Search

Your search keyword '"Woodward, M."' showing total 3,579 results
Start Over Author "Woodward, M."
3,579 results on '"Woodward, M."'

54. Recurrent atherosclerotic cardiovascular disease events preventable with guideline recommended lipid-lowering treatment following myocardial infarction

Author

Sakhuja, S, primary, Bittner, V A, additional, Brown, T M, additional, Farkouh, M E, additional, Levitan, E B, additional, Rosenson, R, additional, Safford, M M, additional, Muntner, P, additional, Chen, L, additional, Sun, R, additional, Noshad, S, additional, Dhalwani, N, additional, Woodward, M, additional, and Colantonio, L D, additional

Published
2022
Full Text
View/download PDF

59. The comparative effects of intensive glucose lowering in diabetes patients aged below or above 65 years: Results from the ADVANCE trial

Author

Ohkuma, T, Chalmers, J, Cooper, M, Hamet, P, Harrap, S, Marre, M, Mancia, G, Poulter, N, Woodward, M, Ohkuma T., Chalmers J., Cooper M., Hamet P., Harrap S., Marre M., Mancia G., Poulter N., Woodward M., Ohkuma, T, Chalmers, J, Cooper, M, Hamet, P, Harrap, S, Marre, M, Mancia, G, Poulter, N, Woodward, M, Ohkuma T., Chalmers J., Cooper M., Hamet P., Harrap S., Marre M., Mancia G., Poulter N., and Woodward M.

Abstract

Aims: For relatively old patients with diabetes, current guidelines recommend adjustment of glycaemic goals based on patients' cognitive function, or coexisting chronic illnesses. However, the evidence which supports the efficacy and safety of intensive glucose lowering in older patients with diabetes is scarce. The objective of the present study was to compare the efficacy and safety of intensive glucose lowering in patients with type 2 diabetes stratified by age (<65 and ≥ 65 years), and examine whether the effects differ according to patients’ characteristics in the older patient group. Materials and Methods: The effects of intensive glucose lowering (to a target glycated haemoglobin [HbA1c] concentration of ≤48 mmol/mol [6.5%]) on major clinical outcomes were evaluated by Cox regression models according to subgroups defined by baseline age of <65 or ≥ 65 years in the ADVANCE trial (n = 11 140). Results: Over a median follow-up of 5 years, intensive glucose lowering significantly decreased the risk of the composite of major macrovascular and microvascular events (hazard ratio 0.90, 95% confidence interval 0.82-0.98), with no heterogeneity in the effects across age subgroups (p for heterogeneity = 0.44). Relative effects on all-cause death, cardiovascular death, and components of major vascular events were also similar (P for heterogeneity ≥0.06), except for severe hypoglycaemia, which was of greater risk for patients aged <65 years. Absolute benefits and harms were broadly consistent across subgroups. Among patients aged ≥65 years, randomized treatment effects did not differ significantly across different levels of cognitive function or coexisting chronic illnesses. Conclusions: Our results suggest that an intensive glycaemic control strategy to reduce HbA1c to 48 mmol/mol (6.5%) provided broadly similar benefits and harms and may be recommended for older, as well as younger, patients.

Published
2021

60. History of lower-limb complications and risk of cancer death in people with type 2 diabetes

Author

Mohammedi, K, Harrap, S, Mancia, G, Marre, M, Poulter, N, Chalmers, J, Woodward, M, Mohammedi K., Harrap S., Mancia G., Marre M., Poulter N., Chalmers J., Woodward M., Mohammedi, K, Harrap, S, Mancia, G, Marre, M, Poulter, N, Chalmers, J, Woodward, M, Mohammedi K., Harrap S., Mancia G., Marre M., Poulter N., Chalmers J., and Woodward M.

Abstract

Background: Individuals with diabetes and lower-limb complications are at high risk for cardiovascular and all-cause mortality, but uncertainties remain in terms of cancer-related death in this population. We investigated this relationship in a large cohort of people with type 2 diabetes. Methods: We used data from the Action in Diabetes and Vascular Disease: PreterAx and DiamicroN Modified-Release Controlled Evaluation (ADVANCE) study. The primary outcome was adjudicated cancer death; secondary outcomes were overall and site-specific incident cancers, determined according to the International Classification of Diseases Code (ICD-10). We compared outcomes in individuals with (versus without) a baseline history of lower-limb complications (peripheral artery disease (PAD) or sensory peripheral neuropathy) using Cox regression models. Results: Among 11,140 participants (women 42%, mean age 66 years), lower-limb complications were reported at baseline in 4293 (38%) individuals: 2439 (22%) with PAD and 2973 (27%) with peripheral neuropathy. Cancer death occurred in 316 (2.8%) participants during a median of 5.0 (25th–75th percentile, 4.7–5.1) years of follow-up corresponding to 53,550 person-years and an incidence rate of 5.9 (95% CI 5.3–6.6) per 1000 person-years. The risk of cancer death was higher in individuals with (versus without) lower-limb complication [hazard ratio 1.53 (95% CI, 1.21–1.94), p = 0.0004], PAD [1.32 (1.02–1.70), p = 0.03] or neuropathy (1.41 (1.11–1.79), p = 0.004], adjusting for potential confounders and study allocations. PAD, but not neuropathy, was associated with excess risk of incident cancers. Conclusions: PAD and peripheral neuropathy were independently associated with increased 5-year risk of cancer death in individuals with type 2 diabetes. PAD was also associated with increased risk of incident cancers. Our findings provide new evidence on the non-cardiovascular prognostic burden of lower-limb complications in people with type 2 dia

Published
2021

61. Polygenic risk scores predict diabetes complications and their response to intensive blood pressure and glucose control

Author

Tremblay, J, Haloui, M, Attaoua, R, Tahir, R, Hishmih, C, Harvey, F, Marois-Blanchet, F, Long, C, Simon, P, Santucci, L, Hizel, C, Chalmers, J, Marre, M, Harrap, S, Cifkova, R, Krajcoviechova, A, Matthews, D, Williams, B, Poulter, N, Zoungas, S, Colagiuri, S, Mancia, G, Grobbee, D, Rodgers, A, Liu, L, Agbessi, M, Bruat, V, Fave, M, Harwood, M, Awadalla, P, Woodward, M, Hussin, J, Hamet, P, Tremblay J., Haloui M., Attaoua R., Tahir R., Hishmih C., Harvey F., Marois-Blanchet F. -C., Long C., Simon P., Santucci L., Hizel C., Chalmers J., Marre M., Harrap S., Cifkova R., Krajcoviechova A., Matthews D. R., Williams B., Poulter N., Zoungas S., Colagiuri S., Mancia G., Grobbee D. E., Rodgers A., Liu L., Agbessi M., Bruat V., Fave M. -J., Harwood M. P., Awadalla P., Woodward M., Hussin J. G., Hamet P., Tremblay, J, Haloui, M, Attaoua, R, Tahir, R, Hishmih, C, Harvey, F, Marois-Blanchet, F, Long, C, Simon, P, Santucci, L, Hizel, C, Chalmers, J, Marre, M, Harrap, S, Cifkova, R, Krajcoviechova, A, Matthews, D, Williams, B, Poulter, N, Zoungas, S, Colagiuri, S, Mancia, G, Grobbee, D, Rodgers, A, Liu, L, Agbessi, M, Bruat, V, Fave, M, Harwood, M, Awadalla, P, Woodward, M, Hussin, J, Hamet, P, Tremblay J., Haloui M., Attaoua R., Tahir R., Hishmih C., Harvey F., Marois-Blanchet F. -C., Long C., Simon P., Santucci L., Hizel C., Chalmers J., Marre M., Harrap S., Cifkova R., Krajcoviechova A., Matthews D. R., Williams B., Poulter N., Zoungas S., Colagiuri S., Mancia G., Grobbee D. E., Rodgers A., Liu L., Agbessi M., Bruat V., Fave M. -J., Harwood M. P., Awadalla P., Woodward M., Hussin J. G., and Hamet P.

Abstract

Aims/hypothesis: Type 2 diabetes increases the risk of cardiovascular and renal complications, but early risk prediction could lead to timely intervention and better outcomes. Genetic information can be used to enable early detection of risk. Methods: We developed a multi-polygenic risk score (multiPRS) that combines ten weighted PRSs (10 wPRS) composed of 598 SNPs associated with main risk factors and outcomes of type 2 diabetes, derived from summary statistics data of genome-wide association studies. The 10 wPRS, first principal component of ethnicity, sex, age at onset and diabetes duration were included into one logistic regression model to predict micro- and macrovascular outcomes in 4098 participants in the ADVANCE study and 17,604 individuals with type 2 diabetes in the UK Biobank study. Results: The model showed a similar predictive performance for cardiovascular and renal complications in different cohorts. It identified the top 30% of ADVANCE participants with a mean of 3.1-fold increased risk of major micro- and macrovascular events (p = 6.3 × 10−21 and p = 9.6 × 10−31, respectively) and a 4.4-fold (p = 6.8 × 10−33) higher risk of cardiovascular death. While in ADVANCE overall, combined intensive blood pressure and glucose control decreased cardiovascular death by 24%, the model identified a high-risk group in whom it decreased the mortality rate by 47%, and a low-risk group in whom it had no discernible effect. High-risk individuals had the greatest absolute risk reduction with a number needed to treat of 12 to prevent one cardiovascular death over 5 years. Conclusions/interpretation: This novel multiPRS model stratified individuals with type 2 diabetes according to risk of complications and helped to target earlier those who would receive greater benefit from intensive therapy. Graphical abstract: [Figure not available: see fulltext.]

Published
2021

62. Age-stratified and blood-pressure-stratified effects of blood-pressure-lowering pharmacotherapy for the prevention of cardiovascular disease and death: an individual participant-level data meta-analysis

Author

Rahimi, K, Bidel, Z, Nazarzadeh, M, Copland, E, Canoy, D, Wamil, M, Majert, J, Mcmanus, R, Adler, A, Agodoa, L, Algra, A, Asselbergs, F, Beckett, N, Berge, E, Black, H, Boersma, E, Brouwers, F, Brown, M, Brugts, J, Bulpitt, C, Byington, R, Cushman, W, Cutler, J, Devereaux, R, Dwyer, J, Estacio, R, Fagard, R, Fox, K, Fukui, T, Gupta, A, Holman, R, Imai, Y, Ishii, M, Julius, S, Kanno, Y, Kjeldsen, S, Kostis, J, Kuramoto, K, Lanke, J, Lewis, E, Lewis, J, Lievre, M, Lindholm, L, Lueders, S, Macmahon, S, Mancia, G, Matsuzaki, M, Mehlum, M, Nissen, S, Ogawa, H, Ogihara, T, Ohkubo, T, Palmer, C, Patel, A, Pfeffer, M, Pitt, B, Poulter, N, Rakugi, H, Reboldi, G, Reid, C, Remuzzi, G, Ruggenenti, P, Saruta, T, Schrader, J, Schrier, R, Sever, P, Sleight, P, Staessen, J, Suzuki, H, Thijs, L, Ueshima, K, Umemoto, S, van Gilst, W, Verdecchia, P, Wachtell, K, Whelton, P, Wing, L, Woodward, M, Yui, Y, Yusuf, S, Zanchetti, A, Zhang, Z, Anderson, C, Baigent, C, Brenner, B, Collins, R, de Zeeuw, D, Lubsen, J, Malacco, E, Neal, B, Perkovic, V, Rodgers, A, Rothwell, P, Salimi-Khorshidi, G, Sundstrom, J, Turnbull, F, Viberti, G, Wang, J, Chalmers, J, Davis, B, Pepine, C, Teo, K, Rahimi K., Bidel Z., Nazarzadeh M., Copland E., Canoy D., Wamil M., Majert J., McManus R., Adler A., Agodoa L., Algra A., Asselbergs F. W., Beckett N. S., Berge E., Black H., Boersma E., Brouwers F. P. J., Brown M., Brugts J. J., Bulpitt C. J., Byington R. P., Cushman W. C., Cutler J., Devereaux R. B., Dwyer J. P., Estacio R., Fagard R., Fox K., Fukui T., Gupta A. K., Holman R. R., Imai Y., Ishii M., Julius S., Kanno Y., Kjeldsen S. E., Kostis J., Kuramoto K., Lanke J., Lewis E., Lewis J. B., Lievre M., Lindholm L. H., Lueders S., MacMahon S., Mancia G., Matsuzaki M., Mehlum M. H., Nissen S., Ogawa H., Ogihara T., Ohkubo T., Palmer C. R., Patel A., Pfeffer M. A., Pitt B., Poulter N. R., Rakugi H., Reboldi G., Reid C., Remuzzi G., Ruggenenti P., Saruta T., Schrader J., Schrier R., Sever P., Sleight P., Staessen J. A., Suzuki H., Thijs L., Ueshima K., Umemoto S., van Gilst W. H., Verdecchia P., Wachtell K., Whelton P., Wing L., Woodward M., Yui Y., Yusuf S., Zanchetti A., Zhang Z. -Y., Anderson C., Baigent C., Brenner B. M., Collins R., de Zeeuw D., Lubsen J., Malacco E., Neal B., Perkovic V., Rodgers A., Rothwell P., Salimi-Khorshidi G., Sundstrom J., Turnbull F., Viberti G., Wang J., Chalmers J., Davis B. R., Pepine C. J., Teo K. K., Rahimi, K, Bidel, Z, Nazarzadeh, M, Copland, E, Canoy, D, Wamil, M, Majert, J, Mcmanus, R, Adler, A, Agodoa, L, Algra, A, Asselbergs, F, Beckett, N, Berge, E, Black, H, Boersma, E, Brouwers, F, Brown, M, Brugts, J, Bulpitt, C, Byington, R, Cushman, W, Cutler, J, Devereaux, R, Dwyer, J, Estacio, R, Fagard, R, Fox, K, Fukui, T, Gupta, A, Holman, R, Imai, Y, Ishii, M, Julius, S, Kanno, Y, Kjeldsen, S, Kostis, J, Kuramoto, K, Lanke, J, Lewis, E, Lewis, J, Lievre, M, Lindholm, L, Lueders, S, Macmahon, S, Mancia, G, Matsuzaki, M, Mehlum, M, Nissen, S, Ogawa, H, Ogihara, T, Ohkubo, T, Palmer, C, Patel, A, Pfeffer, M, Pitt, B, Poulter, N, Rakugi, H, Reboldi, G, Reid, C, Remuzzi, G, Ruggenenti, P, Saruta, T, Schrader, J, Schrier, R, Sever, P, Sleight, P, Staessen, J, Suzuki, H, Thijs, L, Ueshima, K, Umemoto, S, van Gilst, W, Verdecchia, P, Wachtell, K, Whelton, P, Wing, L, Woodward, M, Yui, Y, Yusuf, S, Zanchetti, A, Zhang, Z, Anderson, C, Baigent, C, Brenner, B, Collins, R, de Zeeuw, D, Lubsen, J, Malacco, E, Neal, B, Perkovic, V, Rodgers, A, Rothwell, P, Salimi-Khorshidi, G, Sundstrom, J, Turnbull, F, Viberti, G, Wang, J, Chalmers, J, Davis, B, Pepine, C, Teo, K, Rahimi K., Bidel Z., Nazarzadeh M., Copland E., Canoy D., Wamil M., Majert J., McManus R., Adler A., Agodoa L., Algra A., Asselbergs F. W., Beckett N. S., Berge E., Black H., Boersma E., Brouwers F. P. J., Brown M., Brugts J. J., Bulpitt C. J., Byington R. P., Cushman W. C., Cutler J., Devereaux R. B., Dwyer J. P., Estacio R., Fagard R., Fox K., Fukui T., Gupta A. K., Holman R. R., Imai Y., Ishii M., Julius S., Kanno Y., Kjeldsen S. E., Kostis J., Kuramoto K., Lanke J., Lewis E., Lewis J. B., Lievre M., Lindholm L. H., Lueders S., MacMahon S., Mancia G., Matsuzaki M., Mehlum M. H., Nissen S., Ogawa H., Ogihara T., Ohkubo T., Palmer C. R., Patel A., Pfeffer M. A., Pitt B., Poulter N. R., Rakugi H., Reboldi G., Reid C., Remuzzi G., Ruggenenti P., Saruta T., Schrader J., Schrier R., Sever P., Sleight P., Staessen J. A., Suzuki H., Thijs L., Ueshima K., Umemoto S., van Gilst W. H., Verdecchia P., Wachtell K., Whelton P., Wing L., Woodward M., Yui Y., Yusuf S., Zanchetti A., Zhang Z. -Y., Anderson C., Baigent C., Brenner B. M., Collins R., de Zeeuw D., Lubsen J., Malacco E., Neal B., Perkovic V., Rodgers A., Rothwell P., Salimi-Khorshidi G., Sundstrom J., Turnbull F., Viberti G., Wang J., Chalmers J., Davis B. R., Pepine C. J., and Teo K. K.

