Large-scale population studies of chronic disease

Lead Research Organisation: Medical Research Council

Abstract

This programme on observational studies in both low income and high income countries has two main themes: (i) to generate reliable evidence about the importance of known risk factors, such as smoking, alcohol and obesity, for premature death in different populations; and (ii) to discover novel genes and other novel risk factors for vascular diseases. Our previous research demonstrated the hazards of prolonged smoking and the benefits of stopping in high-income countries, and ongoing population studies, involving more than 4 million participants, are currently assessing the risks of smoking in Cuba, India and China. In 2009 and 2014 we reported that excessive alcohol consumption (chiefly vodka) was responsible for most premature deaths in Russia and this immediately prompted new public health strategies to limit heavy alcohol consumption in Russia. Our study in Mexico (where one-third of men and one-half of women are obese) will examine the risks associated with diabetes and different patterns of obesity. CTSU-led population-based genetic studies have been established in different settings (eg, with different genetic architecture, levels of risk factors and disease rates) to define the causal role of novel risk factors (eg, Lp(a),a lipid that is currently being tested in CTSU’s trials) and identify new strategies for the prevention and treatment of cardiovascular diseases.

Technical Summary

This programme aims to monitor, in many different populations around the world, the current and future hazards of smoking and the benefits of stopping at various ages, disseminate the findings effectively; and to assess the fluctuating alcohol-attributed mortality in Russia; to determine the age and sex-specific relevance of other classic risk factors for vascular, renal and neoplastic disease using prospective studies and meta-analyses of such studies; to conduct Mendelian randomisation studies to assess the causal relevance of selected novel risk factors for vascular disease; and to coordinate GWAS and other studies of genetic variants affecting CHD, stroke and other vascular diseases. CTSU aims to continue being a major source of evidence on country-specific hazards of smoking, alcohol and adiposity. Large-scale meta-analyses using individual level data have allowed reliable assessment of age- and sex-specific associations of classic risk factors with disease outcomes. There is a need for such studies in a wide range of countries, as disease patterns cannot be accounted for by the distributions of known risk factors. Meta-analyses of individual participant data from prospective studies allow more precise estimation of risks and better control for several types of bias. Mendelian randomisation studies of vascular disease have demonstrated the causal relevance of lipoprotein(a) (Lp[a]), but refuted it for C-reactive protein (CRP) and homocysteine. CTSU studies have also contributed to the discovery of several common genetic variants for vascular disease, but a substantial fraction of heritability remains unexplained. As Lp(a) has been identified as a strong risk factor for CHD, additional work is planned to enhance our understanding of the determinants of Lp(a) levels.

Publications

10 25 50

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Collaborative Group On Epidemiological Studies Of Ovarian Cancer (2012) Ovarian cancer and smoking: individual participant meta-analysis including 28,114 women with ovarian cancer from 51 epidemiological studies. in The Lancet. Oncology

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Coronary Artery Disease (C4D) Genetics Consortium (2011) A genome-wide association study in Europeans and South Asians identifies five new loci for coronary artery disease. in Nature genetics

 
Description Health Protection Agency Advisory Group on Ionising Radiation: Radon
Geographic Reach National 
Policy Influence Type Participation in advisory committee
 
Description Health Protection Agency Advisory Group on Non-ionising Radiation: Static Magnetic Fields
Geographic Reach National 
Policy Influence Type Participation in advisory committee
 
Description Russian Presidential decree to initiate strong measures to limit alcohol abuse
Geographic Reach Multiple continents/international 
Policy Influence Type Implementation circular/rapid advice/letter to e.g. Ministry of Health
Impact Our 2009 Lancet publication highlighted the risks of excessive alcohol consumption - particularly vodka - in male Russians and immediately resulted in a Presidential decree of measures to limit alcohol abuse.
URL http://www.telegraph.co.uk/news/worldnews/europe/russia/6190439/Dmitry-Medvedev-begins-tough-anti-al...
 
