Publications
263 results found
Ambrosio G, Collins P, Dechend R, et al., 2019, StaBle Angina: PeRceptIon of NeeDs, Quality of Life and ManaGemEnt of Patients (BRIDGE Study)-A Multinational European Physician Survey, ANGIOLOGY, Vol: 70, Pages: 397-406, ISSN: 0003-3197
Kotecha D, Flather MD, Atar D, et al., 2019, B-type natriuretic peptide trumps other prognostic markers in patients assessed for coronary disease, BMC Medicine, Vol: 17, ISSN: 1741-7015
BackgroundRisk prediction for patients with suspected coronary artery disease is complex due to the common occurrence of prior cardiovascular disease and extensive risk modification in primary care. Numerous markers have the potential to predict prognosis and guide management, but we currently lack robust ‘real-world’ evidence for their use.MethodsProspective, multicentre observational study of consecutive patients referred for elective coronary angiography. Clinicians were blinded to all risk assessments, consisting of conventional factors, radial artery pulse wave analysis, 5-minute heart rate variability, high-sensitivity C-reactive protein and B-type natriuretic peptide (BNP). Blinded, independent adjudication was performed for all-cause mortality and the composite of death, myocardial infarction or stroke, analysed with Cox proportional hazards regression.ResultsFive hundred twenty-two patients were assessed with median age 66 years and 21% prior revascularization. Median baseline left ventricular ejection fraction was 64%, and 62% had ≥ 50% stenosis on angiography. During 5.0 years median follow-up, 30% underwent percutaneous and 16% surgical revascularization. In multivariate analysis, only age and BNP were independently associated with outcomes. The adjusted hazard ratio per log unit increase in BNP was 2.15 for mortality (95% CI 1.45–3.19; p = 0.0001) and 1.27 for composite events (1.04–1.54; p = 0.018). Patients with baseline BNP > 100 pg/mL had substantially higher mortality and composite events (20.9% and 32.2%) than those with BNP ≤ 100 pg/mL (5.6% and 15.5%). BNP improved both classification and discrimination of outcomes (p ≤ 0.003), regardless of left ventricular systolic function. Conversely, high-sensitivity C-reactive protein, pulse wave analysis and heart rate variability were unrelated to prognosis at 5 years afte
Chadeau M, van Veldhoven C, Kiss A, et al., 2019, Impact of short-term traffic-related air pollution on the metabolome – results from two metabolome-wide experimental studies, Environment International, Vol: 123, Pages: 124-131, ISSN: 0160-4120
Exposure to traffic-related air pollution (TRAP) has been associated with adverse health outcomes but underlying biological mechanisms remain poorly understood. Two randomized crossover trials were used here, the Oxford Street II (London) and the TAPAS II (Barcelona) studies, where volunteers were allocated to high or low air pollution exposures. The two locations represent different exposure scenarios, with Oxford Street characterized by diesel vehicles and Barcelona by normal mixed urban traffic. Levels of five and four pollutants were measured, respectively, using personal exposure monitoring devices. Serum samples were used for metabolomic profiling. The association between TRAP and levels of each metabolic feature was assessed. All pollutant levels were significantly higher at the high pollution sites. 29 and 77 metabolic features were associated with at least one pollutant in the Oxford Street II and TAPAS II studies, respectively, which related to 17 and 30 metabolic compounds. Little overlap was observed across pollutants for metabolic features, suggesting that different pollutants may affect levels of different metabolic features. After observing the annotated compounds, the main pathway suggested in Oxford Street II in association with NO2 was the acyl-carnitine pathway, previously found to be associated with cardio-respiratory disease. No overlap was found between the metabolic features identified in the two studies.