Abstract

Background: The effects of pharmacological blood-pressure-lowering on cardiovascular outcomes in individuals aged 70 years and older, particularly when blood pressure is not substantially increased, is uncertain. We compared the effects of blood-pressure-lowering treatment on the risk of major cardiovascular events in groups of patients stratified by age and blood pressure at baseline. Methods: We did a meta-analysis using individual participant-level data from randomised controlled trials of pharmacological blood-pressure-lowering versus placebo or other classes of blood-pressure-lowering medications, or between more versus less intensive treatment strategies, which had at least 1000 persons-years of follow-up in each treatment group. Participants with previous history of heart failure were excluded. Data were obtained from the Blood Pressure Lowering Treatment Triallists' Collaboration. We pooled the data and categorised participants into baseline age groups (<55 years, 55–64 years, 65–74 years, 75–84 years, and ≥85 years) and blood pressure categories (in 10 mm Hg increments from <120 mm Hg to ≥170 mm Hg systolic blood pressure and from <70 mm Hg to ≥110 mm Hg diastolic). We used a fixed effects one-stage approach and applied Cox proportional hazard models, stratified by trial, to analyse the data. The primary outcome was defined as either a composite of fatal or non-fatal stroke, fatal or non-fatal myocardial infarction or ischaemic heart disease, or heart failure causing death or requiring hospital admission. Findings: We included data from 358 707 participants from 51 randomised clinical trials. The age of participants at randomisation ranged from 21 years to 105 years (median 65 years [IQR 59–75]), with 42 960 (12·0%) participants younger than 55 years, 128 437 (35·8%) aged 55–64 years, 128 506 (35·8%) 65–74 years, 54 016 (15·1%) 75–84 years, and 4788 (1·3%) 85 years and older. The hazard ratios for the risk of major cardiovascular events per 5 mm Hg

Published
2021

63. The impact of frailty on the effectiveness and safety of intensive glucose control and blood pressure-lowering therapy for people with type 2 diabetes: Results from the ADVANCE trial

Author

Nguyen, T, Harris, K, Woodward, M, Chalmers, J, Cooper, M, Hamet, P, Harrap, S, Heller, S, Macmahon, S, Mancia, G, Marre, M, Poulter, N, Rogers, A, Williams, B, Zoungas, S, Chow, C, Lindley, R, Nguyen T. N., Harris K., Woodward M., Chalmers J., Cooper M., Hamet P., Harrap S., Heller S., MacMahon S., Mancia G., Marre M., Poulter N., Rogers A., Williams B., Zoungas S., Chow C. K., Lindley R. I., Nguyen, T, Harris, K, Woodward, M, Chalmers, J, Cooper, M, Hamet, P, Harrap, S, Heller, S, Macmahon, S, Mancia, G, Marre, M, Poulter, N, Rogers, A, Williams, B, Zoungas, S, Chow, C, Lindley, R, Nguyen T. N., Harris K., Woodward M., Chalmers J., Cooper M., Hamet P., Harrap S., Heller S., MacMahon S., Mancia G., Marre M., Poulter N., Rogers A., Williams B., Zoungas S., Chow C. K., and Lindley R. I.

Abstract

OBJECTIVE To develop a frailty index (FI) and explore the relationship of frailty to subsequent adverse outcomes on the effectiveness and safety of more intensive control of both blood glucose and blood pressure (BP), among participants with type 2 diabetes in the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation (ADVANCE) trial. RESEARCH DESIGN AND METHODS Cox proportional hazard models were used to estimate the effectiveness and safety of intensive glucose control and BP intervention according to frailty (defined as FI >0.21) status. The primary outcomes were macro- and microvascular events. The secondary outcomes were all-cause mortality, cardiovascular mortality, severe hypoglycemia, and discontinuation of BP treatment due to hypotension/dizziness. RESULTS There were 11,140 participants (mean age, 65.8 years; 42.5% women, 25.7% frail). Frailty was an independent predictor of all primary outcomes and secondary outcomes. The effect of intensive glucose treatment on primary outcomes showed some evidence of attenuation in the frail: hazard ratios for combined major macro- and microvascular events 1.03 (95% CI 0.90-1.19) in the frail versus 0.84 (95% CI 0.74-0.94) in the nonfrail (P = 0.02). A similar trend was observed with BP intervention. Severe hypoglycemia rates (per 1,000 person-years) were higher in the frail: 8.39 (6.15-10.63) vs. 4.80 (3.84-5.76) in nonfrail (P < 0.001). There was no significant difference in discontinuation of BP treatment between frailty groups. CONCLUSIONS It was possible to retrospectively estimate frailty in a trial population, and this FI identified those at higher risk of poor outcomes. Participants with frailty had some attenuation of benefit from intensive glucose-lowering and BP-lowering treatments.

Published
2021

64. Sex differences in risk factors for cognitive decline and dementia, including death as a competing risk, in individuals with diabetes: Results from the ADVANCE trial

Author

Gong, J, Harris, K, Hackett, M, Peters, S, Brodaty, H, Cooper, M, Hamet, P, Harrap, S, Mancia, G, Macmahon, S, Chalmers, J, Woodward, M, Gong J., Harris K., Hackett M., Peters S. A. E., Brodaty H., Cooper M., Hamet P., Harrap S., Mancia G., MacMahon S., Chalmers J., Woodward M., Gong, J, Harris, K, Hackett, M, Peters, S, Brodaty, H, Cooper, M, Hamet, P, Harrap, S, Mancia, G, Macmahon, S, Chalmers, J, Woodward, M, Gong J., Harris K., Hackett M., Peters S. A. E., Brodaty H., Cooper M., Hamet P., Harrap S., Mancia G., MacMahon S., Chalmers J., and Woodward M.

Abstract

Aim: To estimate the associations between risk factors and cognitive decline (CD)/dementia, and the sex differences in these risk factors in individuals with type 2 diabetes, while accounting for the competing risk of death. Materials and Methods: The Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation (ADVANCE) trial of 11,140 individuals with type 2 diabetes was used to estimate the odds of CD/dementia using multinomial logistic regression. Results: During a median 5-year follow-up, 1827 participants (43.2% women) had CD/dementia (1718 with CD only; 21 with dementia only; 88 with CD and dementia), and 929 (31.0% women) died without CD/dementia. Women had lower odds of CD/dementia than men (odds ratio [OR] [95% confidence interval], 0.88 [0.77, 1.00]); older age, higher total cholesterol, HbA1c, waist circumference, waist-to-height ratio, moderately increased albumin-creatinine ratio, stroke/transient ischaemic attack and retinal disease were each associated with greater odds of CD/dementia; higher years at education completion, baseline cognitive function, taller stature and current alcohol use were inversely associated. Higher waist circumference (women-to-men ratio of ORs [ROR], 1.05 [1.00, 1.10] per 5 cm) and presence of anxiety/depression (ROR, 1.28 [1.01, 1.63]) were associated with greater ORs for CD/dementia in women than men. Conclusions: Several risk factors were associated with CD/dementia. Higher waist circumference and mental health symptoms were more strongly associated with CD/dementia in women than men. Further studies should examine the mechanisms that underlie these sex differences.

Published
2021

65. Combination blood pressure lowering in the presence or absence of background statin and aspirin therapy: a combined analysis of PROGRESS and ADVANCE Trials

Author

Wang, N, Harris, K, Chalmers, J, Harrap, S, Mancia, G, Marre, M, Poulter, N, Tzourio, C, Williams, B, Zoungas, S, Woodward, M, Rodgers, A, Wang N., Harris K., Chalmers J., Harrap S., Mancia G., Marre M., Poulter N., Tzourio C., Williams B., Zoungas S., Woodward M., Rodgers A., Wang, N, Harris, K, Chalmers, J, Harrap, S, Mancia, G, Marre, M, Poulter, N, Tzourio, C, Williams, B, Zoungas, S, Woodward, M, Rodgers, A, Wang N., Harris K., Chalmers J., Harrap S., Mancia G., Marre M., Poulter N., Tzourio C., Williams B., Zoungas S., Woodward M., and Rodgers A.

Abstract

Objectives:To assess the effects of combination BP lowering on cardiovascular events and mortality in the presence of aspirin and/or statin therapy in a combined analysis of the ADVANCE and PROGRESS trials.Methods:We conducted an analysis of 14 682 participants allocated combination therapy with perindopril and indapamide or placebo followed up for a mean of 4.2 years. Participants were stratified into four groups defined by background use of medications at baseline: statin, aspirin, both or neither. Linear mixed effect models were used to assess differences in BP and Cox proportional hazard models were used to estimate the risks of major cardiovascular events, all-cause mortality and treatment discontinuation.Results:At baseline, 14% of patients were on both aspirin and statin, 35% on aspirin, 9% on statins and 42% on neither aspirin/statins. Compared with placebo, combination BP therapy reduced mean SBP by 5.7 mmHg in ADVANCE and 12.1 mmHg in PROGRESS, with no difference (P > 0.447) between patients by baseline use of aspirin/statin. Combination BP therapy reduced the risk of major cardiovascular events (hazard ratio 0.78, 95% CI 0.71-0.86), with no significant difference (P = 0.600) between aspirin/statin subgroups. Rates of treatment discontinuation were similar with combination BP therapy compared with placebo (18.4 versus 18%), with no evidence of difference across the subgroups (P = 0.340). Conclusion:BP lowering with perindopril and indapamide reduces the risk of major cardiovascular events independent of baseline use of aspirin and/or statins.

Published
2021

66. Pharmacological blood pressure lowering for primary and secondary prevention of cardiovascular disease across different levels of blood pressure: an individual participant-level data meta-analysis

Author

Adler, A, Agodoa, L, Algra, A, Asselbergs, F, Beckett, N, Berge, E, Black, H, Brouwers, F, Brown, M, Bulpitt, C, Byington, R, Chalmers, J, Cushman, W, Cutler, J, Davis, B, Devereaux, R, Dwyer, J, Estacio, R, Fagard, R, Fox, K, Fukui, T, Gupta, A, Holman, R, Imai, Y, Ishii, M, Julius, S, Kanno, Y, Kjeldsen, S, Kostis, J, Kuramoto, K, Lanke, J, Lewis, E, Lewis, J, Lievre, M, Lindholm, L, Lueders, S, Macmahon, S, Mancia, G, Matsuzaki, M, Mehlum, M, Nissen, S, Ogawa, H, Ogihara, T, Ohkubo, T, Palmer, C, Patel, A, Pepine, C, Pfeffer, M, Pitt, B, Poulter, N, Rakugi, H, Reboldi, G, Reid, C, Remuzzi, G, Ruggenenti, P, Saruta, T, Schrader, J, Schrier, R, Sever, P, Sleight, P, Staessen, J, Suzuki, H, Thijs, L, Ueshima, K, Umemoto, S, van Gilst, W, Verdecchia, P, Wachtell, K, Whelton, P, Wing, L, Woodward, M, Yui, Y, Yusuf, S, Zanchetti, A, Zhang, Z, Anderson, C, Baigent, C, Brenner, B, Collins, R, de Zeeuw, D, Lubsen, J, Malacco, E, Neal, B, Perkovic, V, Rodgers, A, Rothwell, P, Salimi-Khorshidi, G, Sundstrom, J, Turnbull, F, Viberti, G, Wang, J, Adler A., Agodoa L., Algra A., Asselbergs F. W., Beckett N. S., Berge E., Black H., Brouwers F. P. J., Brown M., Bulpitt C. J., Byington R. P., Chalmers J., Cushman W. C., Cutler J., Davis B. R., Devereaux R. B., Dwyer J., Estacio R., Fagard R., Fox K., Fukui T., Gupta A. K., Holman R. R., Imai Y., Ishii M., Julius S., Kanno Y., Kjeldsen S. E., Kostis J., Kuramoto K., Lanke J., Lewis E., Lewis J. B., Lievre M., Lindholm L. H., Lueders S., MacMahon S., Mancia G., Matsuzaki M., Mehlum M. H., Nissen S., Ogawa H., Ogihara T., Ohkubo T., Palmer C. R., Patel A., Pepine C. J., Pfeffer M. A., Pitt B., Poulter N. R., Rakugi H., Reboldi G., Reid C., Remuzzi G., Ruggenenti P., Saruta T., Schrader J., Schrier R., Sever P., Sleight P., Staessen J. A., Suzuki H., Thijs L., Ueshima K., Umemoto S., van Gilst W. H., Verdecchia P., Wachtell K., Whelton P., Wing L., Woodward M., Yui Y., Yusuf S., Zanchetti A., Zhang Z. -Y., Anderson C., Baigent C., Brenner B. M., Collins R., de Zeeuw D., Lubsen J., Malacco E., Neal B., Perkovic V., Rodgers A., Rothwell P., Salimi-Khorshidi G., Sundstrom J., Turnbull F., Viberti G., Wang J., Adler, A, Agodoa, L, Algra, A, Asselbergs, F, Beckett, N, Berge, E, Black, H, Brouwers, F, Brown, M, Bulpitt, C, Byington, R, Chalmers, J, Cushman, W, Cutler, J, Davis, B, Devereaux, R, Dwyer, J, Estacio, R, Fagard, R, Fox, K, Fukui, T, Gupta, A, Holman, R, Imai, Y, Ishii, M, Julius, S, Kanno, Y, Kjeldsen, S, Kostis, J, Kuramoto, K, Lanke, J, Lewis, E, Lewis, J, Lievre, M, Lindholm, L, Lueders, S, Macmahon, S, Mancia, G, Matsuzaki, M, Mehlum, M, Nissen, S, Ogawa, H, Ogihara, T, Ohkubo, T, Palmer, C, Patel, A, Pepine, C, Pfeffer, M, Pitt, B, Poulter, N, Rakugi, H, Reboldi, G, Reid, C, Remuzzi, G, Ruggenenti, P, Saruta, T, Schrader, J, Schrier, R, Sever, P, Sleight, P, Staessen, J, Suzuki, H, Thijs, L, Ueshima, K, Umemoto, S, van Gilst, W, Verdecchia, P, Wachtell, K, Whelton, P, Wing, L, Woodward, M, Yui, Y, Yusuf, S, Zanchetti, A, Zhang, Z, Anderson, C, Baigent, C, Brenner, B, Collins, R, de Zeeuw, D, Lubsen, J, Malacco, E, Neal, B, Perkovic, V, Rodgers, A, Rothwell, P, Salimi-Khorshidi, G, Sundstrom, J, Turnbull, F, Viberti, G, Wang, J, Adler A., Agodoa L., Algra A., Asselbergs F. W., Beckett N. S., Berge E., Black H., Brouwers F. P. J., Brown M., Bulpitt C. J., Byington R. P., Chalmers J., Cushman W. C., Cutler J., Davis B. R., Devereaux R. B., Dwyer J., Estacio R., Fagard R., Fox K., Fukui T., Gupta A. K., Holman R. R., Imai Y., Ishii M., Julius S., Kanno Y., Kjeldsen S. E., Kostis J., Kuramoto K., Lanke J., Lewis E., Lewis J. B., Lievre M., Lindholm L. H., Lueders S., MacMahon S., Mancia G., Matsuzaki M., Mehlum M. H., Nissen S., Ogawa H., Ogihara T., Ohkubo T., Palmer C. R., Patel A., Pepine C. J., Pfeffer M. A., Pitt B., Poulter N. R., Rakugi H., Reboldi G., Reid C., Remuzzi G., Ruggenenti P., Saruta T., Schrader J., Schrier R., Sever P., Sleight P., Staessen J. A., Suzuki H., Thijs L., Ueshima K., Umemoto S., van Gilst W. H., Verdecchia P., Wachtell K., Whelton P., Wing L., Woodward M., Yui Y., Yusuf S., Zanchetti A., Zhang Z. -Y., Anderson C., Baigent C., Brenner B. M., Collins R., de Zeeuw D., Lubsen J., Malacco E., Neal B., Perkovic V., Rodgers A., Rothwell P., Salimi-Khorshidi G., Sundstrom J., Turnbull F., Viberti G., and Wang J.

