Imperial College London

ProfessorPeterCollins

Faculty of MedicineNational Heart & Lung Institute

Professor of Clinical Cardiology
 
 
 
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Contact

 

+44 (0)20 7351 8112peter.collins

 
 
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Location

 

Chelsea WingRoyal Brompton Campus

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Summary

 

Publications

Publication Type
Year
to

264 results found

Ahmed R, Dulay MS, Liu A, Okafor J, Azzu A, Ramphul K, Baksi JA, Wechalekar K, Khattar R, Dar O, Collins P, Wells AU, Kouranos V, Sharma Ret al., 2024, Comparing outcomes of an 'early' versus 'late' diagnosis of cardiac sarcoidosis following a baseline presentation of high-grade atrioventricular block., Curr Probl Cardiol, Vol: 49

BACKGROUND: There is a paucity of evidence on impact of a delay in Cardiac Sarcoidosis (CS) diagnosis after high-grade atrioventricular-block (AVB) and this study aims to fill this void. METHODS: Consecutive CS patients (n = 77) with high grade AVB referred to one specialist hospital in London between February 2007 to February 2023 were retrospectively reviewed. The median time from AVB to diagnosing CS (112 days) was used to define the Early (n = 38) and Late (n = 39) cohorts. The primary endpoint was a composite of all-cause mortality, cardiac transplantation, ventricular arrhythmic events or heart failure hospitalisation. Secondary endpoints included difference in maintenance prednisolone dose, need for cardiac device upgrade and device complications. RESULTS: The mean age of the cohort was 54.4 (±10.6) years of whom 64 % were male and 81 % Caucasian. After a mean follow up of 54.9 (±45.3) months, the primary endpoint was reached by more patients from the Late cohort (16/39 vs. 6/38, p = 0.02; multivariable HR 6.9; 95 %CI 1.5-32.2, p = 0.01). Early Group were more likely to have received an Implantable Cardioverter Defibrillator or Cardiac Resynchronisation Therapy-defibrillator as index device after AVB (19/38 vs. 6/39; p < 0.01) and had fewer device upgrades (19/38 vs. 30/39, p = 0.01) and a trend towards fewer device complications (1 vs. 5, p = 0.20). The maintenance dose of prednisolone was significantly higher in Late Group [20.7(±9.7) mg vs. 15.3(±7.9) mg, p = 0.02]. CONCLUSION: A late diagnosis of CS was associated with more adverse events, a greater probability of needing a device upgrade and required higher maintenance steroid dose.

Journal article

Kostanjsek L, Ardissino M, Moussa O, Rayes B, Amin R, Collins P, Purkayastha Set al., 2023, Bariatric Surgery and Incident Heart Failure: a Propensity Score Matched Nationwide Cohort Study, INTERNATIONAL JOURNAL OF CARDIOLOGY, Vol: 378, Pages: 42-47, ISSN: 0167-5273

Journal article

Ahmed R, Shi R, Okafor J, Azzu A, Baksi AJ, Wechalekar K, Collins P, Khattar RS, Sharma Ret al., 2023, CHARACTERISTICS AND OUTCOMES OF PATIENTS WITH CARDIAC SARCOIDOSIS WHO RECEIVED CARDIAC RESYNCHRONISATION THERAPY: COMPARISON WITH DILATED CARDIOMYOPATHY AND ISCHAEMIC CARDIOMYOPATHY, 72nd Annual Scientific Session (ACC), Publisher: ELSEVIER SCIENCE INC, Pages: 668-668, ISSN: 0735-1097

Conference paper

Vaja R, Ferreira P, Collins P, Rickman M, Punjabi PP, Kirkby N, Mitchell Jet al., 2022, The Effects of Celecoxib on Endothelial Function in Healthy Volunteers; A Double Blind, Placebo Controlled Randomised Trial, Scientific Sessions of the American-Heart-Association / Resuscitation Science Symposium, Publisher: LIPPINCOTT WILLIAMS & WILKINS, ISSN: 0009-7322

Conference paper

Ahmed R, Okator J, Shi R, Azzu A, Wechalekar K, Baksi J, Pennell D, Collins P, Wells A, Khattar R, Sharma R, Kouranos Vet al., 2022, EXPERIENCE WITH TUMOUR NECROSIS FACTOR-ALPHA INHIBITORS FOR THE TREATMENT OF CARDIAC SARCOIDOSIS IN A UK MEDICAL CENTRE, Winter Meeting of the British-Thoracic-Society (BTS), Publisher: BMJ PUBLISHING GROUP, Pages: A197-A199, ISSN: 0040-6376

