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MacGregor and colleagues working at St George's have provided extensive clinical and epidemiological evidence that has changed UK government policy on recommendations for salt intake. In 2011 NICE recommended continued reduction in dietary salt intake in the UK. A 3 gm reduction in daily salt intake is calculated to result in 14-20,000 fewer deaths from cardiovascular disease annually, a saving of approximately £350 million in healthcare costs, and the gain of 130,000 quality-adjusted life years. The global benefits of this policy have been recognised with the WHO making recommendations for similar levels of salt reduction worldwide.
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.
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.
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.
Cardiovascular disease is the largest killer in the developed world, with 50% of people affected during their lifetime. While the link between raised plasma cholesterol and cardiovascular disease is well established, heart-health policy to limit dietary cholesterol intake was based on the unsupported belief that dietary cholesterol was a key determinant of plasma cholesterol.
Researchers at Surrey were central to demonstrating no direct correlation between cholesterol-rich food and plasma cholesterol. This research led to multiple impacts: alteration of national and international dietary guidelines; better public perception of cholesterol control; and commercial impact through the increased consumption of cholesterol-containing foods.
Dietary fat plays an important role in the causation of cardiovascular disease (CVD). Using randomized controlled trials of dietary fat modification, King's College London researchers have provided information about the effects of specific fatty acids on CVD risk which the Food Standards Agency have used to inform its policy decisions and future research strategy. The research also contributed to the development of international guidelines on the intakes of specific types of fatty acids and helped the food industry reformulate fats to be low in trans fatty acids. This research has also had an impact on dietary advice given by health professionals, the media and patient groups.
Caulfield co-led and was a principal investigator (PI) on Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT). Hitman co-led and was a PI on Collaborative AtoRvastatin Diabetes Study (CARDS). These studies dramatically changed national and international guidance for diabetes, hypertension and cholesterol, leading to widespread and far-reaching changes in management of common and potentially fatal risk factors. For example, the proportion of hypertensive patients in England with good BP control (<140/90) rose from 52% in 2006 to 62% in 2011; the mean total cholesterol level of the population has fallen by 0.5 Mmol/L between 1998 and 2011.
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.
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.
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.