Abstract

Background: The effects of pharmacological blood pressure lowering at normal or high-normal blood pressure ranges in people with or without pre-existing cardiovascular disease remains uncertain. We analysed individual participant data from randomised trials to investigate the effects of blood pressure lowering treatment on the risk of major cardiovascular events by baseline levels of systolic blood pressure. Methods: We did a meta-analysis of individual participant-level data from 48 randomised trials of pharmacological blood pressure lowering medications versus placebo or other classes of blood pressure-lowering medications, or between more versus less intensive treatment regimens, which had at least 1000 persons-years of follow-up in each group. Trials exclusively done with participants with heart failure or short-term interventions in participants with acute myocardial infarction or other acute settings were excluded. Data from 51 studies published between 1972 and 2013 were obtained by the Blood Pressure Lowering Treatment Trialists' Collaboration (Oxford University, Oxford, UK). We pooled the data to investigate the stratified effects of blood pressure-lowering treatment in participants with and without prevalent cardiovascular disease (ie, any reports of stroke, myocardial infarction, or ischaemic heart disease before randomisation), overall and across seven systolic blood pressure categories (ranging from <120 to ≥170 mm Hg). The primary outcome was a major cardiovascular event (defined as a composite of fatal and non-fatal stroke, fatal or non-fatal myocardial infarction or ischaemic heart disease, or heart failure causing death or requiring admission to hospital), analysed as per intention to treat. Findings: Data for 344 716 participants from 48 randomised clinical trials were available for this analysis. Pre-randomisation mean systolic/diastolic blood pressures were 146/84 mm Hg in participants with previous cardiovascular disease (n=157 728) and 157/8

Published
2021

67. Correction to: Polygenic risk scores predict diabetes complications and their response to intensive blood pressure and glucose control (Diabetologia, (2021), 64, 9, (2012-2025), 10.1007/s00125-021-05491-7)

Author

Tremblay J., Tremblay, J, Haloui, M, Attaoua, R, Tahir, R, Hishmih, C, Harvey, F, Marois-Blanchet, F, Long, C, Simon, P, Santucci, L, Hizel, C, Chalmers, J, Marre, M, Harrap, S, Cífková, R, Krajčoviechová, A, Matthews, D, Williams, B, Poulter, N, Zoungas, S, Colagiuri, S, Mancia, G, Grobbee, D, Rodgers, A, Liu, L, Agbessi, M, Bruat, V, Favé, M, Harwood, M, Awadalla, P, Woodward, M, Hussin, J, Hamet, P, Tremblay J., Haloui M., Attaoua R., Tahir R., Hishmih C., Harvey F., Marois-Blanchet F. C., Long C., Simon P., Santucci L., Hizel C., Chalmers J., Marre M., Harrap S., Cífková R., Krajčoviechová A., Matthews D. R., Williams B., Poulter N., Zoungas S., Colagiuri S., Mancia G., Grobbee D. E., Rodgers A., Liu L., Agbessi M., Bruat V., Favé M. J., Harwood M. P., Awadalla P., Woodward M., Hussin J. G., Hamet P., Tremblay J., Tremblay, J, Haloui, M, Attaoua, R, Tahir, R, Hishmih, C, Harvey, F, Marois-Blanchet, F, Long, C, Simon, P, Santucci, L, Hizel, C, Chalmers, J, Marre, M, Harrap, S, Cífková, R, Krajčoviechová, A, Matthews, D, Williams, B, Poulter, N, Zoungas, S, Colagiuri, S, Mancia, G, Grobbee, D, Rodgers, A, Liu, L, Agbessi, M, Bruat, V, Favé, M, Harwood, M, Awadalla, P, Woodward, M, Hussin, J, Hamet, P, Tremblay J., Haloui M., Attaoua R., Tahir R., Hishmih C., Harvey F., Marois-Blanchet F. C., Long C., Simon P., Santucci L., Hizel C., Chalmers J., Marre M., Harrap S., Cífková R., Krajčoviechová A., Matthews D. R., Williams B., Poulter N., Zoungas S., Colagiuri S., Mancia G., Grobbee D. E., Rodgers A., Liu L., Agbessi M., Bruat V., Favé M. J., Harwood M. P., Awadalla P., Woodward M., Hussin J. G., and Hamet P.

Published
2021

68. Global, regional, and national burden of stroke and its risk factors, 1990-2019: A systematic analysis for the Global Burden of Disease Study 2019