Conference paper

Maas AHEM, Rosano G, Cifkova R, Chieffo A, van Dijken D, Hamoda H, Kunadian V, Laan E, Lambrinoudaki I, Maclaran K, Panay N, Stevenson JC, van Trotsenburg M, Collins Pet al., 2022, Cardiovascular health after menopause transition, pregnancy disorders, and other gynaecologic conditions: a consensus document from European cardiologists, gynaecologists, and endocrinologists (vol 42, pg 967, 2021), EUROPEAN HEART JOURNAL, Vol: 43, Pages: 2372-2372, ISSN: 0195-668X

Journal article

Moussa O, Ardissino M, Vincent M, Hines O, Amin R, Eichhorn C, Tang AR, Collins P, Purkayastha Set al., 2022, Long-term cardiovascular outcomes after orlistat therapy in patients with obesity: a nationwide, propensity score matched cohort study, European Heart Journal - Cardiovascular Pharmacotherapy, Vol: 8, Pages: 179-186, ISSN: 2055-6845

Aims:The rising prevalence of obesity and its associated comorbidities represent a growing public health issue; in particular, obesity is known to be a major risk factor for cardiovascular disease. Despite the evidence behind the efficacy of orlistat in achieving weight loss in patients with obesity, no study thus far has quantified its long-term effect on cardiovascular outcomes. The purpose of this study is to explore long-term cardiovascular outcomes after orlistat therapy.Methods and results:A propensity-score matched cohort study was conducted on the nation-wide electronic primary and integrated secondary healthcare records of the Clinical Practice Research Datalink (CPRD). The 36 876 patients with obesity in the CPRD database who had completed a course of orlistat during follow-up were matched on a 1:1 basis with equal numbers of controls who had not taken orlistat. Patients were followed up for a median of 6 years for the occurrence of the primary composite endpoint of major adverse cardiovascular events (fatal or non-fatal myocardial infarction or ischaemic stroke), and a number of secondary endpoints including primary endpoint components individually, the occurrence of new-onset heart failure, coronary revascularization, new chronic kidney disease stage III+ (CKD3+), and all-cause mortality. During the median study follow-up of 6 years, the occurrence of major adverse cardiovascular events was lower in the orlistat cohort [hazard ratio (HR) 0.74; 95% confidence interval (CI) 0.66–0.83, P < 0.001]. Patients who took orlistat experienced lower rates of myocardial infarction (HR 0.77; 95% CI 0.66–0.88, P < 0.001) and ischaemic stroke (HR 0.68; 95% CI 0.56 to −0.84, P < 0.001) as well as new-onset heart failure (HR 0.79; 95% CI 0.67–0.94, P = 0.007). There was no differences in revascularization rates (HR 1.12; 95% CI 0.91–1.38, P = 0.27)

Journal article

Kostanjsek L, Ardissino M, Moussa O, Collins P, Purkayastha Set al., 2021, Bariatric Surgery Reduces the Incidence of Heart Failure in Patients With Obesity, Annual Scientific Sessions of the American-Heart-Association / Resuscitation Science Symposium, Publisher: LIPPINCOTT WILLIAMS & WILKINS, ISSN: 0009-7322

Conference paper

Webb CM, Collins P, 2021, Medical management of anginal symptoms in women with stable angina pectoris: A systematic review of randomised controlled trials, International Journal of Cardiology, Vol: 341, Pages: 1-8, ISSN: 0167-5273

BackgroundMedical therapies are used to improve stable anginal symptoms and quality of life in clinical practice however the evidence for the use of antianginal medication in women is largely unknown. We conducted a systematic review to investigate the extent of the evidence-base for the medical management of anginal symptoms in women with stable angina.MethodsMEDLINE, EMBASE, Cochrane and ClinicalTrials.gov databases were searched to the end of December 2019. Retrieved papers were hand searched. Included were randomised controlled trials with at least one week of follow-up that included women with stable angina pectoris, with or without significant coronary atherosclerosis, randomised to conventional antianginal medication or/and a comparator, with a primary or secondary endpoint of angina frequency or glyceryl trinitrate (GTN) consumption.ResultsA total of 397 eligible publications were included in a qualitative analysis, with women comprising up to 20–30% of the study populations. No publication that included women and men reported all data separately for each sex. Twenty-six publications reported any female data separately from male data but only 18 reported angina data for women, 12 of which included fewer than 10 women.ConclusionsSubstantially fewer women than men were included in randomised trials of antianginal medications reporting effects on anginal symptoms, and reporting of data by sex was infrequent. As a result, there is little evidence on which to base treatment recommendations for anginal symptoms in women. Our results provide a platform for future studies to fill this void in the evidence.

