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Joffres M, Falaschetti E, Gillespie C, et al., 2013, Hypertension prevalence, awareness, treatment and control in national surveys from England, the USA and Canada, and correlation with stroke and ischaemic heart disease mortality: a cross-sectional study, BMJ Open, Vol: 3, ISSN: 2044-6055
Objective: Comparison of recent national survey dataon prevalence, awareness, treatment and control ofhypertension in England, the USA and Canada, andcorrelation of these parameters with each countrystroke and ischaemic heart disease (IHD) mortality.Design: Non-institutionalised population surveys.Setting and participants: England (2006 n=6873),the USA (2007–2010 n=10 003) and Canada (2007–2009 n=3485) aged 20–79 years.Outcomes: Stroke and IHD mortality rates wereplotted against countries’ specific prevalence data.Results: Mean systolic blood pressure (SBP) washigher in England than in the USA and Canada in allage–gender groups. Mean diastolic blood pressure(DBP) was similar in the three countries before age 50and then fell more rapidly in the USA, being the lowestin the USA. Only 34% had a BP under 140/90 mm Hgin England, compared with 50% in the USA and66% in Canada. Prehypertension and stages 1 and 2hypertension prevalence figures were the highest inEngland. Hypertension prevalence (≥140 mm Hg SBPand/or ≥90 mm Hg DBP) was lower in Canada(19·5%) than in the USA (29%) and England (30%).Hypertension awareness was higher in the USA (81%)and Canada (83%) than in England (65%). Englandalso had lower levels of hypertension treatment (51%;USA 74%; Canada 80%) and control (<140/90 mm Hg;27%; the USA 53%; Canada 66%). Canada had thelowest stroke and IHD mortality rates, Englandthe highest and the rates were inversely related to themean SBP in each country and strongly related to theblood pressure indicators, the strongest relationshipbeing between low hypertension awareness and strokemortality.Conclusions: While the current prevention efforts inEngland should result in future-improved figures,especially at younger ages, these data still showimportant gaps in the management of hypertension inthese countries, with consequences on stroke and IHDmortality
Sever PS, Poulter NR, Chang CL, et al., 2013, Evaluation of C-Reactive Protein Before and On-Treatment as a Predictor of Benefit of Atorvastatin A Cohort Analysis From the Anglo-Scandinavian Cardiac Outcomes Trial Lipid-Lowering Arm, JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, Vol: 62, Pages: 717-729, ISSN: 0735-1097
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- Citations: 26
Hillis GS, Lowe G, Woodward M, et al., 2013, Inflammatory markers and the risk of vascular complications and mortality in type 2 diabetes mellitus, Congress of the European-Society-of-Cardiology (ESC), Publisher: OXFORD UNIV PRESS, Pages: 962-962, ISSN: 0195-668X
Hillis GS, Welsh P, Chalmers J, et al., 2013, High sensitivity cardiac troponin T and N-terminal pro-BNP predict cardiovascular events and death in patients with type 2 diabetes mellitus, Congress of the European-Society-of-Cardiology (ESC), Publisher: OXFORD UNIV PRESS, Pages: 301-301, ISSN: 0195-668X
Prieto-Merino D, Dobson J, Gupta AK, et al., 2013, ASCORE: an up-to-date cardiovascular risk score for hypertensive patients reflecting contemporary clinical practice developed using the (ASCOT-BPLA) trial data, JOURNAL OF HUMAN HYPERTENSION, Vol: 27, Pages: 492-496, ISSN: 0950-9240
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- Citations: 7
den Hoed M, Eijgelsheim M, Esko T, et al., 2013, Identification of heart rate-associated loci and their effects on cardiac conduction and rhythm disorders, NATURE GENETICS, Vol: 45, Pages: 621-+, ISSN: 1061-4036
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- Citations: 228
Perkovic V, Heerspink HL, Chalmers J, et al., 2013, Intensive glucose control improves kidney outcomes in patients with type 2 diabetes, KIDNEY INTERNATIONAL, Vol: 83, Pages: 517-523, ISSN: 0085-2538
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- Citations: 215
Prieto-Merino D, Dobson J, Gupta AK, et al., 2013, ASCORE: an up-to-date cardiovascular risk score for hypertensive patients reflecting contemporary clinical practice developed using the (ASCOT-BPLA) trial data, J Hum Hypertens.
