducing the prevalence of disability in older age requires the identification of preventable or modifiable risk factors earlier in life. We have examined the relationship between lifestyle and other potential risk factors in men aged 40-59 years at screening and locomotor disability 12-14 years later to assess whether any of these factors have direct and independent roles in influencing disability in later life. METHODS: In 1978-1980, a longitudinal study of cardiovascular disease was initiated in 7735 men aged 40-59 years drawn from one general practice in each of 24 British towns. The present study concerns 5717 men, 88% of the surviving men who were available to follow-up (i.e. were registered with a GP and had an address) and who satisfactorily completed the disability section of a follow-up postal questionnaire in 1992 (Q92). The main endpoint from the questionnaire was locomotor disability based on self-reported inability in any one or more of the following: to get outdoors, walk 400 m, climb stairs, maintain balance, bend down, or straighten up. RESULTS: In the 5717 men (mean age 63 years) who provided information on disability status, 25.0% reported locomotor disability and the majority of these men recalled a doctor-diagnosed disease of which cardiovascular disease was most strongly associated with locomotor disability. Lifestyle factors at screening (smoking, physical inactivity, obesity and heavy drinking) and manual social class were strongly and independently associated with increased odds of locomotor disability 12-14 years later. By contrast, baseline blood pressure and serum total cholesterol showed little relationship with locomotor disability. Among men with diagnosed major cardiovascular disease (stroke, myocardial infarction, angina or aortic aneurysm) those with locomotor disability showed significantly higher adverse lifestyle factors at screening than those who were able. Similarly, adverse lifestyle factors were also seen more frequently among disabled men with respiratory disease and among disabled men with other non-cardiovascular conditions than among their able counterparts. CONCLUSIONS: Smoking, obesity, physical inactivity and heavy drinking in middle age are strong predictors of locomotor disability in later life independent of the presence of diagnosed disease. Leading a healthy lifestyle improves survival and reduces the incidence of disease. It also reduces the risk of locomotor disability and increases the odds of being disability-free even in the event of developing major cardiovascular disease.

562. Weight change and risk of heart attack in middle-aged British men

Author: A G Shaper, Peter H. Whincup, M Walker, and Goya Wannamethee
Subjects: Adult, Male, medicine.medical_specialty, Time Factors, Epidemiology, Myocardial Infarction, Overweight, Weight Gain, Body Mass Index, Weight loss, Risk Factors, Weight Loss, medicine, Humans, Myocardial infarction, Obesity, Prospective Studies, business.industry, Weight change, Smoking, General Medicine, Middle Aged, medicine.disease, United Kingdom, Death, Sudden, Cardiac, Social Class, Physical therapy, medicine.symptom, business, Weight gain, Body mass index, Demography, Follow-Up Studies
Abstract: Both weight gain and weight loss have been associated with increased risk of cardiovascular disease mortality in recent studies from the US. This finding has led to concern and uncertainty about appropriate advice for overweight and obese subjects.In a prospective study of cardiovascular disease, the relationship between weight change over a 5-year period and subsequent risk of a heart attack during a further 6.5 year follow-up was examined in 7100 middle-aged British men.Over half of the men remained stable (4% change in bodyweight) and served as the reference group; 31% gained weight and 13% lost weight. The 6445 men free from a history of coronary heart disease experienced 318 heart attacks, fatal and non-fatal, during the 6.5 years. Men who gained 4-10% bodyweight had the lowest rate of heart attack, although this was not significantly different from the stable group. The men who lost weight had an increased risk of heart attack, which after adjustment (for age, recall of doctor-diagnosed hypertension and diabetes and other coronary risk factors i.e. serum total cholesterol, blood pressure, social class, initial body mass index (BMI) and lung function (FEV1), and smoking status at screening and 5 years later), was of a similar level of risk to the stable group. The men who gained10% bodyweight had a significantly increased risk of a heart attack after the above adjustment (P0.05). When the effect of weight change was examined according to initial BMI, those men with a BMI25 kg/m2 who lost weight had a marginally increased relative risk of heart attack after full adjustment (P = 0.06), while men who were overweight (BMI 25-27.9 kg/m2) or obese (BMIor = 28 kg/m2) showed no benefit from weight loss. A small amount of weight gain (4-10%) in the overweight or obese men was associated with decreased risk, whereas considerable weight gain (10%) was associated with increased risk, both findings reaching statistical significance in the overweight men (P0.05 and P0.001 respectively).Considerable weight gain (10%) in middle-aged men is associated with increased risk of a heart attack, but weight loss does not appear to reduce risk even in the overweight or obese.

563. Role of risk factors for major coronary heart disease events with increasing length of follow up

Author: A G Shaper, M Walker, Peter H. Whincup, and S G Wannamethee
Subjects: Adult, Male, medicine.medical_specialty, Time Factors, Population, Coronary Disease, Risk Assessment, Risk Factors, Internal medicine, Medicine, Humans, Prospective Studies, Risk factor, Prospective cohort study, education, education.field_of_study, business.industry, Absolute risk reduction, Middle Aged, Surgery, Blood pressure, Relative risk, Papers, Cardiology and Cardiovascular Medicine, business, Risk assessment, Body mass index, Follow-Up Studies
Abstract: BACKGROUND—It has been suggested that the predictive value of certain risk factors for coronary heart disease (CHD) measured at one point in time diminishes with increasing length of follow up. DESIGNS AND METHODS—The relation was examined between a wide range of risk factors and the risk of major CHD events over 15 years' total (cumulative) follow up and for three separate five year periods (0-5.0, 5.1-10.0, and 10.1-15.0 years) in men with and without diagnosed CHD in a large prospective study of 7735 men aged 40-59 years. SETTING—General practices in 24 towns in the UK. RESULTS—The cumulative CHD event rate for all men was 9.4/1000 person-years for the 15 years of follow up. In men with no recall of a diagnosis of CHD, the established risk factors—serum total cholesterol, high density lipoprotein cholesterol, systolic and diastolic blood pressure, physical activity, body mass index (BMI), alcohol intake, diabetes mellitus, parental history, and evidence of CHD on chest pain questionnaire or on ECG—were predictive of CHD events occurring in the three specific periods after baseline measurement. Blood pressure (systolic and diastolic) was still predictive of events occurring 10.1-15.0 years later with some attenuation in the relative risk associated with systolic blood pressure. The risks associated with blood glucose and serum insulin concentration, factors measured with greater imprecision, attenuated with longer follow up and were not predictive of events occurring 10.1-15.0 years later. In men with recall of diagnosed CHD, the absolute risk was very high (38.8/1000 person-years); only cigarette smoking, BMI, total cholesterol, and serum insulin were predictive of CHD events occurring 10.1-15.0 years later. CONCLUSION—In men without recall of diagnosed CHD most major risk factors measured in middle age predict risk of CHD events occurring in up to 15 years of follow up, both cumulatively and in the three separate five year periods. Risk factors measured at one point in time in middle age may be regarded as reliable indicators for long term prognosis of major CHD events on a group basis, despite the changes that may take place in these risk factors in some individuals during prolonged follow up. Keywords: coronary heart disease, risk factors; epidemiology

564. Comparing the effectiveness of an enhanced MOtiVational intErviewing InTervention (MOVE IT) with usual care for reducing cardiovascular risk in high risk subjects: study protocol for a randomised controlled trial

Author: Katie Ridge, Kirsty Winkley, Adam Bayley, Derek G Cook, Anne Greenough, Peter H. Whincup, Nicole de Zoysa, Daniel Stahl, Clare Blythe, Paul McCrone, Mark Ashworth, Katherine Twist, Janet Treasure, and Khalida Ismail
Subjects: medicine.medical_specialty, VASCULAR MORTALITY, Psychological intervention, Motivational interviewing, CBT, WEIGHT-LOSS, Medicine (miscellaneous), BLOOD-PRESSURE, Health trainers, law.invention, Social support, Study Protocol, Randomized controlled trial, Clinical Protocols, law, Risk Factors, Intervention (counseling), GLYCEMIC CONTROL, Health care, Outcome Assessment, Health Care, medicine, Humans, Pharmacology (medical), Risk factor, Exercise, Life Style, METAANALYSIS, INDIVIDUAL DATA, business.industry, Physical activity, CAUSE-SPECIFIC MORTALITY, Cardiovascular disease, Primary care, COGNITIVE-BEHAVIOR THERAPY, Diet, Accelerometer, PHYSICAL-ACTIVITY, Clinical trials unit, MYOCARDIAL-INFARCTION, Cardiovascular Diseases, Sample Size, Physical therapy, business
Abstract: BACKGROUND: Interventions targeting multiple risk factors for cardiovascular disease (CVD), including poor diet and physical inactivity, are more effective than interventions targeting a single risk factor. A motivational interviewing (MI) intervention can provide modest dietary improvements and physical activity increases, while adding cognitive behaviour therapy (CBT) skills may enhance the effects of MI. We designed a randomised controlled trial (RCT) to examine whether specific behaviour change techniques integrating MI and CBT result in favourable changes in weight and physical activity in those at high risk of CVD. A group and individual intervention will be compared to usual care. A group intervention offers potential benefits from social support and may be more cost effective. METHODS/DESIGN: Individuals aged between 40 and 74 years in 11 South London Clinical Commissioning Groups who are at high risk of developing CVD (≥20%) in the next 10 years will be recruited. A sample of 1,704 participants will be randomised to receive the enhanced MI intervention, delivered by trained healthy lifestyle facilitators (HLFs), in group or individual formats, in 10 sessions (plus an introductory session) over one year, or usual care. Randomisation will be conducted by King's College London Clinical Trials Unit and researchers collecting outcome data will be blinded to treatment allocation. At 12-month and 24-month follow-up assessments, primary outcomes will be change in weight and physical activity (average steps per day). Secondary outcomes include changes in low-density lipoprotein cholesterol and CVD risk score. Incidence of CVD events since baseline will be recorded. A process evaluation will be conducted to evaluate factors which impact on delivery, adherence and outcome. An economic evaluation will estimate relative cost-effectiveness of each type of intervention delivery. DISCUSSION: This RCT assesses the effectiveness of a healthy lifestyle intervention for people at high risk of CVD. Benefits of the study include the ethnic and socioeconomic diversity of the study population and that, via social support within the group setting and long-term follow-up period, the intervention offers the potential to support maintenance of a healthy lifestyle. TRIAL REGISTRATION: This trial is registered with the ISRCTN registry (identifier: ISRCTN84864870, registered 15 May 2012).
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565. Early life experience and adult cardiovascular disease: Longitudinal and case-control studies

Author: Jonathan Elford, A G Shaper, and Peter H. Whincup
Subjects: Adult, Male, Gerontology, medicine.medical_specialty, Epidemiology, Disease, Prenatal care, Sensitivity and Specificity, Risk Factors, medicine, Humans, Longitudinal Studies, Risk factor, Child, Life Style, Cause of death, business.industry, Public health, Age Factors, Infant, Newborn, Case-control study, General Medicine, Socioeconomic Factors, Cardiovascular Diseases, Case-Control Studies, Female, Bradford Hill criteria, business
Abstract: It has been postulated that experiences early in life influence cardiovascular risk in later adult life. This article considers 15 longitudinal and four case-control studies which, directly or indirectly, have examined the hypothesis concerning the prenatal and childhood origins of adult cardiovascular disease. Criteria laid down by Bradford Hill were used to assess whether these epidemiological studies provided sufficient evidence for a causal relation between experiences early in life and subsequent cardiovascular risk. No consistent dose-response relationship was found between the index of early life experience and adult cardiovascular disease. The relationships were usually non-specific with the index of early life experience being correlated with several causes of death, not only cardiovascular disease. The formulation of the hypothesis varied between the studies. Most reports dealt inadequately with the fact that the relation between adult cardiovascular risk and early life experience was confounded by persisting social and economic disadvantage. Overall these studies do not provide strong support for the hypothesis that experiences early in life determine the subsequent risk of cardiovascular disease. While future epidemiological studies may resolve this issue, the very nature of the hypothesis presents methodological problems that may prove to be insurmountable. Further progress in this field urgently requires the formulation of a clear and specific hypothesis.

566. Effect of two pedometer-based walking interventions on long-term health outcomes: a study using routine primary care data

Author: Michael Ussher, Cheryl Furness, Judith Ibison, Christina R. Victor, Elizabeth S Limb, Tess Harris, Ulf Ekelund, Derek G Cook, Fay J Hosking, Sally Kerry, Charlotte Wahlich, S DeWilde, Iain M Carey, Shaleen Ahmad, Julia Fox-Rushby, Steve Iliffe, and Peter H. Whincup
Subjects: medicine.medical_specialty, business.industry, Psychological intervention, General Medicine, medicine.disease, symbols.namesake, Informed consent, Intervention (counseling), Pedometer, medicine, symbols, Physical therapy, Myocardial infarction, Poisson regression, business, Stroke, Depression (differential diagnoses)
Abstract: Background Data are lacking from physical activity (PA) trials with long-term follow-up of both objectively measured PA levels and robust health outcomes. Two primary care 12-week pedometer-based walking interventions in adults and older adults (PACE-UP and PACE-Lift) found sustained objectively measured PA increases at 3 and 4 years, respectively. Using routine primary care data, we aimed to evaluate intervention effects on long-term health outcomes relevant to walking interventions. Methods We downloaded primary care data for trial participants who gave written informed consent, for 4-year periods after their randomisation from the 7 general practices in the PACE-UP trial and 3 general practices in the PACE-Lift trial (PACE-UP from Oct 23, 2012, to Nov 11, 2017; PACE-Lift from Oct 12, 2011, to Oct 11, 2016). The following new events were counted masked to intervention status for all participants, including those with pre-existing diseases (apart from diabetes, where existing cases were excluded): cardiovascular (myocardial infarction, coronary artery bypass graft, angioplasty, and stroke or transient ischaemic attack), diabetes cases, depression episodes, fractures, and falls. We modelled the effect of the interventions on outcomes using Cox and Poisson regression models, adjusting for age, sex, and practice. Findings Data were downloaded for 1297 (98%) of 1321 trial participants. Event rates were low ( Interpretation Short-term primary care PA interventions led to long-term PA increases in the intervention groups, associated with significant decreases in new cardiovascular events and fractures at 4 years. Though no significant differences between intervention and control groups were demonstrated for other events, direction of effect for diabetes was protective, but our trials were underpowered to find differences in low frequency outcomes. Our study also demonstrates the potential for using routine data to evaluate the outcome of large-scale primary care walking interventions, avoiding expensive objective accelerometry assessment or inaccurate self-report PA data. Funding Supported by the National Institute for Health Research (NIHR).