Journal article

Manolis AJ, Boden WE, Collins P, Dechend R, Kallistratos MS, Sendon LJ, Poulimenos LE, Ambrosio G, Rosano Get al., 2021, State of the art approach to managing angina and ischemia: tailoring treatment to the evidence, EUROPEAN JOURNAL OF INTERNAL MEDICINE, Vol: 92, Pages: 40-47, ISSN: 0953-6205

Journal article

Stevenson JC, Collins P, Hamoda H, Lambrinoudaki I, Maas AHEM, Maclaran K, Panay Net al., 2021, Cardiometabolic health in premature ovarian insufficiency, CLIMACTERIC, Vol: 24, Pages: 474-480, ISSN: 1369-7137

Journal article

Moussa O, Ardissino M, Eichhorn C, Reddy RK, Khan O, Ziprin P, Darzi A, Collins P, Purkayastha Set al., 2021, Atrial fibrillation and obesity: long-term incidence and outcomes after bariatric surgery, European Journal of Preventive Cardiology, Vol: 28, Pages: e22-e24, ISSN: 2047-4873

Journal article

Ardissino M, Watson F, Amin R, Collins P, Moussa O, Purkayastha Set al., 2021, Atherosclerotic disease burden after bariatric surgery in patients with obesity and type 2 diabetes, JOURNAL OF DIABETES, Vol: 13, Pages: 640-647, ISSN: 1753-0393

Journal article

Moussa O, Ardissino M, Tang A, Edwards J, Heaton T, Khan O, Tsang K, Collins P, Purkayastha Set al., 2021, Long-term cerebrovascular outcomes after bariatric surgery: A nationwide cohort study, CLINICAL NEUROLOGY AND NEUROSURGERY, Vol: 203, ISSN: 0303-8467

Journal article

Maas A, Rosano G, Cifkova R, Chieffo A, van Dijken D, Hamoda H, Kunadian V, Laan E, Lambrinoudaki I, Maclaran K, Panay N, Stevenson JC, van Trotsenburg M, Collins Pet al., 2021, Cardiovascular health after menopause transition, pregnancy disorders and other gynaecologic conditions. A consensus document from European cardiologists, gynaecologists and endocrinologists, European Heart Journal, Vol: 42, Pages: 967-984, ISSN: 0195-668X

Women undergo important changes in sex hormones throughout their lifetime that can impact cardiovascular disease risk. Whereas the traditional cardiovascular risk factors dominate in older age, there are several female-specific risk factors and inflammatory risk variables that influence a woman’s risk at younger and middle age. Hypertensive pregnancy disorders and gestational diabetes are associated with a higher risk in younger women. Menopause transition has an additional adverse effect to ageing that may demand specific attention to ensure optimal cardiovascular risk profile and quality of life. In this position paper, we provide an update of gynaecological and obstetric conditions that interact with cardiovascular risk in women. Practice points for clinical use are given according to the latest standards from various related disciplines (Figure 1).

Journal article

Perrino C, Ferdinandy P, Bøtker HE, Brundel BJJM, Collins P, Davidson SM, den Ruijter HM, Engel FB, Gerdts E, Girao H, Gyöngyösi M, Hausenloy DJ, Lecour S, Madonna R, Marber M, Murphy E, Pesce M, Regitz-Zagrosek V, Sluijter JPG, Steffens S, Gollmann-Tepeköylü C, Van Laake LW, Van Linthout S, Schulz R, Ytrehus Ket al., 2021, Improving translational research in sex-specific effects of comorbidities and risk factors in ischaemic heart disease and cardioprotection: position paper and recommendations of the ESC Working Group on Cellular Biology of the Heart, Cardiovascular Research, Vol: 117, Pages: 367-385, ISSN: 0008-6363

Ischaemic heart disease (IHD) is a complex disorder and a leading cause of death and morbidity in both men and women. Sex, however, affects several aspects of IHD, including pathophysiology, incidence, clinical presentation, diagnosis as well as treatment and outcome. Several diseases or risk factors frequently associated with IHD can modify cellular signalling cascades, thus affecting ischaemia/reperfusion injury as well as responses to cardioprotective interventions. Importantly, the prevalence and impact of risk factors and several comorbidities differ between males and females, and their effects on IHD development and prognosis might differ according to sex. The cellular and molecular mechanisms underlying these differences are still poorly understood, and their identification might have important translational implications in the prediction or prevention of risk of IHD in men and women. Despite this, most experimental studies on IHD are still undertaken in animal models in the absence of risk factors and comorbidities, and assessment of potential sex-specific differences are largely missing. This ESC WG Position Paper will discuss: (i) the importance of sex as a biological variable in cardiovascular research, (ii) major biological mechanisms underlying sex-related differences relevant to IHD risk factors and comorbidities, (iii) prospects and pitfalls of preclinical models to investigate these associations, and finally (iv) will provide recommendations to guide future research. Although gender differences also affect IHD risk in the clinical setting, they will not be discussed in detail here.

