Publications
121 results found
Sever P, Gupta A, Thompson D, et al., 2016, LBOS 01-04 THE TRUE INCIDENCE OF STATIN -RELATED ADVERSE EVENTS IN HYPERTENSIVE PATIENTS REVEALED BY COMPARISON OF BLINDED AND UN-BLINDED USE OF STATIN IN THE ANGLO-SCANDINAVIAN CARDIAC OUTCOMES TRIAL (ASCOT)., J Hypertens, Vol: 34 Suppl 1, Pages: e547-e548, ISSN: 1473-5598
OBJECTIVE: To test the hypothesis that adverse effects of statins are only reported in excess in observational studies and not in blinded randomized trials. DESIGN AND METHOD: We collated all reported AEs in hypertensive patients in the Lipid-Lowering arm of the Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT-LLA) during the randomised, double-blind phase (when atorvastatin was compared with placebo) and the subsequent non-randomised un-blinded LLA-extension phase (when patients were offered open-label statin). Among them we blindly and independently adjudicated 4 prespecified AEs (outcomes) that have been claimed to be associated with statin use: muscle-related, erectile dysfunction (ED), sleep disturbance and cognitive impairment . We also performed a sensitivity analysis for all reported AEs. RESULTS: During 5.5 years of follow-up, 20.8% of 10,180 patients reported one (or more) of the 4 AEs. During the double- blind phase, those on statins (vs. placebo) reported a similar incidence of muscle- related AEs (HR 1.03[0.88 to1.21, p = 0.72]), a non significant reduction in ED(0.88 [0.75 to 1.04, p = 0.13]) and a significant reduction in sleep disturbance (0.60 [0.56 to 0.85, p < 0.001]). During the un-blinded phase, a significant increase in muscle related AEs was reported among statin users (vs. non-users) (1.41 [1.10 to 1.79, p = 0.006]). There were no significant differences in the reporting of ED or sleep disturbance among users and non-users. There were too few cases of cognitive impairment to warrant analysis. On sensitivity analyses, during the blinded phase, there was no significant difference in the proportion of patients reporting one or more of all AE's among those allocated to a statin (87.8%) or a placebo (88.8%) (p = 0.12). CONCLUSIONS: These data show that under blinded conditions there is no true increase in AEs with the use of statin. However, with un- blinded observations, there was a significant increase in reporting of muscle-related AEs -an e
Stam-Slob MC, Visseren FLJ, Jukema JW, et al., 2016, Statins for primary and secondary prevention of vascular disease in the elderly: estimation of individual absolute treatment effects, Congress of the European-Society-of-Cardiology (ESC), Publisher: OXFORD UNIV PRESS, Pages: 940-940, ISSN: 0195-668X
Stam-Slob MC, Visseren FL, Wouter Jukema J, et al., 2016, Personalized absolute benefit of statin treatment for primary or secondary prevention of vascular disease in individual elderly patients, Clinical Research in Cardiology, Vol: 106, Pages: 58-68, ISSN: 1861-0692
OBJECTIVE: To estimate the absolute treatment effect of statin therapy on major adverse cardiovascular events (MACE; myocardial infarction, stroke and vascular death) for the individual patient aged ≥70 years. METHODS: Prediction models for MACE were derived in patients aged ≥70 years with (n = 2550) and without (n = 3253) vascular disease from the "PROspective Study of Pravastatin in Elderly at Risk" (PROSPER) trial and validated in the "Secondary Manifestations of ARTerial disease" (SMART) cohort study (n = 1442) and the "Anglo-Scandinavian Cardiac Outcomes Trial-Lipid Lowering Arm" (ASCOT-LLA) trial (n = 1893), respectively, using competing risk analysis. Prespecified predictors were various clinical characteristics including statin treatment. Individual absolute risk reductions (ARRs) for MACE in 5 and 10 years were estimated by subtracting on-treatment from off-treatment risk. RESULTS: Individual ARRs were higher in elderly patients with vascular disease [5-year ARRs: median 5.1 %, interquartile range (IQR) 4.0-6.2 %, 10-year ARRs: median 7.8 %, IQR 6.8-8.6 %] than in patients without vascular disease (5-year ARRs: median 1.7 %, IQR 1.3-2.1 %, 10-year ARRs: 2.9 %, IQR 2.3-3.6 %). Ninety-eight percent of patients with vascular disease had a 5-year ARR ≥2.0 %, compared to 31 % of patients without vascular disease. CONCLUSIONS: With a multivariable prediction model the absolute treatment effect of a statin on MACE for individual elderly patients with and without vascular disease can be quantified. Because of high ARRs, treating all patients is more beneficial than prediction-based treatment for secondary prevention of MACE. For primary prevention of MACE, the prediction model can be used to identify those patients who benefit meaningfully from statin therapy.