Author

Feigin, V, Stark, B, Johnson, C, Roth, G, Bisignano, C, Abady, G, Abbasifard, M, Abbasi-Kangevari, M, Abd-Allah, F, Abedi, V, Abualhasan, A, Abu-Rmeileh, N, Abushouk, A, Adebayo, O, Agarwal, G, Agasthi, P, Ahinkorah, B, Ahmad, S, Ahmadi, S, Salih, Y, Aji, B, Akbarpour, S, Akinyemi, R, Al Hamad, H, Alahdab, F, Alif, S, Alipour, V, Aljunid, S, Almustanyir, S, Al-Raddadi, R, Salman, R, Alvis-Guzman, N, Ancuceanu, R, Anderlini, D, Anderson, J, Ansar, A, Antonazzo, I, Arabloo, J, Arnlov, J, Artanti, K, Aryan, Z, Asgari, S, Ashraf, T, Athar, M, Atreya, A, Ausloos, M, Baig, A, Baltatu, O, Banach, M, Barboza, M, Barker-Collo, S, Barnighausen, T, Barone, M, Basu, S, Bazmandegan, G, Beghi, E, Beheshti, M, Bejot, Y, Bell, A, Bennett, D, Bensenor, I, Bezabhe, W, Bezabih, Y, Bhagavathula, A, Bhardwaj, P, Bhattacharyya, K, Bijani, A, Bikbov, B, Birhanu, M, Boloor, A, Bonny, A, Brauer, M, Brenner, H, Bryazka, D, Butt, Z, Dos Santos, F, Campos-Nonato, I, Cantu-Brito, C, Carrero, J, Castaneda-Orjuela, C, Catapano, A, Chakraborty, P, Charan, J, Choudhari, S, Chowdhury, E, Chu, D, Chung, S, Colozza, D, Costa, V, Costanzo, S, Criqui, M, Dadras, O, Dagnew, B, Dai, X, Dalal, K, Damasceno, A, D'Amico, E, Dandona, L, Dandona, R, Gela, J, Davletov, K, De La Cruz-Gongora, V, Desai, R, Dhamnetiya, D, Dharmaratne, S, Dhimal, M, Diaz, D, Dichgans, M, Dokova, K, Doshi, R, Douiri, A, Duncan, B, Eftekharzadeh, S, Ekholuenetale, M, El Nahas, N, Elgendy, I, Elhadi, M, El-Jaafary, S, Endres, M, Endries, A, Erku, D, Faraon, E, Farooque, U, Farzadfar, F, Feroze, A, Filip, I, Fischer, F, Flood, D, Gad, M, Gaidhane, S, Gheshlagh, R, Ghashghaee, A, Ghith, N, Ghozali, G, Ghozy, S, Gialluisi, A, Giampaoli, S, Gilani, S, Gill, P, Gnedovskaya, E, Golechha, M, Goulart, A, Guo, Y, Gupta, R, Gupta, V, Gyanwali, P, Hafezi-Nejad, N, Hamidi, S, Hanif, A, Hankey, G, Hargono, A, Hashi, A, Hassan, T, Hassen, H, Havmoeller, R, Hay, S, Hayat, K, Hegazy, M, Herteliu, C, Holla, R, Hostiuc, S, Househ, M, Huang, J, Humayun, A, Hwang, B, Iacoviello, L, Iavicoli, I, Ibitoye, S, Ilesanmi, O, Ilic, I, Ilic, M, Iqbal, U, Irvani, S, Islam, S, Ismail, N, Iso, H, Isola, G, Iwagami, M, Jacob, L, Jain, V, Jang, S, Jayapal, S, Jayaram, S, Jayawardena, R, Jeemon, P, Jha, R, Johnson, W, Jonas, J, Joseph, N, Jozwiak, J, Jurisson, M, Kalani, R, Kalhor, R, Kalkonde, Y, Kamath, A, Kamiab, Z, Kanchan, T, Kandel, H, Karch, A, Katoto, P, Kayode, G, Keshavarz, P, Khader, Y, Khan, E, Khan, I, Khan, M, Khatib, M, Khubchandani, J, Kim, G, Kim, M, Kim, Y, Kisa, A, Kisa, S, Kivimaki, M, Kolte, D, Koolivand, A, Laxminarayana, S, Koyanagi, A, Krishan, K, Krishnamoorthy, V, Krishnamurthi, R, Kumar, G, Kusuma, D, Vecchia, C, Lacey, B, Lak, H, Lallukka, T, Lasrado, S, Lavados, P, Leonardi, M, Li, B, Li, S, Lin, H, Lin, R, Liu, X, Lo, W, Lorkowski, S, Lucchetti, G, Saute, R, Abd El Razek, H, Magnani, F, Mahajan, P, Majeed, A, Makki, A, Malekzadeh, R, Malik, A, Manafi, N, Mansournia, M, Mantovani, L, Martini, S, Mazzaglia, G, Mehndiratta, M, Menezes, R, Meretoja, A, Mersha, A, Jonasson, J, Miazgowski, B, Miazgowski, T, Michalek, I, Mirrakhimov, E, Mohammad, Y, Mohammadian-Hafshejani, A, Mohammed, S, Mokdad, A, Mokhayeri, Y, Molokhia, M, Moni, M, Al Montasir, A, Moradzadeh, R, Morawska, L, Morze, J, Muruet, W, Musa, K, Nagarajan, A, Naghavi, M, Swamy, S, Nascimento, B, Negoi, R, Kandel, S, Nguyen, T, Norrving, B, Noubiap, J, Nwatah, V, Oancea, B, Odukoya, O, Olagunju, A, Orru, H, Owolabi, M, Padubidri, J, Pana, A, Parekh, T, Park, E, Kan, F, Pathak, M, Peres, M, Perianayagam, A, Pham, T, Piradov, M, Podder, V, Polinder, S, Postma, M, Pourshams, A, Radfar, A, Rafiei, A, Raggi, A, Rahim, F, Rahimi-Movaghar, V, Rahman, M, Rahmani, A, Rajai, N, Ranasinghe, P, Rao, C, Rao, S, Rathi, P, Rawaf, D, Rawaf, S, Reitsma, M, Renjith, V, Renzaho, A, Rezapour, A, Rodriguez, J, Roever, L, Romoli, M, Rynkiewicz, A, Sacco, S, Sadeghi, M, Moghaddam, S, Sahebkar, A, Saif-Ur-Rahman, K, Salah, R, Samaei, M, Samy, A, Santos, I, Santric-Milicevic, M, Sarrafzadegan, N, Sathian, B, Sattin, D, Schiavolin, S, Schlaich, M, Schmidt, M, Schutte, A, Sepanlou, S, Seylani, A, Sha, F, Shahabi, S, Shaikh, M, Shannawaz, M, Shawon, M, Sheikh, A, Sheikhbahaei, S, Shibuya, K, Siabani, S, Silva, D, Singh, J, Skryabin, V, Skryabina, A, Sobaih, B, Stortecky, S, Stranges, S, Tadesse, E, Tarigan, I, Temsah, M, Teuschl, Y, Thrift, A, Tonelli, M, Tovani-Palone, M, Tran, B, Tripathi, M, Tsegaye, G, Ullah, A, Unim, B, Unnikrishnan, B, Vakilian, A, Tahbaz, S, Vasankari, T, Venketasubramanian, N, Vervoort, D, Vo, B, Volovici, V, Vosoughi, K, Vu, G, Vu, L, Wafa, H, Waheed, Y, Wang, Y, Wijeratne, T, Winkler, A, Wolfe, C, Woodward, M, Wu, J, Hanson, S, Xu, X, Yadav, L, Yadollahpour, A, Jabbari, S, Yamagishi, K, Yatsuya, H, Yonemoto, N, Yu, C, Yunusa, I, Zaman, M, Zaman, S, Zamanian, M, Zand, R, Zandifar, A, Zastrozhin, M, Zastrozhina, A, Zhang, Y, Zhang, Z, Zhong, C, Zuniga, Y, Murray, C, Feigin V. L., Stark B. A., Johnson C. O., Roth G. A., Bisignano C., Abady G. G., Abbasifard M., Abbasi-Kangevari M., Abd-Allah F., Abedi V., Abualhasan A., Abu-Rmeileh N. M. E., Abushouk A. I., Adebayo O. M., Agarwal G., Agasthi P., Ahinkorah B. O., Ahmad S., Ahmadi S., Salih Y. A., Aji B., Akbarpour S., Akinyemi R. O., Al Hamad H., Alahdab F., Alif S. M., Alipour V., Aljunid S. M., Almustanyir S., Al-Raddadi R. M., Salman R. A. -S., Alvis-Guzman N., Ancuceanu R., Anderlini D., Anderson J. A., Ansar A., Antonazzo I. C., Arabloo J., Arnlov J., Artanti K. D., Aryan Z., Asgari S., Ashraf T., Athar M., Atreya A., Ausloos M., Baig A. A., Baltatu O. C., Banach M., Barboza M. A., Barker-Collo S. L., Barnighausen T. W., Barone M. T. U., Basu S., Bazmandegan G., Beghi E., Beheshti M., Bejot Y., Bell A. W., Bennett D. A., Bensenor I. M., Bezabhe W. M., Bezabih Y. M., Bhagavathula A. S., Bhardwaj P., Bhattacharyya K., Bijani A., Bikbov B., Birhanu M. M., Boloor A., Bonny A., Brauer M., Brenner H., Bryazka D., Butt Z. A., Dos Santos F. L. C., Campos-Nonato I. R., Cantu-Brito C., Carrero J. J., Castaneda-Orjuela C. A., Catapano A. L., Chakraborty P. A., Charan J., Choudhari S. G., Chowdhury E. K., Chu D. -T., Chung S. -C., Colozza D., Costa V. M., Costanzo S., Criqui M. H., Dadras O., Dagnew B., Dai X., Dalal K., Damasceno A. A. M., D'Amico E., Dandona L., Dandona R., Gela J. D., Davletov K., De La Cruz-Gongora V., Desai R., Dhamnetiya D., Dharmaratne S. D., Dhimal M. L., Dhimal M., Diaz D., Dichgans M., Dokova K., Doshi R., Douiri A., Duncan B. B., Eftekharzadeh S., Ekholuenetale M., El Nahas N., Elgendy I. Y., Elhadi M., El-Jaafary S. I., Endres M., Endries A. Y., Erku D. A., Faraon E. J. A., Farooque U., Farzadfar F., Feroze A. H., Filip I., Fischer F., Flood D., Gad M. M., Gaidhane S., Gheshlagh R. G., Ghashghaee A., Ghith N., Ghozali G., Ghozy S., Gialluisi A., Giampaoli S., Gilani S. A., Gill P. S., Gnedovskaya E. V., Golechha M., Goulart A. C., Guo Y., Gupta R., Gupta V. B., Gupta V. K., Gyanwali P., Hafezi-Nejad N., Hamidi S., Hanif A., Hankey G. J., Hargono A., Hashi A., Hassan T. S., Hassen H. Y., Havmoeller R. J., Hay S. I., Hayat K., Hegazy M. I., Herteliu C., Holla R., Hostiuc S., Househ M., Huang J., Humayun A., Hwang B. -F., Iacoviello L., Iavicoli I., Ibitoye S. E., Ilesanmi O. S., Ilic I. M., Ilic M. D., Iqbal U., Irvani S. S. N., Islam S. M. S., Ismail N. E., Iso H., Isola G., Iwagami M., Jacob L., Jain V., Jang S. -I., Jayapal S. K., Jayaram S., Jayawardena R., Jeemon P., Jha R. P., Johnson W. D., Jonas J. B., Joseph N., Jozwiak J. J., Jurisson M., Kalani R., Kalhor R., Kalkonde Y., Kamath A., Kamiab Z., Kanchan T., Kandel H., Karch A., Katoto P. D. M. C., Kayode G. A., Keshavarz P., Khader Y. S., Khan E. A., Khan I. A., Khan M., Khan M. A. B., Khatib M. N., Khubchandani J., Kim G. R., Kim M. S., Kim Y. J., Kisa A., Kisa S., Kivimaki M., Kolte D., Koolivand A., Laxminarayana S. L. K., Koyanagi A., Krishan K., Krishnamoorthy V., Krishnamurthi R. V., Kumar G. A., Kusuma D., Vecchia C. L., Lacey B., Lak H. M., Lallukka T., Lasrado S., Lavados P. M., Leonardi M., Li B., Li S., Lin H., Lin R. -T., Liu X., Lo W. D., Lorkowski S., Lucchetti G., Saute R. L., Abd El Razek H. M., Magnani F. G., Mahajan P. B., Majeed A., Makki A., Malekzadeh R., Malik A. A., Manafi N., Mansournia M. A., Mantovani L. G., Martini S., Mazzaglia G., Mehndiratta M. M., Menezes R. G., Meretoja A., Mersha A. G., Jonasson J. M., Miazgowski B., Miazgowski T., Michalek I. M., Mirrakhimov E. M., Mohammad Y., Mohammadian-Hafshejani A., Mohammed S., Mokdad A. H., Mokhayeri Y., Molokhia M., Moni M. A., Al Montasir A., Moradzadeh R., Morawska L., Morze J., Muruet W., Musa K. I., Nagarajan A. J., Naghavi M., Swamy S. N., Nascimento B. R., Negoi R. I., Kandel S. N., Nguyen T. H., Norrving B., Noubiap J. J., Nwatah V. E., Oancea B., Odukoya O. O., Olagunju A. T., Orru H., Owolabi M. O., Padubidri J. R., Pana A., Parekh T., Park E. -C., Kan F. P., Pathak M., Peres M. F. P., Perianayagam A., Pham T. -M., Piradov M. A., Podder V., Polinder S., Postma M. J., Pourshams A., Radfar A., Rafiei A., Raggi A., Rahim F., Rahimi-Movaghar V., Rahman M., Rahman M. A., Rahmani A. M., Rajai N., Ranasinghe P., Rao C. R., Rao S. J., Rathi P., Rawaf D. L., Rawaf S., Reitsma M. B., Renjith V., Renzaho A. M. N., Rezapour A., Rodriguez J. A. B., Roever L., Romoli M., Rynkiewicz A., Sacco S., Sadeghi M., Moghaddam S. S., Sahebkar A., Saif-Ur-Rahman K. M., Salah R., Samaei M., Samy A. M., Santos I. S., Santric-Milicevic M. M., Sarrafzadegan N., Sathian B., Sattin D., Schiavolin S., Schlaich M. P., Schmidt M. I., Schutte A. E., Sepanlou S. G., Seylani A., Sha F., Shahabi S., Shaikh M. A., Shannawaz M., Shawon Md. S. R., Sheikh A., Sheikhbahaei S., Shibuya K., Siabani S., Silva D. A. S., Singh J. A., Singh J. K., Skryabin V. Y., Skryabina A. A., Sobaih B. H., Stortecky S., Stranges S., Tadesse E. G., Tarigan I. U., Temsah M. -H., Teuschl Y., Thrift A. G., Tonelli M., Tovani-Palone M. R., Tran B. X., Tripathi M., Tsegaye G. W., Ullah A., Unim B., Unnikrishnan B., Vakilian A., Tahbaz S. V., Vasankari T. J., Venketasubramanian N., Vervoort D., Vo B., Volovici V., Vosoughi K., Vu G. T., Vu L. G., Wafa H. A., Waheed Y., Wang Y., Wijeratne T., Winkler A. S., Wolfe C. D. A., Woodward M., Wu J. H., Hanson S. W., Xu X., Yadav L., Yadollahpour A., Jabbari S. H. Y., Yamagishi K., Yatsuya H., Yonemoto N., Yu C., Yunusa I., Zaman M. S., Zaman S. B., Zamanian M., Zand R., Zandifar A., Zastrozhin M. S., Zastrozhina A., Zhang Y., Zhang Z. -J., Zhong C., Zuniga Y. M. H., Murray C. J. L., Feigin, V, Stark, B, Johnson, C, Roth, G, Bisignano, C, Abady, G, Abbasifard, M, Abbasi-Kangevari, M, Abd-Allah, F, Abedi, V, Abualhasan, A, Abu-Rmeileh, N, Abushouk, A, Adebayo, O, Agarwal, G, Agasthi, P, Ahinkorah, B, Ahmad, S, Ahmadi, S, Salih, Y, Aji, B, Akbarpour, S, Akinyemi, R, Al Hamad, H, Alahdab, F, Alif, S, Alipour, V, Aljunid, S, Almustanyir, S, Al-Raddadi, R, Salman, R, Alvis-Guzman, N, Ancuceanu, R, Anderlini, D, Anderson, J, Ansar, A, Antonazzo, I, Arabloo, J, Arnlov, J, Artanti, K, Aryan, Z, Asgari, S, Ashraf, T, Athar, M, Atreya, A, Ausloos, M, Baig, A, Baltatu, O, Banach, M, Barboza, M, Barker-Collo, S, Barnighausen, T, Barone, M, Basu, S, Bazmandegan, G, Beghi, E, Beheshti, M, Bejot, Y, Bell, A, Bennett, D, Bensenor, I, Bezabhe, W, Bezabih, Y, Bhagavathula, A, Bhardwaj, P, Bhattacharyya, K, Bijani, A, Bikbov, B, Birhanu, M, Boloor, A, Bonny, A, Brauer, M, Brenner, H, Bryazka, D, Butt, Z, Dos Santos, F, Campos-Nonato, I, Cantu-Brito, C, Carrero, J, Castaneda-Orjuela, C, Catapano, A, Chakraborty, P, Charan, J, Choudhari, S, Chowdhury, E, Chu, D, Chung, S, Colozza, D, Costa, V, Costanzo, S, Criqui, M, Dadras, O, Dagnew, B, Dai, X, Dalal, K, Damasceno, A, D'Amico, E, Dandona, L, Dandona, R, Gela, J, Davletov, K, De La Cruz-Gongora, V, Desai, R, Dhamnetiya, D, Dharmaratne, S, Dhimal, M, Diaz, D, Dichgans, M, Dokova, K, Doshi, R, Douiri, A, Duncan, B, Eftekharzadeh, S, Ekholuenetale, M, El Nahas, N, Elgendy, I, Elhadi, M, El-Jaafary, S, Endres, M, Endries, A, Erku, D, Faraon, E, Farooque, U, Farzadfar, F, Feroze, A, Filip, I, Fischer, F, Flood, D, Gad, M, Gaidhane, S, Gheshlagh, R, Ghashghaee, A, Ghith, N, Ghozali, G, Ghozy, S, Gialluisi, A, Giampaoli, S, Gilani, S, Gill, P, Gnedovskaya, E, Golechha, M, Goulart, A, Guo, Y, Gupta, R, Gupta, V, Gyanwali, P, Hafezi-Nejad, N, Hamidi, S, Hanif, A, Hankey, G, Hargono, A, Hashi, A, Hassan, T, Hassen, H, Havmoeller, R, Hay, S, Hayat, K, Hegazy, M, Herteliu, C, Holla, R, Hostiuc, S, Househ, M, Huang, J, Humayun, A, Hwang, B, Iacoviello, L, Iavicoli, I, Ibitoye, S, Ilesanmi, O, Ilic, I, Ilic, M, Iqbal, U, Irvani, S, Islam, S, Ismail, N, Iso, H, Isola, G, Iwagami, M, Jacob, L, Jain, V, Jang, S, Jayapal, S, Jayaram, S, Jayawardena, R, Jeemon, P, Jha, R, Johnson, W, Jonas, J, Joseph, N, Jozwiak, J, Jurisson, M, Kalani, R, Kalhor, R, Kalkonde, Y, Kamath, A, Kamiab, Z, Kanchan, T, Kandel, H, Karch, A, Katoto, P, Kayode, G, Keshavarz, P, Khader, Y, Khan, E, Khan, I, Khan, M, Khatib, M, Khubchandani, J, Kim, G, Kim, M, Kim, Y, Kisa, A, Kisa, S, Kivimaki, M, Kolte, D, Koolivand, A, Laxminarayana, S, Koyanagi, A, Krishan, K, Krishnamoorthy, V, Krishnamurthi, R, Kumar, G, Kusuma, D, Vecchia, C, Lacey, B, Lak, H, Lallukka, T, Lasrado, S, Lavados, P, Leonardi, M, Li, B, Li, S, Lin, H, Lin, R, Liu, X, Lo, W, Lorkowski, S, Lucchetti, G, Saute, R, Abd El Razek, H, Magnani, F, Mahajan, P, Majeed, A, Makki, A, Malekzadeh, R, Malik, A, Manafi, N, Mansournia, M, Mantovani, L, Martini, S, Mazzaglia, G, Mehndiratta, M, Menezes, R, Meretoja, A, Mersha, A, Jonasson, J, Miazgowski, B, Miazgowski, T, Michalek, I, Mirrakhimov, E, Mohammad, Y, Mohammadian-Hafshejani, A, Mohammed, S, Mokdad, A, Mokhayeri, Y, Molokhia, M, Moni, M, Al Montasir, A, Moradzadeh, R, Morawska, L, Morze, J, Muruet, W, Musa, K, Nagarajan, A, Naghavi, M, Swamy, S, Nascimento, B, Negoi, R, Kandel, S, Nguyen, T, Norrving, B, Noubiap, J, Nwatah, V, Oancea, B, Odukoya, O, Olagunju, A, Orru, H, Owolabi, M, Padubidri, J, Pana, A, Parekh, T, Park, E, Kan, F, Pathak, M, Peres, M, Perianayagam, A, Pham, T, Piradov, M, Podder, V, Polinder, S, Postma, M, Pourshams, A, Radfar, A, Rafiei, A, Raggi, A, Rahim, F, Rahimi-Movaghar, V, Rahman, M, Rahmani, A, Rajai, N, Ranasinghe, P, Rao, C, Rao, S, Rathi, P, Rawaf, D, Rawaf, S, Reitsma, M, Renjith, V, Renzaho, A, Rezapour, A, Rodriguez, J, Roever, L, Romoli, M, Rynkiewicz, A, Sacco, S, Sadeghi, M, Moghaddam, S, Sahebkar, A, Saif-Ur-Rahman, K, Salah, R, Samaei, M, Samy, A, Santos, I, Santric-Milicevic, M, Sarrafzadegan, N, Sathian, B, Sattin, D, Schiavolin, S, Schlaich, M, Schmidt, M, Schutte, A, Sepanlou, S, Seylani, A, Sha, F, Shahabi, S, Shaikh, M, Shannawaz, M, Shawon, M, Sheikh, A, Sheikhbahaei, S, Shibuya, K, Siabani, S, Silva, D, Singh, J, Skryabin, V, Skryabina, A, Sobaih, B, Stortecky, S, Stranges, S, Tadesse, E, Tarigan, I, Temsah, M, Teuschl, Y, Thrift, A, Tonelli, M, Tovani-Palone, M, Tran, B, Tripathi, M, Tsegaye, G, Ullah, A, Unim, B, Unnikrishnan, B, Vakilian, A, Tahbaz, S, Vasankari, T, Venketasubramanian, N, Vervoort, D, Vo, B, Volovici, V, Vosoughi, K, Vu, G, Vu, L, Wafa, H, Waheed, Y, Wang, Y, Wijeratne, T, Winkler, A, Wolfe, C, Woodward, M, Wu, J, Hanson, S, Xu, X, Yadav, L, Yadollahpour, A, Jabbari, S, Yamagishi, K, Yatsuya, H, Yonemoto, N, Yu, C, Yunusa, I, Zaman, M, Zaman, S, Zamanian, M, Zand, R, Zandifar, A, Zastrozhin, M, Zastrozhina, A, Zhang, Y, Zhang, Z, Zhong, C, Zuniga, Y, Murray, C, Feigin V. L., Stark B. A., Johnson C. O., Roth G. A., Bisignano C., Abady G. G., Abbasifard M., Abbasi-Kangevari M., Abd-Allah F., Abedi V., Abualhasan A., Abu-Rmeileh N. M. E., Abushouk A. I., Adebayo O. M., Agarwal G., Agasthi P., Ahinkorah B. O., Ahmad S., Ahmadi S., Salih Y. A., Aji B., Akbarpour S., Akinyemi R. O., Al Hamad H., Alahdab F., Alif S. M., Alipour V., Aljunid S. M., Almustanyir S., Al-Raddadi R. M., Salman R. A. -S., Alvis-Guzman N., Ancuceanu R., Anderlini D., Anderson J. A., Ansar A., Antonazzo I. C., Arabloo J., Arnlov J., Artanti K. D., Aryan Z., Asgari S., Ashraf T., Athar M., Atreya A., Ausloos M., Baig A. A., Baltatu O. C., Banach M., Barboza M. A., Barker-Collo S. L., Barnighausen T. W., Barone M. T. U., Basu S., Bazmandegan G., Beghi E., Beheshti M., Bejot Y., Bell A. W., Bennett D. A., Bensenor I. M., Bezabhe W. M., Bezabih Y. M., Bhagavathula A. S., Bhardwaj P., Bhattacharyya K., Bijani A., Bikbov B., Birhanu M. M., Boloor A., Bonny A., Brauer M., Brenner H., Bryazka D., Butt Z. A., Dos Santos F. L. C., Campos-Nonato I. R., Cantu-Brito C., Carrero J. J., Castaneda-Orjuela C. A., Catapano A. L., Chakraborty P. A., Charan J., Choudhari S. G., Chowdhury E. K., Chu D. -T., Chung S. -C., Colozza D., Costa V. M., Costanzo S., Criqui M. H., Dadras O., Dagnew B., Dai X., Dalal K., Damasceno A. A. M., D'Amico E., Dandona L., Dandona R., Gela J. D., Davletov K., De La Cruz-Gongora V., Desai R., Dhamnetiya D., Dharmaratne S. D., Dhimal M. L., Dhimal M., Diaz D., Dichgans M., Dokova K., Doshi R., Douiri A., Duncan B. B., Eftekharzadeh S., Ekholuenetale M., El Nahas N., Elgendy I. Y., Elhadi M., El-Jaafary S. I., Endres M., Endries A. Y., Erku D. A., Faraon E. J. A., Farooque U., Farzadfar F., Feroze A. H., Filip I., Fischer F., Flood D., Gad M. M., Gaidhane S., Gheshlagh R. G., Ghashghaee A., Ghith N., Ghozali G., Ghozy S., Gialluisi A., Giampaoli S., Gilani S. A., Gill P. S., Gnedovskaya E. V., Golechha M., Goulart A. C., Guo Y., Gupta R., Gupta V. B., Gupta V. K., Gyanwali P., Hafezi-Nejad N., Hamidi S., Hanif A., Hankey G. J., Hargono A., Hashi A., Hassan T. S., Hassen H. Y., Havmoeller R. J., Hay S. I., Hayat K., Hegazy M. I., Herteliu C., Holla R., Hostiuc S., Househ M., Huang J., Humayun A., Hwang B. -F., Iacoviello L., Iavicoli I., Ibitoye S. E., Ilesanmi O. S., Ilic I. M., Ilic M. D., Iqbal U., Irvani S. S. N., Islam S. M. S., Ismail N. E., Iso H., Isola G., Iwagami M., Jacob L., Jain V., Jang S. -I., Jayapal S. K., Jayaram S., Jayawardena R., Jeemon P., Jha R. P., Johnson W. D., Jonas J. B., Joseph N., Jozwiak J. J., Jurisson M., Kalani R., Kalhor R., Kalkonde Y., Kamath A., Kamiab Z., Kanchan T., Kandel H., Karch A., Katoto P. D. M. C., Kayode G. A., Keshavarz P., Khader Y. S., Khan E. A., Khan I. A., Khan M., Khan M. A. B., Khatib M. N., Khubchandani J., Kim G. R., Kim M. S., Kim Y. J., Kisa A., Kisa S., Kivimaki M., Kolte D., Koolivand A., Laxminarayana S. L. K., Koyanagi A., Krishan K., Krishnamoorthy V., Krishnamurthi R. V., Kumar G. A., Kusuma D., Vecchia C. L., Lacey B., Lak H. M., Lallukka T., Lasrado S., Lavados P. M., Leonardi M., Li B., Li S., Lin H., Lin R. -T., Liu X., Lo W. D., Lorkowski S., Lucchetti G., Saute R. L., Abd El Razek H. M., Magnani F. G., Mahajan P. B., Majeed A., Makki A., Malekzadeh R., Malik A. A., Manafi N., Mansournia M. A., Mantovani L. G., Martini S., Mazzaglia G., Mehndiratta M. M., Menezes R. G., Meretoja A., Mersha A. G., Jonasson J. M., Miazgowski B., Miazgowski T., Michalek I. M., Mirrakhimov E. M., Mohammad Y., Mohammadian-Hafshejani A., Mohammed S., Mokdad A. H., Mokhayeri Y., Molokhia M., Moni M. A., Al Montasir A., Moradzadeh R., Morawska L., Morze J., Muruet W., Musa K. I., Nagarajan A. J., Naghavi M., Swamy S. N., Nascimento B. R., Negoi R. I., Kandel S. N., Nguyen T. H., Norrving B., Noubiap J. J., Nwatah V. E., Oancea B., Odukoya O. O., Olagunju A. T., Orru H., Owolabi M. O., Padubidri J. R., Pana A., Parekh T., Park E. -C., Kan F. P., Pathak M., Peres M. F. P., Perianayagam A., Pham T. -M., Piradov M. A., Podder V., Polinder S., Postma M. J., Pourshams A., Radfar A., Rafiei A., Raggi A., Rahim F., Rahimi-Movaghar V., Rahman M., Rahman M. A., Rahmani A. M., Rajai N., Ranasinghe P., Rao C. R., Rao S. J., Rathi P., Rawaf D. L., Rawaf S., Reitsma M. B., Renjith V., Renzaho A. M. N., Rezapour A., Rodriguez J. A. B., Roever L., Romoli M., Rynkiewicz A., Sacco S., Sadeghi M., Moghaddam S. S., Sahebkar A., Saif-Ur-Rahman K. M., Salah R., Samaei M., Samy A. M., Santos I. S., Santric-Milicevic M. M., Sarrafzadegan N., Sathian B., Sattin D., Schiavolin S., Schlaich M. P., Schmidt M. I., Schutte A. E., Sepanlou S. G., Seylani A., Sha F., Shahabi S., Shaikh M. A., Shannawaz M., Shawon Md. S. R., Sheikh A., Sheikhbahaei S., Shibuya K., Siabani S., Silva D. A. S., Singh J. A., Singh J. K., Skryabin V. Y., Skryabina A. A., Sobaih B. H., Stortecky S., Stranges S., Tadesse E. G., Tarigan I. U., Temsah M. -H., Teuschl Y., Thrift A. G., Tonelli M., Tovani-Palone M. R., Tran B. X., Tripathi M., Tsegaye G. W., Ullah A., Unim B., Unnikrishnan B., Vakilian A., Tahbaz S. V., Vasankari T. J., Venketasubramanian N., Vervoort D., Vo B., Volovici V., Vosoughi K., Vu G. T., Vu L. G., Wafa H. A., Waheed Y., Wang Y., Wijeratne T., Winkler A. S., Wolfe C. D. A., Woodward M., Wu J. H., Hanson S. W., Xu X., Yadav L., Yadollahpour A., Jabbari S. H. Y., Yamagishi K., Yatsuya H., Yonemoto N., Yu C., Yunusa I., Zaman M. S., Zaman S. B., Zamanian M., Zand R., Zandifar A., Zastrozhin M. S., Zastrozhina A., Zhang Y., Zhang Z. -J., Zhong C., Zuniga Y. M. H., and Murray C. J. L.