567. Low serum total cholesterol concentrations and mortality in middle aged British men

Author: M Walker, Goya Wannamethee, A G Shaper, and Peter H. Whincup
Subjects: Gerontology, medicine.medical_specialty, education.field_of_study, business.industry, Population, General Engineering, Cancer, Blood lipids, General Medicine, medicine.disease, Hypocholesterolemia, Internal medicine, Epidemiology, medicine, General Earth and Planetary Sciences, business, education, Prospective cohort study, General Environmental Science, Cause of death, Cohort study, Research Article
Abstract: OBJECTIVE--To examine the relation between low serum total cholesterol concentrations and causes of mortality. DESIGN--Cohort study of men followed up for an average of 14.8 years (range 13.5-16.0 years). SETTING--One general practice in each of 24 British towns. SUBJECTS--7735 men aged 40-59 at screening selected at random from the 24 general practices. MAIN OUTCOME MEASURES--Deaths from all causes, cardiovascular causes, cancer, and non-cardiovascular, non-cancer causes. RESULTS--During the mean follow up period of 14.8 years there were 1257 deaths from all causes, 640 cardiovascular deaths, 433 cancer deaths, and 184 deaths from other causes. Low serum cholesterol concentrations (< 4.8 mmol/l), present in 5% (n = 410) of the men, were associated with the highest mortality from all causes, largely due to a significant increase in cancer deaths (age adjusted relative risk 1.6 (95% confidence interval 1.1 to 2.3); < 4.8 v 4.8-5.9 mmol/l) and in other non-cardiovascular deaths (age adjusted relative risk 1.9 (1.1 to 3.1)). Low serum cholesterol concentration was associated with an increased prevalence of several diseases and indicators of ill health and with lifestyle characteristics such as smoking and heavy drinking. After adjustment for these factors in the multivariate analysis the increased risk for cancer was attenuated (relative risk 1.4 (0.9 to 2.0) and the inverse association with other non-cardiovascular, non-cancer causes was no longer significant (relative risk 1.5 (0.9 to 2.6); < 4.8 v 4.8-5.9 mmol/l). The excess risks of cancer and of other non-cardiovascular deaths were most pronounced in the first five years and became attenuated and non-significant with longer follow up. By contrast, the positive association between serum total cholesterol concentration and cardiovascular mortality was seen even after more than 10 years of follow up. CONCLUSION--The association between comparatively low serum total cholesterol concentrations and excess mortality seemed to be due to preclinical cancer and other non-cardiovascular diseases. This suggests that public health programmes encouraging lower average concentrations of serum total cholesterol are unlikely to be associated with increased cancer or other non-cardiovascular mortality.

568. Interpreting population reach of a large, successful physical activity trial delivered through primary care

Author: Sally Kerry, Judith Ibison, Derek G Cook, Michael Ussher, Ulf Ekelund, Julia Fox-Rushby, Cheryl Furness, Steve Iliffe, Tess Harris, Stephen DeWilde, Elizabeth S Limb, Peter H. Whincup, Katy E Morgan, Christina R. Victor, Iain M Carey, and Apollo - University of Cambridge Repository
Subjects: Male, Program evaluation, medicine.medical_specialty, Randomised trials, Population, Psychological intervention, Health Promotion, Walking, Non-participation, 03 medical and health sciences, 0302 clinical medicine, Surveys and Questionnaires, London, Epidemiology, Ethnicity, medicine, Humans, 030212 general & internal medicine, education, Exercise, Poverty, Minority Groups, Aged, education.field_of_study, Primary Health Care, Physical activity, business.industry, lcsh:Public aspects of medicine, 030503 health policy & services, Public health, Community Participation, Public Health, Environmental and Occupational Health, lcsh:RA1-1270, Health Status Disparities, Middle Aged, Primary care, non-particiation, Health promotion, Female, Recruitment, Sedentary Behavior, Biostatistics, 0305 other medical science, business, Program Evaluation, Research Article, Demography
Abstract: Background: Failure to include socio-economically deprived or ethnic minority groups in physical activity (PA) trials may limit representativeness and could lead to implementation of interventions that then increase health inequalities. Randomised intervention trials often have low recruitment rates and rarely assess recruitment bias. A previous trial by the same team using similar methods recruited 30% of the eligible population but was in an affluent setting with few non-white residents and was limited to those over 60 years of age. Methods: PACE-UP is a large, effective, population-based walking trial in inactive 45-75 year-olds that recruited through seven London general practices. Anonymised practice demographic data were available for all those invited, enabling investigation of inequalities in trial recruitment. Non-participants were invited to complete a questionnaire. Results: From 10,927 postal invitations, 1150 (10.5%) completed baseline assessment. Participation rate ratios (95% CI), adjusted for age and gender as appropriate, were lower in men 0.59 (0.52, 0.67) than women, in those under 55 compared with those ≥65, 0.60 (0.51, 0.71), in the most deprived quintile compared with the least deprived 0.52 (0.39, 0.70) and in Asian individuals compared with whites 0.62 (0.50, 0.76). Black individuals were equally likely to participate as white individuals. Participation was also associated with having a co-morbidity or some degree of health limitation. The most common reasons for non-participation were considering themselves as being too active or lack of time. Conclusions: Conducting the trial in this diverse setting reduced overall response, with lower response in socio-economically deprived and Asian sub-groups. Trials with greater reach are likely to be more expensive in terms of recruitment and gains in generalizability need to be balanced with greater costs. Differential uptake of successful trial interventions may increase inequalities in PA levels and should be monitored. Trial registration: ISRCTN.com ISRCTN98538934. Registered 2nd March 2012.

569. Does initial breastfeeding lead to lower blood cholesterol in adult life? A quantitative review of the evidence

Author: Samantha J. Kaye, Rachel R. Huxley, Richard M. Martin, George Davey Smith, Caroline H.D. Fall, Jorma Viikari, Sanja Kolaček, Derek G Cook, C. Paul Leeson, Jing Nie, Erik Bergström, Anita C.J. Ravelli, Michael E. J. Wadsworth, Jo L. Freudenheim, Christopher G. Owen, David P. Strachan, Olli T. Raitakari, Peter H. Whincup, Sheila M. Williams, Alicja R. Rudnicka, Stephanie Black, Mark S. Pearce, Irina Lisinen, APH - Amsterdam Public Health, ARD - Amsterdam Reproduction and Development, and Medical Informatics
Subjects: Adult, Male, medicine.medical_specialty, Adolescent, breastfeeding, blood cholesterol, Hypercholesterolemia, Breastfeeding, Medicine (miscellaneous), Physiology, Breast milk, Body Mass Index, chemistry.chemical_compound, Risk Factors, Internal medicine, medicine, Odds Ratio, Humans, Longitudinal Studies, Infant Nutritional Physiological Phenomena, Aged, Nutrition and Dietetics, Milk, Human, business.industry, Cholesterol, Confounding, Smoking, Infant, Newborn, Infant, Confounding Factors, Epidemiologic, Odds ratio, Middle Aged, Infant Formula, Endocrinology, Breast Feeding, chemistry, Infant formula, Socioeconomic Factors, Female, Infant Food, business, Body mass index, Breast feeding
Abstract: BACKGROUND: Earlier studies have suggested that infant feeding may program long-term changes in cholesterol metabolism. OBJECTIVE: We aimed to examine whether breastfeeding is associated with lower blood cholesterol concentrations in adulthood. DESIGN: The study consisted of a systematic review of published observational studies relating initial infant feeding status to blood cholesterol concentrations in adulthood (ie, aged >16 y). Data were available from 17 studies (17 498 subjects; 12 890 breastfed, 4608 formula-fed). Mean differences in total cholesterol concentrations (breastfed minus formula-fed) were pooled by using fixed-effect models. Effects of adjustment (for age at outcome, socioeconomic position, body mass index, and smoking status) and exclusion (of nonexclusive breast feeders) were examined. RESULTS: Mean total blood cholesterol was lower (P = 0.037) among those ever breastfed than among those fed formula milk (mean difference: -0.04 mmol/L; 95% CI: -0.08, 0.00 mmol/L). The difference in cholesterol between infant feeding groups was larger (P = 0.005) and more consistent in 7 studies that analyzed "exclusive" feeding patterns (-0.15 mmol/L; -0.23, -0.06 mmol/L) than in 10 studies that analyzed nonexclusive feeding patterns (-0.01 mmol/L; -0.06, 0.03 mmol/L). Adjustment for potential confounders including socioeconomic position, body mass index, and smoking status in adult life had minimal effect on these estimates. CONCLUSIONS: Initial breastfeeding (particularly when exclusive) may be associated with lower blood cholesterol concentrations in later life. Moves to reduce the cholesterol content of formula feeds below those of breast milk should be treated with caution.

570. Serum total homocysteine and coronary heart disease: Prospective study in middle aged men

Author: LL Lennon, H Refsum, Ivan J. Perry, S B J Ebrahim, A Thomson, Richard W Morris, M Walker, Peter H. Whincup, and P. M Ueland
Subjects: Adult, Male, medicine.medical_specialty, Homocysteine, Myocardial Infarction, Coronary Disease, Gastroenterology, chemistry.chemical_compound, Risk Factors, Internal medicine, Odds Ratio, medicine, Humans, Prospective Studies, Myocardial infarction, Risk factor, Prospective cohort study, business.industry, Age Factors, Case-control study, Odds ratio, Middle Aged, Prognosis, medicine.disease, Endocrinology, chemistry, Case-Control Studies, Papers, Attributable risk, Population study, Cardiology and Cardiovascular Medicine, business, Biomarkers, Follow-Up Studies
Abstract: OBJECTIVES—To examine the prospective relation between total homocysteine and major coronary heart disease events. DESIGN—A nested case-control study carried out within the British regional heart study, a prospective investigation of cardiovascular disease in men aged 40-59 years at entry. Serum total homocysteine concentrations were analysed retrospectively and blindly in baseline samples from 386 cases who had a myocardial infarct during 12.8 years of follow up and from 454 controls, frequency matched by age and town. RESULTS—Geometric mean serum total homocysteine was slightly higher in cases (14.2 µmol/l) than in controls (13.5 µmol/l), a proportional difference of 5.5% (95% confidence interval (CI) −0.02% to 10.8%, p = 0.06). Age adjusted risk of myocardial infarction increased weakly with log total homocysteine concentration; a 1 SD increase in log total homocysteine (equivalent to a 47% increase in total homo cysteine) was associated with an increase in odds of myocardial infarction of 1.15 (95% CI 1.00 to 1.32; p = 0.05). The relation was particularly marked in the top fifth of the total homocysteine distribution (values >16.5 µmol/l), which had an odds ratio of 1.77 (95% CI 1.28 to 2.42) compared with lower levels. Adjustment for other risk factors had little effect on these findings. Total homocysteine concentrations more than 16.5 µmol/l accounted for 13% of the attributable risk of myocardial infarction in this study population. Serum total homocysteine among control subjects varied between towns and was correlated with town standardised mortality ratios for coronary heart disease (r = 0.43, p = 0.08). CONCLUSIONS—Serum total homocysteine is prospectively related to increased coronary risk and may also be related to geographical variation in coronary risk within Britain. These results strengthen the case for trials of total homocysteine reduction with folate. Keywords: coronary heart disease; homocysteine; epidemiology

571. Measurement of blood pressure in children

Author: Derek G Cook, Peter H. Whincup, and A. G. Shaper
Subjects: Blood pressure, Text mining, business.industry, Speech recognition, General Engineering, General Earth and Planetary Sciences, Medicine, General Medicine, Medical emergency, business, medicine.disease, General Environmental Science
Published: 1989

572. Establishing international optimal cut-offs of waist-to-height ratio for predicting cardiometabolic risk in children and adolescents aged 6–18 years

Author: Xin’nan Zong, Roya Kelishadi, Young Mi Hong, Peter Schwandt, Tandi E. Matsha, Jose G. Mill, Peter H. Whincup, Lucia Pacifico, Abel López-Bermejo, Carmelo Antonio Caserta, Carla Campos Muniz Medeiros, Anastasios Kollias, Mostafa Qorbani, Fariborz Sharifian Jazi, Gerda-Maria Haas, Rafael de Oliveira Alvim, Divanei Zaniqueli, Claudio Chiesa, Judit Bassols, Elisabetta Lucia Romeo, Danielle Franklin de Carvalho, Mônica Oliveira da Silva Simões, George S. Stergiou, Evangelos Grammatikos, Min Zhao, Costan G. Magnussen, and Bo Xi
Subjects: Waist-to-height ratio, Central obesity, Cardiovascular risk factors, Child, Adolescent, Medicine
Abstract: Abstract Background Waist-to-height ratio (WHtR) has been proposed as a simple and effective screening tool for assessing central obesity and cardiometabolic risk in both adult and pediatric populations. However, evidence suggests that the use of a uniform WHtR cut-off of 0.50 may not be universally optimal for pediatric populations globally. We aimed to determine the optimal cut-offs of WHtR in children and adolescents with increased cardiometabolic risk across different countries worldwide. Methods We used ten population-based cross-sectional data on 24,605 children and adolescents aged 6–18 years from Brazil, China, Greece, Iran, Italy, Korea, South Africa, Spain, the UK, and the USA for establishing optimal WHtR cut-offs. We performed an external independent test (9,619 children and adolescents aged 6–18 years who came from other six countries) to validate the optimal WHtR cut-offs based on the predicting performance for at least two or three cardiometabolic risk factors. Results Based on receiver operator characteristic curve analyses of various WHtR cut-offs to discriminate those with ≥ 2 cardiometabolic risk factors, the relatively optimal percentile cut-offs of WHtR in the normal weight subsample population in each country did not always coincide with a single fixed percentile, but varied from the 75th to 95th percentiles across the ten countries. However, these relatively optimal percentile values tended to cluster irrespective of sex, metabolic syndrome (MetS) criteria used, and WC measurement position. In general, using ≥ 2 cardiometabolic risk factors as the predictive outcome, the relatively optimal WHtR cut-off was around 0.50 in European and the US youths but was lower, around 0.46, in Asian, African, and South American youths. Secondary analyses that directly tested WHtR values ranging from 0.42 to 0.56 at 0.01 increments largely confirmed the results of the main analyses. In addition, the proposed cut-offs of 0.50 and 0.46 for two specific pediatric populations, respectively, showed a good performance in predicting ≥ 2 or ≥ 3 cardiometabolic risk factors in external independent test populations from six countries (Brazil, China, Germany, Italy, Korea, and the USA). Conclusions The proposed international WHtR cut-offs are easy and useful to identify central obesity and cardiometabolic risk in children and adolescents globally, thus allowing international comparison across populations.
Published: 2023
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573. Early influences on blood pressure: a study of 5-7-year-old children

Author: Derek G Cook, A G Shaper, and Peter H. Whincup
Subjects: Pediatrics, medicine.medical_specialty, Blood pressure, Physiology, business.industry, Internal Medicine, Medicine, Cardiology and Cardiovascular Medicine, business
Published: 1989