Halliday BP, Gulati A, Ali A, et al., 2018, Sex and age-based differences in the natural history and outcome of dilated cardiomyopathy, European Journal of Heart Failure, Vol: 20, Pages: 1392-1400, ISSN: 1388-9842
Aims: To evaluate the relationship between sex, age and outcome in dilated cardiomyopathy (DCM). Methods & Results: We used proportional hazard modelling to examine the association between sex, age and all-cause mortality in consecutive patients with DCM. Overall, 881 patients (290 women, median age 52 years) were followed for a median of 4.9 years. Women were more likely to present with heart failure (64.0% vs 54.5%; p=0.007) and had more severe symptoms (p<0.001) compared to men. Women had smaller left ventricular end-diastolic volume (125ml/m2 vs 135ml/m2, p<0.001), higher left ventricular ejection fraction (40.2% vs 37.9%, p=0.019) and were less likely to have mid-wall late gadolinium enhancement (23.0% vs 38.9%, p<0.0001). During follow-up 149 (16.9%) patients died, including 41 (4.7%) who died suddenly. After adjustment, all-cause mortality (HR 0.61; 95%CI 0.41:0.92; p=0.018) was lower in women, with similar trends for cardiovascular (HR 0.60; 95%CI 0.35-1.05; p=0.07), non-sudden (HR 0.63; 95%CI 0.39-1.02; p=0.06) and sudden death (HR 0.70, 95%CI 0.30:1.63; p=0.41). All-cause mortality (per 10 yrs: HR 1.36, 95%CI 1.20-1.55; p<0.00001) and non-sudden death (per 10 yrs: HR 1.51, 95%CI 1.26 – 1.82; p<0.00001) increased with age. Cumulative incidence curves confirmed favourable outcomes, particularly in women and those <60 years. Increased all-cause mortality in patients >60 years of age was driven by non-sudden death. Conclusion: Women with DCM have better survival compared to men, which may partly be due to less severe left ventricular dysfunction and a smaller scar burden. There is increased mortality driven by non-sudden death in patients >60 years of age that is less marked in women. Outcomes with contemporary treatment were favourable, with a low incidence of sudden death.
Richards T, Collins P, Webb C, 2018, Factors affecting participation in cardiovascular clinical research – a comparison of men and women, British Association for Cardiovascular Prevention & Rehabilitation
Zheng SL, Collins P, 2018, Cardiovascular outcomes with the incretin-based therapies GLP-1 agonists and DPP-4 inhibitors in type 2 diabetes participants with and without heart failure, Publisher: WILEY, Pages: 202-203, ISSN: 1388-9842
Krauskopf J, Caiment F, van Veldhoven K, et al., 2018, The human circulating miRNome reflects multiple organ disease risks in association with short-term exposure to traffic-related air pollution, Environment International, Vol: 113, Pages: 26-34, ISSN: 0160-4120
Traffic-related air pollution is a complex mixture of particulate matter (PM) and gaseous pollutants, such as nitrogen dioxide (NO2). PM exposure contributes to the pathogenesis of many diseases including several types of cancer, as well as pulmonary, cardiovascular and neurodegenerative diseases. Also exposure to NO2 has been related to increased cardiovascular mortality. In search of an early diagnostic biomarker for improved air pollution-associated health risk assessment, recent human studies have shown that certain circulating miRNAs are altered upon exposure to traffic-related air pollutants. Here, we present for the first time a global analysis of the circulating miRNA genome in an experimental cross-over study of a human population exposed to traffic-related air pollution. By utilizing next-generation sequencing technology and detailed real-time exposure measurements we identified 54 circulating miRNAs to be dose- and pollutant species-dependently associated with PM10, PM2.5, black carbon, ultrafine particles and NO2 already after 2 h of exposure. Bioinformatics analysis suggests that these circulating miRNAs actually reflect the adverse consequences of traffic pollution-induced toxicity in target tissues including the lung, heart, kidney and brain. This study shows the strong potential of circulating miRNAs as novel biomarkers for environmental health risk assessment.