Description STT Collaboration's contribution to review
Geographic Reach National 
Policy Influence Type Participation in a national consultation
Impact Stroke Thrombolysis work contribute directly to the MHRA's review of alteplaste for acute ischaemic stroke
 
Description UK policy on folic acid fortification
Geographic Reach Europe 
Policy Influence Type Participation in a advisory committee
Impact European Food Safety Panel on 'Folic acid and cancer' 2009
 
Description US policy on safety of folic acid fortification
Geographic Reach National 
Policy Influence Type Participation in a national consultation
Impact US National Toxicology Review (USA) on 'Identifying research needs for assessing safe use of high intakes of folic acid' 2015
 
Description WHO Framework Convention on Tobacco Control: MPOWER measures
Geographic Reach Multiple continents/international 
Policy Influence Type Implementation circular/rapid advice/letter to e.g. Ministry of Health
Impact In 2008 the WHO adopted a set of 6 strategic recommendations for tobacco control, which they refer to as MPOWER: Monitor tobacco use and prevention policies, Protect people, Offer help to quit, Warn, Enforce bans, Raise taxes. Many of the key epidemiological statistics on tobacco hazards in the report derive from our research.
URL http://www.who.int/tobacco/mpower/en/
 
Description WHO Global Hearts Initiative
Geographic Reach Multiple continents/international 
Policy Influence Type Gave evidence to a government review
Impact Our work has informed the World Health Organisation Global Hearts Initiative to address cardiovascular disease in low and middle income countries. Government policy on non-communicable disease control in Cuba, Russia and India
 
Description WHO Handbook on indoor radon - a public health perspective
Geographic Reach Multiple continents/international 
Policy Influence Type Participation in advisory committee
 
Description WHO policy on folic acid fortification
Geographic Reach Multiple continents/international 
Policy Influence Type Membership of a guideline committee
Impact World Health Organization: Optimum population plasma levels of red-cell folate for folic acid fortification 2014
 
Description Research Excellence Award
Amount £112,000 (GBP)
Organisation British Heart Foundation (BHF) 
Sector Charity/Non Profit
Country United Kingdom
Start 06/2011 
End 01/2014
 
Description Research Excellence Award
Amount £88,000 (GBP)
Organisation British Heart Foundation (BHF) 
Sector Charity/Non Profit
Country United Kingdom
Start 02/2014 
End 05/2014
 
Description Research Excellence Award
Amount £115,000 (GBP)
Organisation British Heart Foundation (BHF) 
Sector Charity/Non Profit
Country United Kingdom
Start 01/2009 
End 12/2010
 
Description Research Excellence Award
Amount £27,000 (GBP)
Organisation British Heart Foundation (BHF) 
Sector Charity/Non Profit
Country United Kingdom
Start 08/2013 
End 03/2014
 
Description Research grant (Chinese case control studies)
Amount £154,000 (GBP)
Organisation AstraZeneca 
Sector Private
Country United Kingdom
Start 12/2004 
End 12/2015
 
Description Research grant (PROCARDIS)
Amount £521,000 (GBP)
Funding ID 37273 
Organisation European Commission 
Sector Public
Country European Union (EU)
Start 04/2007 
End 09/2011
 
Description Research grant (Vitamin B12)
Amount £75,000 (GBP)
Organisation Food Standards Agency (FSA) 
Sector Public
Country United Kingdom
Start 03/2007 
End 09/2010
 
Description Russian Health Project Grant
Amount £38,000 (GBP)
Organisation European Commission 
Sector Public
Country European Union (EU)
Start 07/2007 
End 06/2010
 
Description BHF Centre for Research Excellence 
Organisation University of Oxford
Department BHF Centre of Research Excellence
Country United Kingdom 
Sector Academic/University 
PI Contribution n/a
Collaborator Contribution funding
Impact Support for Dr Ben Lacey to work on routinely-collected electronic health records in preparation for fellowship
Start Year 2018
 