574. Painless Mesenteric Infarction in Patient With Diabetes Mellitus

Author: Martin J S Dennis, Peter H. Whincup, and Colin D Selby
Subjects: Advanced and Specialized Nursing, medicine.medical_specialty, Mesenteric infarction, business.industry, Endocrinology, Diabetes and Metabolism, Diabetes mellitus, Internal medicine, Internal Medicine, Cardiology, medicine, In patient, medicine.disease, business
Published: 1987

575. PACE-UP (Pedometer and consultation evaluation - UP) – a pedometer-based walking intervention with and without practice nurse support in primary care patients aged 45–75 years: study protocol for a randomised controlled trial

Author: Ulf Ekelund, Derek G Cook, Sunil M. Shah, Judith Ibison, Cheryl Furness, Michael Ussher, Tess Harris, Julia Fox-Rushby, Steve Iliffe, Nana Anokye, Christina R. Victor, Rebecca Dale, Peter H. Whincup, Elizabeth S Limb, Lee David, Stephen DeWilde, Sally Kerry, Debbie Brewin, and Emma Howard
Subjects: Research design, medicine.medical_specialty, Middle-aged adults, Psychological intervention, Nurses, Medicine (miscellaneous), Walking, Pedometers, law.invention, Study Protocol, Physical medicine and rehabilitation, Quality of life (healthcare), Clinical Protocols, Randomized controlled trial, law, Behaviour change techniques, Outcome Assessment, Health Care, Health care, Humans, Medicine, Postal, Pharmacology (medical), Referral and Consultation, Walking intervention, Aged, Primary Health Care, Physical activity, business.industry, Cognitive behavioural, Middle Aged, Primary care, Quality-adjusted life year, Light intensity, Research Design, Sample Size, Pedometer, Physical therapy, Accelerometers, Older people, Practice nurse, business
Abstract: © 2013 Harris et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Background - Most adults do not achieve the 150 minutes weekly of at least moderate intensity activity recommended for health. Adults’ most common physical activity (PA) is walking, light intensity if strolling, moderate if brisker. Pedometers can increase walking; however, most trials have been short-term, have combined pedometer and support effects, and have not reported PA intensity. This trial will investigate whether pedometers, with or without nurse support, can help less active 45–75 year olds to increase their PA over 12 months. Methods/design: Design: Primary care-based 3-arm randomized controlled trial with 12-month follow-up and health economic and qualitative evaluations. Participants: Less active 45–75 year olds (n = 993) will be recruited by post from six South West London general practices, maximum of two per household and households randomised into three groups. Step-count and time spent at different PA intensities will be assessed for 7 days at baseline, 3 and 12 months by accelerometer. Questionnaires and anthropometric assessments will be completed. Intervention: The pedometer-alone group will be posted a pedometer (Yamax Digi-Walker SW-200), handbook and diary detailing a 12-week pedometer-based walking programme, using targets from their baseline assessment. The pedometer-plus-support group will additionally receive three practice nurse PA consultations. The handbook, diary and consultations include behaviour change techniques (e.g., self-monitoring, goal-setting, relapse prevention planning). The control group will receive usual care. Outcomes: Changes in average daily step-count (primary outcome), time spent sedentary and in at least moderate intensity PA weekly at 12 months, measured by accelerometry. Other outcomes include change in body mass index, body fat, self-reported PA, quality of life, mood and adverse events. Cost-effectiveness will be assessed by the incremental cost of the intervention to the National Health Service and incremental cost per change in step-count and per quality adjusted life year. Qualitative evaluations will explore reasons for trial non-participation and the interventions’ acceptability. Discussion- The PACE-UP trial will determine the effectiveness and cost-effectiveness of a pedometer-based walking intervention delivered by post or practice nurse to less active primary care patients aged 45–75 years old. Approaches to minimise bias and challenges anticipated in delivery will be discussed. This project was funded by the National Institute for Health Research Health Technology Assessment (NIHR HTA) Programme (project number HTA 10/32/02) and will be published in full in Health Technology Assessment.
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576. Missed opportunities for secondary prevention of cerebrovascular disease in elderly British men from 1999 to 2005: a population-based study.

Author: Sheena E. Ramsay, Peter H. Whincup, S. G. Wannamethee, Olia Papacosta, Lucy Lennon, Mary C. Thomas, and Richard W. Morris
Subjects: CEREBROVASCULAR disease, STATINS (Cardiovascular agents), DISEASES in men, ANTICOAGULANTS, BLOOD pressure
Abstract: Objective We examined patterns in medication use for secondary prevention of cerebrovascular disease in older British men from 1999 to 2005, and investigated socio-demographic and disease-related influences on medication use. Methods Percentage use of antiplatelet drugs, blood pressure-lowering drugs and statins use was calculated in men, aged 65â87 years in 2005, who had been diagnosed with stroke or transient ischaemic attack (TIA) from a population-based cohort based in one general practice in each of 24 British towns. Results In 1999, most men with cerebrovascular disease received antiplatelet drugs (67%). However, a few received blood pressure-lowering drugs (50%) and statins (13%). By 2005, the use of all drug types had increased; at least half of the patients received each type of drug. However, only one-third of patients received all three medication types and combined blood pressure treatment was limited. Older age, a diagnosis of TIA rather than stroke and absence of co-existing coronary heart disease were associated with lower rates of use of specific medication categories. Conclusion Despite improvements in secondary prevention medication use, there is scope for achieving the full potential of these medications, particularly by increasing combination blood pressure treatment and statin use and ensuring that older patients receive the benefits of prevention. [ABSTRACT FROM AUTHOR]
Published: 2007
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577. Associations between inflammation, coagulation, cardiac strain and injury, and subclinical vascular disease with frailty in older men: a cross-sectional study

Author: Douglas G. J. McKechnie, Meera Patel, A. Olia Papacosta, Lucy T. Lennon, Elizabeth A. Ellins, Julian P. J. Halcox, Sheena E. Ramsay, Peter H. Whincup, and S. Goya Wannamethee
Subjects: Frailty, Biomarkers, Cardiovascular diseases, Aging, Atherosclerosis, Geriatrics, RC952-954.6
Abstract: Abstract Background Inflammation, coagulation activation, endothelial dysfunction and subclinical vascular disease are cross-sectionally associated with frailty. Cardiac-specific biomarkers are less-well characterised. We assessed associations between these and frailty, in men with, and without, cardiovascular disease (CVD). Methods Cross-sectional analysis of 1096 men without, and 303 with, CVD, aged 71–92, from the British Regional Heart Study. Multinominal logistic regression was performed to examine the associations between frailty status (robust/pre-frail/frail) and, separately, C-reactive protein (CRP), interleukin-6 (IL-6), tissue plasminogen activator (tPA), D-dimer, von Willebrand factor (vWF), high-sensitivity cardiac troponin-T (hs-cTnT), N-terminal pro B-type natriuretic peptide (NT-proBNP) (all natural log-transformed), and, in men without CVD, carotid intima-media thickness (CIMT), carotid-femoral pulse wave velocity (cfPWV), carotid distensibility coefficient (DC), and ankle-brachial pressure index (ABPI), adjusted for age, renal function, BMI, social class, smoking, polypharmacy, cognition, multimorbidity and systolic blood pressure. Explanatory variables with p
Published: 2022
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578. GWAS on retinal vasculometry phenotypes

Author: Xiaofan Jiang, Pirro G. Hysi, Anthony P. Khawaja, Omar A. Mahroo, Zihe Xu, Christopher J. Hammond, Paul J. Foster, Roshan A. Welikala, Sarah A. Barman, Peter H. Whincup, Alicja R. Rudnicka, Christopher G. Owen, and David P. Strachan
Subjects: Genetics, QH426-470
Abstract: The eye is the window through which light is transmitted and visual sensory signalling originates. It is also a window through which elements of the cardiovascular and nervous systems can be directly inspected, using ophthalmoscopy or retinal imaging. Measurements of ocular parameters may therefore offer important information on the physiology and homeostasis of these two important systems. Here we report the results of a genetic characterisation of retinal vasculature. Four genome-wide association studies performed on different aspects of retinal vasculometry phenotypes, such as arteriolar and venular tortuosity and width, found significant similarities between retinal vascular characteristics and cardiometabolic health. Our analyses identified 119 different regions of association with traits of retinal vasculature, including 89 loci associated arteriolar tortuosity, the strongest of which was rs35131825 (p = 2.00×10−108), 2 loci with arteriolar width (rs12969347, p = 3.30×10−09 and rs5442, p = 1.9E-15), 17 other loci associated with venular tortuosity and 11 novel associations with venular width. Our causal inference analyses also found that factors linked to arteriolar tortuosity cause elevated diastolic blood pressure and not vice versa. Author summary Vessels at the back of the eye (the “retina”) can be imaged easily. This paper reports on the largest genetic study of retinal vessel shape and size characteristics so far undertaken, to the best of our knowledge. Our study is novel in using an automated artificial intelligence imaging approach to distinguish between arteries and veins, and in demonstrating more genetic associations with vessel characteristics than any previous study (119 genetic loci in all). We also show that the tortuosity of retinal arteries is the most strongly genetically determined vessel characteristic (replicated remarkable well in a separate second large dataset). In addition, using a particular type of genetic analysis (so called “Mendelian Randomization”) we show for the first time that the tortuosity of arteries in the retina is causally related to elevated diastolic blood pressure and not the other way around. This is important as it provides unique insights into the mechanism of elevated blood pressure and hypertension, providing pointers to novel therapeutic targets for future treatment.
Published: 2023

579. Oral health and all-cause, cardiovascular disease, and respiratory mortality in older people in the UK and USA

Author: Eftychia Kotronia, Heather Brown, A. Olia Papacosta, Lucy T. Lennon, Robert J. Weyant, Peter H. Whincup, S. Goya Wannamethee, and Sheena E. Ramsay
Subjects: Medicine, Science
Abstract: Abstract Preventing deterioration of oral health in older age can be crucial for survival. We aimed to examine associations of oral health problems with all-cause, cardiovascular disease (CVD), and respiratory mortality in older people. We used cohort data from the British Regional Health Study (BRHS) (N = 2147, 71–92 years), and the Health, Aging and Body Composition (HABC) Study (USA) (N = 3075, 71–80 years). Follow-up was 9 years (BRHS) and 15 years (HABC Study). Oral health comprised tooth loss, periodontal disease, dry mouth, and self-rated oral health. Cox regression was performed for all-cause mortality, competing risks for CVD mortality, and accelerated failure time models for respiratory mortality. In the BRHS, tooth loss was associated with all-cause mortality (hazard ratio (HR) = 1.59, 95% CI 1.09, 2.31). In the HABC Study, tooth loss, dry mouth, and having ≥ 3 oral problems were associated with all-cause mortality; periodontal disease was associated with increased CVD mortality (subdistribution hazard ratio (SHR) = 1.49, 95% CI 1.01, 2.20); tooth loss, and accumulation of oral problems were associated with high respiratory mortality (tooth loss, time ratio (TR) = 0.73, 95% CI 0.54, 0.98). Findings suggest that poor oral health is associated with mortality. Results highlight the importance of improving oral health to lengthen survival in older age.
Published: 2021
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580. Longitudinal impact of changes in the residential built environment on physical activity: findings from the ENABLE London cohort study

Author: Christelle Clary, Daniel Lewis, Elizabeth Limb, Claire M. Nightingale, Bina Ram, Angie S. Page, Ashley R. Cooper, Anne Ellaway, Billie Giles-Corti, Peter H. Whincup, Alicja R. Rudnicka, Derek G. Cook, Christopher G. Owen, and Steven Cummins
Subjects: Longitudinal, Built environment, Physical activity, Social inequalities, Neighbourhood walkability, Park proximity, Nutritional diseases. Deficiency diseases, RC620-627, Public aspects of medicine, RA1-1270
Abstract: Abstract Background Previous research has reported associations between features of the residential built environment and physical activity but these studies have mainly been cross-sectional, limiting inference. This paper examines whether changes in a range of residential built environment features are associated with changes in measures of physical activity in adults. It also explores whether observed effects are moderated by socio-economic status. Methods Data from the Examining Neighbourhood Activity in Built Living Environments in London (ENABLE London) study were used. A cohort of 1278 adults seeking to move into social, intermediate, and market-rent East Village accommodation was recruited in 2013–2015, and followed up after 2 years. Accelerometer-derived steps (primary outcome), and GIS-derived measures of residential walkability, park proximity and public transport accessibility were obtained both at baseline and follow-up. Daily steps at follow-up were regressed on daily steps at baseline, change in built environment exposures and confounding variables using multilevel linear regression to assess if changes in neighbourhood walkability, park proximity and public transport accessibility were associated with changes in daily steps. We also explored whether observed effects were moderated by housing tenure as a marker of socio-economic status. Results Between baseline and follow-up, participants experienced a 1.4 unit (95%CI 1.2,1.6) increase in neighbourhood walkability; a 270 m (95%CI 232,307) decrease in distance to their nearest park; and a 0.7 point (95% CI 0.6,0.9) increase in accessibility to public transport. A 1 s.d. increase in neighbourhood walkability was associated with an increase of 302 (95%CI 110,494) daily steps. A 1 s.d. increase in accessibility to public transport was not associated with any change in steps overall, but was associated with a decrease in daily steps amongst social housing seekers (− 295 steps (95%CI − 595, 3), and an increase in daily steps for market-rent housing seekers (410 95%CI -191, 1010) (P-value for effect modification = 0.03). Conclusion Targeted changes in the residential built environment may result in increases in physical activity levels. However, the effect of improved accessibility to public transport may not be equitable, showing greater benefit to the more advantaged.
Published: 2020
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581. The effect of moving to East Village, the former London 2012 Olympic and Paralympic Games Athletes' Village, on mode of travel (ENABLE London study, a natural experiment)