A number of risk scores already exist to predict cardiovascular (CV) events. However, scores developed with data collected some time ago might not accurately predict the CV risk of contemporary hypertensive patients that benefit from more modern treatments and management. Using data from the randomised clinical trial Anglo-Scandinavian Cardiac Outcomes Trial-BPLA, with 15 955 hypertensive patients without previous CV disease receiving contemporary preventive CV management, we developed a new risk score predicting the 5-year risk of a first CV event (CV death, myocardial infarction or stroke). Cox proportional hazard models were used to develop a risk equation from baseline predictors. The final risk model (ASCORE) included age, sex, smoking, diabetes, previous blood pressure (BP) treatment, systolic BP, total cholesterol, high-density lipoprotein-cholesterol, fasting glucose and creatinine baseline variables. A simplified model (ASCORE-S) excluding laboratory variables was also derived. Both models showed very good internal validity. User-friendly integer score tables are reported for both models. Applying the latest Framingham risk score to our data significantly overpredicted the observed 5-year risk of the composite CV outcome. We conclude that risk scores derived using older databases (such as Framingham) may overestimate the CV risk of patients receiving current BP treatments; therefore, 'updated' risk scores are needed for current patients.Journal of Human Hypertension advance online publication, 14 February 2013; doi:10.1038/jhh.2013.3.
Hata J, Arima H, Zoungas S, et al., 2013, Effects of the Endpoint Adjudication Process on the Results of a Randomised Controlled Trial: The ADVANCE Trial, PLOS One, Vol: 8, ISSN: 1932-6203
Background: Endpoint adjudication committees (EPAC) are widely used in clinical trials. The aim of the present analysis is toassess the effects of the endpoint adjudication process on the main findings of the ADVANCE trial (Trial registration:ClinicalTrials.gov NCT00145925).Methods and Findings: The ADVANCE trial was a multicentre, 262 factorial randomised controlled trial of blood pressurelowering and intensive blood glucose control in 11140 patients with type 2 diabetes. Primary outcomes were majormacrovascular (nonfatal myocardial infarction, nonfatal stroke and cardiovascular death) and microvascular (new orworsening nephropathy and retinopathy) events. Suspected primary outcomes were initially reported by the investigatorsat the 215 sites with subsequent adjudication by the EPAC. The EPAC also adjudicated upon potential events identifieddirectly by ongoing screening of all reported events. Over a median follow-up of 5 years, the site investigators reported oneor more primary outcomes among 2443 participants. After adjudication these events were confirmed for 2077 (85%) with 48further events added through the EPAC-led database screening process. The estimated relative risk reductions (95%confidence intervals) in the primary outcome for the blood pressure lowering comparison were 8% (21 to 15%) based onthe investigator-reported events and 9% (0 to 17%) based on the EPAC-based events (P for homogeneity = 0.70). Thecorresponding findings for the glucose comparison were 8% (1 to 15%) and 10% (2% to 18%) (P for homogeneity = 0.60).The effect estimates were also highly comparable when studied separately for macrovascular events and microvascularevents for both comparisons (all P for homogeneity.0.6).Conclusions: The endpoint adjudication process had no discernible impact on the main findings in ADVANCE. These datahighlight the need for careful consideration of the likely impact of an EPAC on the findings and conclusions of clinical trialsprior to their establishment.
Wong MG, Perkovic V, Woodward M, et al., 2013, Circulating bone morphogenetic protein-7 and transforming growth factor-β1 are better predictors of renal end points in patients with type 2 diabetes mellitus, KIDNEY INTERNATIONAL, Vol: 83, Pages: 278-284, ISSN: 0085-2538
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- Citations: 43
Thom SA, Field J, Poulter NR, et al., 2012, Use of a Multidrug Pill In Reducing cardiovascular Events (UMPIRE), Scientific Sessions of the American-Heart-Association, Publisher: LIPPINCOTT WILLIAMS & WILKINS, Pages: 2781-2781, ISSN: 0009-7322
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- Citations: 1
Sever PS, Chang CL, Prescott MF, et al., 2012, Is plasma renin activity a biomarker for the prediction of renal and cardiovascular outcomes in treated hypertensive patients? Observations from the Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT), EUROPEAN HEART JOURNAL, Vol: 33, Pages: 2970-2979, ISSN: 0195-668X
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- Citations: 10
Maekinen JI, Chow C, Zoungas S, et al., 2012, The Influence of Alcohol Use on Vascular Complications and Mortality in Patients with Type 2 Diabetes Mellitus, CIRCULATION, Vol: 126, ISSN: 0009-7322
Maekinen JI, Chow C, Zoungas S, et al., 2012, The Influence of Exercise on Vascular Complications and Mortality Ii Patients with Type 2 Diabetes Mellitus, CIRCULATION, Vol: 126, ISSN: 0009-7322
Asselbergs FW, Guo Y, van Iperen EPA, et al., 2012, Large-Scale Gene-Centric Meta-analysis across 32 Studies Identifies Multiple Lipid Loci, AMERICAN JOURNAL OF HUMAN GENETICS, Vol: 91, Pages: 823-838, ISSN: 0002-9297
