1
|
Eastwood SV, Hemani G, Watkins SH, Scally A, Davey Smith G, Chaturvedi N. Ancestry, ethnicity, and race: explaining inequalities in cardiometabolic disease. Trends Mol Med 2024:S1471-4914(24)00090-X. [PMID: 38677980 DOI: 10.1016/j.molmed.2024.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 03/30/2024] [Accepted: 04/03/2024] [Indexed: 04/29/2024]
Abstract
Population differences in cardiometabolic disease remain unexplained. Misleading assumptions over genetic explanations are partly due to terminology used to distinguish populations, specifically ancestry, race, and ethnicity. These terms differentially implicate environmental and biological causal pathways, which should inform their use. Genetic variation alone accounts for a limited fraction of population differences in cardiometabolic disease. Research effort should focus on societally driven, lifelong environmental determinants of population differences in disease. Rather than pursuing population stratifiers to personalize medicine, we advocate removing socioeconomic barriers to receipt of and adherence to healthcare interventions, which will have markedly greater impact on improving cardiometabolic outcomes. This requires multidisciplinary collaboration and public and policymaker engagement to address inequalities driven by society rather than biology per se.
Collapse
Affiliation(s)
- S V Eastwood
- MRC Unit for Lifelong Health and Ageing at UCL Population Sciences and Experimental Medicine, Institute of Cardiovascular Sciences Faculty of Population Health Sciences, University College London, London, UK
| | - G Hemani
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; MRC Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - S H Watkins
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; MRC Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - A Scally
- Department of Genetics, University of Cambridge, Downing Street, Cambridge, UK
| | - G Davey Smith
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; MRC Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - N Chaturvedi
- MRC Unit for Lifelong Health and Ageing at UCL Population Sciences and Experimental Medicine, Institute of Cardiovascular Sciences Faculty of Population Health Sciences, University College London, London, UK.
| |
Collapse
|
2
|
Topriceanu CC, Shah M, Webber M, Chan F, Shiwani H, Richards M, Schott J, Chaturvedi N, Moon JC, Hughes AD, Hingorani AD, O'Regan DP, Captur G. APOE ε4 carriage associates with improved myocardial performance from adolescence to older age. BMC Cardiovasc Disord 2024; 24:172. [PMID: 38509472 PMCID: PMC10956279 DOI: 10.1186/s12872-024-03808-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 02/21/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND Although APOE ε4 allele carriage confers a risk for coronary artery disease, its persistence in humans might be explained by certain survival advantages (antagonistic pleiotropy). METHODS Combining data from ~ 37,000 persons from three older age British cohorts (1946 National Survey of Health and Development [NSHD], Southall and Brent Revised [SABRE], and UK Biobank) and one younger age cohort (Avon Longitudinal Study of Parents and Children [ALSPAC]), we explored whether APOE ε4 carriage associates with beneficial or unfavorable left ventricular (LV) structural and functional metrics by echocardiography and cardiovascular magnetic resonance (CMR). RESULTS Compared to the non-APOE ε4 group, APOE ε4 carriers had similar cardiac phenotypes in terms of LV ejection fraction, E/e', posterior wall and interventricular septal thickness, and LV mass. However, they had improved myocardial performance resulting in greater LV stroke volume generation per 1 mL of myocardium (higher myocardial contraction fraction). In NSHD (n = 1467) and SABRE (n = 1187), ε4 carriers had a 4% higher MCF (95% CI 1-7%, p = 0.016) using echocardiography. Using CMR data, in UK Biobank (n = 32,972), ε4 carriers had a 1% higher MCF 95% (CI 0-1%, p = 0.020) with a dose-response relationship based on the number of ε4 alleles. In addition, UK Biobank ε4 carriers also had more favorable radial and longitudinal strain rates compared to non APOE ε4 carriers. In ALSPAC (n = 1397), APOE ε4 carriers aged < 24 years had a 2% higher MCF (95% CI 0-5%, p = 0.059). CONCLUSIONS By triangulating results in four independent cohorts, across imaging modalities (echocardiography and CMR), and in ~ 37,000 individuals, our results point towards an association between ε4 carriage and improved cardiac performance in terms of LV MCF. This potentially favorable cardiac phenotype adds to the growing number of reported survival advantages attributed to the pleiotropic effects APOE ε4 carriage that might collectively explain its persistence in human populations.