Author: Elizabeth S. Limb, Duncan S. Procter, Ashley R. Cooper, Angie S. Page, Claire M. Nightingale, Bina Ram, Aparna Shankar, Christelle Clary, Daniel Lewis, Steven Cummins, Anne Ellaway, Billie Giles-Corti, Peter H. Whincup, Alicja R. Rudnicka, Derek G. Cook, and Christopher G. Owen
Subjects: Built environment, Travel mode, Physical activity, Walking, Cycling, Housing tenure, Nutritional diseases. Deficiency diseases, RC620-627, Public aspects of medicine, RA1-1270
Abstract: Abstract Background Interventions to encourage active modes of travel (walking, cycling) may improve physical activity levels, but longitudinal evidence is limited and major change in the built environment / travel infrastructure may be needed. East Village (the former London 2012 Olympic Games Athletes Village) has been repurposed on active design principles with improved walkability, open space and public transport and restrictions on residential car parking. We examined the effect of moving to East Village on adult travel patterns. Methods One thousand two hundred seventy-eight adults (16+ years) seeking to move into social, intermediate, and market-rent East Village accommodation were recruited in 2013–2015, and followed up after 2 years. Individual objective measures of physical activity using accelerometry (ActiGraph GT3X+) and geographic location using GPS travel recorders (QStarz) were time-matched and a validated algorithm assigned four travel modes (walking, cycling, motorised vehicle, train). We examined change in time spent in different travel modes, using multilevel linear regresssion models adjusting for sex, age group, ethnicity, housing group (fixed effects) and household (random effect), comparing those who had moved to East Village at follow-up with those who did not. Results Of 877 adults (69%) followed-up, 578 (66%) provided valid accelerometry and GPS data for at least 1 day (≥540 min) at both time points; half had moved to East Village. Despite no overall effects on physical activity levels, sizeable improvements in walkability and access to public transport in East Village resulted in decreased daily vehicle travel (8.3 mins, 95%CI 2.5,14.0), particularly in the intermediate housing group (9.6 mins, 95%CI 2.2,16.9), and increased underground travel (3.9 mins, 95%CI 1.2,6.5), more so in the market-rent group (11.5 mins, 95%CI 4.4,18.6). However, there were no effects on time spent walking or cycling. Conclusion Designing walkable neighbourhoods near high quality public transport and restrictions on car usage, may offer a community-wide strategy shift to sustainable transport modes by increasing public transport use, and reducing motor vehicle travel.
Published: 2020
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582. Associations between objectively assessed and questionnaire-based sedentary behaviour with body mass index and systolic blood pressure in Kuwaiti adolescents

Author: Rawan Hashem, Juan Pablo Rey-Lόpez, Mark Hamer, Anne McMunn, Alex Rowlands, Peter H. Whincup, Christopher G. Owen, Ding Ding, Lauren Powell, and Emmanuel Stamatakis
Subjects: Blood pressure, Body mass index, Adiposity, Accelerometry, Sedentary behavior, Medicine, Biology (General), QH301-705.5, Science (General), Q1-390
Abstract: Abstract Objective Kuwait has one of the highest obesity rates in the world. This study examined the associations between sedentary behaviour (objectively measured and self-reported), adiposity and systolic blood pressure in a sample of adolescents residing in Kuwait. Data was obtained from the Study of Health and Activity among adolescents in Kuwait (2012–2013). The sample included a total of 435 adolescents (201 boys). Outcomes were age- and sex specific body mass index Z-scores and systolic blood pressure. Exposures were total sedentary behaviour measured by accelerometry and time spent in some sedentary behaviours (television viewing, video games, computer use and total screen-time). We used multiple linear regression analyses, adjusted for age, governorate, maternal education and physical activity, to examine associations between sedentary behaviour and adiposity and systolic blood pressure. Results Only 2 statistically significant associations were found between sedentary behaviour and the study outcomes: body mass in boys was directly associated with higher sedentary time [β (95% CIs) 0.003 (0.00 to 0.06)]; body mass index was inversely associated with videogames in both sexes [girls: β (95% CIs) − 0.17 (− 0.48 to − 0.04); boys: − 0.24 (− 0.57 to − 0.12)]. In this sample of Kuwaiti adolescents, sedentary behaviour showed limited deleterious associations with adiposity and systolic blood pressure.
Published: 2019
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583. Measuring change in trials of physical activity interventions: a comparison of self-report questionnaire and accelerometry within the PACE-UP trial

Author: Elizabeth S. Limb, Shaleen Ahmad, Derek G. Cook, Sally M. Kerry, Ulf Ekelund, Peter H. Whincup, Christina R. Victor, Steve Iliffe, Michael Ussher, Julia Fox-Rushby, Cheryl Furness, Judith Ibison, Stephen DeWilde, and Tess Harris
Subjects: Walking, Intervention, Primary care, MVPA, Accelerometry, IPAQ, Nutritional diseases. Deficiency diseases, RC620-627, Public aspects of medicine, RA1-1270
Abstract: Abstract Background Few trials have compared estimates of change in physical activity (PA) levels using self-reported and objective PA measures when evaluating trial outcomes. The PACE-UP trial offered the opportunity to assess this, using the self-administered International Physical Activity Questionnaire (IPAQ) and waist-worn accelerometry. Methods The PACE-UP trial (N = 1023) compared usual care (n = 338) with two pedometer-based walking interventions, by post (n = 339) or with nurse support (n = 346). Participants wore an accelerometer at baseline and 12 months and completed IPAQ for the same 7-day periods. Main outcomes were weekly minutes, all in ≥10 min bouts as per UK PA guidelines of: i) accelerometer moderate-to-vigorous PA (Acc-MVPA) ii) IPAQ moderate+vigorous PA (IPAQ-MVPA) and iii) IPAQ walking (IPAQ-Walk). For each outcome, 12 month values were regressed on baseline to estimate change. Results Analyses were restricted to 655 (64%) participants who provided data on all outcomes at baseline and 12 months. Both intervention groups significantly increased their accelerometry MVPA minutes/week compared with control: postal group 42 (95% CI 22, 61), nurse group 43 (95% CI 24, 63). IPAQ-Walk minutes/week also increased: postal 57 (95% CI 2, 112), nurse 43 (95% CI -11, 97) but IPAQ-MVPA minutes/week showed non-significant decreases: postal -11 (95% CI -65, 42), nurse -34 (95% CI -87, 19). Conclusions Our results demonstrate the necessity of using a questionnaire focussing on the activities being altered, as with IPAQ-Walk questions. Even then, the change in PA was estimated with far less precision than with accelerometry. Accelerometry is preferred to self-report measurement, minimising bias and improving precision when assessing effects of a walking intervention. Trial registration: ISRCTN, ISRCTN98538934. Registered 2 March 2012.
Published: 2019
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584. GWAS and colocalization analyses implicate carotid intima-media thickness and carotid plaque loci in cardiovascular outcomes

Author: Nora Franceschini, Claudia Giambartolomei, Paul S. de Vries, Chris Finan, Joshua C. Bis, Rachael P. Huntley, Ruth C. Lovering, Salman M. Tajuddin, Thomas W. Winkler, Misa Graff, Maryam Kavousi, Caroline Dale, Albert V. Smith, Edith Hofer, Elisabeth M. van Leeuwen, Ilja M. Nolte, Lingyi Lu, Markus Scholz, Muralidharan Sargurupremraj, Niina Pitkänen, Oscar Franzén, Peter K. Joshi, Raymond Noordam, Riccardo E. Marioni, Shih-Jen Hwang, Solomon K. Musani, Ulf Schminke, Walter Palmas, Aaron Isaacs, Adolfo Correa, Alan B. Zonderman, Albert Hofman, Alexander Teumer, Amanda J. Cox, André G. Uitterlinden, Andrew Wong, Andries J. Smit, Anne B. Newman, Annie Britton, Arno Ruusalepp, Bengt Sennblad, Bo Hedblad, Bogdan Pasaniuc, Brenda W. Penninx, Carl D. Langefeld, Christina L. Wassel, Christophe Tzourio, Cristiano Fava, Damiano Baldassarre, Daniel H. O’Leary, Daniel Teupser, Diana Kuh, Elena Tremoli, Elmo Mannarino, Enzo Grossi, Eric Boerwinkle, Eric E. Schadt, Erik Ingelsson, Fabrizio Veglia, Fernando Rivadeneira, Frank Beutner, Ganesh Chauhan, Gerardo Heiss, Harold Snieder, Harry Campbell, Henry Völzke, Hugh S. Markus, Ian J. Deary, J. Wouter Jukema, Jacqueline de Graaf, Jacqueline Price, Janne Pott, Jemma C. Hopewell, Jingjing Liang, Joachim Thiery, Jorgen Engmann, Karl Gertow, Kenneth Rice, Kent D. Taylor, Klodian Dhana, Lambertus A. L. M. Kiemeney, Lars Lind, Laura M. Raffield, Lenore J. Launer, Lesca M. Holdt, Marcus Dörr, Martin Dichgans, Matthew Traylor, Matthias Sitzer, Meena Kumari, Mika Kivimaki, Mike A. Nalls, Olle Melander, Olli Raitakari, Oscar H. Franco, Oscar L. Rueda-Ochoa, Panos Roussos, Peter H. Whincup, Philippe Amouyel, Philippe Giral, Pramod Anugu, Quenna Wong, Rainer Malik, Rainer Rauramaa, Ralph Burkhardt, Rebecca Hardy, Reinhold Schmidt, Renée de Mutsert, Richard W. Morris, Rona J. Strawbridge, S. Goya Wannamethee, Sara Hägg, Sonia Shah, Stela McLachlan, Stella Trompet, Sudha Seshadri, Sudhir Kurl, Susan R. Heckbert, Susan Ring, Tamara B. Harris, Terho Lehtimäki, Tessel E. Galesloot, Tina Shah, Ulf de Faire, Vincent Plagnol, Wayne D. Rosamond, Wendy Post, Xiaofeng Zhu, Xiaoling Zhang, Xiuqing Guo, Yasaman Saba, MEGASTROKE Consortium, Abbas Dehghan, Adrie Seldenrijk, Alanna C. Morrison, Anders Hamsten, Bruce M. Psaty, Cornelia M. van Duijn, Deborah A. Lawlor, Dennis O. Mook-Kanamori, Donald W. Bowden, Helena Schmidt, James F. Wilson, James G. Wilson, Jerome I. Rotter, Joanna M. Wardlaw, John Deanfield, Julian Halcox, Leo-Pekka Lyytikäinen, Markus Loeffler, Michele K. Evans, Stéphanie Debette, Steve E. Humphries, Uwe Völker, Vilmundur Gudnason, Aroon D. Hingorani, Johan L. M. Björkegren, Juan P. Casas, and Christopher J. O’Donnell
Subjects: Science
Abstract: Carotid intima-media thickness (cIMT) and plaque are associated with subclinical atherosclerosis and coronary heart disease (CHD). Here, the authors identify and prioritize genetic loci for cIMT and plaque by GWAS and colocalization approaches and further demonstrate genetic correlation with CHD and stroke.
Published: 2018
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585. Tracking of sport and exercise types from midlife to old age: a 20-year cohort study of British men

Author: Daniel Aggio, Olia Papacosta, Lucy T. Lennon, Sarah Ash, Peter H. Whincup, S. Goya Wannamethee, and Barbara J. Jefferis
Subjects: Aging, Physical activity, Longitudinal, Stability, Geriatrics, RC952-954.6
Abstract: Abstract Background Previous physical activity (PA) tracking studies have examined the stability of overall PA and/or PA types, but few have investigated how specific types of sport/exercise track over the life course. The aim of this study was to determine how specific sports/exercises in midlife track and predict future sport/exercise and PA in men transitioning to old age. Methods Seven thousand seven hundred thirty-five men (aged 40–59 years) recruited in 1978–80 were followed up after 12, 16 and 20 years. At each wave men self-reported participation in sport/exercise. Frequent sport/exercise participants (> 1/month) reported the types of sport/exercise they engaged in. Men also reported total PA, health status, lifestyle behaviours and socio-demographic characteristics. Stability of each sport/exercise was assessed using kappa statistics and intraclass correlation coefficients. Logistic regression estimated the odds of participating in sport/exercise and being active at 20-year follow up according to specific types of sport/exercise in midlife. Results Three thousand three hundred eighty-four men with complete data at all waves were included in analyses. Tracking of specific sports/exercises ranged from fair to substantial, with golf being the most common and most stable. Bowls was the most frequently adopted. Odds of participating in sport/exercise and being active in old age varied according to sport/exercise types in midlife. Golf and bowls in midlife were the strongest predictors of sport/exercise participation in old age. Golf, cricket and running/jogging in midlife were among the strongest predictors of being active in old age. Compared to participating in just one sport/exercise in midlife, sampling multiple sports/exercises was more strongly associated with sport/exercise participation and being active in old age. Conclusion The stability of sport/exercise participation from midlife to old age varies by type. Specific sports/exercises in midlife may be more likely to predict future PA than others. However, participating in a range of sports/exercises may be optimal for preserving PA into old age.
Published: 2018
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586. Response bias to a randomised controlled trial of a lifestyle intervention in people at high risk of cardiovascular disease: a cross-sectional analysis

Author: Adam Bayley, Daniel Stahl, Mark Ashworth, Derek G. Cook, Peter H. Whincup, Janet Treasure, Anne Greenough, Katie Ridge, Kirsty Winkley, and Khalida Ismail
Subjects: Cardiovascular disease, Physical activity, Lifestyle, Complex intervention, Participation bias, Primary care, Public aspects of medicine, RA1-1270
Abstract: Abstract Background Research evaluating lifestyle interventions for prevention of cardiovascular disease (CVD) may not reach those most at risk. We compared the response rate to a randomised controlled trial (RCT) of a lifestyle intervention by CVD risk, ethnicity and level of deprivation. Methods Primary care patients with a QRisk2 score ≥ 20% were invited to participate in a RCT of an intensive lifestyle intervention versus usual care. This cross-sectional analysis compares anonymised data of responders and non-responders with multiple logistic regression, using adjusted odds ratios (AORs) for QRisk2 score, ethnicity, Index of Multiple Deprivation (IMD 2010) quintile, age and sex. Results From 60 general practices, 8902 patients were invited and 1489 responded. The mean age was 67.3 years and 21.0% were female. Of all patients invited, 69.9% were of white ethnic background, 13.9% ethnic minority backgrounds and 16.2% had no ethnicity data recorded in their medical records. Likelihood of response decreased as QRisk2 score increased (AOR 0.82 per 5 percentage points, 95% CI 0.77–0.88). Black African or Caribbean patients (AOR 0.67; 95% CI 0.45–0.98) and those with missing ethnicity data (AOR 0.55; 95% CI 0.46–0.66) were less likely to respond compared to participants of white ethnicity, but there was no difference in the response rates between south Asian and white ethnicity (AOR 1.08; 95% CI 0.84–1.38). Patients residing in the fourth (AOR 0.70; 95% CI 0.56–0.87) and fifth (AOR 0.52; 95% CI 0.40–0.68) most deprived IMD quintile were less likely to respond compared to the least deprived quintile. Conclusions Evaluations of interventions intended for those at high risk of CVD may fail to reach those at highest risk. Hard to reach patient groups may require different recruitment strategies to maximise participation in future trials. Improvements in primary care ethnicity data recording is required to aid understanding of how successfully study samples represent the target population. Trial registration ISRCTN, ISRCTN84864870. Registered 15 May 2012, https://doi.org/10.1186/ISRCTN84864870.
Published: 2018
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587. An open-source tool to identify active travel from hip-worn accelerometer, GPS and GIS data