Abstract

Background Regularly updated data on stroke and its pathological types, including data on their incidence, prevalence, mortality, disability, risk factors, and epidemiological trends, are important for evidence-based stroke care planning and resource allocation. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) aims to provide a standardised and comprehensive measurement of these metrics at global, regional, and national levels. Methods We applied GBD 2019 analytical tools to calculate stroke incidence, prevalence, mortality, disability-adjusted life-years (DALYs), and the population attributable fraction (PAF) of DALYs (with corresponding 95% uncertainty intervals [UIs]) associated with 19 risk factors, for 204 countries and territories from 1990 to 2019. These estimates were provided for ischaemic stroke, intracerebral haemorrhage, subarachnoid haemorrhage, and all strokes combined, and stratified by sex, age group, and World Bank country income level. Findings In 2019, there were 12·2 million (95% UI 11·0–13·6) incident cases of stroke, 101 million (93·2–111) prevalent cases of stroke, 143 million (133–153) DALYs due to stroke, and 6·55 million (6·00–7·02) deaths from stroke. Globally, stroke remained the second-leading cause of death (11·6% [10·8–12·2] of total deaths) and the third-leading cause of death and disability combined (5·7% [5·1–6·2] of total DALYs) in 2019. From 1990 to 2019, the absolute number of incident strokes increased by 70·0% (67·0–73·0), prevalent strokes increased by 85·0% (83·0–88·0), deaths from stroke increased by 43·0% (31·0–55·0), and DALYs due to stroke increased by 32·0% (22·0–42·0). During the same period, age-standardised rates of stroke incidence decreased by 17·0% (15·0–18·0), mortality decreased by 36·0% (31·0–42·0), prevalence decreased by 6·0% (5·0–7·0), and DALYs decreased by 36·0% (31·0–42·0). However, among people younger than 70 years, prevalence rates increased by 22·0% (21·0–24·0) and incidence rates

Published
2021

71. SCORE2 risk prediction algorithms: new models to estimate 10-year risk of cardiovascular disease in Europe

Author

Hageman, S., Pennells, L., Ojeda, F., Kaptoge, S., Kuulasmaa, K., Vries, T. de, Xu, Z., Kee, F., Chung, R., Wood, A., McEvoy, J.W., Veronesi, G., Bolton, T., Dendale, P., Ference, B.A., Halle, M., Timmis, A., Vardas, P., Danesh, J., Graham, I., Salomaa, V., Visseren, F., Bacquer, D. de, Blankenberg, S., Dorresteijn, J., Angelantonio, E. di, Achenbach, S., Aleksandrova, K., Amiano, P., Amouyel, P., Andersson, J., Bakker, S.J.L., Costa, R.B.D., Beulens, J.W.J., Blaha, M., Bobak, M., Boer, J.M.A., Bonet, C., Bonnet, F., Boutron-Ruault, M.C., Braaten, T., Brenner, H., Brunner, F., Brunner, E.J., Brunstrom, M., Buring, J., Butterworth, A.S., Capkova, N., Cesana, G., Chrysohoou, C., Colorado-Yohar, S., Cook, N.R., Cooper, C., Dahm, C.C., Davidson, K., Dennison, E., Castelnuovo, A. di, Donfrancesco, C., Dorr, M., Dorynska, A., Eliasson, M., Engstrom, G., Ferrari, P., Ferrario, M., Ford, I., Fu, M., Gansevoort, R.T., Giampaoli, S., Gillum, R.F., Camara, A.G. de la, Grassi, G., Hansson, P.O., Huculeci, R., Hveem, K., Iacoviello, L., Ikram, M.K., Jorgensen, T., Joseph, B., Jousilahti, P., Jukema, J.W., Kaaks, R., Katzke, V., Kavousi, M., Kiechl, S., Klotsche, J., Konig, W., Kronmal, R.A., Kubinova, R., Kucharska-Newton, A., Lall, K., Lehmann, N., Leistner, D., Linneberg, A., Pablos, D.L., Lorenz, T., Lu, W.T., Luksiene, D., Lyngbakken, M., Magnussen, C., Malyutina, S., Ibanez, A.M., Masala, G., Mathiesen, E.B., Matsushita, K., Meade, T.W., Melander, O., Meyer, H.E., Moons, K.G.M., Moreno-Iribas, C., Muller, D., Munzel, T., Nikitin, Y., Nordestgaard, B.G., Omland, T., Onland, C., Overvad, K., Packard, C., Pajak, A., Palmieri, L., Panagiotakos, D., Panico, S., Perez-Cornago, A., Peters, A., Pietila, A., Pikhart, H., Psaty, B.M., Quarti-Trevano, F., Garcia, J.R.Q., Riboli, E., Ridker, P.M., Rodriguez, B., Rodriguez-Barranco, M., Rosengren, A., Roussel, R., Sacerdote, C., Sans, S., Sattar, N., Schiborn, C., Schmidt, B., Schottker, B., Schulze, M., Schwartz, J.E., Selmer, R.M., Shea, S., Shipley, M.J., Sieri, S., Soderberg, S., Sofat, R., Tamosiunas, A., Thorand, B., Tillmann, T., Tjonneland, A., Tong, T.Y.N., Trichopoulou, A., Tumino, R., Tunstall-Pedoe, H., Tybjaerg-Hansen, A., Tzoulaki, J., Heijden, A. van der, Schouw, Y.T. van der, Verschuren, W.M.M., Volzke, H., Waldeyer, C., Wareham, N.J., Weiderpass, E., Weidinger, F., Wild, P., Willeit, J., Willeit, P., Wilsgaard, T., Woodward, M., Zeller, T., Zhang, D.D., Zhou, B., SCORE2 Working Grp, ESC Cardiovasc Risk Collaboration, collaboration, SCORE2 working group and ESC Cardiovascular risk, Groningen Institute for Organ Transplantation (GIOT), Groningen Kidney Center (GKC), Cardiovascular Centre (CVC), Epidemiology, Neurology, Achenbach, S, Aleksandrova, K, Amiano, P, San Sebastian, D, Amouyel, P, Andersson, J, Bakker, S, Da Providencia Costa, R, Beulens, J, Blaha, M, Bobak, M, Boer, J, Bonet, C, Bonnet, F, Boutron-Ruault, M, Braaten, T, Brenner, H, Brunner, F, Brunner, E, Brunström, M, Buring, J, Butterworth, A, Capkova, N, Cesana, G, Chrysohoou, C, Colorado-Yohar, S, Cook, N, Cooper, C, Dahm, C, Davidson, K, Dennison, E, Di Castelnuovo, A, Donfrancesco, C, Dörr, M, Doryńska, A, Eliasson, M, Engström, G, Ferrari, P, Ferrario, M, Ford, I, Fu, M, Gansevoort, R, Giampaoli, S, Gillum, R, Gómez de la Cámara, A, Grassi, G, Hansson, P, Huculeci, R, Hveem, K, Iacoviello, L, Ikram, M, Jørgensen, T, Joseph, B, Jousilahti, P, Wouter Jukema, J, Kaaks, R, Katzke, V, Kavousi, M, Kiechl, S, Klotsche, J, König, W, Kronmal, R, Kubinova, R, Kucharska-Newton, A, Läll, K, Lehmann, N, Leistner, D, Linneberg, A, Pablos, D, Lorenz, T, Lu, W, Luksiene, D, Lyngbakken, M, Magnussen, C, Malyutina, S, Ibañez, A, Masala, G, Mathiesen, E, Matsushita, K, Meade, T, Melander, O, Meyer, H, Moons, K, Moreno-Iribas, C, Muller, D, Münzel, T, Nikitin, Y, Nordestgaard, B, Omland, T, Onland, C, Overvad, K, Packard, C, Pająk, A, Palmieri, L, Panagiotakos, D, Panico, S, Perez-Cornago, A, Peters, A, Pietilä, A, Pikhart, H, Psaty, B, Quarti-Trevano, F, Garcia, J, Riboli, E, Ridker, P, Rodriguez, B, Rodriguez-Barranco, M, Rosengren, A, Roussel, R, Sacerdote, C, S, S, Sattar, N, Schiborn, C, Schmidt, B, Schöttker, B, Schulze, M, Schwartz, J, Selmer, R, Shea, S, Shipley, M, Sieri, S, Söderberg, S, Sofat, R, Tamosiunas, A, Thorand, B, Tillmann, T, Tjønneland, A, Tong, T, Trichopoulou, A, Tumino, R, Tunstall-Pedoe, H, Tybjaerg-Hansen, A, Tzoulaki, J, van der Heijden, A, van der Schouw, Y, Verschuren, W, Völzke, H, Waldeyer, C, Wareham, N, Weiderpass, E, Weidinger, F, Wild, P, Willeit, J, Willeit, P, Wilsgaard, T, Woodward, M, Zeller, T, Zhang, D, Zhou, B, and Apollo - University of Cambridge Repository