Halliday B, Gulati A, Ali A, et al., 2018, SEX DIFFERENCES IN THE NATURAL HISTORY AND OUTCOME OF DILATED CARDIOMYOPATHY, 67th Annual Scientific Session and Expo of the American-College-of-Cardiology (ACC), Publisher: ELSEVIER SCIENCE INC, Pages: 704-704, ISSN: 0735-1097
Liu S, Grigoryan H, Edmands WMB, et al., 2018, Cys34 Adductomes Differ between Patients with Chronic Lung or Heart Disease and Healthy Controls in Central London, Environmental Science and Technology (Washington), Vol: 52, Pages: 2307-2313, ISSN: 0013-936X
Oxidative stress generates reactive species that modify proteins, deplete antioxidant defenses, and contribute to chronic obstructive pulmonary disease (COPD) and ischemic heart disease (IHD). To determine whether protein modifications differ between COPD or IHD patients and healthy subjects, we performed untargeted analysis of adducts at the Cys34 locus of human serum albumin (HSA). Biospecimens were obtained from nonsmoking participants from London, U.K., including healthy subjects (n = 20) and patients with COPD (n = 20) or IHD (n = 10). Serum samples were digested with trypsin and analyzed by liquid chromatography-high resolution mass spectrometry. Effects of air pollution on adduct levels were also investigated based on estimated residential exposures to PM2.5, O3 and NO2. For the 39 adducts with sufficient data, levels were essentially identical in blood samples collected from the same subjects on two consecutive days, consistent with the 28 day residence time of HSA. Multivariate linear regression revealed 21 significant associations, mainly with the underlying diseases but also with air-pollution exposures (p-value < 0.05). Interestingly, most of the associations indicated that adduct levels decreased with the presence of disease or increased pollutant concentrations. Negative associations of COPD and IHD with the Cys34 disulfide of glutathione and two Cys34 sulfoxidations, were consistent with previous results from smoking and nonsmoking volunteers and nonsmoking women exposed to indoor combustion of coal and wood.
Sinharay R, Gong J, Barratt B, et al., 2017, Respiratory and cardiovascular responses to walking down a traffic-polluted road compared with walking in a traffic-free area in participants aged 60 years and older with chronic lung or heart disease and age-matched healthy controls: a randomised, crossover study, Lancet, Vol: 391, Pages: 339-349, ISSN: 0140-6736
BackgroundLong-term exposure to pollution can lead to an increase in the rate of decline of lung function, especially in older individuals and in those with chronic obstructive pulmonary disease (COPD), whereas shorter-term exposure at higher pollution levels has been implicated in causing excess deaths from ischaemic heart disease and exacerbations of COPD. We aimed to assess the effects on respiratory and cardiovascular responses of walking down a busy street with high levels of pollution compared with walking in a traffic-free area with lower pollution levels in older adults.MethodsIn this randomised, crossover study, we recruited men and women aged 60 years and older with angiographically proven stable ischaemic heart disease or stage 2 Global initiative for Obstructive Lung Disease (GOLD) COPD who had been clinically stable for 6 months, and age-matched healthy volunteers. Individuals with ischaemic heart disease or COPD were recruited from existing databases or outpatient respiratory and cardiology clinics at the Royal Brompton & Harefield NHS Foundation Trust and age-matched healthy volunteers using advertising and existing databases. All participants had abstained from smoking for at least 12 months and medications were taken as recommended by participants' doctors during the study. Participants were randomly assigned by drawing numbered disks at random from a bag to do a 2 h walk either along a commercial street in London (Oxford Street) or in an urban park (Hyde Park). Baseline measurements of participants were taken before the walk in the hospital laboratory. During each walk session, black carbon, particulate matter (PM) concentrations, ultrafine particles, and nitrogen dioxide (NO2) concentrations were measured.FindingsBetween October, 2012, and June, 2014, we screened 135 participants, of whom 40 healthy volunteers, 40 individuals with COPD, and 39 with ischaemic heart disease were recruited. Concentrations of black carbon, NO2, PM10, PM2.5, and ul
Webb CM, Collins P, 2017, Role of testosterone in the treatment of cardiovascular disease, European Cardiology Review, Vol: 12, ISSN: 1758-3756
Cardiovascular disease (CVD) is the most prevalent non-communicable cause of death worldwide. Testosterone is a sex hormone that is predominant in males but also occurs in lower concentrations in females. It has effects directly on the blood vessels of the cardiovascular system and on the heart, as well as effects on risk factors for CVD. Serum testosterone concentrations are known to decrease with age and reduced testosterone levels are linked to premature coronary artery disease, unfavourable effects on CVD risk factors and increased risk of cardiovascular mortality independent of age. A significant number of men with heart failure demonstrate reduced serum testosterone concentrations and there is early evidence suggesting that low testosterone levels affect cardiac repolarisation. Any association between endogenous testosterone concentrations and CVD in women has yet to be established. Testosterone replacement is used to treat men with hypogonadism but also has cardiovascular effects. This review will present the current evidence, expert opinion and controversies around the role of testosterone in the pathophysiology of CVD and surrounding the use of testosterone treatment and its effects on the cardiovascular system and CVD.