Description CARDIoGRAMplusC4D Consortium 
Organisation Queen Mary University of London
Department William Harvey Research Institute
Country United Kingdom 
Sector Academic/University 
PI Contribution joint academic collaboration
Collaborator Contribution joint academic collaboration
Impact multiple high profile publications and presentations at international meetings of novel findings in relation to identifying genetic determinants of coronary artery disease, further publications in progress
Start Year 2009
 
Description CDC Foundation 
Organisation CDC Foundation
Country Georgia 
Sector Public 
PI Contribution Co-principal Investigator
Collaborator Contribution The CDC Foundation and Amgen are partnering on a new global cardiovascular health initiative to support independent epidemiological research by the University of Oxford and technological and evaluation research by the Centers for Disease Control and Prevention (CDC).
Impact none yet
Start Year 2018
 
Description CDC Foundation 
Organisation Center for Disease Control Foundation
Country Georgia 
Sector Charity/Non Profit 
PI Contribution academic partnership
Collaborator Contribution academic partnership
Impact n/a
Start Year 2016
 
Description CDC collaboration 
Organisation Centers for Disease Control and Prevention (CDC)
Department Division of Global Health Protection and Security
Country Georgia 
Sector Public 
PI Contribution Joint academic partnership
Collaborator Contribution Joint academic partnership
Impact n/a
Start Year 2015
 
Description Chinese cohort with Chinese Center for Disease Control and Prevention 
Organisation Chinese Center for Disease Control and Prevention (China CDC)
Department National Center for Chronic and Noncommunicable Disease Control and Prevention
Country China 
Sector Public 
PI Contribution Joint academic collaboration.
Collaborator Contribution Joint academic collaboration.
Impact This cohort will contribute to our programme of research assessing the evolving hazards from smoking, drinking, adiposity and blood pressure.
Start Year 2014
 
Description Chronic Kidney Disease Prognosis Consortium 
Organisation Johns Hopkins University
Country United States 
Sector Academic/University 
PI Contribution member
Collaborator Contribution Established the group
Impact N/A
Start Year 2009
 
Description Cuba cohort in 150,000 adults 
Organisation Institute of Cardiology and Cardiovascular Surgery
Country Cuba 
Sector Hospitals 
PI Contribution Joint academic collaboration.
Collaborator Contribution Joint academic collaboration
Impact The Cuban cohort has contributed to our programme of research assessing the evolving hazards from smoking, drinking, adiposity and blood pressure.
Start Year 2006
 
Description Egyptian cohort of 200,000 adults 
Organisation Suez Canal University
Country Egypt 
Sector Academic/University 
PI Contribution Joint academic collaboration.
Collaborator Contribution Joint academic collaboration.
Impact The Egyptian cohort is currently undertaking a pilot to determine whether longitudinal follow-up is possible.
 
Description Emerging Risk Factors Collaboration 
Organisation University of Cambridge
Department Department of Public Health and Primary Care
Country United Kingdom 
Sector Academic/University 
PI Contribution Member of steering committee
Collaborator Contribution N/A
Impact co-authors or listed on the steering committee of all papers from this collaboration (http://www.phpc.cam.ac.uk/ceu/research/erfc/publications/)
 
Description Ethnic differences in the association between smoking and lung cancer: a comparison between Korea and the UK 
Organisation Yonsei University
Country Korea, Republic of 
Sector Academic/University 
PI Contribution Statistical and epidemiological expertise
Collaborator Contribution Epidemiological expertise and data
Impact Peer-reviewed publciations
Start Year 2017
 
Description Indian Chennai cohort in 500,000 adults 
Organisation National Institute of Epidemiology (India)
Country India 
Sector Public 
PI Contribution Joint academic collaboration.
Collaborator Contribution Joint academic collaboration.
Impact The cohort has contributed to our programme of research assessing the evolving hazards from smoking, drinking, adiposity and blood pressure.
Start Year 2006
 