Marcano Belisario JS, Gupta A, O'Donoghue J, et al., 2016, Tablet computers for implementing NICE antenatal mental health guidelines: protocol of a feasibility study, BMJ Open, Vol: 6, ISSN: 2044-6055
Introduction Depression is one of the most common mental health disorders that may affect women during pregnancy. The prompt identification of this disorder, and the provision of treatment, may help to reduce the likelihood of post-partum depression, prevent severe forms of the disease, and reduce its intergenerational impact. Despite women's repeated encounters with health services throughout their antenatal care, depression often goes undiagnosed. This is one area where mobile health could prove useful. We will assess the feasibility of using tablets to incorporate depression screening into antenatal pathways. We will also assess if survey layout could affect the quality of the data collected through these devices.Methods and analysis We will test the feasibility of using iPad Airs for the administration of the Whooley questions and the Edinburgh Postnatal Depression Scale (EPDS) to pregnant women attending antenatal clinics in England. We will assess the impact of survey layout on the quality of the responses given to these screening scales using a parallel, randomised controlled study design. We will calculate the positive predictive value, the negative predictive value and the false omission rate of the Whooley questions in comparison with the EPDS. We will calculate differences in data equivalence, time needed to complete the surveys, break-off rates, data completeness and requests for help between the 2 experimental groups: using all questions in one screen and navigation by vertical scrolling, or a single question per screen and navigation by multiple pages.Ethics and dissemination This study has been approved by the National Research Ethics Service Committee South East Coast—Surrey. Our findings will be disseminated through academic peer-reviewed publications, conferences and discussion with peers.
Robinson JG, Nedergaard BS, Rogers WJ, et al., 2014, Effect of Evolocumab or Ezetimibe Added to Moderate- or High-Intensity Statin Therapy on LDL-C Lowering in Patients With Hypercholesterolemia The LAPLACE-2 Randomized Clinical Trial, JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, Vol: 311, Pages: 1870-1882, ISSN: 0098-7484
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- Citations: 388
Watson S, Gupta AK, Poulter N, 2014, Influence of a short-term school-based intervention on the health behaviours and prevalence of obesity among schoolchildren and their parents: results of the RATIONAL HEALTH pilot programme, DIABETIC MEDICINE, Vol: 31, Pages: 23-23, ISSN: 0742-3071
Thom S, Poulter N, Field J, et al., 2013, Effects of a Fixed-Dose Combination Strategy on Adherence and Risk Factors in Patients With or at High Risk of CVD The UMPIRE Randomized Clinical Trial, JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, Vol: 310, Pages: 918-929, ISSN: 0098-7484
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- Citations: 286
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
Chapman N, Dixon F, Gupta AK, 2013, Incidence of angioedema in randomised controlled trials of angiotensin receptor blockers: a meta-analysis, Congress of the European-Society-of-Cardiology (ESC), Publisher: OXFORD UNIV PRESS, Pages: 335-335, 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, 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.