Journal article

Khan TZ, Haskard D, Hartley A, Caga-Annan M, Pennell DJ, Collins P, Barbir M, Khamis Ret al., 2021, Oxidised LDL and Anti-Oxidised LDL Antibodies Are Reduced by Lipoprotein Apheresis in a Randomised Controlled Trial on Patients with Refractory Angina and Elevated Lipoprotein(a), Antioxidants, Vol: 10, ISSN: 2076-3921

Aims: An abundance of epidemiological evidence demonstrates that elevated lipoprotein(a) (Lp(a)) represents a significant contributing risk factor towards the development of cardiovascular disease. In particular, raised Lp(a) may play a mechanistic role in patients with refractory angina. Studies have also shown a correlation between oxidised LDL (oxLDL) levels and atherosclerotic burden as well as rates of cardiovascular events. Antibodies against oxLDL (anti-oxLDL) are involved in the removal of oxLDL. Lipoprotein apheresis (LA), which removes lipoproteins using extra-corporeal processes, is an established means of reducing Lp(a), and thereby reduces cardiovascular events. The aim of this study was to investigate the effect of LA on oxLDL and anti-oxLDL levels amongst those with refractory angina in the context of raised Lp(a). Methods: We performed a sub-study within a randomised controlled crossover trial involving 20 patients with refractory angina and raised Lp(a) > 500 mg/L, comparing the effect of three months of blinded weekly LA or sham, followed by crossover to the opposite study arm. We utilized enzyme-linked immunosorbent assays (ELISA) to quantify oxLDL and IgG/ IgM anti-oxLDL antibody levels at baseline and following three months of active LA or sham sessions. Results: Following three months of LA, there was a 30% reduction in oxLDL from 0.37 ± 0.06 to 0.26 ± 0.04 with a mean drop of −0.11 units (U) (95% CI −0.13, −0.09) compared to no significant change with sham therapy (p < 0.0001 between treatment arms). LA also led to a 22% reduction in levels of IgG and IgM anti-oxLDL, again with no significant change demonstrated during sham (p = 0.0036 and p = 0.012, respectively, between treatment arms). Conclusion: Amongst patients with refractory angina in the context of elevated Lp(a), LA significantly lowers levels of oxLDL and anti-oxLDL antibodies, representing potential mechanisms by which LA yields symptomatic and

Journal article

Moussa O, Ardissino M, Muttoni S, Faraj A, Tang A, Khan O, Collins P, Jaffer U, Purkayastha Set al., 2021, Long-term incidence and outcomes of obesity-related peripheral vascular disease after bariatric surgery, Langenbecks Archives of Surgery, Vol: 406, Pages: 1029-1036, ISSN: 1435-2443

Background and aimsPatients with obesity are at high risk of suffering from arterial and venous peripheral vascular disease (PVD). Bariatric surgery is an effective strategy to achieve weight reduction for patients with obesity. The long-term impact of bariatric surgery on obesity-related morbidity is subject to increasing research interest. This study aimed to ascertain the impact of bariatric surgery on the long-term occurrence of PVD in patients with obesity.MethodsThe study population was extracted from the Clinical Practice Research Datalink, a nation-wide database containing primary and secondary care records of consenting patients. The intervention cohort was 2959 patients who had undergone bariatric surgery during follow-up; their controls were 2959 propensity-score-matched counterparts. The primary endpoint was development of any PVD: arterial or venous. Secondary endpoints were incident peripheral arterial disease alone, incident peripheral venous disease alone.ResultsThree hundred forty-six patients suffered a primary endpoint during follow-up. Bariatric surgery did not improve peripheral vascular disease rates as a whole, but it was associated with significantly lower event rates of arterial disease (HR = 0.560, 95%CI 0.327–0.959, p = 0.035) but higher event rates of venous disease (HR = 1.685, 95%CI 1.256–2.262, p < 0.001).ConclusionsBariatric surgery was associated with significantly reduced long-term occurrence of arterial disease but increased occurrence of venous disease in patients with obesity.