Author: Duncan S. Procter, Angie S. Page, Ashley R. Cooper, Claire M. Nightingale, Bina Ram, Alicja R. Rudnicka, Peter H. Whincup, Christelle Clary, Daniel Lewis, Steven Cummins, Anne Ellaway, Billie Giles-Corti, Derek G. Cook, and Christopher G. Owen
Subjects: Machine learning, Xgboost, Active travel, Travel mode, Physical activity, GPS, Nutritional diseases. Deficiency diseases, RC620-627, Public aspects of medicine, RA1-1270
Abstract: Abstract Background Increases in physical activity through active travel have the potential to have large beneficial effects on populations, through both better health outcomes and reduced motorized traffic. However accurately identifying travel mode in large datasets is problematic. Here we provide an open source tool to quantify time spent stationary and in four travel modes(walking, cycling, train, motorised vehicle) from accelerometer measured physical activity data, combined with GPS and GIS data. Methods The Examining Neighbourhood Activities in Built Living Environments in London study evaluates the effect of the built environment on health behaviours, including physical activity. Participants wore accelerometers and GPS receivers on the hip for 7 days. We time-matched accelerometer and GPS, and then extracted data from the commutes of 326 adult participants, using stated commute times and modes, which were manually checked to confirm stated travel mode. This yielded examples of five travel modes: walking, cycling, motorised vehicle, train and stationary. We used this example data to train a gradient boosted tree, a form of supervised machine learning algorithm, on each data point (131,537 points), rather than on journeys. Accuracy during training was assessed using five-fold cross-validation. We also manually identified the travel behaviour of both 21 participants from ENABLE London (402,749 points), and 10 participants from a separate study (STAMP-2, 210,936 points), who were not included in the training data. We compared our predictions against this manual identification to further test accuracy and test generalisability. Results Applying the algorithm, we correctly identified travel mode 97.3% of the time in cross-validation (mean sensitivity 96.3%, mean active travel sensitivity 94.6%). We showed 96.0% agreement between manual identification and prediction of 21 individuals’ travel modes (mean sensitivity 92.3%, mean active travel sensitivity 84.9%) and 96.5% agreement between the STAMP-2 study and predictions (mean sensitivity 85.5%, mean active travel sensitivity 78.9%). Conclusion We present a generalizable tool that identifies time spent stationary and time spent walking with very high precision, time spent in trains or vehicles with good precision, and time spent cycling with moderate precisionIn studies where both accelerometer and GPS data are available this tool complements analyses of physical activity, showing whether differences in PA may be explained by differences in travel mode. All code necessary to replicate, fit and predict to other datasets is provided to facilitate use by other researchers.
Published: 2018
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588. Trajectories of self-reported physical activity and predictors during the transition to old age: a 20-year cohort study of British men

Author: Daniel Aggio, Efstathios Papachristou, Olia Papacosta, Lucy T. Lennon, Sarah Ash, Peter H. Whincup, S. Goya Wannamethee, and Barbara J. Jefferis
Subjects: Physical activity, Ageing, Retirement, Cardiovascular disease, Nutritional diseases. Deficiency diseases, RC620-627, Public aspects of medicine, RA1-1270
Abstract: Abstract Background Maintenance of physical activity (PA) during later life is associated with optimal health; however, the long-term trajectories of PA into old age and their predictors have not been extensively researched using latent class methods. This study aimed to identify trajectories of self-reported PA and their predictors in men transitioning from midlife to old age. Methods 7735 men (aged 40–59 years) recruited in 1978–80 were followed up after 12, 16 and 20 years, reporting PA, health status, lifestyle behaviours and socio-demographic characteristics. Group-based trajectory modelling identified the trajectories of PA and associations with time-stable and time-varying covariates. We considered a range of sociodemographic and health and lifestyle factors as potential covariates. Results 4952 men (mean baseline age 49.1 ± 5.6 years) providing PA data at ≥3 time points were included in analyses. Three distinct 20-year trajectories were identified: low decreasing (24.6%, n = 1218), light stable (51.1%, n = 2530) and moderate increasing (24.3%, n = 1204). Being older, having a manual occupation, having never married or had children, residing in the midlands or North of England, suffering from a range of health conditions, being a smoker/ex-smoker and never consuming breakfast cereal or alcohol were independently associated with reduced odds of belonging to the moderate increasing trajectory group compared to the low decreasing group. Of the time-varying covariates considered, leaving employment was associated with a decrease in PA in the low decreasing group (β −0.306, p
Published: 2018
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589. Serum Conjugated Linoleic Acid and Risk of Incident Heart Failure in Older Men: The British Regional Heart Study

Author: S. Goya Wannamethee, Barbara J. Jefferis, Lucy Lennon, Olia Papacosta, Peter H. Whincup, and Aroon D. Hingorani
Subjects: epidemiology, fatty acid, heart failure, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract: BackgroundEvidence largely from animal studies suggests that conjugated linoleic acid (CLA) may have cardiovascular health benefits. However, few prospective studies have examined the association between CLA and cardiovascular disease. We have prospectively examined the association between serum CLA and incident coronary heart disease and heart failure (HF) in older men. Methods and ResultsProspective study of 3806 men, aged 60 to 79 years, without prevalent HF followed up for an average of 13 years, during which there were 295 incident HF cases. A high‐throughput serum nuclear magnetic resonance metabolomics platform was used to measure CLA concentration in serum, expressed as a percentage of total fatty acids (CLA%). CLA% was adversely associated with cholesterol and high‐density lipoprotein cholesterol but was inversely associated with C‐reactive protein and NT‐proBNP (N‐terminal pro‐B‐type natriuretic peptide; a marker of ventricular stress). No association was seen between CLA% and incident coronary heart disease. High CLA% was associated with significantly reduced risk of HF after adjustment for HF risk factors and C‐reactive protein (hazard ratio [95% confidence interval], 0.64 [0.43–0.96]; quartile 4 versus quartile 1). Elevated CLA% was associated with reduced HF risk only in those with higher dairy fat intake, a major dietary source of CLA (test for interaction P=0.03). The reduced risk of HF was partially explained by NT‐proBNP. High dairy fat intake was not associated with incident coronary heart disease but was associated with reduced risk of HF, largely because of the inverse effect of CLA. ConclusionsThe finding that high CLA% is associated with lower risk of incident HF in older men requires confirmation in larger studies.
Published: 2018
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590. Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants

