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Many research groups around the world have produced evidence that cardiovascular disease (CVD) can be prevented by dietary salt reduction. The specific contribution of the University of Warwick consists of primary research carried out between 2005 and 2013 by Professor Francesco Cappuccio, who has demonstrated that lower salt intake can lead to a reduction in strokes and total cardiovascular events. These results have informed public health awareness and policy- making both nationally and globally. The research contributed directly to the development of a national policy for salt reduction by the UK National Institute for Health and Care Excellence (NICE) in 2010 by indicating the likely health gains of a population strategy. The research also influenced global policies set out by the World Health Organization (WHO) in 2007, 2010 and 2012. Population-wide reductions in dietary salt are now the second priority after tobacco control set by the United Nations in 2011 for the prevention of non-communicable disease worldwide.
Around 25% of UK adults have high blood pressure (hypertension), accounting for more than half of all strokes and heart disease. The pressure that the heart and brain senses that leads to these diseases is central aortic pressure. The Unit's research developed and evaluated methods for the non-invasive assessment of central aortic pressure, demonstrating its important relationship to clinical outcomes. The work has contributed to improvements in the way high blood pressure is treated for millions of people, nationally and worldwide, by (i) providing a rationale for one of the biggest-ever changes in treatment guidance in 2006; (ii) stimulating major growth in medical devices for the non-invasive measurement of aortic pressure with a simple, easy-to-use wristwatch invention; (iii) and developing central aortic pressure as a better biomarker for pharmaceutical companies to develop new drugs to treat hypertension.
Although an adequate micronutrient intake and status is necessary for health and deficiency disease prevention, an excess dietary intake may have deleterious effects on health. Our impact has been to inform, stimulate and move forward our understanding of micronutrient requirements across the human lifecycle. Our activities have led to the development of WHO, EU and national nutrient intake recommendations which have had a significant impact on public health policies and initiatives which address food security.
We provided specialist expertise to the WHO Guidance Expert Advisory Group for assessing the effects of potassium and sodium intakes on human health. As a result, WHO has developed its first dietary guideline on intakes of potassium (adults and children) and sodium (children) for cardiovascular health.
Our original research in micronutrients including iron, zinc and fluoride and our systematic review approach have generated the evidence required for deriving nutritional recommendations, exemplified by our contribution to European dietary reference values (DRVs). These are used by member states to produce national health policies, guidelines and nutrient intake recommendations.
Research by Professor Elliott and colleagues at Imperial College on worldwide salt and potassium intakes, their relationships to blood pressure, and co-authored systematic reviews and meta-analyses of their effects in adults and children on blood pressure and cardiovascular disease — and potential adverse effects — has played an instrumental role in developing international guidelines and public policy on sodium reduction strategies. Furthermore, published primary research has influenced US Centers for Disease Control and Prevention (CDC) strategies for population-wide monitoring of sodium intakes in the USA. This work has thus had impact on policies for sodium reduction and monitoring of sodium intakes worldwide.
Two multicentre clinical trials conducted by Professor Potter have contributed to revised international guidelines for the management of hypertension following acute stroke, the single largest cause of adult disability worldwide. Before these trials, there was little evidence on the effects of using antihypertensive drugs immediately after stroke and there was concern that use of these drugs could extend the stroke. The trials found no serious adverse effects of using antihypertensive drugs immediately after stroke whilst mortality after 3 months was halved. The American Heart Association, the European Societies of Hypertension and of Cardiology, and the Royal College of Physicians all reference these trials in support of their recent Guidelines, thereby promoting better patient care and improved outcomes.
Novel work undertaken at this centre has demonstrated that vitamin B2 (riboflavin) can significantly decrease BP, specifically in people with a common genetic variant affecting the folate-metabolising enzyme MTHFR. The extent of BP-lowering demonstrated is as good as that expected from BP-lowering drugs and much better than that found with common dietary approaches and furthermore, the effect is independent of concurrent BP-lowering drugs. These findings offer a simple, cost-effective targeted treatment for the management of BP in this genetically at-risk group. The global prevalence of this genetic variant is 10% but can be as high as 32% in other countries such as Mexico and Northern China.
Research in Leeds has identified independent risk factors associated with pressure ulcer development and made a significant contribution to the evidence base for choosing the most cost- effective mattress to prevent pressure ulcers. Through publication and subsequent integration into systematic reviews/ practice guidelines, and membership of committees the research has been disseminated to policy makers and practitioners. Leeds evidence is now included in international guidelines in at least 17 languages. This has led to a change in clinical and purchasing practice with likely reduction in the number of pressure ulcers and health service cost.
The Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT; Co-Chairman, Professor Sever) was an investigator designed and led multinational study in which different blood pressure-lowering and lipid-lowering treatment strategies were investigated in an attempt to define optimal programmes for intervention to prevent cardiovascular disease in hypertensive subjects. The outcomes of both the antihypertensive arm and the lipid arm of the trial defined the benefits of more contemporary treatments for hypertensive subjects, including calcium channel blockers, angiotensin converting enzyme inhibitors and statins, which have been incorporated into national and international guidelines (including NICE), and have impacted on current clinical practice in the prevention of cardiovascular disease worldwide.
This research provided the first evidence that long-chain polyunsaturated fatty acids (LCPUFAs) added to infant formula improve the development of specific cognitive abilities. Manufacturers of infant formula have included the research in their submissions to regulatory authorities to justify inclusion of LCPUFAs in infant formula. The research is also included in information and advice on infant feeding provided by manufacturers for the general public. Between 2008 and 2013, the research has been cited by national and international organisations in connection with recommendations for dietary intakes of LCPUFAs and policy on infant nutrition. Formulas enriched with LCPUFA are now available in most countries, and the formula-fed infants worldwide receive the benefits of LCPUFAs.
High blood pressure (or hypertension) is the major cause of stroke and other cardiovascular disease, and is one of the most important preventable causes of morbidity and mortality in developed and developing countries. In the UK it affects half the population over 60 and costs the NHS £1Bn per year in drugs alone.
A University of Birmingham primary care-led study has provided definitive evidence of the superiority of ambulatory blood pressure measurement (ABPM) over clinic and home blood pressure monitoring as a means of diagnosing hypertension. The associated cost-effectiveness study showed that this approach will save the NHS over £10.5M per year. As a result of this research, NICE guidelines have been amended and ABPM has become the reference standard. The research has also influenced public and policy debate in the UK and internationally.