Subjects
Male, Cardiology, RATIONALE, Blood Pressure, Disease, 030204 cardiovascular system & hematology, PROFILE, ACUTE CORONARY EVENTS, VALIDATION, Europe/epidemiology, 03 medical and health sciences, 0302 clinical medicine, SDG 3 - Good Health and Well-being, DESIGN, Clinical Research, Risk Factors, Diabetes mellitus, medicine, PARTICIPANTS, Humans, 030212 general & internal medicine, Risk factor, Aged, Primary prevention, business.industry, 10-year CVD risk, Incidence (epidemiology), Cardiovascular Diseases/epidemiology, Risk Prediction, Cardiovascular Disease, Primary Prevention, 10-year Cvd Risk, External validation, PRIMARY-CARE, Middle Aged, medicine.disease, Cardiovascular disease, Risk prediction, 3. Good health, Europe, Prediction algorithms, Blood pressure, Cardiovascular Diseases, Smoking status, Female, Cardiology and Cardiovascular Medicine, business, Algorithms, Demography
Abstract

Aims The aim of this study was to develop, validate, and illustrate an updated prediction model (SCORE2) to estimate 10-year fatal and non-fatal cardiovascular disease (CVD) risk in individuals without previous CVD or diabetes aged 40-69 years in Europe.Methods and results We derived risk prediction models using individual-participant data from 45 cohorts in 13 countries (677 684 individuals, 30 121 CVD events). We used sex-specific and competing risk-adjusted models, including age, smoking status, systolic blood pressure, and total- and HDL-cholesterol. We defined four risk regions in Europe according to country-specific CVD mortality, recalibrating models to each region using expected incidences and risk factor distributions. Region-specific incidence was estimated using CVD mortality and incidence data on 10 776 466 individuals. For external validation, we analysed data from 25 additional cohorts in 15 European countries (1 133 181 individuals, 43 492 CVD events). After applying the derived risk prediction models to external validation cohorts, C-indices ranged from 0.67 (0.65-0.68) to 0.81 (0.76-0.86). Predicted CVD risk varied several-fold across European regions. For example, the estimated 10-year CVD risk for a 50-year-old smoker, with a systolic blood pressure of 140 mmHg, total cholesterol of 5.5 mmol/L, and HDL-cholesterol of 1.3 mmol/L, ranged from 5.9% for men in low- risk countries to 14.0% for men in very high-risk countries, and from 4.2% for women in low-risk countries to 13.7% for women in very high-risk countries.Conclusion SCORE2-a new algorithm derived, calibrated, and validated to predict 10-year risk of first-onset CVD in European populations-enhances the identification of individuals at higher risk of developing CVD across Europe. Acknowledgements We thank investigators and participants of the several studies that contributed data to the Emerging Risk Factors Collaboration (ERFC). This research has been conducted using the UK Biobank Resource under Application Number 26865. Data from the Clinical Practice Research Datalink (CPRD) were obtained under licence from the UK Medicines and Healthcare products Regulatory Agency (protocol 162RMn2). CPRD uses data provided by patients and collected by the NHS as part of their care and support. We thank all EPIC participants and staff for their contribution to the study, the laboratory teams at the Medical Research Council Epidemiology Unit for sample management and Cambridge Genomic Services for genotyping, Sarah Spackman for data management and the team at the EPIC-CVD Coordinating Centre for study co-ordination and administration. Funding The ERFC co-ordinating centre was underpinned by programme grants from the British Heart Foundation (SP/09/002; RG/13/13/30194; RG/18/13/33946), BHF Centre of Research Excellence (RE/18/1/34212), the UK Medical Research Council (MR/L003120/1), and the National Institute for Health Research (NIHR) Cambridge Biomedical Research Centre (BRC1215-20014), with project-specific support received from the UK NIHR [*], British United Provident Association UK Foundation and an unrestricted educational grant from GlaxoSmithKline. A variety of funding sources have supported recruitment, follow-up, and laboratory measurements in the studies contributing data to the ERFC, which are listed on the ERFC website (www.phpc.cam.ac.uk/ceu/erfc/list-of-studies). *The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. This work was supported by Health Data Research UK, which is funded by the UK Medical Research Council, Engineering and Physical Sciences Research Council, Economic and Social Research Council, Department of Health and Social Care (England), Chief Scientist Office of the Scottish Government Health and Social Care Directorates, Health and Social Care Research and Development Division (Welsh Government), Public Health Agency (Northern Ireland), British Heart Foundation, and Wellcome. The MORGAM Project has received funding from EU projects MORGAM (Biomed BMH4-CT98-3183), GenomEUtwin (FP5, QLG2-CT-2002-01254), ENGAGE (FP7, HEALTH-F4-2007-201413),CHANCES (FP7, HEALTH-F3-2010-242244), BiomarCaRE (FP7,HEALTH-F2-2011-278913), euCanSHare (Horizon 2020, No. 825903) and AFFECT-EU (Horizon 2020, No. 847770); and Medical Research Council, London (G0601463, No. 80983: Biomarkers in the MORGAM Populations). This has supported central coordination, workshops and part of the activities of the MORGAM Data Centre, the MORGAM Laboratories and the MORGAM Participating Centres EPIC-CVD was funded by the European Research Council (268834), and the European Commission Framework Programme 7 (HEALTH-F2-2012-279233). This work was supported by the Estonian Research Council grant PUTs (PRG687, PUT1660, PUT1665, PRG184), by European Union through the European Regional Development Fund project no. MOBERA5 (Norface Network project no 462.16.107), by the Green ICT programme under Norway Grants 2014 – 2021 (grant number EU53928), by the European Union through Horizon 2020 grant no. 810645 and through the European Regional Development Fund (Project No. 2014-2020.4.01.16-0125) and by the PRECISE4Q consortium. PRECISE4Q project has received funding from the European Union’s Horizon 2020 Research and Innovation Programme under Grant agreement 777107. This work was partly funded through the CoMorMent project. CoMorMent has received funding from the European Union’s Horizon 2020 Research and Innovation Programme under Grant agreement 847776. The KORA study was initiated and financed by the Helmholtz Zentrum Mu¨nchen—German Research Center for Environmental Health, which is funded by the German Federal Ministry of Education and Research (BMBF) and by the State of Bavaria. The KORA study was supported by a research grant from the Virtual Institute of Diabetes Research (Helmholtz Zentrum Mu¨nchen), the Clinical Cooperation Group Diabetes between Ludwig-Maximilians-Universita¨t Mu¨nchen and Helmholtz Zentrum Mu¨nchen, and by the German Diabetes Center (DDZ). The HAPIEE project, Institute, was supported by grants from the Wellcome Trust (064947/Z/01/Z; WT081081) and US National Institute on Aging (1R01 and AG23522). The co-ordination of EPIC is financially supported by International Agency for Research on Cancer (IARC) and also by the Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, which has additional infrastructure support provided by the NIHR Imperial Biomedical Research Centre (BRC). The national cohorts are supported by: Danish Cancer Society (Denmark); Ligue Contre le Cancer, Institut Gustave Roussy, Mutuelle Ge´ne´rale de l’Education Nationale, Institut National de la Sante´ et de la Recherche Me´dicale (INSERM) (France); German Cancer Aid, German Cancer Research Center (DKFZ), German Institute of Human Nutrition Potsdam Rehbruecke (DIfE), Federal Ministry of Education and Research (BMBF) (Germany); Associazione Italiana per la Ricerca sul Cancro-AIRC-Italy, Compagnia di SanPaolo and National Research Council (Italy); Dutch 2448 SCORE2 working group and ESC Cardiovascular Risk Collaboration Ministry of Public Health, Welfare and Sports (VWS), Netherlands Cancer Registry (NKR), LK Research Funds, Dutch Prevention Funds, Dutch ZON (Zorg Onderzoek Nederland), World Cancer Research Fund (WCRF), Statistics Netherlands (The Netherlands); Health Research Fund (FIS)—Instituto de Salud Carlos III (ISCIII), Regional Governments of Andalucı´a, Asturias, Basque Country, Murcia and Navarra, and the Catalan Institute of Oncology—ICO (Spain); Swedish Cancer Society, Swedish Research Council and County Councils of Ska˚ne and Va¨sterbotten (Sweden); Cancer Research UK (14136 to EPIC-Norfolk; C8221/A29017 to EPIC-Oxford), Medical Research Council (1000143 to EPIC-Norfolk; MR/M012190/1 to EPIC-Oxford) (United Kingdom)

Published
2021

73. Effects of intensive glycemic control on clinical outcomes among patients with type 2 diabetes with different levels of cardiovascular risk and hemoglobin A1c in the ADVANCE trial

Author

Tian, J, Ohkuma, T, Cooper, M, Harrap, S, Mancia, G, Poulter, N, Wang, J, Zoungas, S, Woodward, M, Chalmers, J, Tian J., Ohkuma T., Cooper M., Harrap S., Mancia G., Poulter N., Wang J. -G., Zoungas S., Woodward M., Chalmers J., Tian, J, Ohkuma, T, Cooper, M, Harrap, S, Mancia, G, Poulter, N, Wang, J, Zoungas, S, Woodward, M, Chalmers, J, Tian J., Ohkuma T., Cooper M., Harrap S., Mancia G., Poulter N., Wang J. -G., Zoungas S., Woodward M., and Chalmers J.

Abstract

OBJECTIVE To study whether the effects of intensive glycemic control on major vascular outcomes (a composite of major macrovascular and major microvascular events), all-cause mortality, and severe hypoglycemia events differ among participants with different levels of 10-year risk of atherosclerotic cardiovascular disease (ASCVD) and hemoglobin A1c (HbA1c)atbaseline. RESEARCH DESIGN AND METHODS We studied the effects of more intensive glycemic control in 11,071 patients with type 2 diabetes (T2D), without missing values, in the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation (ADVANCE) trial, using Cox models. RESULTS During 5 years’ follow-up, intensive glycemic control reduced major vascular events (hazard ratio [HR] 0.90 [95% CI 0.83–0.98]), with the major driver being a reduction in the development of macroalbuminuria. There was no evidence of differences in the effect, regardless of baseline ASCVD risk or HbA1c level (P for interaction 5 0.29 and 0.94, respectively). Similarly, the beneficial effects of intensive glycemic control on all-cause mortality were not significantly different across baseline ASCVD risk (P 5 0.15) or HbA1c levels (P 5 0.87). The risks of severe hypoglycemic events were higher in the intensive glycemic control group compared with the standard glycemic control group (HR 1.85 [1.41–2.42]), with no significant heterogeneity across subgroups defined by ASCVD risk or HbA1c at baseline (P 5 0.09 and 0.18, respectively). CONCLUSIONS The major benefits for patients with T2D in ADVANCE did not substantially differ across levels of baseline ASCVD risk and HbA1c.

Published
2020

74. Intensive glucose-lowering and the risk of vascular events and premature death in patients with decreased kidney function: The ADVANCE trial

Author

Ohkuma, T, Zoungas, S, Jun, M, Lisheng, L, Mancia, G, Marre, M, Rodgers, A, Williams, B, Woodward, M, Chalmers, J, Ohkuma T., Zoungas S., Jun M., Lisheng L., Mancia G., Marre M., Rodgers A., Williams B., Woodward M., Chalmers J., Ohkuma, T, Zoungas, S, Jun, M, Lisheng, L, Mancia, G, Marre, M, Rodgers, A, Williams, B, Woodward, M, Chalmers, J, Ohkuma T., Zoungas S., Jun M., Lisheng L., Mancia G., Marre M., Rodgers A., Williams B., Woodward M., and Chalmers J.

Abstract

To assess the effects of intensive glucose control on the risk of major clinical outcomes according to estimated glomerular filtration rate (eGFR) levels in people with type 2 diabetes. Of 11 140 ADVANCE trial participants, 11 096 with baseline eGFR measurements were included, and classified into three eGFR groups: ≥90 mL/min/1.73 m2; 60 to 89 mL/min/1.73 m2; and < 60 mL/min/1.73 m2. Relative risk reduction of randomized intensive glucose control with regard to the composite outcome of major macro- and microvascular events, all-cause death and cardiovascular death did not significantly vary by eGFR level (P for heterogeneity ≥0.49). The risk of severe hypoglycaemia increased with intensive glucose control; however, this risk did not vary across eGFR groups (P for heterogeneity = 0.83). The risk–benefit profile of intensive glucose control in patients with type 2 diabetes and impaired kidney function appears similar to that observed in those with preserved kidney function.

