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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.
Research in the MONICA project set the standards for national cardiovascular health surveys in Europe, by establishing quality assessment benchmarks for how cardiovascular health should be monitored in populations. These standards were subsequently adopted by the European Union, and by local health bodies, to improve their commissioning decisions. This research has had an important impact on public health monitoring, enabling robust epidemiological comparisons across countries and the sort of analysis that policy makers need to inform the balance between primary and secondary prevention for cardiovascular health.
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.
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.
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.
University of Sheffield research which evaluated the clinical and cost-effectiveness of statins for the primary and secondary prevention of cardiovascular events has directly led to an additional 3.3 million people in England and Wales becoming eligible for this treatment. Statins have been shown to reduce the risk of future cardiovascular events, such as heart attacks and stroke.
Guidance on statin prescribing in England and Wales, issued by the National Institute for Health and Care Excellence (NICE) Appraisal Committee in January 2006 was informed by our research report. Following this guidance the number of patients receiving statins has increased year on year with the number of prescriptions increasing by 29% between 2007 and 2011, enabling these patients to benefit from reduced risk of heart attacks and stroke and CVD related deaths.
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.
Our research has used epidemiological insights, data and methods to enable Legal & General (L&G), a major pensions and annuity provider, to understand the drivers of long-term trends in the annual rates of improvement in mortality in older ages. Our first-ever analysis of inequalities in mortality trends by cause of death over 25 years in England, and future projections of these, has resulted in better informed pricing and risk management (capital reserving) practices at L&G. We also modelled how much of the decline in coronary heart disease, the main contributor to improving life expectancy, was due to improved healthcare versus healthier lifestyles. Projections of these, based on plausible scenarios of evolution of risk factors and disease management, helped strengthen the evidence base for L&G's assumptions of mortality improvements for the UK financial regulators.
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.
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.