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- Citations: 202
Jardine MJ, Hata J, Woodward M, et al., 2012, Prediction of Kidney-Related Outcomes in Patients With Type 2 Diabetes, AMERICAN JOURNAL OF KIDNEY DISEASES, Vol: 60, Pages: 770-778, ISSN: 0272-6386
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- Citations: 96
Hillis GS, Hata J, Woodward M, et al., 2012, Resting Heart Rate and the Risk of Microvascular Complications in Patients With Type 2 Diabetes Mellitus, Journal of the American Heart Association, Vol: 1, ISSN: 2047-9980
Background-—A higher resting heart rate is associated with an increased probability of cardiovascular complications andpremature death in patients with type 2 diabetes mellitus. The impact of heart rate on the risk of developing microvascularcomplications, such as diabetic retinopathy and nephropathy, is, however, unknown. The present study tests the hypothesis that ahigher resting heart rate is associated with an increased incidence and a greater progression of microvascular complications inpatients with type 2 diabetes mellitus.Methods and Results-—The relation between baseline resting heart rate and the development of a major microvascular event wasexamined in 11 140 patients who participated in the Action in Diabetes and Vascular Disease: Preterax and Diamicron ModifiedRelease Controlled Evaluation (ADVANCE) study. Major microvascular events were defined as a composite of new or worseningnephropathy or new or worsening retinopathy. Patients with a higher baseline heart rate were at increased risk of a new majormicrovascular complication during follow-up (adjusted hazard ratio: 1.13 per 10 beats per minute; 95% confidence interval: 1.07–1.20; P<0.001). The excess hazard was evident for both nephropathy (adjusted hazard ratio: 1.16 per 10 beats per minute; 95%confidence interval: 1.08–1.25) and retinopathy (adjusted hazard ratio: 1.11 per 10 beats per minute; 95% confidence interval:1.02–1.21).Conclusion-—Patients with type 2 diabetes mellitus who have a higher resting heart rate experience a greater incidence of newonsetor progressive nephropathy and retinopathy.
Surendran P, Vangjeli C, McCarthy N, et al., 2012, Genome-wide association analysis identifies the MTHFR-CLCN6-NPPA-NPPB gene cluster as an important influence on BNP levels-implications for the use of BNP levels in the diagnosis and therapeutic monitoring of heart failure-an ASCOT sub study, JOURNAL OF HUMAN HYPERTENSION, Vol: 26, Pages: 620-620, ISSN: 0950-9240
van Dieren S, Kengne AP, Chalmers J, et al., 2012, Effects of blood pressure lowering on cardiovascular outcomes in different cardiovascular risk groups among participants with type 2 diabetes, DIABETES RESEARCH AND CLINICAL PRACTICE, Vol: 98, Pages: 83-90, ISSN: 0168-8227
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- Citations: 18
Poulter NR, Chaturvedi N, 2012, Commentary: Shaper and Jones, 'Serum-cholesterol, diet and coronary heart-disease in Africans and Asians in Uganda': 50-year-old findings only need interpretational fine tuning to come up to speed!, INTERNATIONAL JOURNAL OF EPIDEMIOLOGY, Vol: 41, Pages: 1228-1230, ISSN: 0300-5771
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- Citations: 1
Sever PS, Chang CL, Prescott MF, et al., 2012, Is plasma renin activity a biomarker for the prediction of renal and cardiovascular outcomes in treated hypertensive patients? Observations from the Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT, European Heart Journal
Deshmukh HA, Colhoun HM, Johnson T, et al., 2012, Genome-wide association study of genetic determinants of LDL-c response to atorvastatin therapy: importance of Lp(a), Journal of Lipid Research, Vol: 53, Pages: 1000-1011, ISSN: 0022-2275
We carried out a genome-wide association study (GWAS) of LDL-c response to statin using data from participants in the Collaborative Atorvastatin Diabetes Study (CARDS; n = 1,156), the Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT; n = 895), and the observational phase of ASCOT (n = 651), all of whom were prescribed atorvastatin 10 mg. Following genome-wide imputation, we combined data from the three studies in a meta-analysis. We found associations of LDL-c response to atorvastatin that reached genome-wide significance at rs10455872 (P = 6.13 × 10−9) within the LPA gene and at two single nucleotide polymorphisms (SNP) within the APOE region (rs445925; P = 2.22 × 10−16 and rs4420638; P = 1.01 × 10−11) that are proxies for the ϵ2 and ϵ4 variants, respectively, in APOE. The novel association with the LPA SNP was replicated in the PROspective Study of Pravastatin in the Elderly at Risk (PROSPER) trial (P = 0.009). Using CARDS data, we further showed that atorvastatin therapy did not alter lipoprotein(a) [Lp(a)] and that Lp(a) levels accounted for all of the associations of SNPs in the LPA gene and the apparent LDL-c response levels. However, statin therapy had a similar effect in reducing cardiovascular disease (CVD) in patients in the top quartile for serum Lp(a) levels (HR = 0.60) compared with those in the lower three quartiles (HR = 0.66; P = 0.8 for interaction). The data emphasize that high Lp(a) levels affect the measurement of LDL-c and the clinical estimation of LDL-c response. Therefore, an apparently lower LDL-c response to statin therapy may indicate a need for measurement of Lp(a). However, statin therapy seems beneficial even in those with high Lp(a).