Author: Zhou, B, Carrillo-Larco, Rm, Danaei, G, Riley, Lm, Paciorek, Cj, Stevens, Ga, Gregg, Ew, Bennett, Je, Solomon, B, Singleton, Rk, Sophiea, Mk, Iurilli, Mlc, Lhoste, Vpf, Cowan, Mj, Savin, S, Woodward, M, Balanova, Y, Cifkova, R, Damasceno, A, Elliott, P, Farzadfar, F, He, J, Ikeda, N, Kengne, Ap, Khang, Yh, Kim, Hc, Laxmaiah, A, Lin, Hh, Maira, Pm, Miranda, Jj, Neuhauser, H, Sundstrom, J, Varghese, C, Widyahening, Is, Zdrojewski, T, Ezzati, M, Abarca-Gomez, L, Abdeen, Za, Rahim, Hfa, Abu-Rmeileh, Nm, Acosta-Cazares, B, Adams, Rj, Aekplakorn, W, Afsana, K, Afzal, S, Agdeppa, Ia, Aghazadeh-Attari, J, Aguilar-Salinas, Ca, Agyemang, C, Ahmad, Na, Ahmadi, A, Ahmadi, N, Ahmadizar, F, Ahmed, Sh, Ahrens, W, Ajlouni, K, Al-Raddadi, R, Alarouj, M, Albuhairan, F, Aldhukair, S, Ali, Mm, Alkandari, A, Alkerwi, A, Allin, K, Aly, E, Amarapurkar, Dn, Amougou, N, Amouyel, P, Andersen, Lb, Anderssen, Sa, Anjana, Rm, Ansari-Moghaddam, A, Ansong, D, Aounallah-Skhiri, H, Araujo, J, Ariansen, I, Aris, T, Arku, Re, Arlappa, N, Aryal, Kk, Aspelund, T, Assah, Fk, Assuncao, Mcf, Auvinen, J, Avdicova, M, Azevedo, A, Azimi-Nezhad, M, Azizi, F, Azmin, M, Babu, Bv, Bahijri, S, Balakrishna, N, Bamoshmoosh, M, Banach, M, Banadinovic, M, Bandosz, P, Banegas, Jr, Baran, J, Barbagallo, Cm, Barcelo, A, Barkat, A, Barreto, M, Barros, Ajd, Barros, Mvg, Bartosiewicz, A, Basit, A, Bastos, Jld, Bata, I, Batieha, Am, Batyrbek, A, Baur, La, Beaglehole, R, Belavendra, A, Ben Romdhane, H, Benet, M, Benson, Ls, Berkinbayev, S, Bernabe-Ortiz, A, Bettiol, H, Bezerra, J, Bhagyalaxmi, A, Bhargava, Sk, Bia, D, Biasch, K, Lele, Ecb, Bikbov, Mm, Bista, B, Bjerregaard, P, Bjertness, E, Bjertness, Mb, Bjorkelund, C, Bloch, Kv, Blokstra, A, Bo, S, Bobak, M, Boeing, H, Boggia, Jg, Boissonnet, Cp, Bojesen, Se, Bongard, V, Bonilla-Vargas, A, Bopp, M, Borghs, H, Bovet, P, Boyer, Cb, Braeckman, L, Brajkovich, I, Branca, F, Breckenkamp, J, Brenner, H, Brewster, Lm, Briceno, Y, Brito, M, Bruno, G, Bueno-de-Mesquita, Hb, Bueno, G, Bugge, A, Burns, C, Bursztyn, M, de Leon, Ac, Cacciottolo, J, Cameron, C, Can, G, Candido, Apc, Capanzana, Mv, Capkova, N, Capuano, E, Capuano, V, Cardoso, Vc, Carlsson, Ac, Carvalho, J, Casanueva, Ff, Censi, L, Cervantes-Loaiza, M, Chadjigeorgiou, Ca, Chamukuttan, S, Chan, Aw, Chan, Q, Chaturvedi, Hk, Chaturvedi, N, Chee, Ml, Chen, Cj, Chen, Ff, Chen, Hs, Chen, Sh, Chen, Zm, Cheng, Cy, Cheraghian, B, Dekkaki, Ic, Chetrit, A, Chien, Kl, Chiolero, A, Chiou, St, Chirita-Emandi, A, Chirlaque, Md, Cho, B, Christensen, K, Christofaro, Dg, Chudek, J, Cinteza, E, Claessens, F, Clarke, J, Clays, E, Cohen, E, Concin, H, Cooper, C, Coppinger, Tc, Costanzo, S, Cottel, D, Cowell, C, Craig, Cl, Crampin, Ac, Crujeiras, Ab, Cruz, Jj, Csilla, S, Cui, Lf, Cureau, Fv, Cuschieri, S, D'Arrigo, G, D'Orsi, E, Dallongeville, J, Dankner, R, Dantoft, Tm, Dauchet, L, Davletov, K, De Backer, G, De Bacquer, D, De Curtis, A, de Gaetano, G, De Henauw, S, de Oliveira, Pd, De Ridder, D, De Smedt, D, Deepa, M, Deev, Ad, Degennaro, V, Delisle, H, Demarest, S, Dennison, E, Deschamps, V, Dhimal, M, Di Castelnuovo, Af, Dias-da-Costa, Js, Diaz, A, Dickerson, Tt, Dika, Z, Djalalinia, S, Htp, Do, Dobson, Aj, Donfrancesco, C, Donoso, Sp, Doring, A, Dorobantu, M, Dorr, M, Doua, K, Dragano, N, Drygas, W, Duante, Ca, Duboz, P, Duda, Rb, Dulskiene, V, Dushpanova, A, Dzakula, A, Dzerve, V, Dziankowska-Zaborszczyk, E, Eddie, R, Eftekhar, E, Eggertsen, R, Eghtesad, S, Eiben, G, Ekelund, U, El-Khateeb, M, El Ati, J, Eldemire-Shearer, D, Eliasen, M, Elosua, R, Erasmus, Rt, Erbel, R, Erem, C, Eriksen, L, Eriksson, Jg, Escobedo-de la Pena, J, Eslami, S, Esmaeili, A, Evans, A, Faeh, D, Fakhretdinova, Aa, Fall, Ch, Faramarzi, E, Farjam, M, Fattahi, Mr, Fawwad, A, Felix-Redondo, Fj, Felix, Sb, Ferguson, Ts, Fernandes, Ra, Fernandez-Berges, D, Ferrante, D, Ferrao, T, Ferrari, M, Ferrario, Mm, Ferreccio, C, Ferreira, Hs, Ferrer, E, Ferrieres, J, Figueiro, Th, Fink, G, Fischer, K, Foo, Lh, Forsner, M, Fouad, Hm, Francis, Dk, Grego, Franco, Frikke-Schmidt, R, Frontera, G, Fuchs, Fd, Fuchs, Sc, Fujita, Y, Fumihiko, M, Furdela, V, Furer, A, Furusawa, T, Gaciong, Z, Galbarczyk, A, Galenkamp, H, Galvano, F, Gao, Jl, Gao, P, Garcia-de-la-Hera, M, Garcia, P, Gareta, D, Garnett, Sp, Gaspoz, Jm, Gasull, M, Gazzinelli, A, Gehring, U, Geleijnse, Jm, George, R, Ghanbari, A, Ghasemi, E, Gheorghe-Fronea, Of, Ghimire, A, Gialluisi, A, Giampaoli, S, Gieger, C, Gill, Tk, Giovannelli, J, Gironella, G, Giwercman, A, Gkiouras, K, Goldberg, M, Goldsmith, Ra, Gomez, Lf, Gomula, A, da Silva, Bgc, Goncalves, H, Goncalves, M, Gonzalez-Chica, Da, Gonzalez-Gross, M, Gonzalez-Rivas, Jp, Gonzalez-Villalpando, C, Gonzalez-Villalpando, Me, Gonzalez, Ar, Gorbea, Mb, Gottrand, F, Graff-Iversen, S, Grafnetter, D, Grajda, A, Grammatikopoulou, Mg, Gregor, Rd, Grodzicki, T, Grosso, G, Gruden, G, Df, Gu, Guan, Op, Gudmundsson, Ef, Gudnason, V, Guerrero, R, Guessous, I, Guimaraes, Al, Gulliford, Mc, Gunnlaugsdottir, J, Gunter, Mj, Gupta, Pc, Gupta, R, Gureje, O, Gurzkowska, B, Gutierrez, L, Gutzwiller, F, Ha, S, Hadaegh, F, Haghshenas, R, Hakimi, H, Halkjaer, J, Hambleton, Ir, Hamzeh, B, Hange, D, Hanif, Aam, Hantunen, S, Hao, J, Hardman, Cm, Kumar, Rh, Hashemi-Shahri, Sm, Hata, J, Haugsgjerd, T, Hayes, Aj, Yn, He, Heier, M, Hendriks, Me, Henrique, Rd, Henriques, A, Cadena, Lh, Herrala, S, Heshmat, R, Hill, Ag, Sy, Ho, Sc, Ho, Hobbs, M, Holdsworth, M, Homayounfar, R, Dinc, Gh, Horimoto, Arvr, Hormiga, Cm, Horta, Bl, Houti, L, Howitt, C, Htay, Tt, Htet, As, Htike, Mmt, Yh, Hu, Huerta, Jm, Huhtaniemi, It, Huiart, L, Huisman, M, Husseini, As, Huybrechts, I, Hwalla, N, Iacoviello, L, Iannone, Ag, Ibrahim, Mm, Wong, Ni, Ikram, Ma, Iotova, V, Irazola, Ve, Ishida, T, Isiguzo, Gc, Islam, M, Islam, Sms, Iwasaki, M, Jackson, Rt, Jacobs, Jm, Jaddou, Hy, Jafar, T, James, K, Jamrozik, K, Janszky, I, Janus, E, Jarvelin, Mr, Jasienska, G, Jelakovic, A, Jelakovic, B, Jennings, G, Jha, Ak, Jiang, Cq, Jimenez, Ro, 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Montpellier (CIHEAM-IAMM), Centre International de Hautes Études Agronomiques Méditerranéennes (CIHEAM)-Centre International de Hautes Études Agronomiques Méditerranéennes (CIHEAM)-Institut national d’études supérieures agronomiques de Montpellier (Montpellier SupAgro), Institut national d'enseignement supérieur pour l'agriculture, l'alimentation et l'environnement (Institut Agro)-Institut national d'enseignement supérieur pour l'agriculture, l'alimentation et l'environnement (Institut Agro)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Interactions Gène-Environnement en Physiopathologie Cardio-Vasculaire (IGE-PCV), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Clinicum, Research Programs Unit, Johan Eriksson / Principal Investigator, Department of General Practice and Primary Health Care, University of Helsinki, HUS Helsinki and Uusimaa Hospital District, Department of Public Health, 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Life, APH - Societal Participation & Health, Public and occupational health, APH - Health Behaviors & Chronic Diseases, VU University medical center, APH - Personalized Medicine, Psychiatry, APH - Mental Health, Bin Zhou, Rodrigo M Carrillo-Larco, Goodarz Danaei, Leanne M Riley, Christopher J Paciorek, Gretchen A Stevens, Edward W Gregg, James E Bennett, Bethlehem Solomon, Rosie K Singleton, Marisa K Sophiea, Maria Lc Iurilli, Victor Pf Lhoste, Melanie J Cowan, Stefan Savin, Mark Woodward, Yulia Balanova, Renata Cifkova, Albertino Damasceno, Paul Elliott, Farshad Farzadfar, Jiang He, Nayu Ikeda, Andre P Kengne, Young-Ho Khang, Hyeon Chang Kim, Avula Laxmaiah, Hsien-Ho Lin, Paula Margozzini Maira, J Jaime Miranda, Hannelore Neuhauser, Johan Sundström, Cherian Varghese, Indah S Widyahening, Tomasz Zdrojewski, Leandra Abarca-Gómez, Ziad A Abdeen, Hanan F Abdul Rahim, Niveen M Abu-Rmeileh, Benjamin Acosta-Cazares, Robert J Adams, Wichai Aekplakorn, Kaosar Afsana, Shoaib Afzal, Imelda A 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Huybrechts, Nahla Hwalla, Licia Iacoviello, Anna G Iannone, Mohsen M Ibrahim, Norazizah Ibrahim Wong, M Arfan Ikram, Violeta Iotova, Vilma E Irazola, Takafumi Ishida, Godsent C Isiguzo, Muhammad Islam, Sheikh Mohammed Shariful Islam, Masanori Iwasaki, Rod T Jackson, Jeremy M Jacobs, Hashem Y Jaddou, Tazeen Jafar, Kenneth James, Konrad Jamrozik, Imre Janszky, Edward Janus, Marjo-Riitta Jarvelin, Grazyna Jasienska, Ana Jelaković, Bojan Jelaković, Garry Jennings, Anjani Kumar Jha, Chao Qiang Jiang, Ramon O Jimenez, Karl-Heinz Jöckel, Michel Joffres, Mattias Johansson, Jari J Jokelainen, Jost B Jonas, Torben Jørgensen, Pradeep Joshi, Farahnaz Joukar, Jacek Jóżwiak, Anne Juolevi, Gregor Jurak, Vesna Jureša, Rudolf Kaaks, Anthony Kafatos, Eero O Kajantie, Zhanna Kalmatayeva, Natasa Kalpourtzi, Ofra Kalter-Leibovici, Freja B Kampmann, Srinivasan Kannan, Eva Karaglani, Line L Kårhus, Khem B Karki, Marzieh Katibeh, Joanne Katz, Jussi Kauhanen, Prabhdeep Kaur, Maryam Kavousi, Gyulli M Kazakbaeva, Ulrich Keil, Lital Keinan Boker, Sirkka Keinänen-Kiukaanniemi, Roya Kelishadi, Han Cg Kemper, Maryam Keramati, Alina Kerimkulova, Mathilde Kersting, Timothy Key, Yousef Saleh Khader, Davood Khalili, Kay-Tee Khaw, Bahareh Kheiri, Motahareh Kheradmand, Alireza Khosravi, Ursula Kiechl-Kohlendorfer, Stefan Kiechl, Japhet Killewo, Dong Wook Kim, Jeongseon Kim, Heidi Klakk, Magdalena Klimek, Jurate Klumbiene, Michael Knoflach, Elin Kolle, Patrick Kolsteren, Jukka P Kontto, Raija Korpelainen, Paul Korrovits, Jelena Kos, Seppo Koskinen, Katsuyasu Kouda, Sudhir Kowlessur, Slawomir Koziel, Jana Kratenova, Vilma Kriaucioniene, Peter Lund Kristensen, Steiner Krokstad, Daan Kromhout, Herculina S Kruger, Ruzena Kubinova, Renata Kuciene, Urho M Kujala, Zbigniew Kulaga, R Krishna Kumar, Pawel Kurjata, Yadlapalli S Kusuma, Vladimir Kutsenko, Kari Kuulasmaa, Catherine Kyobutungi, Tiina Laatikainen, Carl Lachat, Youcef Laid, Tai Hing Lam, Orlando Landrove, Vera Lanska, Georg Lappas, Bagher 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Dimitrios Papandreou, Soon-Woo Park, Suyeon Park, Winsome R Parnell, Mahboubeh Parsaeian, Patrick Pasquet, Nikhil D Patel, Halyna Pavlyshyn, Ivan Pećin, Mangesh S Pednekar, João M Pedro, Nasheeta Peer, Sergio Viana Peixoto, Markku Peltonen, Alexandre C Pereira, Karen Gda Peres, Marco A Peres, Annette Peters, Janina Petkeviciene, Niloofar Peykari, Son Thai Pham, Rafael N Pichardo, Iris Pigeot, Hynek Pikhart, Aida Pilav, Lorenza Pilotto, Freda Pitakaka, Aleksandra Piwonska, Andreia N Pizarro, Pedro Plans-Rubió, Ozren Polašek, Miquel Porta, Anil Poudyal, Farhad Pourfarzi, Akram Pourshams, Hossein Poustchi, Rajendra Pradeepa, Alison J Price, Jacqueline F Price, Rui Providencia, Soile E Puhakka, Maria Puiu, Margus Punab, Radwan F Qasrawi, Mostafa Qorbani, Daniel Queiroz, Tran Quoc Bao, Ivana Radić, Ricardas Radisauskas, Salar Rahimikazerooni, Mahfuzar Rahman, Olli Raitakari, Manu Raj, Ellina M Rakhimova, Sudha Ramachandra Rao, Ambady Ramachandran, Elisabete Ramos, Lekhraj Rampal, Sanjay Rampal, Daniel A Rangel Reina, Vayia Rarra, Cassiano Ricardo Rech, Josep Redon, Paul Ferdinand M Reganit, Valéria Regecová, Luis Revilla, Abbas Rezaianzadeh, Robespierre Ribeiro, Elio Riboli, Adrian Richter, Fernando Rigo, Tobias F Rinke de Wit, Raphael M Ritti-Dias, Cynthia Robitaille, Fernando Rodríguez-Artalejo, María Del Cristo Rodriguez-Perez, Laura A Rodríguez-Villamizar, Ulla Roggenbuck, Rosalba Rojas-Martinez, Dora Romaguera, Elisabetta L Romeo, Annika Rosengren, Joel Gr Roy, Adolfo Rubinstein, Jean-Bernard Ruidavets, Blanca Sandra Ruiz-Betancourt, Maria Ruiz-Castell, Iuliia A Rusakova, Paola Russo, Marcin Rutkowski, Charumathi Sabanayagam, Hamideh Sabbaghi, Harshpal S Sachdev, Alireza Sadjadi, Ali Reza Safarpour, Sare Safi, Saeid Safiri, Olfa Saidi, Sibel Sakarya, Nader Saki, Benoit Salanave, Eduardo Salazar Martinez, Diego Salmerón, Veikko Salomaa, Jukka T Salonen, Massimo Salvetti, Jose Sánchez-Abanto, Susana Sans, Diana A Santos, Ina S Santos, Lèlita C Santos, Maria Paula 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Krishna, Kurjata, Pawel, Kusuma, Yadlapalli S., Kutsenko, Vladimir, Kuulasmaa, Kari, Kyobutungi, Catherine, Laatikainen, Tiina, Lachat, Carl, Laid, Youcef, Lam, Tai Hing, Landrove, Orlando, Lanska, Vera, Lappas, Georg, Larijani, Bagher, Latt, Tint Swe, Le Coroller, Gwenaelle, Khanh Le Nguyen Bao, Le, Tuyen D., Lee, Jeannette, Lee, Jeonghee, Lehmann, Nils, Lehtimaki, Terho, Lemogoum, Daniel, Levitt, Naomi S., Li, Yanping, Lilly, Christa L., Lim, Wei-Yen, Lima-Costa, M. Fernanda, Lin, Xu, Lin, Yi-Ting, Lind, Lars, Lingam, Vijaya, Linneberg, Allan, Lissner, Lauren, Litwin, Mieczyslaw, Lo, Wei-Cheng, Loit, Helle-Mai, Lopez-Garcia, Esther, Lopez, Tania, Lotufo, Paulo A., Lozano, Jose Eugenio, Lovrencic, Iva Lukacevic, Lukrafka, Janice L., Luksiene, Dalia, Lundqvist, Annamari, Lundqvist, Robert, Lunet, Nuno, Lustigova, Michala, Luszczki, Edyta, Ma, Guansheng, Ma, Jun, Machado-Coelho, George L. L., Machado-Rodrigues, Aristides M., Macia, Enguerran, Macieira, Luisa M., Madar, Ahmed A., Maggi, Stefania, Magliano, Dianna J., Magriplis, Emmanuella, Mahasampath, Gowri, Maire, Bernard, Majer, Marjeta, Makdisse, Marcia, Malekzadeh, Fatemeh, Malekzadeh, Reza, Malhotra, Rahul, Mallikharjuna, Kodavanti, Malyutina, Sofia K., Maniego, Lynell V., Manios, Yannis, Mann, Jim I., Mansour-Ghanaei, Fariborz, Manzato, Enzo, Marcil, Anie, Margozzini, Paula, Marild, Staffan B., Glavic, Mihalea Marinovic, Marques-Vidal, Pedro, Marques, Larissa Pruner, Marrugat, Jaume, Martorell, Reynaldo, Mascarenhas, Luis P., Matasin, Marija, Mathiesen, Ellisiv B., Mathur, Prashant, Matijasevich, Alicia, Matlosz, Piotr, Matsha, Tandi E., Mavrogianni, Christina, Mbanya, Jean Claude N., Mc Donald Posso, Anselmo J., McFarlane, Shelly R., McGarvey, Stephen T., McLachlan, Stela, McLean, Rachael M., McLean, Scott B., McNulty, Breige A., Benchekor, Sounnia Mediene, Medzioniene, Jurate, Mehdipour, Parinaz, Mehlig, Kirsten, Mehrparvar, Amir Houshang, Meirhaeghe, Aline, Meisinger, Christa, Mendoza Montano, Carlos, Menezes, Ana Maria B., Menon, Geetha R., Mereke, Alibek, Meshram, Indrapal I., Metspalu, Andres, Meyer, Haakon E., Mi, Jie, Michels, Nathalie, Mikkel, Kairit, Milkowska, Karolina, Miller, Jody C., Minderico, Claudia S., Mini, G. 