Journal article

Watson F, Ardissino M, Amin RJ, Arhi C, Collins P, Moussa O, Purkayastha Set al., 2020, Bariatric Surgery is Associated With Reduced Atherosclerotic Cardiovascular Disease Burden in Obese Patients With Type 2 Diabetes: A Propensity-matched Cohort Study, Publisher: LIPPINCOTT WILLIAMS & WILKINS, ISSN: 0009-7322

Conference paper

Gaudino M, Benedetto U, Fremes S, Ballman K, Biondi-Zoccai G, Sedrakyan A, Nasso G, Raman J, Buxton B, Hayward PA, Moat N, Collins P, Webb C, Peric M, Petrovic I, Yoo KJ, Hameed I, Di Franco A, Moscarelli M, Speziale G, Puskas JD, Girardi LN, Hare DL, Taggart DPet al., 2020, Association of Radial Artery Graft vs Saphenous Vein Graft With Long-term Cardiovascular Outcomes Among Patients Undergoing Coronary Artery Bypass Grafting, JAMA, Vol: 324, Pages: 179-179, ISSN: 0098-7484

Importance Observational studies have suggested that the use of radial artery grafts for coronary artery bypass grafting may improve clinical outcomes compared with the use of saphenous vein grafts, but this has not been confirmed in randomized trials.Objective To compare clinical outcomes between patients receiving radial artery vs saphenous vein grafts for coronary artery bypass grafting after long-term follow-up.Design, Setting, and Participants Patient-level pooled analysis comparing radial artery vs saphenous vein graft in adult patients undergoing isolated coronary artery bypass grafting from 5 countries (Australia, Italy, Serbia, South Korea, and the United Kingdom), with enrollment from 1997 to 2009 and follow-up completed in 2019.Interventions Patients were randomized to undergo either radial artery (n = 534) or saphenous vein (n = 502) grafts for coronary artery bypass grafting.Main Outcomes and Measures The primary outcome was a composite of death, myocardial infarction, or repeat revascularization and the secondary outcome was a composite of death or myocardial infarction.Results A total of 1036 patients were randomized (mean age, 66.6 years in the radial artery group vs 67.1 years in the saphenous vein group; 376 [70.4%] men in the radial artery group vs 351 [69.9%] in the saphenous vein group); 942 (90.9%) of the originally randomized patients completed 10 years of follow-up (510 in the radial artery group). At a median (interquartile range) follow-up of 10 (10-11) years, the use of the radial artery, compared with the saphenous vein, in coronary artery bypass grafting was associated with a statistically significant reduction in the incidence of the composite outcome of death, myocardial infarction, or repeat revascularization (220 vs 237 total events; 41 vs 47 events per 1000 patient-years; hazard ratio, 0.73 [95% CI, 0.61-0.88]; P < .001) and of the composite of death or myocardial infarction (188 vs

Journal article

Rozenberg S, Al-Daghri N, Aubertin-Leheudre M, Brandi M-L, Cano A, Collins P, Cooper C, Genazzani AR, Hillard T, Kanis JA, Kaufman J-M, Lambrinoudaki I, Laslop A, McCloskey E, Palacios S, Prieto-Alhambra D, Reginster J-Y, Rizzoli R, Rosano G, Trémollieres F, Harvey NCet al., 2020, Is there a role for menopausal hormone therapy in the management of postmenopausal osteoporosis?, Osteoporosis International, Vol: 31, Pages: 2271-2286, ISSN: 0937-941X

We provide an evidence base and guidance for the use of menopausal hormone therapy (MHT) for the maintenance of skeletal health and prevention of future fractures in recently menopausal women. Despite controversy over associated side effects, which has limited its use in recent decades, the potential role for MHT soon after menopause in the management of postmenopausal osteoporosis is increasingly recognized. We present a narrative review of the benefits versus risks of using MHT in the management of postmenopausal osteoporosis. Current literature suggests robust anti-fracture efficacy of MHT in patients unselected for low BMD, regardless of concomitant use with progestogens, but with limited evidence of persisting skeletal benefits following cessation of therapy. Side effects include cardiovascular events, thromboembolic disease, stroke and breast cancer, but the benefit-risk profile differs according to the use of opposed versus unopposed oestrogens, type of oestrogen/progestogen, dose and route of delivery and, for cardiovascular events, timing of MHT use. Overall, the benefit-risk profile supports MHT treatment in women who have recently (< 10 years) become menopausal, who have menopausal symptoms and who are less than 60 years old, with a low baseline risk for adverse events. MHT should be considered as an option for the maintenance of skeletal health in women, specifically as an additional benefit in the context of treatment of menopausal symptoms, when commenced at the menopause, or shortly thereafter, in the context of a personalized benefit-risk evaluation.

