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QRisk is a statistical model / score derived from routine general practice (GP) records to calculate an individual's risk of developing cardiovascular disease (CVD). Queen Mary researchers formed the London arm of a multi-centre study and were particularly instrumental in testing the tool in general practice. QRisk targets treatment more effectively than other scores; it is also more equitable for disadvantaged and minority ethnic groups and cheaper per event prevented. QRisk is used in the NHS Health Checks programme covering 20 million people in England and is available at a keystroke in all GP computer systems in England. It has contributed to the identification of an additional 2.8 million people in England at high risk of CVD and their treatment with statins, reducing CVD deaths and events by an estimated 9,000 per year — about 50,000 to date since the NHS Checks programme started in 2009.
We are facing a diabetes epidemic: the number of people affected worldwide is estimated to rise from 366 million in 2011 to 552 million by 2030, representing a huge financial burden on society. Using data from the United Kingdom Prospective Diabetes Study (UKPDS), the University of Oxford's Diabetes Trials Unit developed two assessment tools - the UKPDS Risk Engine (a diabetes-specific heart attack and stroke risk calculator) and the UKPDS Outcomes Model (a lifetime simulator for people with diabetes) to better understand and plan for diabetes risk and its outcomes on both individuals and society as a whole. Patients, clinicians and policymakers globally are now using these tools to assist in planning for future health economic needs, and for predicting health risks for people with diabetes.
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.
RVC's Veterinary Epidemiology, Economics and Public Health team (VEEPH) has been at the forefront of applying and evaluating new techniques for modelling disease risk, for policy and decision makers to use in surveillance and control of animal and zoonotic infections. Application of their recommendations, including European `Commission Decision' legislation, is contributing to ensuring that Europe remains free from African swine fever (ASF). The status of FAO Reference Centre in Veterinary Epidemiology, awarded by the United Nations' Food and Agriculture Organisation in 2012, recognises the RVC as a centre of excellence in this field and reinforces its role in guiding policies relating to animal health.
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.
The Cambridge-led Emerging Risk Factors Collaboration (ERFC) is a global consortium involving individual-participant data on 2.5 million participants from 130 cohort studies. The ERFC has helped optimise approaches to cardiovascular disease (CVD) risk assessment by: 1) quantifying the incremental predictive value provided by assessment of risk factors 2) evaluating the independence of associations between risk factors and CVD and 3) addressing uncertainties related to the implementation of screening. ERFC publications on lipids, lipoproteins, and inflammation biomarkers have been cited by 9 guidelines published since 2010, including those of the European Society of Cardiology and the American Heart Association.
Atrial fibrillation (AF) is the commonest heart rhythm abnormality, affecting around 8.8 million people in the European Union, and confers a substantial risk of stroke and death. It accounts for one third of hospital admissions for cardiac rhythm disturbances, and the rate of AF-related admissions has continued to rise in recent years. The work of Prof Gregory Lip and Dr Deirdre Lane has made Birmingham an internationally-respected centre of excellence for research in AF, delivering crucial impacts in international clinical practice guidelines and improvements in patient care within three main areas: treatment decisions related to stroke and bleeding risk, screening practice in primary care, and stroke and bleeding risk assessment, ultimately reducing morbidity and mortality for a significant proportion of the population, particularly among the elderly.
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.
Research by Reimer Kühn (RK) and collaborators has produced a framework to study and quantify the influence of interactions on risk in complex systems, including default risk in economy-wide networks of financial exposures. This work has had impact on practitioners and professional services dealing with financial risk, including research groups at central banks, who — partly in response to the recent financial crisis — have adopted such network oriented approaches to analyse and quantify systemic risk. The Financial Stability Division at the Bank of England has, for instance, developed refined versions of the network-oriented models proposed by Kühn and collaborators to specifically assess risk in the British banking system.
Research founded on population-based cohort studies has directly informed NICE Public Health guidance on the prevention of diabetes. In prospective studies Wareham and Griffin demonstrated that diabetes can be predicted by a simple risk score using routinely available information and by HbA1c levels. Although people with a high HbA1c account for 36% of incidence, the majority of future cases emerge from the larger population of people with moderately elevated levels, justifying a more population-wide perspective on the prevention of diabetes. The research also showed that the same behaviour targets that are effective in high risk individuals are strongly associated with diabetes in the wider population.