Kelishadi R, Amin MM, Haghdoost AA, et al., 2013, Pollutants source control and health effects., J Environ Public Health, Vol: 2013
Kelishadi R, de Ferranti SD, Majdzadeh R, et al., 2013, Childhood obesity: today and tomorrow's health challenge., J Obes, Vol: 2013
Elley CR, Gupta AK, Webster R, et al., 2012, The efficacy and tolerability of ‘polypills’: meta-analysis of randomised controlled trials, PLOS One, Vol: 7, ISSN: 1932-6203
BackgroundTo assess the blood pressure and lipid-lowering efficacy and tolerability of ‘polypills’ used in cardiovascular disease prevention trials.Methodology/Principal FindingsSystematic review and meta-analysis. Search strategy: The Cochrane Central Register of Controlled Trials, Medline, and PubMed databases were searched for eligible trials. Study inclusion criteria: Randomised controlled trials of at least six weeks duration, which compared a ‘polypill’ (that included at least one anti-hypertensive and one lipid-lowering medication) with a placebo (or one active component). Outcome measures: Change from baseline in systolic and diastolic blood pressures, and total and LDL-cholesterol; discontinuation of study medication and reported adverse effects. Of 44 potentially eligible studies, six trials (including 2,218 patients without previous cardiovascular disease) fulfilled the inclusion criteria. Compared with placebo, ‘polypills’ reduced systolic blood pressure by −9.2 mmHg (95% confidence interval (CI): −13.4, −5.0) diastolic blood pressure by −5.0 mmHg (95%CI: −7.4, −2.6), total cholesterol by −1.22 mmol/L (95%CI: −1.60, −0.84) and LDL-cholesterol by −1.02 mmol/L (95%CI: −1.37, −0.67). However, those taking a ‘polypill’ (vs. placebo or component) were more likely to discontinue medication (20% vs 14%) (Odds ratio: 1.5 (95% CI: 1.2, 1.9)). There was no significant difference in reported adverse effects amongst those on a ‘polypill’ (36% vs. 28%) (OR: 1.3 (95%CI: 0.7, 2.5)). There was high statistical heterogeneity in comparisons for blood pressure and lipid-lowering but use of random-effects and quality-effects models produced very similar results.Conclusions/SignificanceCompared with placebo, the ‘polypills’ reduced blood pressure and lipids. Tolerability was lower amongst those on ‘polypills’ than those o
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
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
Gupta A, Udupa N, Sreedhar D, 2012, Fixed-dose combinations, Pharmaceutical Technology Europe, Vol: 24, ISSN: 0164-6826
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- Citations: 1
Gupta AK, 2011, The efficacy and cost-effectiveness of statins in low-risk patients, CMAJ
Gupta AK, Nasothimiou EG, Chang CL, et al., 2011, Baseline predictors of resistant hypertension in the Anglo-Scandinavian Cardiac Outcome Trial (ASCOT): a risk score to identify those at high-risk, JOURNAL OF HYPERTENSION, Vol: 29, Pages: 2004-2013, ISSN: 0263-6352
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- Citations: 124
Gupta AK, Chang CL, Dahlof B, et al., 2011, Cardiovascular and all-cause mortality outcomes among hypertensive patients with moderate renal dysfunction in the ASCOT-LLA, and its extended follow-up, JOURNAL OF HUMAN HYPERTENSION, Vol: 25, Pages: 633-634, ISSN: 0950-9240
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- Citations: 3
Sever PS, Chang CL, Gupta AK, et al., 2011, The Anglo-Scandinavian Cardiac Outcomes Trial: 11-year mortality follow-up of the lipid-lowering arm in the UK, EUROPEAN HEART JOURNAL, Vol: 32, Pages: 2525-2532, ISSN: 0195-668X
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- Citations: 93
Gupta AK, et al, 2011, 1. Cardiovascular and all-cause mortality outcomes among hypertensive patients with moderate renal dysfunction in the ASCOT-LLA, and its extended follow-up, British Hypertension Society Conference