Description Indian Trivandrum cohort in 400,000 adults 
Organisation Population Health and Research Institute, Trivandrum
Country India 
Sector Academic/University 
PI Contribution Joint academic collaboration.
Collaborator Contribution Joint academic collaboration.
Impact The cohort has contributed to our programme of research assessing the evolving hazards from smoking, drinking, adiposity and blood pressure.
Start Year 2006
 
Description International Genomics of Alzheimer's Disease 
Organisation International Genomics of Alzheimer’s Project (IGAP)
Country Global 
Sector Charity/Non Profit 
PI Contribution joint academic collaboration
Collaborator Contribution joint academic collaboration
Impact multiple high profile publications and presentations at international meetings, and more in progress
Start Year 2010
 
Description Korean Cancer Prevention Study - II 
Organisation Yonsei University
Country Korea, Republic of 
Sector Academic/University 
PI Contribution working together on papers
Collaborator Contribution N/A
Impact This cohort will contribute to our programme of research assessing the evolving hazards from smoking, drinking, adiposity and blood pressure
Start Year 2015
 
Description Life Line Screening 
Organisation Life Line Screening
Country United States 
Sector Private 
PI Contribution Richard Bulbulia and I are members of the Life Line Screening Scientific Advisory Network (see below)
Collaborator Contribution They have provided data on 4.5 million from their database. "Data have been collected on 4.5 million middle-aged and elderly people, living in the USA or UK, who attended for a cardiovascular disease prevention screening assessment carried out by LifeLine Screening. This assessment, by a commercial screening company, includes recording personal and family medical history, medication use, smoking and alcohol consumption, measurement of height, weight, blood pressure, ankle-brachial artery index, ECG and carotid artery ultrasound. The ECG has been coded for heart rate, presence of AF, ventricular ectopics, left ventricular hypertrophy or ischaemic changes. The carotid artery ultrasound includes examination of right and left external and internal carotid arteries to determine the presence of carotid artery stenosis (mild, moderate and significant stenosis). Data have already been obtained on 350,000 people living in the UK and 200,000 in the US, and access to the remaining 4 million from the US has been promised."
Impact Several abstracts presented at conferences - AHA, Society for Vascular Medicine (SVM), BHF-CRE
Start Year 2012
 
Description METASTROKE Collaboration of the International Stroke Genetics Consortium 
Organisation Massachusetts General Hospital
Department International Stroke Genetics Consortium
Country United States 
Sector Charity/Non Profit 
PI Contribution joint academic collaboration
Collaborator Contribution joint academic collaboration
Impact multiple publications and presentations at international meetings of novel findings in relation to identifying genetic determinants of stroke, further publications in progress
Start Year 2010
 
Description Mexico City cohort in 150,000 adults 
Organisation National Autonomous University of Mexico
Country Mexico 
Sector Academic/University 
PI Contribution Joint academic collaboration.
Collaborator Contribution Joint academic collaboration.
Impact The cohort has contributed to our programme of research assessing the evolving hazards from smoking, drinking, adiposity and blood pressure.
Start Year 2006
 
Description Middle-East Cohort Studies Collaboration 
Organisation New York University Abu Dhabi
Country United Arab Emirates 
Sector Academic/University 
PI Contribution Statistical and epidemiological expertise
Collaborator Contribution Sharing of results from individual studies for preparation of manuscripts for publication
Impact n/a
Start Year 2017
 
Description NIHR Oxford BRC 
Organisation Oxford University Hospitals NHS Foundation Trust
Department NIHR Oxford Biomedical Research Centre
Country United Kingdom 
Sector Public 
PI Contribution Personal award
Collaborator Contribution funding
Impact Support for Dr Ben Lacey to work on large-scale observation studies
Start Year 2017
 