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D. A., Peres, Marco A., Peters, Annette, Petkeviciene, Janina, Peykari, Niloofar, Son Thai Pham, Pichardo, Rafael N., Pigeot, Iris, Pikhart, Hynek, Pilav, Aida, Pilotto, Lorenza, Pitakaka, Freda, Piwonska, Aleksandra, Pizarro, Andreia N., Plans-Rubio, Pedro, Polasek, Ozren, Porta, Miquel, Poudyal, Anil, Pourfarzi, Farhad, Pourshams, Akram, Poustchi, Hossein, Pradeepa, Rajendra, Price, Alison J., Price, Jacqueline F., Providencia, Rui, Puhakka, Soile E., Puiu, Maria, Punab, Margus, Qasrawi, Radwan F., Qorbani, Mostafa, Queiroz, Daniel, Tran Quoc Bao, Radic, Ivana, Radisauskas, Ricardas, Rahimikazerooni, Salar, Rahman, Mahfuzar, Raitakari, Olli, Raj, Manu, Rakhimova, Ellina M., Rao, Sudha Ramachandra, Ramachandran, Ambady, Ramos, Elisabete, Rampal, Lekhraj, Rampal, Sanjay, Rangel Reina, Daniel A., Rarra, Vayia, Rech, Cassiano Ricardo, Redon, Josep, Reganit, Paul Ferdinand M., Regecova, Valeria, Revilla, Luis, Rezaianzadeh, Abbas, Ribeiro, Robespierre, Riboli, Elio, Richter, Adrian, Rigo, Fernando, de Wit, Tobias F. Rinke, Ritti-Dias, Raphael M., Robitaille, Cynthia, Rodriguez-Artalejo, Fernando, del Cristo Rodriguez-Perez, Maria, Rodriguez-Villamizar, Laura A., Roggenbuck, Ulla, Rojas-Martinez, Rosalba, Romaguera, Dora, Romeo, Elisabetta L., Rosengren, Annika, Roy, Joel G. R., Rubinstein, Adolfo, Ruidavets, Jean-Bernard, Sandra Ruiz-Betancourt, Blanca, Ruiz-Castell, Maria, Rusakova, Iuliia A., Russo, Paola, Rutkowski, Marcin, Sabanayagam, Charumathi, Sabbaghi, Hamideh, Sachdev, Harshpal S., Sadjadi, Alireza, Safarpour, Ali Reza, Safi, Sare, Safiri, Saeid, Saidi, Olfa, Saki, Nader, Salanave, Benoit, Salazar Martinez, Eduardo, Salmeron, Diego, Salomaa, Veikko, Salonen, Jukka T., Salvetti, Massimo, Sanchez-Abanto, Jose, Sans, Susana, Santos, Diana A., Santos, Ina S., Santos, Lelita C., Santos, Maria Paula, Santos, Rute, Saramies, Jouko L., Sardinha, Luis B., Sarganas, Giselle, Sarrafzadegan, Nizal, Sathish, Thirunavukkarasu, Saum, Kai-Uwe, Savva, Savvas, Sawada, Norie, Sbaraini, Mariana, Scazufca, Marcia, Schaan, Beatriz D., Schargrodsky, Herman, Schipf, Sabine, Schmidt, Carsten O., Schnohr, Peter, Schoettker, Ben, Schramm, Sara, Schultsz, Constance, Schutte, Aletta E., Sebert, Sylvain, Sein, Aye Aye, Sen, Abhijit, Senbanjo, Idowu O., Sepanlou, Sadaf G., Servais, Jennifer, Shalnova, Svetlana A., Shamah-Levy, Teresa, Shamshirgaran, Morteza, Shanthirani, Coimbatore Subramaniam, Sharafkhah, Maryam, Sharma, Sanjib K., Shaw, Jonathan E., Shayanrad, Amaneh, Shayesteh, Ali Akbar, Shi, Zumin, Shibuya, Kenji, Shimizu-Furusawa, Hana, Shin, Dong Wook, Shirani, Majid, Shiri, Rahman, Shrestha, Namuna, Si-Ramlee, Khairil, Siani, Alfonso, Siantar, Rosalynn, Sibai, Abla M., de Moura Silva, Caroline Ramos, Santos Silva, Diego Augusto, Simon, Mary, Simons, Judith, Simons, Leon A., Sjostrom, Michael, Slowikowska-Hilczer, Jolanta, Slusarczyk, Przemyslaw, Smeeth, Liam, So, Hung-Kwan, Soares, Fernanda Cunha, Sobngwi, Eugene, Soderberg, Stefan, Soemantri, Agustinus, Sofat, Reecha, Solfrizzi, Vincenzo, Somi, Mohammad Hossein, Sonestedt, Emily, Song, Yi, Sorensen, Thorkild I. A., Sorgjerd, Elin P., Soric, Maroje, Jerome, Charles Sossa, Soumare, Aicha, Sparboe-Nilsen, Bente, Sparrenberger, Karen, Staessen, Jan A., Starc, Gregor, Stavreski, Bill, Steene-Johannessen, Jostein, Stehle, Peter, Stein, Aryeh D., Stergiou, George S., Stessman, Jochanan, Stieber, Jutta, Stoeckl, Doris, Stocks, Tanja, Stokwiszewski, Jakub, Stronks, Karien, Strufaldi, Maria Wany, Suka, Machi, Sun, Chien-An, Sung, Yn-Tz, Suriyawongpaisal, Paibul, Sy, Rody G., Syddall, Holly E., Sylva, Rene Charles, Szklo, Moyses, Tai, E. Shyong, Tammesoo, Mari-Liis, Tamosiunas, Abdonas, Tan, Eng Joo, Tang, Xun, Tanser, Frank, Tao, Yong, Tarawneh, Mohammed Rasoul, Tarqui-Mamani, Carolina B., Taylor, Anne, Taylor, Julie, Tebar, William R., Tell, Grethe S., Tello, Tania, Tham, Yih Chung, Thankappan, K. R., Theobald, Holger, Theodoridis, Xenophon, Thinggaard, Mikael, Thomas, Nihal, Thorand, Barbara, Thuesen, Betina H., Timmermans, Erik J., Tjandrarini, Dwi H., Tjonneland, Anne, Toft, Ulla, Tolonen, Hanna K., Tolstrup, Janne S., Topbas, Murat, Topor-Madry, Roman, Jose Tormo, Maria, Tornaritis, Michael J., Torrent, Maties, Torres-Collado, Laura, Touloumi, Giota, Traissac, Pierre, Triantafyllou, Areti, Trichopoulos, Dimitrios, Trichopoulou, Antonia, Trinh, Oanh T. H., Trivedi, Atul, Tshepo, Lechaba, Tsugane, Shoichiro, Tuliakova, Azaliia M., Tulloch-Reid, Marshall K., Tullu, Fikru, Tuomainen, Tomi-Pekka, Tuomilehto, Jaakko, Turley, Maria L., Twig, Gilad, Tynelius, Per, Tzourio, Christophe, Ueda, Peter, Ugel, Eunice, Ulmer, Hanno, Uusitalo, Hannu M. T., Valdivia, Gonzalo, Valvi, Damaskini, van Dam, Rob M., van den Born, Bert-Jan, Van der Heyden, Johan, van der Schouw, Yvonne T., Van Herck, Koen, Hoang Van Minh, Van Schoor, Natasja M., van Valkengoed, Irene G. 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Goya, Wareham, Nicholas, Wei, Wenbin, Weres, Aneta, Werner, Bo, Whincup, Peter H., Widhalm, Kurt, Wiecek, Andrzej, Wilks, Rainford J., Willeit, Johann, Willeit, Peter, Williams, Emmanuel A., Wilsgaard, Tom, Wojtyniak, Bogdan, Wong-McClure, Roy A., Wong, Andrew, Wong, Tien Yin, Woo, Jean, Wu, Frederick C., Wu, Shouling, Wyszynska, Justyna, Xu, Haiquan, Xu, Liang, Yaacob, Nor Azwany, Yan, Weili, Yang, Ling, Yang, Xiaoguang, Yang, Yang, Yasuharu, Tabara, Ye, Xingwang, Yiallouros, Panayiotis K., Yoosefi, Moein, Yoshihara, Akihiro, You, San-Lin, Younger-Coleman, Novie O., Yusoff, Ahmad Faudzi, Zainuddin, Ahmad A., Zakavi, Seyed Rasoul, Zamani, Farhad, Zambon, Sabina, Zampelas, Antonis, Elisa Zapata, Maria, Zaw, Ko Ko, Zejglicova, Kristyna, Vrkic, Tajana Zeljkovic, Zeng, Yi, Zhang, Luxia, Zhao, Dong, Zhao, Ming-Hui, Zhen, Shiqi, Zheng, Yingfeng, Zholdin, Bekbolat, Zhu, Dan, Zins, Marie, Zitt, Emanuel, Zocalo, Yanina, Zoghlami, Nada, Zuniga Cisneros, Julio., School of Medicine, ACS - Diabetes & metabolism, APH - Global Health, Pulmonology, Medical Informatics, Adult Psychiatry, Global Health, APH - Quality of Care, APH - Methodology, Vascular Medicine, ACS - Atherosclerosis & ischemic syndromes, Anesthesiology, Graduate School, and ACS - Heart failure & arrhythmias
Subjects: Male, Latin Americans, Nutrition and Disease, Epidemiology, [SDV]Life Sciences [q-bio], Medizin, BLOOD-PRESSURE, 030204 cardiovascular system & hematology, Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants, Hypertension, Prevalence, Control, Tretament, GUIDELINES, Global Health, Worldwide trends, 0302 clinical medicine, Hypertension prevalence, Voeding en Ziekte, Medicine and Health Sciences, kohonnut verenpaine, Medicine, 030212 general & internal medicine, Prevention and Control, 11 Medical and Health Sciences, ComputingMilieux_MISCELLANEOUS, education.field_of_study, food and beverages, Public Health, Global Health, Social Medicine and Epidemiology, General Medicine, Noncommunicable diseases, Period prevalence, Middle Aged, kansainvälinen vertailu, 3142 Public health care science, environmental and occupational health, 3. Good health, MIDDLE-INCOME, Pooled analysis, SYSTEMATIC ANALYSIS, INCOME COUNTRIES, ADULTS, PREVENTION, MANAGEMENT, ADHERENCE, DIAGNOSIS, Western europe, [SDE]Environmental Sciences, Hypertension/diagnosis, NCD Risk Factor Collaboration (NCD-RisC), Female, B990 Subjects Allied to Medicine not elsewhere classified, Life Sciences & Biomedicine, Adult, health-care, esiintyvyys, Central asia, Population, Nursing, 3121 Internal medicine, 03 medical and health sciences, Medicine, General & Internal, Drug Therapy, General & Internal Medicine, Life Science, Humans, ddc:610, education, Antihypertensive Agents, VLAG, Aged, Science & Technology, Antihypertensive Agents/therapeutic use, business.industry, Omvårdnad, fungi, General and internal medicine, Estados de Saúde e de Doença, Taking medication, Treatment, Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi, Blood pressure, Faculdade de Ciências Sociais, 3121 General medicine, internal medicine and other clinical medicine, lääkehoito, 1182 Biochemistry, cell and molecular biology, business, Demography
Abstract: Background: hypertension can be detected at the primary health-care level and low-cost treatments can effectively control hypertension. We aimed to measure the prevalence of hypertension and progress in its detection, treatment, and control from 1990 to 2019 for 200 countries and territories. Methods: we used data from 1990 to 2019 on people aged 30-79 years from population-representative studies with measurement of blood pressure and data on blood pressure treatment. We defined hypertension as having systolic blood pressure 140 mm Hg or greater, diastolic blood pressure 90 mm Hg or greater, or taking medication for hypertension. We applied a Bayesian hierarchical model to estimate the prevalence of hypertension and the proportion of people with hypertension who had a previous diagnosis (detection), who were taking medication for hypertension (treatment), and whose hypertension was controlled to below 140/90 mm Hg (control). The model allowed for trends over time to be non-linear and to vary by age. Findings: the number of people aged 30-79 years with hypertension doubled from 1990 to 2019, from 331 (95% credible interval 306-359) million women and 317 (292-344) million men in 1990 to 626 (584-668) million women and 652 (604-698) million men in 2019, despite stable global age-standardised prevalence. In 2019, age-standardised hypertension prevalence was lowest in Canada and Peru for both men and women; in Taiwan, South Korea, Japan, and some countries in western Europe including Switzerland, Spain, and the UK for women; and in several low-income and middle-income countries such as Eritrea, Bangladesh, Ethiopia, and Solomon Islands for men. Hypertension prevalence surpassed 50% for women in two countries and men in nine countries, in central and eastern Europe, central Asia, Oceania, and Latin America. Globally, 59% (55-62) of women and 49% (46-52) of men with hypertension reported a previous diagnosis of hypertension in 2019, and 47% (43-51) of women and 38% (35-41) of men were treated. Control rates among people with hypertension in 2019 were 23% (20-27) for women and 18% (16-21) for men. In 2019, treatment and control rates were highest in South Korea, Canada, and Iceland (treatment >70%; control >50%), followed by the USA, Costa Rica, Germany, Portugal, and Taiwan. Treatment rates were less than 25% for women and less than 20% for men in Nepal, Indonesia, and some countries in sub-Saharan Africa and Oceania. Control rates were below 10% for women and men in these countries and for men in some countries in north Africa, central and south Asia, and eastern Europe. Treatment and control rates have improved in most countries since 1990, but we found little change in most countries in sub-Saharan Africa and Oceania. Improvements were largest in high-income countries, central Europe, and some upper-middle-income and recently high-income countries including Costa Rica, Taiwan, Kazakhstan, South Africa, Brazil, Chile, Turkey, and Iran. Interpretation Improvements in the detection, treatment, and control of hypertension have varied substantially across countries, with some middle-income countries now outperforming most high-income nations. The dual approach of reducing hypertension prevalence through primary prevention and enhancing its treatment and control is achievable not only in high-income countries but also in low-income and middle-income settings., British Heart Foundation Centre of Research Excellence Grant; World Health Organization (WHO); Abdul Latif Jameel Institute for Disease and Emergency Analytics Fellowship
Published: 2021