Journal article

Ardissino M, Moussa O, Eichhorn C, Reddy R, Khan O, Ziprin P, Darzi A, Collins P, Purkayastha Set al., 2020, Atrial fibrillation and obesity: long-term incidence and outcomes after bariatric surgery, Conference of American-College-of-Cardiology (ACC) / World Congress of Cardiology (WCC), Publisher: ELSEVIER SCIENCE INC, Pages: 1986-1986, ISSN: 0735-1097

BackgroundObesity is among the fastest growing global health threats. Among the management options for patients with obesity, bariatric surgery is a rapidly evolving field that has been shown to result in reliable weight loss. The association between obesity and atrial fibrillation has been well established; but the long-term impact of bariatric surgery on atrial fibrillation has not yet been explored. This study aims to assess the long-term incidence and resolution rates of atrial fibrillation in patients who undergo bariatric surgery in the United Kingdom.MethodsThe primary and secondary electronic healthcare records included in the Clinical Practice Research Datalink (CPRD) database were used to conduct a nation-wide cohort study. The 3,077 patients in the CPRD with no previous history of atrial fibrillation who had undergone bariatric surgery, were matched to 3,077 age, gender and BMI matched controls, also with no past history of atrial fibrillation. The primary endpoint was the incidence of any type of atrial fibrillation by clinical coded diagnosis. The secondary endpoint was a coded resolution of atrial fibrillation among the patients who received a diagnosis during follow-up.ResultsPatients were followed up for a median of 12.3 years; the median age was 50 years and median BMI was 43 kg/m2. Patients who had undergone bariatric surgery did not have a significantly lower occurrence of the primary outcome of incident AF (adjusted HR 0.720; 95% CI 0.492–1.054; p=0.091). However, secondary analysis among patients with AF identified higher rates of resolution among patients who had undergone bariatric surgery (p=0.049).ConclusionThe results of this nationwide cohort study identify an association between bariatric surgery and higher rates of AF resolution; and describe a non-significant but biologically plausible trend towards lower rates of incident AF in patients who underwent bariatric surgery.

Conference paper

Moussa O, Ardissino M, Heaton T, Tang A, Khan O, Ziprin P, Darzi A, Collins P, Purkayastha Set al., 2020, Effect of bariatric surgery on long-term cardiovascular outcomes: a nationwide nested cohort study, European Heart Journal, Vol: 41, Pages: 2660-2667, ISSN: 0195-668X

AIMS: This study aims to evaluate the long-term effect of bariatric surgery on cardiovascular outcomes of patients with obesity. METHODS AND RESULTS: A nested cohort study was carried out within the Clinical Practice Research Datalink. The study cohort included the 3701 patients on the database who had undergone bariatric surgery and 3701 age, gender, and body mass index-matched controls. The primary endpoint was the composite of fatal or non-fatal myocardial infarction and fatal or non-fatal ischaemic stroke. Secondary endpoints included fatal or non-fatal myocardial infarction alone, fatal or non-fatal ischaemic stroke alone, incident heart failure, and mortality. The median follow-up achieved was 11.2 years. Patients who had undergone bariatric surgery had a significantly lower occurrence of major adverse cardiovascular events [hazard ratio (HR) 0.410, 95% confidence interval (CI) 0.274-0.615; P < 0.001]. This was mainly driven by a reduction in myocardial infarction (HR 0.412, 95% CI 0.280-0.606; P < 0.001) and not in acute ischaemic stroke (HR 0.536, 95% CI 0.164-1.748; P = 0.301). A reduction was also observed in new diagnoses of heart failure (HR 0.403, 95% CI 0.181-0.897; P = 0.026) and mortality (HR 0.254, 95% CI 0.183-0.353; P < 0.001). CONCLUSION: The results of this large, nationwide cohort study support the association of bariatric surgery with lower long-term risk of major cardiovascular events and incident heart failure in patients with obesity.

Journal article

Gaudino M, Benedetto U, Fremes SE, Hare DL, Hayward P, Moat N, Moscarelli M, Di Franco A, Nasso G, Peric M, Petrovic I, Collins P, Webb CM, Puskas JD, Speziale G, Yoo KJ, Girardi LN, Taggart DP, RADIAL Investigatorset al., 2020, Angiographic outcome of coronary artery bypass grafts: Radial Artery Database International Alliance, Annals of Thoracic Surgery, Vol: 109, Pages: 688-694, ISSN: 0003-4975

BACKGROUND: We used a large patient-level dataset including six angiographic randomized trials (RCTs) on coronary artery bypass conduits to explore incidence and determinants of coronary graft failure. METHODS: Patient-level angiographic data of six RCTs comparing long-term outcomes of the radial artery and other conduits were joined. Primary outcome was graft occlusion at maximum follow-up. The analysis was divided as follows: 1) left anterior descending coronary (LAD) distribution, 2) non-LAD distribution (circumflex and right coronary artery). To identify predictors of graft occlusion, mixed model multivariable Cox regression including all baseline characteristics with stratification by individual trials was used. RESULTS: 1091 patients and 2281 grafts were included (921 left internal mammary arteries, 74 right internal mammary arteries, 710 radial artery and 576 saphenous veins; all left internal mammary arteries were used on the LAD, the other conduits were used on the non-LAD distribution; mean angiographic follow up: 65±29 months). Occlusion rate was 2.3%, 13.5%, 9.4%, 17.5% for the left internal mammary arteries, right internal mammary arteries, radial artery and saphenous veins, respectively. At multivariable analysis type of conduit used, age, female gender, left ventricular ejection fraction<50% and use of the Y graft were significantly associated with graft occlusion in the non-LAD distribution. CONCLUSIONS: Our analyses showed that failure of the left internal mammary arteries to LAD bypass is a very uncommon event. For the non-LAD distribution, the non-use of radial artery, age, female gender, left ventricular ejection fraction<50% and use of the Y graft configuration were significantly associated with mid-term graft failure.