Description PROCARDIS 
Organisation PROCARDIS Precocious Coronary Artery Disease
Country United Kingdom 
Sector Public 
PI Contribution joint academic collaboration
Collaborator Contribution joint academic collaboration
Impact Procardis is a European Commision Framework 6 funded project which exploits advances in complex trait genetics and functional genomics to discover novel susceptibility genes for coronary heart disease. Multiple high profile publications and presentations at international meetings and more in progress
Start Year 2007
 
Description Russian retrospective case-control study and cohort in 200,000 adults 
Organisation Russian Academy of Medical Sciences
Department Cancer Research Centre
Country Russian Federation 
Sector Academic/University 
PI Contribution Joint academic collaboration.
Collaborator Contribution Joint academic collaboration.
Impact Our 2009 Lancet publication resulted in a Presidential decree to initiate strong measures in Russia to limit alcohol abuse.
Start Year 2006
 
Description Cyber Security in the UAE 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Undergraduate students
Results and Impact science communicator on the UAE 'CyberQuest' project. This is a national competition for University/ high school students run by the Secret Intelligence Agency across the UAE. The Edinburgh International Science Festival was hired by the UAE government to design and teach one week of cybersecurity modules in order to prepare the kids for the competition. Prizes include things like full scholarships to study Cyber security at some of the top institutions in the world, and MacBook pro's etc. I was designated a class of 25 students aged 18+ and I taught them the following modules:
- Linux basics
- Port Scanning
- Firewalls
- Phishing Basic
- Phishing advanced
- Information gathering
- Web hacking basics
- Using wire-shark
- Web hacking advanced
- Securing web Apps
Each module would consist of about 2 hours of teaching time (using simulated online environments created by the EISF team) and then a timed, online assessment at the end. The test scores are combined for the whole 'training camp' and used to decide which children are through to the final competition. In April 2017, I was based in Abu Dhabi (8th-12th of April), but this January (6th-10th of January, 2018) I was based in Fujairah - a more conservative region in the North of the country.
Year(s) Of Engagement Activity 2017
 
Description Edinburgh International Science Festival 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Public/other audiences
Results and Impact However, for the past few years EISF has been running the same events in the UAE at the Abu Dhabi Science Festival (more info: https://www.adsftickets.com ). I first went out to the UAE for two weeks in November 2014. I usually run an event called 'ER Surgery' which involves teaching children aged 8-12 years about medicine using a simulated surgical environment - e.g. removing pretend 'gallstones' from a manikin using laparoscopy. In Edinburgh, I worked as a Science Communicator, whereas in Abu Dhabi (2014) I worked as a Team Leader, which involved teaching science communicators to run the workshops themselves. These science communicators were all National UAE citizens studying science and engineering at University, and working as a science communicator at the ADSF was a mandatory part of their University degree.
Year(s) Of Engagement Activity 2016,2017
 
Description Obesity can shorten lifespan substantially: Press release 
Form Of Engagement Activity A press release, press conference or response to a media enquiry/interview
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Public/other audiences
Results and Impact Press release resulted in following media coverage:

Overweight by four stone? That's three years off your life: The Daily Telegraph, p. 12, 18/03/2009 http://www.telegraph.co.uk/health/healthnews/5006104/Being-four-stone-overweight-can-reduce-lifespan-by-three-years.html
Obese die up to 10 years early, study of a million people finds: The Guardian, p.12, 18/03/2009
http://www.guardian.co.uk/society/2009/mar/18/health-nhs-obesity-smoking
Being 4 stone overweight cuts life by 3 years: The Independent, p.12, 18/03/2009
Carrying 4st of flab cuts life by 4yrs: The Daily Mirror, p.23, 18/03/2009
How four stones of extra weight can take three years off your life: Daily Mail, p.7, 18/03/2009
http://www.dailymail.co.uk/health/article-1162737/How-stones-extra-weight-years-life.html
Obesity danger rivals smoking: BBC news online, 18/03/2009
http://news.bbc.co.uk/1/hi/health/7946290.stm
Obesity's 10-yr toll: The Sun, 18/03/2009, p.12, Unattributed
http://www.thesun.co.uk/sol/homepage/news/article2325689.ece
Weighty: Metro, p.17, 18/03/2009
Fat's the way to an early grave: Daily Sport, p.12, 18/03/2009
Obesity can shorten lifespan up to a decade: CNN online, 18/03/2009
http://edition.cnn.com/2009/HEALTH/03/18/healthmag.obesity.lifespan/?iref=mpstoryview
Two-thirds of adults eating to an early grave: The Australian, 19/03/2009


