Summary of the impact

More than half of UK adults aged over 45 years have high cholesterol levels, the major modifiable risk factor for cardiovascular disease (CVD). Over the past 20 years, University of Glasgow researchers have led numerous landmark clinical trials establishing the benefits of statins for CVD prevention. High-profile international clinical guidelines on lipid lowering cite these studies in the key evidence base for recommendations to guide statin use, demonstrating the considerable influence this work exerts on current clinical practice and public health. This has driven the global uptake of statins and provided the evidence-base for CVD risk assessment and prevention strategies that are now implemented worldwide. The use of statins has transformed patient care, provided a cost-effective prevention strategy for healthcare providers and made major contributions to the falling CVD mortality rates across Europe and the US.

Summary of the impact

Studies coordinated by the University of Oxford's Clinical Trial Service Unit (CTSU) within the Nuffield Department of Population Health (NDPH) have strongly influenced the labelling of statin medication internationally, treatment guidelines, and the resulting changes in prescribing have contributed to reductions in mortality and morbidity from heart attack and ischaemic stroke in many countries. CTSU's randomised trials and meta-analyses of trials have shown that lowering low-density lipoprotein (LDL) cholesterol safely reduces the risk of heart attacks, strokes and revascularisation procedures in a wide range of people, and work conducted in collaboration with the NDPH's Health Economic Research Centre has provided clear evidence of cost-effectiveness of statins.

Summary of the impact

Over the past ten years, the prescription of cholesterol-lowering statins has soared and they are now the most prescribed drugs in the UK and the US. However, this has raised concerns about inappropriate prescribing. University of Glasgow research has been pivotal in addressing this issue and has triggered revision of major international guidelines to stratify patients in the general population for statin therapy and guide statin use in the rheumatoid arthritis patient population. The identification of a statin-associated risk for diabetes prompted the European Medicines Agency and the US Food & Drug Administration to revise safety labelling for all classes of statins. This risk is now communicated to the 27 million patients in the UK and US who are prescribed statins.

Summary of the impact

An eight year MRC-funded clinical trial led by the University of Dundee and run throughout Scotland (16 hospitals, 188 GP Surgeries) exploring aspirin in diabetes for primary cardiovascular event prevention, where clinical practice had evolved without evidence.

• NHS: Implementation of results in general practices, hospitals, and Health Boards globally, by ceasing to prescribe aspirin as primary prevention in diabetes.
• Policy: Resulted in major changes to international Guidelines globally e.g. American Diabetes Association Guidelines, Australian, New Zealand and Canadian Guidelines and Scottish Intercollegiate Guideline Network (SIGN).
• Improved Patient Care and Health Outcomes: Reduction in aspirin prescribing with decrease in adverse events, reduction in concomitant proton pump inhibition prescribing.
• Internationalisation: Implementation worldwide, by doctors and pharmacists with reports in lay publications, radio programmes, TV interviews and patient targeted websites.

Summary of the impact

The Collaborative Atorvastatin Diabetes Study (2004), led by researchers at the University of Manchester (UoM), established the efficacy of statin therapy in the prevention of atherosclerotic cardiovascular disease (CVD) among patients with diabetes. The research challenged the previously held view that, since CVD risk is markedly raised in people with diabetes even when blood cholesterol levels are normal, statins were unlikely to be beneficial for this group. These key findings have informed clinical guidelines governing the use of statin therapy in the UK (NICE, SIGN) and internationally (American Heart Association and the American Diabetes Association, ESC, EAS), ensuring that statins are now considered for all diabetic patients.

Summary of the impact

Research at the University of Sheffield to evaluate the cost-effectiveness of different treatments for women with osteoporosis was used by the National Institute of Health and Care Excellence (NICE) to develop their guidance on the condition. The evaluation model was the first to combine cost-effectiveness of both treatment and screening and to include more detailed categorisation of patients. The model was used by NICE in their 2005, 2008 and 2011 guidance, which is mandatory for the NHS in England and Wales, and, therefore, since 2008 has influenced the treatment of over two million women with osteoporosis.

Summary of the impact

Over the past 20 years, the University of Oxford's Clinical Trial Service Unit (CTSU), within the Nuffield Department of Population Health (NDPH), has conducted some of the world's largest trials and collaborative meta-analyses of trials of antiplatelet therapy, including aspirin, that have together had a major ongoing and incremental impact on the treatment and prevention of cardiovascular disease. They have helped ensure that antiplatelet therapy is widely used both in the acute care of patients with heart attacks and for the secondary prevention of heart attacks and strokes in high-risk patients. This research has been recognised as the gold standard for international guidelines, and has been instrumental in changing prescribing labelling for aspirin.

Summary of the impact

Capewell's MRC/EU/NIHR funded IMPACT programme has been developed at the University of Liverpool (UoL) since 1999. It examines why cardiovascular disease (CVD) death rates have recently halved in the UK, USA and Europe (mainly risk factor improvements plus modern treatments), and why CVD rates are increasing in China and most developing countries (adverse risk factor trends reflecting a Westernised diet). Results have informed CVD prevention strategies in the UK and beyond, notably NICE Guidance on CVD prevention in whole populations. The strong NICE recommendations on diet and tobacco were recently endorsed in NICE Commissioning Guidance and European and American guidance.

Summary of the impact

Research led by Professor Harry Hemingway at UCL on the quality and outcomes of care of people with, or at risk of, cardiovascular diseases has informed guidelines and clinical management in a number of areas. The work influenced NICE guidelines on Chest pain of recent onset (CG95) with regard to the use of exercise electrocardiography (ECG) in the diagnosis of stable angina and approaches to sex and ethnicity in diagnosis. Our research also underpinned recommendations on revascularisation in the NICE guidelines on Management of stable angina (CH126). Additionally, the research has led to recommendations about the need to assess psychosocial factors including depression in people with myocardial infarction.

Summary of the impact

QRISK is a new algorithm which predicts an individual's risk of cardiovascular over 10 years. It was developed using the QResearch database and is in routine use across the NHS. It is included in national guidelines from NICE and the Department of Health and in the GP quality and outcomes framework. It is incorporated into > 90% of GP computer systems as well as pharmacy and secondary care systems. The web calculator has been used >500,000 times worldwide. ClinRisk Ltd was incorporated in 2008 to develop software to ensure the reliable widespread implementation of the QRISK algorithm into clinical practice.