591. Equalization of four cardiovascular risk algorithms after systematic recalibration: individual-participant meta-analysis of 86 prospective studies

Author: Pennells, Lisa, Kaptoge, Stephen, Wood, Angela, Sweeting, Mike, Zhao, Xiaohui, White, Ian, Burgess, Stephen, Willeit, Peter, Bolton, Thomas, Moons, Karel G M, van der Schouw, Yvonne T, Selmer, Randi, Khaw, Kay-Tee, Gudnason, Vilmundur, Assmann, Gerd, Amouyel, Philippe, Salomaa, Veikko, Kivimaki, Mika, Nordestgaard, Børge G, Blaha, Michael J, Kuller, Lewis H, Brenner, Hermann, Gillum, Richard F, Meisinger, Christa, Ford, Ian, Knuiman, Matthew W, Rosengren, Annika, Lawlor, Debbie A, Völzke, Henry, Cooper, Cyrus, Marín Ibañez, Alejandro, Casiglia, Edoardo, Kauhanen, Jussi, Cooper, Jackie A, Rodriguez, Beatriz, Sundström, Johan, Barrett-Connor, Elizabeth, Dankner, Rachel, Nietert, Paul J, Davidson, Karina W, Wallace, Robert B, Blazer, Dan G, Björkelund, Cecilia, Donfrancesco, Chiara, Krumholz, Harlan M, Nissinen, Aulikki, Davis, Barry R, Coady, Sean, Whincup, Peter H, Jørgensen, Torben, Ducimetiere, Pierre, Trevisan, Maurizio, Engström, Gunnar, Crespo, Carlos J, Meade, Tom W, Visser, Marjolein, Kromhout, Daan, Kiechl, Stefan, Daimon, Makoto, Price, Jackie F, Gómez de la Cámara, Agustin, Wouter Jukema, J, Lamarche, Benoît, Onat, Altan, Simons, Leon A, Kavousi, Maryam, Ben-Shlomo, Yoav, Gallacher, John, Dekker, Jacqueline M, Arima, Hisatomi, Shara, Nawar, Tipping, Robert W, Roussel, Ronan, Brunner, Eric J, Koenig, Wolfgang, Sakurai, Masaru, Pavlovic, Jelena, Gansevoort, Ron T, Nagel, Dorothea, Goldbourt, Uri, Barr, Elizabeth L M, Palmieri, Luigi, Njølstad, Inger, Sato, Shinichi, Monique Verschuren, W M, Varghese, Cherian V, Graham, Ian, Onuma, Oyere, Greenland, Philip, Woodward, Mark, Ezzati, Majid, Psaty, Bruce M, Sattar, Naveed, Jackson, Rod, Ridker, Paul M, Cook, Nancy R, D'Agostino, Ralph B, Thompson, Simon G, Danesh, John, Di Angelantonio, Emanuele, Simpson, Lara M, Pressel, Sara L, Couper, David J, Nambi, Vijay, Matsushita, Kunihiro, Folsom, Aaron R, Shaw, Jonathan E, Magliano, Dianna J, Zimmet, Paul Z, Wannamethee, S Goya, Willeit, Johann, Santer, Peter, Egger, Georg, Casas, Juan Pablo, Amuzu, Antointtte, Tikhonoff, Valérie, Sutherland, Susan E, Cushman, Mary, Søgaard, Anne Johanne, Håheim, Lise Lund, Ariansen, Inger, Tybjærg-Hansen, Anne, Jensen, Gorm B, Schnohr, Peter, Giampaoli, Simona, Vanuzzo, Diego, Panico, Salvatore, Balkau, Beverley, Bonnet, Fabrice, Marre, Michel, de la Cámara, Agustin Gómez, Rubio Herrera, Miguel Angel, Friedlander, Yechiel, McCallum, John, McLachlan, Stela, Guralnik, Jack, Phillips, Caroline L, Wareham, Nick, Schöttker, Ben, Saum, Kai-Uwe, Holleczek, Bernd, Tolonen, Hanna, Vartiainen, Erkki, Jousilahti, Pekka, Harald, Kennet, D’Agostino, Ralph B, Massaro, Joseph M, Pencina, Michael, Vasan, Ramachandran, Kayama, Takamasa, Kato, Takeo, Oizumi, Toshihide, Jespersen, Jørgen, Møller, Lars, Bladbjerg, Else Marie, Chetrit, A, Wilhelmsen, Lars, Lissner, Lauren, Dennison, Elaine, Kiyohara, Yutaka, Ninomiya, Toshiharu, Doi, Yasufumi, Nijpels, Giel, Stehouwer, Coen D A, Kazumasa, Yamagishi, Iso, Hiroyasu, Kurl, Sudhir, Tuomainen, Tomi-Pekka, Salonen, Jukka T, Deeg, Dorly J H, Nilsson, Peter M, Hedblad, Bo, Melander, Olle, De Boer, Ian H, DeFilippis, Andrew Paul, Verschuren, W M Monique, Watt, Graham, Tverdal, Aage, Kirkland, Susan, Shimbo, Daichi, Shaffer, Jonathan, Bakker, Stephan J L, van der Harst, Pim, Hillege, Hans L, Dallongeville, Jean, Schulte, Helmut, Trompet, Stella, Smit, Roelof A J, Stott, David J, Després, Jean-Pierre, Cantin, Bernard, Dagenais, Gilles R, Laughlin, Gail, Wingard, Deborah, Aspelund, Thor, Eiriksdottir, Gudny, Gudmundsson, Elias Freyr, Ikram, Arfan, van Rooij, Frank J A, Franco, Oscar H, Rueda-Ochoa, Oscar L, Muka, Taulant, Glisic, Marija, Tunstall-Pedoe, Hugh, Howard, Barbara V, Zhang, Ying, Jolly, Stacey, Davey-Smith, George, Can, Günay, Yüksel, Hüsniye, Nakagawa, Hideaki, Morikawa, Yuko, Miura, Katsuyuki, Ingelsson, Martin, Giedraitis, Vilmantas, Gaziano, J Michael, Shipley, Martin, Arndt, Volker, Cook, Nancy, Ibañez, Alejandro Marín, Geleijnse, Johanna M, Epidemiology, Læknadeild (HÍ), Faculty of Medicine (UI), Heilbrigðisvísindasvið (HÍ), School of Health Sciences (UI), Háskóli Íslands, University of Iceland, Pennells, Lisa [0000-0002-8594-3061], Kaptoge, Stephen [0000-0002-1155-4872], Wood, Angela [0000-0002-7937-304X], Sweeting, Michael [0000-0003-0980-8965], Zhao, Xiaohui [0000-0001-9922-2815], Burgess, Stephen [0000-0001-5365-8760], Danesh, John [0000-0003-1158-6791], Di Angelantonio, Emanuele [0000-0001-8776-6719], Apollo - University of Cambridge Repository, Nutrition and Health, APH - Aging & Later Life, APH - Societal Participation & Health, APH - Health Behaviors & Chronic Diseases, Cardiovascular Centre (CVC), Groningen Kidney Center (GKC), Groningen Institute for Organ Transplantation (GIOT), Lifestyle Medicine (LM), Life Course Epidemiology (LCE), AGEM - Endocrinology, metabolism and nutrition, Internal medicine, Epidemiology and Data Science, İÜC, Lisa, Pennell, Stephen, Kaptoge, Angela, Wood, Mike, Sweeting, Xiaohui, Zhao, Ian, White, Stephen, Burge, Peter, Willeit, Thomas, Bolton, Karel G M, Moon, Yvonne T, van der Schouw, Randi, Selmer, Kay-Tee, Khaw, Vilmundur, Gudnason, Gerd, Assmann, Philippe, Amouyel, Veikko, Salomaa, Mika, Kivimaki, Børge G, Nordestgaard, Michael J, Blaha, Lewis H, Kuller, Hermann, Brenner, Richard F, Gillum, Christa, Meisinger, Ian, Ford, Matthew W, Knuiman, Annika, Rosengren, Debbie A, Lawlor, Henry, Völzke, Cyrus, Cooper, Alejandro, Marín Ibañez, Edoardo, Casiglia, Jussi, Kauhanen, Jackie A, Cooper, Beatriz, Rodriguez, Johan, Sundström, Elizabeth, Barrett-Connor, Rachel, Dankner, Paul J, Nietert, Karina W, Davidson, Robert B, Wallace, Dan G, Blazer, Cecilia, Björkelund, Chiara, Donfrancesco, Harlan M, Krumholz, Aulikki, Nissinen, Barry R, Davi, Sean, Coady, Peter H, Whincup, Torben, Jørgensen, Pierre, Ducimetiere, Maurizio, Trevisan, Gunnar, Engström, Carlos J, Crespo, Tom W, Meade, Marjolein, Visser, Daan, Kromhout, Stefan, Kiechl, Makoto, Daimon, Jackie F, Price, Agustin, Gómez de la Cámara, J, Wouter Jukema, Benoît, Lamarche, Altan, Onat, Leon A, Simon, Maryam, Kavousi, Yoav, Ben-Shlomo, John, Gallacher, Jacqueline M, Dekker, Hisatomi, Arima, Nawar, Shara, Robert W, Tipping, Ronan, Roussel, Eric J, Brunner, Wolfgang, Koenig, Masaru, Sakurai, Jelena, Pavlovic, Ron T, Gansevoort, Dorothea, Nagel, Uri, Goldbourt, Elizabeth L M, Barr, Luigi, Palmieri, Inger, Njølstad, Shinichi, Sato, W M, Monique Verschuren, Cherian V, Varghese, Ian, Graham, Oyere, Onuma, Philip, Greenland, Mark, Woodward, Majid, Ezzati, Bruce M, Psaty, Sattar, W Tipping, Naveerobert, M Simpson, Lara, L Pressel, Sara, J Couper, David, Nambi, Vijay, Matsushita, Kunihiro, R Folsom, Aaron, E Shaw, Jonathan, J Magliano, Dianna, Z Zimmet, Paul, W Knuiman, Matthew, H Whincup, Peter, Goya Wannamethee, S, Willeit, Johann, Santer, Peter, Egger, Georg, Pablo Casas, Juan, Amuzu, Antoinette, Ben-Shlomo, Yoav, Gallacher, John, Tikhonoff, Valérie, Casiglia, Edoardo, E Sutherland, Susan, J Nietert, Paul, Cushman, Mary, M Psaty, Bruce, Johanne Søgaard, Anne, Lund Håheim, Lise, Ariansen, Inger, Tybjærg-Hansen, Anne, B Jensen, Gorm, Schnohr, Peter, Giampaoli, Simona, Vanuzzo, Diego, Panico, Salvatore, Palmieri, Luigi, Balkau, Beverley, Bonnet, Fabrice, Marre, Michel, Gómez de la Cámara, Agustin, Angel Rubio Herrera, Miguel, Friedlander, Yechiel, Mccallum, John, Mclachlan, Stela, Guralnik, Jack, L Phillips, Caroline, Khaw, Kay-Tee, Wareham, Nick, Schöttker, Ben, Saum, Kai-Uwe, Holleczek, Bernd, Nissinen, Aulikki, Tolonen, Hanna, Donfrancesco, Chiara, Vartiainen, Erkki, Jousilahti, Pekka, Harald, Kennet, B D’Agostino, Ralph, M Massaro, Joseph, Pencina, Michael, Vasan, Ramachandran, Kayama, Takamasa, Kato, Takeo, Oizumi, Toshihide, Jespersen, Jørgen, Møller, Lar, Marie Bladbjerg, Else, Chetrit, A, Rosengren, Annika, Wilhelmsen, Lar, Björkelund, Cecilia, Lissner, Lauren, Nagel, Dorothea, Dennison, Elaine, Kiyohara, Yutaka, Ninomiya, Toshiharu, Doi, Yasufumi, Rodriguez, Beatriz, Nijpels, Giel, A Stehouwer, Coen D, Sato, Shinichi, Kazumasa, Yamagishi, Iso, Hiroyasu, Goldbourt, Uri, Salomaa, Veikko, Kurl, Sudhir, Tuomainen, Tomi-Pekka, T Salonen, Jukka, Visser, Marjolein, H Deeg, Dorly J, W Meade, Tom, M Nilsson, Peter, Hedblad, Bo, Melander, Olle, H De Boer, Ian, Paul DeFilippis, Andrew, M Monique Verschuren, W, Sattar, Naveed, Watt, Graham, Meisinger, Christa, Koenig, Wolfgang, H Kuller, Lewi, Tverdal, Aage, F Gillum, Richard, A Cooper, Jackie, Kirkland, Susan, Shimbo, Daichi, Shaffer, Jonathan, Ducimetiere, Pierre, L Bakker, Stephan J, van der Harst, Pim, L Hillege, Han, J Crespo, Carlo, Amouyel, Philippe, Dallongeville, Jean, Assmann, Gerd, Schulte, Helmut, Trompet, Stella, J Smit, Roelof A, J Stott, David, T van der Schouw, Yvonne, Després, Jean-Pierre, Cantin, Bernard, R Dagenais, Gille, Laughlin, Gail, Wingard, Deborah, Trevisan, Maurizio, Aspelund, Thor, Eiriksdottir, Gudny, Freyr Gudmundsson, Elia, Ikram, Arfan, A van Rooij, Frank J, H Franco, Oscar, L Rueda-Ochoa, Oscar, Muka, Taulant, Glisic, Marija, Tunstall-Pedoe, Hugh, Völzke, Henry, V Howard, Barbara, Zhang, Ying, Jolly, Stacey, Davey-Smith, George, Can, Günay, Yüksel, Hüsniye, Nakagawa, Hideaki, Morikawa, Yuko, Miura, Katsuyuki, Njølstad, Inger, Ingelsson, Martin, Giedraitis, Vilmanta, M Ridker, Paul, Michael Gaziano, J, Kivimaki, Mika, Shipley, Martin, J Brunner, Eric, Arndt, Volker, Brenner, Hermann, Cook, Nancy, Ford, Ian, Marín Ibañez, Alejandro, M Geleijnsed, Johanna, Rod, Jackson, Paul M, Ridker, Nancy R, Cook, Ralph B, D'Agostino, Simon G, Thompson, John, Danesh, and Emanuele, Di Angelantonio
Subjects: Male, Cardiac & Cardiovascular Systems, Nutrition and Disease, Prevention and Epidemiology, PREDICTION, Áhættuþættir, 030204 cardiovascular system & hematology, GUIDELINES, 0302 clinical medicine, Risk Factors, Voeding en Ziekte, FRAMINGHAM, Discrimination, Medicine, Cardiac and Cardiovascular Systems, Blóðrásarsjúkdómar, Prospective Studies, Prospective cohort study, Non-U.S. Gov't, 1102 Cardiorespiratory Medicine and Haematology, CALIBRATION, Kardiologi, Framingham Risk Score, Emerging Risk Factors Collaboration, SCORES, Research Support, Non-U.S. Gov't, Incidence (epidemiology), Middle Aged, Cardiovascular disease, Justice and Strong Institutions, Risk prediction, ddc, 3. Good health, Cardiovascular Diseases, Meta-analysis, Cohort, Calibration, Female, Risk assessment, Cardiology and Cardiovascular Medicine, Algorithm, Life Sciences & Biomedicine, Algorithms, SDG 16 - Peace, Risk algorithms, DISEASE PREVENTION, Research Support, Risk Assessment, VALIDATION, 03 medical and health sciences, Clinical Research, Journal Article, Humans, ddc:610, Risk factor, VLAG, Aged, Science & Technology, business.industry, SDG 16 - Peace, Justice and Strong Institutions, 030229 sport sciences, R1, STATIN USE, Cardiovascular System & Hematology, Cardiovascular System & Cardiology, business, PRIMARY PREVENTION, TASK-FORCE
Abstract: Publisher's version (útgefin grein), Aims: There is debate about the optimum algorithm for cardiovascular disease (CVD) risk estimation. We conducted head-to-head comparisons of four algorithms recommended by primary prevention guidelines, before and after 'recalibration', a method that adapts risk algorithms to take account of differences in the risk characteristics of the populations being studied. Methods and results: Using individual-participant data on 360 737 participants without CVD at baseline in 86 prospective studies from 22 countries, we compared the Framingham risk score (FRS), Systematic COronary Risk Evaluation (SCORE), pooled cohort equations (PCE), and Reynolds risk score (RRS). We calculated measures of risk discrimination and calibration, and modelled clinical implications of initiating statin therapy in people judged to be at 'high' 10 year CVD risk. Original risk algorithms were recalibrated using the risk factor profile and CVD incidence of target populations. The four algorithms had similar risk discrimination. Before recalibration, FRS, SCORE, and PCE over-predicted CVD risk on average by 10%, 52%, and 41%, respectively, whereas RRS under-predicted by 10%. Original versions of algorithms classified 29-39% of individuals aged ≥40 years as high risk. By contrast, recalibration reduced this proportion to 22-24% for every algorithm. We estimated that to prevent one CVD event, it would be necessary to initiate statin therapy in 44-51 such individuals using original algorithms, in contrast to 37-39 individuals with recalibrated algorithms. Conclusion: Before recalibration, the clinical performance of four widely used CVD risk algorithms varied substantially. By contrast, simple recalibration nearly equalized their performance and improved modelled targeting of preventive action to clinical need., The work of the co-ordinating centre was funded by the UK Medical Research Council (G0800270), British Heart Foundation (SP/09/ 002), British Heart Foundation Cambridge Cardiovascular Centre of Excellence, UK National Institute for Health Research Cambridge Biomedical Research Centre, European Research Council (268834), and European Commission Framework Programme 7 (HEALTH-F2-2012-279233). The Emerging Risk Factor Collaboration’s website https://www.phpc.cam.ac.uk/ceu/erfc/list-of-studies/ has compiled a list provided by investigators of some of the funders of the component studies in this analysis. I.W. was supported by the Medical Research Council Unit Programme MC_UU_12023/21. M.K. is supported by the Netherlands Organization for Scientific Research (NWO) Veni grant (Veni, 91616079). J.P. is supported by Erasmus Mundus Western Balkans (ERAWEB), a project funded by the European Commission.
Published: 2019

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