Gupta AK, Chang CL, Dahlof B, et al., 2011, Cardiovascular and all-cause mortality outcomes among hypertensive patients with moderate renal dysfunction in the ASCOT-LLA, and its extended follow-up, EUROPEAN HEART JOURNAL, Vol: 32, Pages: 220-220, ISSN: 0195-668X
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- Citations: 1
Gupta AK, Prieto-Merino D, Dahlof B, et al., 2011, Metabolic syndrome, impaired fasting glucose and obesity, as predictors of incident diabetes in 14 120 hypertensive patients of ASCOT-BPLA: comparison of their relative predictability using a novel approach, DIABETIC MEDICINE, Vol: 28, Pages: 941-947, ISSN: 0742-3071
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- Citations: 21
Gupta AK, et al, 2011, The relationship between statin therapy and progression of renal damage among 10,305 hypertensive patients randomised in the ASCOT-lipid-lowering arm (LLA), European Atherosclerosis Society Congress
Gupta AK, Savopoulos CG, Ahuja J, et al., 2011, Role of phytosterols in lipid-lowering: current perspectives, QJM-AN INTERNATIONAL JOURNAL OF MEDICINE, Vol: 104, Pages: 301-308, ISSN: 1460-2725
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- Citations: 66
Bangalore S, Kumar S, Kjeldsen SE, et al., 2011, Antihypertensive drugs and risk of cancer: network meta-analyses and trial sequential analyses of 324168 participants from randomised trials, LANCET ONCOLOGY, Vol: 12, Pages: 65-82, ISSN: 1470-2045
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- Citations: 273
Gupta AK, Poulter NR, 2010, The Concept of the Metabolic Syndrome Is It Dead Yet?, JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, Vol: 56, Pages: 1355-1356, ISSN: 0735-1097
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- Citations: 3
Gupta AK, Poulter NR, Dobson J, et al., 2010, Ethnic Differences in Blood Pressure Response to First and Second-Line Antihypertensive Therapies in Patients Randomized in the ASCOT Trial, AMERICAN JOURNAL OF HYPERTENSION, Vol: 23, Pages: 1023-1030, ISSN: 0895-7061
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- Citations: 58
Gupta AK, Dahlof B, Sever PS, et al., 2010, Metabolic Syndrome, Independent of Its Components, Is a Risk Factor for Stroke and Death But Not for Coronary Heart Disease Among Hypertensive Patients in the ASCOT-BPLA, Diabetes Care, Vol: 33, Pages: 1647-1651, ISSN: 1935-5548
OBJECTIVE — To evaluate whether in hypertensive patients the risk of cardiovascular diseaseis greater in association with the metabolic syndrome (MetS) or the sum of its individualcomponents.RESEARCH DESIGN AND METHODS — Cox regression analysis models were developedto assess the influence of age, sex, ethnicity, and the individual components of MetS on riskassociated with the MetS (using several definitions) of coronary outcomes, stroke, and all-causemortality.RESULTS — MetS was significantly associated with coronary outcomes, stroke, and all-causemortality after adjusting for age, sex, and ethnicity. However, when the model was furtheradjusted for the individual components, MetS was associated with significantly increased risk ofstroke (hazard ratio 1.34 [95% CI 1.07–1.68]) and all-cause mortality (1.35 [1.16–1.58]) butnot coronary outcomes (fatal coronary heart disease plus nonfatal myocardial infarction 1.16[0.95–1.43] and total coronary events 1.06 [0.91–1.24]).CONCLUSIONS — MetS, independent of its individual components, is associated withincreased risk of stroke and all-cause mortality but not coronary outcomes.
Gupta AK, Arshad S, Poulter NR, 2010, Compliance, Safety, and Effectiveness of Fixed-Dose Combinations of Antihypertensive Agents A Meta-Analysis, HYPERTENSION, Vol: 55, Pages: 399-407, ISSN: 0194-911X
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- Citations: 493
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