van Dieren S, Czernichow S, Chalmers J, et al., 2012, Weight changes and their predictors amongst 11 140 patients with type 2 diabetes in the ADVANCE trial, DIABETES OBESITY & METABOLISM, Vol: 14, Pages: 464-469, ISSN: 1462-8902
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- Citations: 35
Hillis GS, Woodward M, Rodgers A, et al., 2012, Resting heart rate and the risk of death and cardiovascular complications in patients with type 2 diabetes mellitus, DIABETOLOGIA, Vol: 55, Pages: 1283-1290, ISSN: 0012-186X
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- Citations: 80
Saxena R, Elbers CC, Guo Y, et al., 2012, Large-Scale Gene-Centric Meta-Analysis across 39 Studies Identifies Type 2 Diabetes Loci, AMERICAN JOURNAL OF HUMAN GENETICS, Vol: 90, Pages: 410-425, ISSN: 0002-9297
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- Citations: 205
Zoungas S, Chalmers J, Ninomiya T, et al., 2012, Association of HbA<sub>1c</sub> levels with vascular complications and death in patients with type 2 diabetes: evidence of glycaemic thresholds, DIABETOLOGIA, Vol: 55, Pages: 636-643, ISSN: 0012-186X
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- Citations: 219
Sever PS, Poulter NR, Chang CL, et al., 2012, Evaluation of C-reactive protein prior to and on-treatment as a predictor of benefit from atorvastatin: observations from the Anglo-Scandinavian Cardiac Outcomes Trial, EUROPEAN HEART JOURNAL, Vol: 33, Pages: 486-494, ISSN: 0195-668X
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- Citations: 44
Cholesterol Treatment Trialists' CTT Collaboration, Emberson JR, Kearney PM, et al., 2012, Lack of effect of lowering LDL cholesterol on cancer: meta-analysis of individual data from 175,000 people in 27 randomised trials of statin therapy., PLoS One, Vol: 7, Pages: e29849-e29849, ISSN: 1932-6203
BACKGROUND: Statin therapy reduces the risk of occlusive vascular events, but uncertainty remains about potential effects on cancer. We sought to provide a detailed assessment of any effects on cancer of lowering LDL cholesterol (LDL-C) with a statin using individual patient records from 175,000 patients in 27 large-scale statin trials. METHODS AND FINDINGS: Individual records of 134,537 participants in 22 randomised trials of statin versus control (median duration 4.8 years) and 39,612 participants in 5 trials of more intensive versus less intensive statin therapy (median duration 5.1 years) were obtained. Reducing LDL-C with a statin for about 5 years had no effect on newly diagnosed cancer or on death from such cancers in either the trials of statin versus control (cancer incidence: 3755 [1.4% per year [py]] versus 3738 [1.4% py], RR 1.00 [95% CI 0.96-1.05]; cancer mortality: 1365 [0.5% py] versus 1358 [0.5% py], RR 1.00 [95% CI 0.93-1.08]) or in the trials of more versus less statin (cancer incidence: 1466 [1.6% py] vs 1472 [1.6% py], RR 1.00 [95% CI 0.93-1.07]; cancer mortality: 447 [0.5% py] versus 481 [0.5% py], RR 0.93 [95% CI 0.82-1.06]). Moreover, there was no evidence of any effect of reducing LDL-C with statin therapy on cancer incidence or mortality at any of 23 individual categories of sites, with increasing years of treatment, for any individual statin, or in any given subgroup. In particular, among individuals with low baseline LDL-C (<2 mmol/L), there was no evidence that further LDL-C reduction (from about 1.7 to 1.3 mmol/L) increased cancer risk (381 [1.6% py] versus 408 [1.7% py]; RR 0.92 [99% CI 0.76-1.10]). CONCLUSIONS: In 27 randomised trials, a median of five years of statin therapy had no effect on the incidence of, or mortality from, any type of cancer (or the aggregate of all cancer).
Cholesterol Treatment Trialists' Collaboration, 2012, Lack of effect of lowering LDL cholesterol on cancer: meta-analysis of individual data from 175,000 people in 27 randomised trials of statin therapy., PLoS One
Johnson T, Gaunt TR, Newhouse SJ, et al., 2011, Blood Pressure Loci Identified with a Gene-Centric Array, AMERICAN JOURNAL OF HUMAN GENETICS, Vol: 89, Pages: 688-700, ISSN: 0002-9297
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- Citations: 130
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