Published
2020

75. Self-rated health scores predict mortality among people with type 2 diabetes differently across three different country groupings: findings from the ADVANCE and ADVANCE-ON trials

Author

Hua, X, Lung, T, Woodward, M, Salomon, J, Hamet, P, Harrap, S, Mancia, G, Poulter, N, Chalmers, J, Clarke, P, Hua X., Lung T. W. C., Woodward M., Salomon J. A., Hamet P., Harrap S. B., Mancia G., Poulter N., Chalmers J., Clarke P. M., Hua, X, Lung, T, Woodward, M, Salomon, J, Hamet, P, Harrap, S, Mancia, G, Poulter, N, Chalmers, J, Clarke, P, Hua X., Lung T. W. C., Woodward M., Salomon J. A., Hamet P., Harrap S. B., Mancia G., Poulter N., Chalmers J., and Clarke P. M.

Abstract

Aims: To explore whether there is a different strength of association between self-rated health and all-cause mortality in people with type 2 diabetes across three country groupings: nine countries grouped together as 'established market economies'; Asia; and Eastern Europe. Methods: The ADVANCE trial and its post-trial follow-up were used in this study, which included 11 140 people with type 2 diabetes from 20 countries, with a median follow-up of 9.9 years. Self-rated health was reported on a 0–100 visual analogue scale. Cox proportional hazard models were fitted to estimate the relationship between the visual analogue scale score and all-cause mortality, controlling for a range of demographic and clinical risk factors. Interaction terms were used to assess whether the association between the visual analogue scale score and mortality varied across country groupings. Results: The visual analogue scale score had different strengths of association with mortality in the three country groupings. A 10-point increase in visual analogue scale score was associated with a 15% (95% CI 12–18) lower mortality hazard in the established market economies, a 25% (95% CI 21–28) lower hazard in Asia, and an 8% (95% CI 3–13) lower hazard in Eastern Europe. Conclusions: Self-rated health appears to predict 10-year all-cause mortality for people with type 2 diabetes worldwide, but this relationship varies across groups of countries.

Published
2020

79. Effect of Oral Methylprednisolone on Decline in Kidney Function or Kidney Failure in Patients With IgA Nephropathy: The TESTING Randomized Clinical Trial

Author

Lv, J, Wong, MG, Hladunewich, MA, Jha, V, Hooi, LS, Monaghan, H, Zhao, M, Barbour, S, Jardine, MJ, Reich, HN, Cattran, D, Glassock, R, Levin, A, Wheeler, DC, Woodward, M, Billot, L, Stepien, S, Rogers, K, Chan, TM, Liu, Z-H, Johnson, DW, Cass, A, Feehally, J, Floege, J, Remuzzi, G, Wu, Y, Agarwal, R, Zhang, H, Perkovic, V, and TESTING Study Group

Subjects
Adult, Male, Administration, Oral, Glomerulonephritis, IGA, Kidney, Methylprednisolone, Proteinuria, Double-Blind Method, Renal Dialysis, General & Internal Medicine, Disease Progression, Humans, Female, Renal Insufficiency, 11 Medical and Health Sciences
Abstract

Importance: The effect of glucocorticoids on major kidney outcomes and adverse events in IgA nephropathy has been uncertain. Objective: To evaluate the efficacy and adverse effects of methylprednisolone in patients with IgA nephropathy at high risk of kidney function decline. Design, Setting, and Participants: An international, multicenter, double-blind, randomized clinical trial that enrolled 503 participants with IgA nephropathy, proteinuria greater than or equal to 1 g per day, and estimated glomerular filtration rate (eGFR) of 20 to 120 mL/min/1.73 m2 after at least 3 months of optimized background care from 67 centers in Australia, Canada, China, India, and Malaysia between May 2012 and November 2019, with follow-up until June 2021. Interventions: Participants were randomized in a 1:1 ratio to receive oral methylprednisolone (initially 0.6-0.8 mg/kg/d, maximum 48 mg/d, weaning by 8 mg/d/mo; n = 136) or placebo (n = 126). After 262 participants were randomized, an excess of serious infections was identified, leading to dose reduction (0.4 mg/kg/d, maximum 32 mg/d, weaning by 4 mg/d/mo) and addition of antibiotic prophylaxis for pneumocystis pneumonia for subsequent participants (121 in the oral methylprednisolone group and 120 in the placebo group). Main Outcomes And Measures: The primary end point was a composite of 40% decline in eGFR, kidney failure (dialysis, transplant), or death due to kidney disease. There were 11 secondary outcomes, including kidney failure. Results: Among 503 randomized patients (mean age, 38 years; 198 [39%] women; mean eGFR, 61.5 mL/min/1.73 m2; mean proteinuria, 2.46 g/d), 493 (98%) completed the trial. Over a mean of 4.2 years of follow-up, the primary outcome occurred in 74 participants (28.8%) in the methylprednisolone group compared with 106 (43.1%) in the placebo group (hazard ratio [HR], 0.53 [95% CI, 0.39-0.72]; P

Published
2022

80. Acute Treatment Effects on GFR in Randomized Clinical Trials of Kidney Disease Progression

Author

Neuen, B.L., Tighiouart, H., Heerspink, H.J., Vonesh, E.F., Chaudhari, J., Miao, S., Chan, T.M., Fervenza, F.C., Floege, J., Goicoechea, M., Herrington, W.G., Imai, E., Jafar, T.H., Lewis, J.B., Li, P.K., Locatelli, F., Maes, B.D., Perrone, R.D., Praga, M., Perna, A., Schena, F.P., Wanner, C., Wetzels, J.F.M., Woodward, M., Xie, D., Greene, T., Inker, L.A., Neuen, B.L., Tighiouart, H., Heerspink, H.J., Vonesh, E.F., Chaudhari, J., Miao, S., Chan, T.M., Fervenza, F.C., Floege, J., Goicoechea, M., Herrington, W.G., Imai, E., Jafar, T.H., Lewis, J.B., Li, P.K., Locatelli, F., Maes, B.D., Perrone, R.D., Praga, M., Perna, A., Schena, F.P., Wanner, C., Wetzels, J.F.M., Woodward, M., Xie, D., Greene, T., and Inker, L.A.

Abstract

Item does not contain fulltext, BACKGROUND: Acute changes in GFR can occur after initiation of interventions targeting progression of CKD. These acute changes complicate the interpretation of long-term treatment effects. METHODS: To assess the magnitude and consistency of acute effects in randomized clinical trials and explore factors that might affect them, we performed a meta-analysis of 53 randomized clinical trials for CKD progression, enrolling 56,413 participants with at least one estimated GFR measurement by 6 months after randomization. We defined acute treatment effects as the mean difference in GFR slope from baseline to 3 months between randomized groups. We performed univariable and multivariable metaregression to assess the effect of intervention type, disease state, baseline GFR, and albuminuria on the magnitude of acute effects. RESULTS: The mean acute effect across all studies was -0.21 ml/min per 1.73 m(2) (95% confidence interval, -0.63 to 0.22) over 3 months, with substantial heterogeneity across interventions (95% coverage interval across studies, -2.50 to +2.08 ml/min per 1.73 m(2)). We observed negative average acute effects in renin angiotensin system blockade, BP lowering, and sodium-glucose cotransporter 2 inhibitor trials, and positive acute effects in trials of immunosuppressive agents. Larger negative acute effects were observed in trials with a higher mean baseline GFR. CONCLUSION: The magnitude and consistency of acute GFR effects vary across different interventions, and are larger at higher baseline GFR. Understanding the nature and magnitude of acute effects can help inform the optimal design of randomized clinical trials evaluating disease progression in CKD.

Published
2022

81. Scaling-up food policies in the Pacific Islands: protocol for policy engagement and mixed methods evaluation of intervention implementation

Author

Webster, J, Waqa, G, Thow, AM, Allender, Steven, Lung, T, Woodward, M, Rogers, K, Tukana, I, Kama, A, Wilson, D, Mounsey, S, Dodd, R, Reeve, Erica, McKenzie, BL, Johnson, C, Bell, Colin, Webster, J, Waqa, G, Thow, AM, Allender, Steven, Lung, T, Woodward, M, Rogers, K, Tukana, I, Kama, A, Wilson, D, Mounsey, S, Dodd, R, Reeve, Erica, McKenzie, BL, Johnson, C, and Bell, Colin

Abstract

Abstract Background There is a crisis of non-communicable diseases (NCDs) in the Pacific Islands, and poor diets are a major contributor. The COVID-19 pandemic and resulting economic crisis will likely further exacerbate the burden on food systems. Pacific Island leaders have adopted a range of food policies and regulations to improve diets. This includes taxes and regulations on compositional standards for salt and sugar in foods or school food policies. Despite increasing evidence for the effectiveness of such policies globally, there is a lack of local context-specific evidence about how to implement them effectively in the Pacific. Methods Our 5-year collaborative project will test the feasibility and effectiveness of policy interventions to reduce salt and sugar consumption in Fiji and Samoa, and examine factors that support sustained implementation. We will engage government agencies and civil society in Fiji and Samoa, to support the design, implementation and monitoring of evidence-informed interventions. Specific objectives are to: (1) conduct policy landscape analysis to understand potential opportunities and challenges to strengthen policies for prevention of diet-related NCDs in Fiji and Samoa; (2) conduct repeat cross sectional surveys to measure dietary intake, food sources and diet-related biomarkers; (3) use Systems Thinking in Community Knowledge Exchange (STICKE) to strengthen implementation of policies to reduce salt and sugar consumption; (4) evaluate the impact, process and cost effectiveness of implementing these policies. Quantitative and qualitative data on outcomes and process will be analysed to assess impact and support scale-up of future interventions. Discussion The project will provide new evidence to support policy making, as well as developin

Published
2022

83. Associations of Early Systolic Blood Pressure Control and Outcome After Thrombolysis-Eligible Acute Ischemic Stroke: Results From the ENCHANTED Study

Author

Wang, X, Minhas, JS, Moullaali, TJ, Di Tanna, GL, Lindley, R, Chen, X, Arima, H, Chen, G, Delcourt, C, Bath, PM, Broderick, JP, Demchuk, AM, Donnan, GA, Durham, AC, Lavados, PM, Lee, T-H, Levi, C, Martins, SO, Olavarria, VV, Pandian, JD, Parsons, MW, Pontes-Neto, OM, Ricci, S, Sato, S, Sharma, VK, Silva, F, Thang, NH, Wang, J-G, Woodward, M, Chalmers, J, Song, L, Anderson, CS, Robinson, TG, Wang, X, Minhas, JS, Moullaali, TJ, Di Tanna, GL, Lindley, R, Chen, X, Arima, H, Chen, G, Delcourt, C, Bath, PM, Broderick, JP, Demchuk, AM, Donnan, GA, Durham, AC, Lavados, PM, Lee, T-H, Levi, C, Martins, SO, Olavarria, VV, Pandian, JD, Parsons, MW, Pontes-Neto, OM, Ricci, S, Sato, S, Sharma, VK, Silva, F, Thang, NH, Wang, J-G, Woodward, M, Chalmers, J, Song, L, Anderson, CS, and Robinson, TG

Abstract

BACKGROUND AND PURPOSE: In thrombolysis-eligible patients with acute ischemic stroke, there is uncertainty over the most appropriate systolic blood pressure (SBP) lowering profile that provides an optimal balance of potential benefit (functional recovery) and harm (intracranial hemorrhage). We aimed to determine relationships of SBP parameters and outcomes in thrombolyzed acute ischemic stroke patients. METHODS: Post hoc analyzes of the ENCHANTED (Enhanced Control of Hypertension and Thrombolysis Stroke Study), a partial-factorial trial of thrombolysis-eligible and treated acute ischemic stroke patients with high SBP (150-180 mm Hg) assigned to low-dose (0.6 mg/kg) or standard-dose (0.9 mg/kg) alteplase and intensive (target SBP, 130-140 mm Hg) or guideline-recommended (target SBP <180 mm Hg) treatment. All patients were followed up for functional status and serious adverse events to 90 days. Logistic regression models were used to analyze 3 SBP summary measures postrandomization: attained (mean), variability (SD) in 1-24 hours, and magnitude of reduction in 1 hour. The primary outcome was a favorable shift on the modified Rankin Scale. The key safety outcome was any intracranial hemorrhage. RESULTS: Among 4511 included participants (mean age 67 years, 38% female, 65% Asian) lower attained SBP and smaller SBP variability were associated with favorable shift on the modified Rankin Scale (per 10 mm Hg increase: odds ratio, 0.76 [95% CI, 0.71-0.82]; P<0.001 and 0.86 [95% CI, 0.76-0.98]; P=0.025) respectively, but not for magnitude of SBP reduction (0.98, [0.93-1.04]; P=0.564). Odds of intracranial hemorrhage was associated with higher attained SBP and greater SBP variability (1.18 [1.06-1.31]; P=0.002 and 1.34 [1.11-1.62]; P=0.002) but not with magnitude of SBP reduction (1.05 [0.98-1.14]; P=0.184). CONCLUSIONS: Attaining early and consistent low levels in SBP <140 mm Hg, even as low as 110 to 120 mm Hg, over 24 hours is associated with better outcomes in thrombolyzed

Published
2022

84. Triple Therapy Prevention of Recurrent Intracerebral Disease Events Trial: Rationale, design and progress

Author

Anderson, C.S, Rodgers, A., Silva, H.A. de, Martins, S.O., Klijn, C.J.M., Senanayake, B., Freed, R., Billot, L., Arima, H., Thang, N.H., Zaidi, W.A.W., Kherkheulidze, T., Wahab, K., Fisher, U., Lee, Theo A.J. van der, Chen, C, Pontes-Neto, O., Robinson, T., Wang, Jiaguang, Naismith, S., Song, Lili, Schreuder, F.H.B.M., Lindley, R.I., Woodward, M., MacMahon, S, Salman, R.A., Chow, C.K., Chalmers, J., Anderson, C.S, Rodgers, A., Silva, H.A. de, Martins, S.O., Klijn, C.J.M., Senanayake, B., Freed, R., Billot, L., Arima, H., Thang, N.H., Zaidi, W.A.W., Kherkheulidze, T., Wahab, K., Fisher, U., Lee, Theo A.J. van der, Chen, C, Pontes-Neto, O., Robinson, T., Wang, Jiaguang, Naismith, S., Song, Lili, Schreuder, F.H.B.M., Lindley, R.I., Woodward, M., MacMahon, S, Salman, R.A., Chow, C.K., and Chalmers, J.