Plummer C, Collins P, Rosario DJ, et al., 2017, Managing cardiovascular risk in high-risk prostate cancer, TRENDS IN UROLOGY & MENS HEALTH, Vol: 8, Pages: 13-18, ISSN: 2044-3730
Khan TZ, Hsu LY, Arai AE, et al., 2017, Apheresis as novel treatment for refractory angina with raised lipoprotein(a): a randomised controlled trial, European Heart Journal, Vol: 38, Pages: 1561-1569, ISSN: 1522-9645
AimsTo determine the clinical impact of lipoprotein apheresis in patients with refractory angina and raised lipoprotein(a) > 500 mg/L on the primary end point of quantitative myocardial perfusion, as well as secondary end points including atheroma burden, exercise capacity, symptoms, and quality of life.MethodsWe conducted a single-blinded randomized controlled trial in 20 patients with refractory angina and raised lipoprotein(a) > 500 mg/L, with 3 months of blinded weekly lipoprotein apheresis or sham, followed by crossover. The primary endpoint was change in quantitative myocardial perfusion reserve (MPR) assessed by cardiovascular magnetic resonance. Secondary endpoints included measures of atheroma burden, exercise capacity, symptoms and quality of life.ResultsThe primary endpoint, namely MPR, increased following apheresis (0.47; 95% CI 0.31–0.63) compared with sham (−0.16; 95% CI − 0.33–0.02) yielding a net treatment increase of 0.63 (95% CI 0.37–0.89; P < 0.001 between groups). Improvements with apheresis compared with sham also occurred in atherosclerotic burden as assessed by total carotid wall volume (P < 0.001), exercise capacity by the 6 min walk test (P = 0.001), 4 of 5 domains of the Seattle angina questionnaire (all P < 0.02) and quality of life physical component summary by the short form 36 survey (P = 0.001).ConclusionLipoprotein apheresis may represent an effective novel treatment for patients with refractory angina and raised lipoprotein(a) improving myocardial perfusion, atheroma burden, exercise capacity and symptoms.
Collins P, Webb CM, de Villiers TJ, et al., 2016, Cardiovascular risk assessment in women - an update, Climacteric, Vol: 19, Pages: 329-336, ISSN: 1473-0804
Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in postmenopausal women. Although it is a disease of aging, vascular disease initiates much earlier in life. Thus, there is a need to be aware of the potential to prevent the development of the disease from an early age, and continue this surveillance throughout life. The menopausal period and early menopause presents an ideal opportunity to assess cardiovascular risk and plan accordingly. Generally in this period, women will be seen by primary health care professionals and non-cardiovascular specialists. This review addresses female-specific risk factors that may contribute to the potential development of CVD. It is important for all health care professionals dealing with women in midlife and beyond, to be cognisant of these risk factors and to initiate female specific preventative measures or to refer to a cardiovascular specialist.