Journal article

Collins P, Maas A, Prasad M, Schierbeck L, Lerman Aet al., 2020, Endothelial Vascular Function as a Surrogate of Vascular Risk and Aging in Women, MAYO CLINIC PROCEEDINGS, Vol: 95, Pages: 541-553, ISSN: 0025-6196

Journal article

Gaudino M, Benedetto U, Fremes S, Ballman K, Biondi-Zoccai G, Sedrakyan A, Nasso G, Raman J, Buxton B, Hayward PA, Moat N, Collins P, Webb C, Peric M, Petrovic I, Yoo KJ, Hameed I, Di Franco A, Moscarelli M, Speziale G, Girardi LN, Hare DL, Taggart DPet al., 2019, The RADial artery International ALliance (RADIAL) extended follow-up study: rationale and study protocol, European Journal of Cardio-Thoracic Surgery, Vol: 56, Pages: 1025-1030, ISSN: 1010-7940

It is generally accepted that radial artery (RA) grafts have better mid-term patency rate compared to saphenous vein grafts. However, the clinical correlates of the improved patency rate are still debated. Observational studies have suggested increased survival and event-free survival for patients who receive an RA rather than a saphenous vein, but they are open to bias and confounders. The only evidence based on randomized data is a pooled meta-analysis of 6 randomized controlled trial comparing the RA and the saphenous vein published by the RADial artery International Alliance (RADIAL). In the RADIAL database, improved freedom from follow-up cardiac events (death, myocardial infarction and repeat revascularization) was found at 5-year follow-up in the RA arm. The most important limitation of the RADIAL analysis is that most of the included trials had an angiographic follow-up in the first 5 years and it is unclear whether the rate of repeat revascularization (the main driver of the composite outcome) was clinically indicated due to per-protocol angiographies. Here, we present the protocol for the long-term analysis of the RADIAL database. By extending the follow-up beyond the 5th postoperative year (all trials except 1 did not have angiographic follow-up beyond 5 years), we aim to provide data on the role of RA in coronary artery bypass surgery with respect to long-term outcomes.

Journal article

Ardissino M, Moussa O, Heaton T, Tang A, Ziprin P, Darzi A, Khan O, Collins P, Purkayastha Set al., 2019, Bariatric Surgery and Cerebrovascular Outcomes in Patients With Obesity, Scientific Sessions of the American-Heart-Association, Publisher: LIPPINCOTT WILLIAMS & WILKINS, ISSN: 0009-7322

Conference paper

Moussa O, Ardissino M, Muttoni S, Faraj A, Tang A, Ziprin P, Darzi A, Khan O, Collins P, Jaffer U, Purkayastha Set al., 2019, Long-term effect of bariatric surgery on the incidence and outcomes of obesity-related peripheral vascular disease, Scientific Sessions of the American-Heart-Association, Publisher: Lippincott, Williams & Wilkins, Pages: 1-2, ISSN: 0009-7322

Background: Patients with obesity are at high risk of suffering from both arterial and venous peripheral vascular disease. Bariatric surgery is an effective and increasingly popular strategy to achieve weight reduction and for patients with obesity. The long-term impact of bariatric surgery on obesity-related morbidity is a subject of increasing research interest.Hypothesis: The aim of this study is to ascertain the impact of bariatric surgery on the long-term occurrence of peripheral vascular disease in patients with obesity.Design: The study cohort consisted of 7,892 patients in theClinical Practice Research Datalink. This a prospectively collected nation-wide database containing primary and secondary care records of consenting patients. The intervention cohort were the 3,946 patients who had undergone bariatric surgery during follow-up; their controls were 3,946 age, gender and BMI-matched controls. The primary endpoint was considered to be the development of any peripheral vascualr disease: arterial or venous. Secondary endpoints included were peripheral arterial disease alone, peripheral venous disease alone, and amputation of a limb due to any cause. The median follow-up achieved in the study was 11.5 years.Results: A total of 1,244 patients suffered a primary endpoint during follow up; bariatric surgery was associated with a reduction in primary event rates (HR=0.651, 95%CI 0.558-0.758, p<0.001); this was driven by a reduction in both arterial and venous disease. The protective effect observed was strongest in women (p int<0.001), those with diabetes (p int<0.001) and those of WHO BMI Categories I and II (p int=0.003). Amputation rates were also non-significantly reduced in the bariatric surgery cohort HR=0.443, 95%CI 0.181-1.085, p=0.075).Conclusion: Bariatric surgery was associated with a reduction in the occurrence of both arterial and venous peripheral vascular disease in patients with obesity.