Abstract

Item does not contain fulltext, BACKGROUND: Patients who suffer intracerebral hemorrhage (ICH) are at very high risk of recurrent ICH and other serious cardiovascular events. A single-pill combination (SPC) of blood pressure (BP) lowering drugs offers a potentially powerful but simple strategy to optimize secondary prevention. OBJECTIVES: The Triple Therapy Prevention of Recurrent Intracerebral Disease Events Trial (TRIDENT) aims to determine the effects of a novel SPC "Triple Pill," three generic antihypertensive drugs with demonstrated efficacy and complementary mechanisms of action at half standard dose (telmisartan 20 mg, amlodipine 2.5 mg, and indapamide 1.25 mg), with placebo for the prevention of recurrent stroke, cardiovascular events, and cognitive impairment after ICH. DESIGN: An international, double-blind, placebo-controlled, randomized trial in adults with ICH and mild-moderate hypertension (systolic BP: 130-160 mmHg), who are not taking any Triple Pill component drug at greater than half-dose. A total of 1500 randomized patients provide 90% power to detect a hazard ratio of 0.5, over an average follow-up of 3 years, according to a total primary event rate (any stroke) of 12% in the control arm and other assumptions. Secondary outcomes include recurrent ICH, cardiovascular events, and safety. RESULTS: Recruitment started 28 September 2017. Up to 31 October 2021, 821 patients were randomized at 54 active sites in 10 countries. Triple Pill adherence after 30 months is 86%. The required sample size should be achieved by 2024. CONCLUSION: Low-dose Triple Pill BP lowering could improve long-term outcome from ICH.

Published
2022

85. Age-Related Variation in the Provision of Primary Care Services and Medication Prescriptions for Patients with Cardiovascular Disease

Author

Tu, Q, Hyun, K, Hafiz, N, Knight, A, Hespe, C, Chow, CK, Briffa, T, Gallagher, R, Reid, CM, Hare, DL, Zwar, N, Woodward, M, Jan, S, Atkins, ER, Laba, T-L, Halcomb, E, Usherwood, T, Billot, L, Redfern, J, Tu, Q, Hyun, K, Hafiz, N, Knight, A, Hespe, C, Chow, CK, Briffa, T, Gallagher, R, Reid, CM, Hare, DL, Zwar, N, Woodward, M, Jan, S, Atkins, ER, Laba, T-L, Halcomb, E, Usherwood, T, Billot, L, and Redfern, J

Abstract

As population aging progresses, demands of patients with cardiovascular diseases (CVD) on the primary care services is inevitably increased. However, the utilisation of primary care services across varying age groups is unknown. The study aims to explore age-related variations in provision of chronic disease management plans, mental health care, guideline-indicated cardiovascular medications and influenza vaccination among patients with CVD over differing ages presenting to primary care. Data for patients with CVD were extracted from 50 Australian general practices. Logistic regression, accounting for covariates and clustering effects by practices, was used for statistical analysis. Of the 14,602 patients with CVD (mean age, 72.5 years), patients aged 65-74, 75-84 and ≥85 years were significantly more likely to have a GP management plan prepared (adjusted odds ratio (aOR): 1.6, 1.88 and 1.55, respectively, p < 0.05), have a formal team care arrangement (aOR: 1.49, 1.8, 1.65, respectively, p < 0.05) and have a review of either (aOR: 1.63, 2.09, 1.93, respectively, p < 0.05) than those < 65 years. Patients aged ≥ 65 years were more likely to be prescribed blood-pressure-lowering medications and to be vaccinated for influenza. However, the adjusted odds of being prescribed lipid-lowering and antiplatelet medications and receiving mental health care were significantly lowest among patients ≥ 85 years. There are age-related variations in provision of primary care services and pharmacological therapy. GPs are targeting care plans to older people who are more likely to have long-term conditions and complex needs.

Published
2022

86. Mild-to-Moderate Kidney Dysfunction and Cardiovascular Disease: Observational and Mendelian Randomization Analyses

Author

Gaziano, L, Sun, L, Arnold, M, Bell, S, Cho, K, Kaptoge, SK, Song, RJ, Burgess, S, Posner, DC, Mosconi, K, Cohen, CR, Mason, AM, Bolton, TR, Tao, R, Allara, E, Schubert, P, Chen, L, Staley, JR, Staplin, N, Altay, S, Amiano, P, Arndt, PV, Arnlov, J, Barr, ELM, Bjorkelund, C, Boer, JMA, Brenner, H, Casiglia, E, Chiodini, P, Cooper, JA, Coresh, J, Cushman, M, Dankner, R, Davidson, KW, de Jongh, RT, Donfrancesco, C, Engstrom, G, Freisling, H, de la Camara, AG, Gudnason, V, Hankey, GJ, Hansson, P, Heath, AK, Hoorn, EJ, Imano, H, Jassal, SK, Kaaks, R, Katzke, V, Kauhanen, J, Kiechl, S, Koenig, W, Kronmal, RA, Kyro, C, Lawlor, DA, Ljungberg, B, MacDonald, C, Masala, G, Meisinger, C, Melander, O, Iribas, CM, Ninomiya, T, Nitsch, D, Nordestgaard, BG, OnlandMoret, C, Palmieri, L, Petrova, D, Garcia, JRQ, Rosengren, A, Sacerdote, C, Sakurai, M, Santiuste, C, Schulze, MB, Sieri, S, Sundstrom, J, Tikhonoff, V, Tjonneland, A, Tong, T, Tumino, R, Tzoulaki, I, van der Schouw, YT, Verschuren, WMM, Volzke, H, Wallace, RB, Wannamethee, SG, Weiderpass, E, Willeit, P, Woodward, M, Yamagishi, K, ZamoraRos, R, Akwo, EA, Pyarajan, S, Gagnon, DR, Tsao, PS, Muralidhar, S, Edwards, TL, Damrauer, SM, Joseph, J, Pennells, L, Wilson, PWF, Harrison, S, Gaziano, TA, Inouye, M, Baigent, C, Casas, JP, Langenberg, C, Wareham, N, Riboli, E, Gaziano, JM, Danesh, J, Hung, AM, Butterworth, AS, Wood, AM, Di Angelantonio, E, Gaziano, L, Sun, L, Arnold, M, Bell, S, Cho, K, Kaptoge, SK, Song, RJ, Burgess, S, Posner, DC, Mosconi, K, Cohen, CR, Mason, AM, Bolton, TR, Tao, R, Allara, E, Schubert, P, Chen, L, Staley, JR, Staplin, N, Altay, S, Amiano, P, Arndt, PV, Arnlov, J, Barr, ELM, Bjorkelund, C, Boer, JMA, Brenner, H, Casiglia, E, Chiodini, P, Cooper, JA, Coresh, J, Cushman, M, Dankner, R, Davidson, KW, de Jongh, RT, Donfrancesco, C, Engstrom, G, Freisling, H, de la Camara, AG, Gudnason, V, Hankey, GJ, Hansson, P, Heath, AK, Hoorn, EJ, Imano, H, Jassal, SK, Kaaks, R, Katzke, V, Kauhanen, J, Kiechl, S, Koenig, W, Kronmal, RA, Kyro, C, Lawlor, DA, Ljungberg, B, MacDonald, C, Masala, G, Meisinger, C, Melander, O, Iribas, CM, Ninomiya, T, Nitsch, D, Nordestgaard, BG, OnlandMoret, C, Palmieri, L, Petrova, D, Garcia, JRQ, Rosengren, A, Sacerdote, C, Sakurai, M, Santiuste, C, Schulze, MB, Sieri, S, Sundstrom, J, Tikhonoff, V, Tjonneland, A, Tong, T, Tumino, R, Tzoulaki, I, van der Schouw, YT, Verschuren, WMM, Volzke, H, Wallace, RB, Wannamethee, SG, Weiderpass, E, Willeit, P, Woodward, M, Yamagishi, K, ZamoraRos, R, Akwo, EA, Pyarajan, S, Gagnon, DR, Tsao, PS, Muralidhar, S, Edwards, TL, Damrauer, SM, Joseph, J, Pennells, L, Wilson, PWF, Harrison, S, Gaziano, TA, Inouye, M, Baigent, C, Casas, JP, Langenberg, C, Wareham, N, Riboli, E, Gaziano, JM, Danesh, J, Hung, AM, Butterworth, AS, Wood, AM, and Di Angelantonio, E

Abstract

BACKGROUND: End-stage renal disease is associated with a high risk of cardiovascular events. It is unknown, however, whether mild-to-moderate kidney dysfunction is causally related to coronary heart disease (CHD) and stroke. METHODS: Observational analyses were conducted using individual-level data from 4 population data sources (Emerging Risk Factors Collaboration, EPIC-CVD [European Prospective Investigation into Cancer and Nutrition-Cardiovascular Disease Study], Million Veteran Program, and UK Biobank), comprising 648 135 participants with no history of cardiovascular disease or diabetes at baseline, yielding 42 858 and 15 693 incident CHD and stroke events, respectively, during 6.8 million person-years of follow-up. Using a genetic risk score of 218 variants for estimated glomerular filtration rate (eGFR), we conducted Mendelian randomization analyses involving 413 718 participants (25 917 CHD and 8622 strokes) in EPIC-CVD, Million Veteran Program, and UK Biobank. RESULTS: There were U-shaped observational associations of creatinine-based eGFR with CHD and stroke, with higher risk in participants with eGFR values <60 or >105 mL·min-1·1.73 m-2, compared with those with eGFR between 60 and 105 mL·min-1·1.73 m-2. Mendelian randomization analyses for CHD showed an association among participants with eGFR <60 mL·min-1·1.73 m-2, with a 14% (95% CI, 3%-27%) higher CHD risk per 5 mL·min-1·1.73 m-2 lower genetically predicted eGFR, but not for those with eGFR >105 mL·min-1·1.73 m-2. Results were not materially different after adjustment for factors associated with the eGFR genetic risk score, such as lipoprotein(a), triglycerides, hemoglobin A1c, and blood pressure. Mendelian randomization results for stroke were nonsignificant but broadly similar to those for CHD. CONCLUSIONS: In people without manifest cardiovascular disease or diabetes, mild-to-moderate kidney dysfunction is causally related to risk of CHD, highlighting the potential value of preventive approaches th

Published
2022

87. Data-driven quality improvement program to prevent hospitalisation and improve care of people living with coronary heart disease: Protocol for a process evaluation

Author

Hafiz, N, Hyun, K, Tu, Q, Knight, A, Hespe, C, Chow, CK, Briffa, T, Gallagher, R, Reid, CM, Hare, DL, Zwar, N, Woodward, M, Jan, S, Atkins, ER, Laba, T-L, Halcomb, E, Johnson, T, Usherwood, T, Redfern, J, Hafiz, N, Hyun, K, Tu, Q, Knight, A, Hespe, C, Chow, CK, Briffa, T, Gallagher, R, Reid, CM, Hare, DL, Zwar, N, Woodward, M, Jan, S, Atkins, ER, Laba, T-L, Halcomb, E, Johnson, T, Usherwood, T, and Redfern, J

Abstract

BACKGROUND: Practice-level quality improvement initiatives using rapidly advancing technology offers a multidimensional approach to reduce cardiovascular disease burden. For the "QUality improvement in primary care to prevent hospitalisations and improve Effectiveness and efficiency of care for people Living with heart disease" (QUEL) cluster randomised controlled trial, a 12-month quality improvement intervention was designed for primary care practices to use data and implement progressive changes using "Plan, Do, Study, Act" cycles within their practices with training in a series of interactive workshops. This protocol aims to describe the systematic methods to conduct a process evaluation of the data-driven intervention within the QUEL study. METHODS: A mixed-method approach will be used to conduct the evaluation. Quantitative data collected throughout the intervention period, via surveys and intervention materials, will be used to (1) identify the key elements of the intervention and how, for whom and in what context it was effective; (2) determine if the intervention is delivered as intended; and (3) describe practice engagement, commitment and capacity associated with various intervention components. Qualitative data, collected via semi-structured interviews and open-ended questions, will be used to gather in-depth understanding of the (1) satisfaction, utility, barriers and enablers; (2) acceptability, uptake and feasibility, and (3) effect of the COVID-19 pandemic on the implementation of the intervention. CONCLUSION: Findings from the evaluation will provide new knowledge on the implementation of a complex, multi-component intervention at practice-level using their own electronic patient data to enhance secondary prevention of cardiovascular disease. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry (ANZCTR) number ACTRN12619001790134.

Published
2022

88. Nationally Informed Recommendations on Approaching the Detection, Assessment, and Management of Mild Cognitive Impairment

Author

Woodward, M, Brodaty, H, McCabe, M, Masters, CL, Naismith, SL, Morris, P, Rowe, CC, Walker, P, Yates, M, Woodward, M, Brodaty, H, McCabe, M, Masters, CL, Naismith, SL, Morris, P, Rowe, CC, Walker, P, and Yates, M

Abstract

Prior to the usual clinical symptoms of dementia, there can be subtle changes in cognitive function that differ from the normal age-related cognitive decline, which has been termed mild cognitive impairment (MCI). The increase in the numbers of individuals with possible MCI presenting to health care professionals, notably, General Practitioners (GPs), is going to rise dramatically in the coming years. With ever increasing demands on GPs, it is therefore timely to provide information that can be accessed by health care professionals to assist them in making appropriate diagnoses and to provide the most relevant, evidence-based treatment options. We have provided a comprehensive list of recommendations that aim to address key aspects of MCI in primary care. Specifically, these relate to detection and diagnosis; sharing the diagnosis, monitoring, and follow up; practical interventions to potentially delay progression; and personalizing care-planning, engagement, and patient motivation for the long term.

Published
2022

89. Assessing the Reach, Scope and Outcomes of Government Action on Women’s Health and Human Rights: A Protocol for the Development of an International Women’s Rights Dataset

Author

Shanthosh, J, Muvva, K, Woodward, M, Vijeyarasa, R, Palagyi, A, Shanthosh, J, Muvva, K, Woodward, M, Vijeyarasa, R, and Palagyi, A

Abstract

Background: The UN Convention on the Elimination of all Forms of Discrimination Against Women (CEDAW) represents an international commitment to equality in the enjoyment of human rights. International human rights scholars posit that, in facilitating constructive dialogues between states and human rights experts, the near-universally ratified Convention is a powerful tool for achieving global health goals, such as the Sustainable Development Goals (SDGs). Yet, the performance of such rights-based approaches in achieving gender equality, and empowering all women, has not been systematically measured and evaluated on a global scale. This study seeks to address the urgent need to support data-driven analyses to hold governments to account through the development of a global dataset measuring state action on women’s health and human rights. Methods: Standard systematic review methods will be used to review CEDAW periodic review reports produced by United Nations (UN) Member States, civil society organisations and the CEDAW Committee. Global participation with the review mechanism, the scope of health inequities covered by Committee recommendations, the nature of reported government action and the extent of implementation of each program will be extracted from each report. Only data from the two most recent reporting cycles will be analysed. Descriptive statistics will be used to analyse quantitative data, and all qualitative data will be analysed using policy mapping techniques. Discussion: Using these data, the study will navigate the nature and the extent of state action to address these issues including by increasing women’s leadership and participation, data collection, strengthening health systems, governance and coordination and establishing new human rights infrastructure. It will use the diversity of health and human rights issues affecting women to reframe traditional conceptualisations of global women’s health which have largely focussed on sexual and reproduc

Published
2022

Catalog

Books, media, physical & digital resources
See catalog results