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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.
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.
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.
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.
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.
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.
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.
Caffeine is widely consumed in pregnancy as has the potential to harm the developing fetus. Professor Janet Cade and colleagues at the University of Leeds designed a robust study to accurately quantify caffeine intake in 2635 pregnant women throughout pregnancy. The results showed caffeine intake is associated with an increased risk of fetal growth restriction, which is linked with perinatal mortality and morbidity and adverse effects in later life. As a result of this study, and a review of previous evidence, the Food Standards Agency issued new advice to pregnant women to limit their daily caffeine intake to below 200mg/day.
Since 2011, an estimated 3 million UK milk consumers have benefitted each year from research conducted at the University of Reading, which has helped reduce saturated fatty acids (SFAs) in milk and milk products. The research, which was carried out between 2004 and 2013, manipulated dairy cows' diets to produce milk with reduced saturated fat and increased unsaturated fat content. Leading UK retailer, Marks and Spencer (M&S), used this research to support its suppliers in providing a new diet regime for their dairy cows, launching a new low saturated fat M&S milk in October 2011. The launch of this healthier milk product has led to (i) improved diets and reduced associated health risks (heart disease, obesity and cancer) for M&S customers (ii) reduced use of non-sustainable palm oil in cow diets (iii) reduced harmful greenhouse gas emissions (iv) increased sales for M&S and enhanced reputation in terms of quality and corporate social responsibility (v) increased payment contracts for milk producers and (vi) new techniques to measure fatty acids in milk for the dairy industry.
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.