To highlight the health risks of obesity.
Year(s) Of Engagement Activity 2009
 
Description Oxford Science Fair 
Form Of Engagement Activity Participation in an open day or visit at my research institution
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Public/other audiences
Results and Impact Participated in the Oxford Science Fair, 25 June 2016
Year(s) Of Engagement Activity 2016
 
Description Primary school visit (Oxford) 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Schools
Results and Impact Talk about statistics
Year(s) Of Engagement Activity 2015
 
Description Risks of low levels of naturally occurring radon: Press release 
Form Of Engagement Activity A press release, press conference or response to a media enquiry/interview
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Public/other audiences
Results and Impact Press release resulted in following media coverage:

Risks of natural killer radon are ignored, warns study: The Independent, p.8, 07/01/2009
http://www.independent.co.uk/life-style/health-and-wellbeing/health-news/risks-of-natural-killer-radon-are-ignored-warns-study-1230041.html
Radon gas action needed across the UK: BBC Online, 07/01/2009
http://news.bbc.co.uk/1/hi/health/7813107.stm
Radon leaks that kill 1100 a year are easy to halt: Daily Express, p.25, Jo Willey (UK), 07/01/2009


To highlight to the [public the risks of low level exposure to naturally occurring radon
Year(s) Of Engagement Activity 2009
 
Description School visit 
Form Of Engagement Activity Participation in an open day or visit at my research institution
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Schools
Results and Impact Presented a talk 'Maths in Action'
Year(s) Of Engagement Activity 2016
 
Description School visit (Oxford) 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Schools
Results and Impact Careers evening
Year(s) Of Engagement Activity 2015
 
Description Smoking and obesity shorten life expectancy: Press release 
Form Of Engagement Activity A press release, press conference or response to a media enquiry/interview
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Public/other audiences
Results and Impact Press release resulted in following media coverage:

Poor lifestyle 'could shorten your life by 15 years': The Times, p.29, 18/09/2009
Risks that take 10 years off life: The Guardian, p.11, 18/09/2009
http://www.guardian.co.uk/society/2009/sep/17/heart-risk-factors-shorten-lifespan
Unhealthy men 'may lose 10 years': BBC News Online, 18/09/2009
http://news.bbc.co.uk/1/hi/health/8260561.stm
Middle-aged smokers risk life span: Daily Mirror, 18/09/2009
http://www.mirror.co.uk/news/latest/2009/09/18/middle-aged-smokers-risk-life-span-115875-21682048/
Middle-aged smokers risk life span: Daily Express, 18/09/2009
Middle-aged smokers cut 10 years off their lives: Metro, 18/09/2009
http://www.metro.co.uk/news/article.html?Middle-aged_smokers_cut_10_years_off_their_lives?_article_id=740273?_page_id=34
Smoking may cut life short by ten years: The Scotsman, 18/09/2009
http://news.scotsman.com/uk/Smoking-may-cut-life-short.5658843.jp
Smoking risks are revealed: Oxford Mail, p.17, 21/09/2009
Radio: BBC Radio Scotland Newsdrive: 18/09/2009, 5:17pm


To highlight the combined risks of smoking and obesity.
Year(s) Of Engagement Activity 2009