Conference paper

Ardissino M, Moussa O, Tang A, Lazzari L, Millar O, Ziprin P, Darzi A, Khan O, Collins P, Purkayastha Set al., 2019, Impact of bariatric surgery on long-term venous thromboembolic risk: a matched cohort study, Scientific Sessions of the American-Heart-Association, Publisher: Lippincott, Williams & Wilkins, Pages: 1-2, ISSN: 0009-7322

Background: Obesity is a well-established risk factor for venous thromboembolic events, such as pulmonary emoblism and deep vein thrombosis. The rising prevalence of obesity and its associated co-morbidities, including VTE, represent a growing public health issue. Bariatric surgery has been widely validated as an effective method of achieving weight reduction in patients with obesity. However, the impact of this weight loss on the long-term risk of thromboembolic events has yet to be explored. The aim of the present study is to evaluate the effect of bariatric surgery on long-term risk of venous thromboembolic events in a large cohort of patients with obesity.Methods: A nested cohort study was designed; including the 4,056 patients of the Clinical Practice Research Datalink database who had undergone bariatric surgery, and equal numbers of age, gender and BMI matched controls. The primary endpoint of the study was the occurrence of any venous thromboembolic event; with secondary endpoints of deep vein thrombosis alone, pulmonary embolism alone and all-cause mortality. A landmark analysis was carried out to describe and quantify the time-dependent pattern of thromboembolic risk in the initial three years following bariatric surgery. Data was analysed using a Cox proportional hazards model accounting for multiple covariates.Results: Patients were followed up for a median of 10·7 years. The bariatric surgery cohort had a significantly lower occurrence of the primary outcome (HR 0·601; 95%CI 0·430-0·841, p=0·003); mainly driven by a reduction in deep vein thrombosis (HR 0·523; 95% CI 0·349-0·783, p=0·002) and not in pumonary embolism (HR 0·882; 95% CI 0·511-1.521, p=0·651).Conclusion: The results of this nation-wide investigation set out to characterise the impact of bariatric surgery on long-term risk of thromboembolic events in patients with obesity outline a significant reduction in t

Conference paper

Collins P, Moussa O, Ardissino M, Heaton O, Tang A, Khan O, Ziprin P, Darzi A, Purkayastha Set al., 2019, Effect of bariatric surgery on long-term cardiovascular outcomes A nation-wide nested cohort study, European Heart Journal, Vol: 40, ISSN: 0195-668X

BackgroundObesity is a cardinal risk factor for the development of atherosclerotic cardiovascular disease. Bariatric surgery is an effective method of achieving weight reduction and improving control of cardiovascular risk factors in patients with obesity. However, the effect of bariatric surgery on long-term cardiovascular outcomes has yet to be defined.PurposeThe aim of this study is to evaluate the effect of bariatric surgery on long-term risk of major adverse cardiovascular events in a large population of patients with obesity.MethodsA nested cohort study was carried out; including the 3,701 patients of the Clinical Practice Research Datalink database who had undergone bariatric surgery, and 3,701 age, gender and BMI matched controls. The primary endpoint was the composite of fatal or non-fatal myocardial infarction; and fatal or non-fatal acute ischaemic stroke. Secondary endpoints included all-cause mortality, new diagnosis of heart failure, fatal or non-fatal myocardial infarction, and fatal or non-fatal acute ischaemic stroke. Data was analysed using a Cox proportional hazards model to account for multiple covariates.ResultsPatients were followed up for a median of 11.2 years; 20.3% of the population were female, the median age was 36 years and median BMI was 40.4 kg/m2. Patients who had undergone bariatric surgery had a significantly lower occurrence of the primary composite outcome (HR 0.450; 95% CI 0.312–0.671, p<0.001, NNT=62); this was driven by a reduction in myocardial infarction (HR 0.444; 95% CI 0.302–0.654, p<0.001, NNT=64) and not in acute ischaemic stroke (HR 0.528; 95% CI 0.159–1.751, p=0.296). A significant reduction was observed in rates all-cause mortality (HR 0.254; 95% CI 0.183–0.353; p<0.001, NNT=27) and of new diagnosis of heart failure (HR 0.519; 95% CI 0.311–0.864, p=0.012, NNT=153).ConclusionThe results of this large, nation-wide nested cohort study support the role of bariatric surgery in reducin

Journal article

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