Kotecha D, Altman DG, Collins PD, et al., 2016, Authors' reply to Cunningham and Messerli and colleagues., BMJ, Vol: 353
Webb CM, Collins P, 2016, Syndrome X: how should it be investigated and treated?, Dialogues in Cardiovascular Medicine, Vol: 21, Pages: 191-195, ISSN: 1272-9949
Webb CM, Rosano GMC, Kaski J-C, et al., 2016, Twenty-five year follow-up of patients with chest pain and smooth, unobstructed epicardial coronary arteries, ESC Congress 2016, Publisher: Oxford University Press (OUP), ISSN: 1522-9645
Kotecha D, Manzano L, Krum H, et al., 2016, Effect of age and gender on efficacy and tolerability of beta-blockers in heart failure with reduced ejection fraction: An individual patient data meta-analysis, BMJ, Vol: 353, ISSN: 0959-8138
Background: Beta-blockers are recommended in heart failure patients with reduced ejection fraction (HFrEF) and sinus rhythm, but prescription rates are consistently lower in older patients and women. Objectives: We sought to determine the efficacy and tolerability of beta-blockers in a broad age-range of adult women and men with HFrEF by pooling individual patient data (IPD) from placebo-controlled randomized trials.Methods: The study was a prospectively designed IPD meta-analysis of patients aged 40-85 years in sinus rhythm at baseline, with left-ventricular ejection fraction <0.45. The primary outcome was all-cause mortality and major secondary outcome heart failure hospitalization. Analysis was by intention to treat using an adjusted one-stage Cox proportional hazards model. Registration: PROSPERO CRD42014010012; Clinicaltrials.gov NCT00832442.Results: 13,833 patients were included from 11 trials, with median age 64 years and 24% women. Beta-blockers were effective in reducing mortality versus placebo across all ages: Quartile 1 (median age 50) hazard ratio (HR) 0.66 (95% CI 0.53 to 0.83); Quartile 2 (median 60) HR 0.71 (0.58 to 0.87); Quartile 3 (median 68) HR 0.65 (0.53 to 0.78); Quartile 4 (median 75) HR 0.77 (0.64 to 0.92). There was no significant interaction when age was modelled continuously (p=0.10) and the absolute mortality reduction was 4.3% over a median follow-up of 1.3 years (number needed to treat=23). Heart failure hospitalization was significantly reduced by beta-blockers, although this effect was attenuated at older age (interaction p=0.05). There was no evidence of an interaction between treatment effect and gender in any age group. Drug discontinuation was similar regardless of treatment allocation, age or gender (14.4% beta-blockers, 15.6% placebo).Conclusion: Irrespective of age or gender, patients with HFrEF in sinus rhythm should receive beta-blockers to reduce the risk of death and hospitalization.
Webb CM, Collins P, 2016, Coronary heart disease in women
Dr Carolyn Webb and Professor Peter Collins highlight common presenting symptoms in women with coronary heart disease (CHD) and reflects on the need to take a careful gynaecological history. Key learning points for healthcare professionals include the influence of female-specific factors on the development of CHD, and conditions that raise cardiovascular risk including polycystic ovary syndrome.
Niespialolwska-Steuden M, Markides V, Okafor O, et al., 2015, IMPROVEMENT IN ENDOGENOUS THROMBOLYTIC STATUS FOLLOWING SUCCESSFUL ABLATION OF ATRIAL FIBRILLATION, British-Cardiac-Society (BCS) Annual Conference on Hearts and Genes, Publisher: BMJ PUBLISHING GROUP, Pages: A30-A30, ISSN: 1355-6037
de Silva R, Tsujioka H, Gaze D, et al., 2015, Serial Changes in High-Sensitivity Cardiac Troponin, N-terminal Pro-B-Type Natriuretic Peptide, and Heart Fatty Acid Binding Protein during Exercise Echocardiography in Patients with Suspected Angina Pectoris and Normal Resting Left Ventricular Function, CLINICAL CHEMISTRY, Vol: 61, Pages: 554-556, ISSN: 0009-9147
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Kotecha D, Jenkins E, Flather MD, et al., 2014, Long-term predictors of death and incident myocardial infarction in cardiology patients assessed for coronary artery disease, Annual Meeting of the European-Society-of-Cardiology (ESC), Publisher: OXFORD UNIV PRESS, Pages: 819-819, ISSN: 0195-668X
Niespialowska-Steuden M, Christopoulos C, Okafor O, et al., 2014, COMPARISON OF GLOBAL THROMBOTIC STATUS IN AF AND CORONARY DISEASE, HEART, Vol: 100, Pages: A15-A15, ISSN: 1355-6037
Niespialowska-Steuden M, Okafor O, Collins P, et al., 2014, DIFFERENTIAL EFFECTS OF NOAC AND VKA ON <i>IN VITRO</i> TEST OF GLOBAL THROMBOTIC STATUS, Annual Conference of the British-Cardiovascular-Society, Publisher: BMJ PUBLISHING GROUP, Pages: A8-A8, ISSN: 1355-6037
Niespialowska-Steuden M, Okafor O, Collins P, et al., 2014, NOAC BUT NOT VKA FAVORABLY AFFECT ENDOGENOUS THROMBOLYTIC STATUS: A NOVEL MECHANISM OF ACTION, JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, Vol: 63, Pages: A323-A323, ISSN: 0735-1097
Niespialowska-Steuden M, Christopoulos C, Okafor O, et al., 2014, CHARACTERISATION OF DIFFERING IN VITRO THROMBOTIC PROFILES IN AF AND CORONARY DISEASE: ROLE OF ENDOGENOUS THROMBOLYSIS, JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, Vol: 63, Pages: A467-A467, ISSN: 0735-1097
Niespialowska-Steuden M, Collins P, Costopoulos C, et al., 2014, NOAC in acute coronary syndrome and AF?, Cardiovasc Hematol Disord Drug Targets, Vol: 14, Pages: 154-164
Cardiovascular disease remains a major cause of morbidity and mortality in developed countries. New treatments, in the form of novel oral anticoagulants (NOAC) that reduce thrombotic risk are now available for patients with atrial fibrillation (AF) or acute coronary syndrome (ACS). Warfarin has been the cornerstone of thromboprophylaxis in patients with AF, but treatment is cumbersome, inconvenient and often unreliable, with fluctuating time in therapeutic range. Thrombotic events also continue to occur in a significant number of ACS patients despite antiplatelet therapy. Thus there is an unfilled need to reduce thrombotic events in ACS and AF patients. NOAC comprise direct factor Xa inhibitors (apixaban, rivaroxaban, darexaban, edoxaban), direct thrombin inhibitors (dabigatran) and PAR-1 antagonists (vorapaxar, atopaxar). In this review, we compare and contrast NOACs and review their individual and specific clinical trial database in ACS and AF. In the setting of ACS, the role of NOAC is unclear, as any reduction in ischemic events appears to be offset by hemorrhagic risk. However, NOAC have a definite place in the treatment of patients with non-valvular AF, where they are at least as effective, if not superior to warfarin.
Sinharay R, Barratt B, Meesang W, et al., 2014, Ambient Exposure To Diesel Traffic Particles And Cardio-Respiratory Outcomes In Healthy And In COPD Subjects: 'oxford Street 2', AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, Vol: 189, ISSN: 1073-449X
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Sinharay R, Barratt B, Rocha JP, et al., 2013, AMBIENT EXPOSURE TO DIESEL TRAFFIC PARTICLES AND CARDIO-RESPIRATORY OUTCOMES IN HEALTHY AND IN COPD SUBJECTS: 'OXFORD STREET 2', Winter Meeting of the British-Thoracic-Society, Publisher: BMJ PUBLISHING GROUP, Pages: A129-A130, ISSN: 0040-6376
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Kotecha D, New G, Collins P, et al., 2013, Radial artery pulse wave analysis for non-invasive assessment of coronary artery disease, INTERNATIONAL JOURNAL OF CARDIOLOGY, Vol: 167, Pages: 917-924, ISSN: 0167-5273
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