Collapse
Affiliation(s)
- Constantin-Cristian Topriceanu
- UCL MRC Unit for Lifelong Health and Ageing, University College London, London, UK
- UCL Institute of Cardiovascular Science, University College London, London, UK
- Cardiac MRI Unit, Barts Heart Centre, London, UK
- Cardiology Department, Centre for Inherited Heart Muscle Conditions, The Royal Free Hospital, Pond Street, Hampstead, London, UK
| | - Mit Shah
- Imperial Centre for Translational and Experimental Medicine, National Heart and Lung Institute, Imperial College London, London, UK
- MRC London Institute of Medical Science, Imperial College London, London, UK
| | - Matthew Webber
- UCL MRC Unit for Lifelong Health and Ageing, University College London, London, UK
- UCL Institute of Cardiovascular Science, University College London, London, UK
| | - Fiona Chan
- UCL MRC Unit for Lifelong Health and Ageing, University College London, London, UK
- UCL Institute of Cardiovascular Science, University College London, London, UK
| | - Hunain Shiwani
- UCL Institute of Cardiovascular Science, University College London, London, UK
- Cardiac MRI Unit, Barts Heart Centre, London, UK
| | - Marcus Richards
- UCL MRC Unit for Lifelong Health and Ageing, University College London, London, UK
| | - Jonathan Schott
- UCL MRC Unit for Lifelong Health and Ageing, University College London, London, UK
- Dementia Research Centre, UCL Queen Square Institute of Neurology, London, UK
| | - Nishi Chaturvedi
- UCL MRC Unit for Lifelong Health and Ageing, University College London, London, UK
- UCL Institute of Cardiovascular Science, University College London, London, UK
| | - James C Moon
- UCL Institute of Cardiovascular Science, University College London, London, UK
- Cardiac MRI Unit, Barts Heart Centre, London, UK
| | - Alun D Hughes
- UCL MRC Unit for Lifelong Health and Ageing, University College London, London, UK
- UCL Institute of Cardiovascular Science, University College London, London, UK
| | - Aroon D Hingorani
- UCL Institute of Cardiovascular Science, University College London, London, UK
- BHF Research Accelerator, University College London, London, UK
- Health Data Research, University College London, London, UK
| | - Declan P O'Regan
- Imperial Centre for Translational and Experimental Medicine, National Heart and Lung Institute, Imperial College London, London, UK
- MRC London Institute of Medical Science, Imperial College London, London, UK
| | - Gabriella Captur
- UCL MRC Unit for Lifelong Health and Ageing, University College London, London, UK.
- UCL Institute of Cardiovascular Science, University College London, London, UK.
- Cardiac MRI Unit, Barts Heart Centre, London, UK.
- Imperial Centre for Translational and Experimental Medicine, National Heart and Lung Institute, Imperial College London, London, UK.
- Cardiology Department, Centre for Inherited Heart Muscle Conditions, The Royal Free Hospital, Pond Street, Hampstead, London, UK.
| |
Collapse
|
3
|
Rhead R, Wels J, Moltrecht B, Shaw RJ, Silverwood R, Zhu J, Hughes A, Chaturvedi N, Demou E, Katikireddi SV, Ploubidis G. Long COVID and financial outcomes: evidence from four longitudinal population surveys. J Epidemiol Community Health 2024:jech-2023-221059. [PMID: 38508701 DOI: 10.1136/jech-2023-221059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 01/22/2024] [Indexed: 03/22/2024]
Abstract
BACKGROUND Long-term sequelae of COVID-19 (long COVID) include muscle weakness, fatigue, breathing difficulties and sleep disturbance over weeks or months. Using UK longitudinal data, we assessed the relationship between long COVID and financial disruption. METHODS We estimated associations between long COVID (derived using self-reported length of COVID-19 symptoms) and measures of financial disruption (subjective financial well-being, new benefit claims, changes in household income) by analysing data from four longitudinal population studies, gathered during the first year of the pandemic. We employed modified Poisson regression in a pooled analysis of the four cohorts adjusting for a range of potential confounders, including pre-pandemic (pre-long COVID) factors. RESULTS Among the 20 112 observations across four population surveys, 13% reported having COVID-19 with symptoms that impeded their ability to function normally-10.7% had such symptoms for <4 weeks (acute COVID-19), 1.2% had such symptoms for 4-12 weeks (ongoing symptomatic COVID-19) and 0.6% had such symptoms for >12 weeks (post-COVID-19 syndrome). We found that post-COVID-19 syndrome was associated with worse subjective financial well-being (adjusted relative risk ratios (aRRRs)=1.57, 95% CI=1.25, 1.96) and new benefit claims (aRRR=1.79, CI=1.27, 2.53). Associations were broadly similar across sexes and education levels. These results were not meaningfully altered when scaled to represent the population by age. CONCLUSIONS Long COVID was associated with financial disruption in the UK. If our findings reflect causal effects, extending employment protection and financial support to people with long COVID may be warranted.
Collapse
Affiliation(s)
- Rebecca Rhead
- Department of Psychological Medicine, King's College London, London, UK
- University College London, London, UK
- ESRC Centre for Society and Mental Health, King's College London, London, UK
| | - Jacques Wels
- University College London, London, UK
- BE, Washington, District of Columbia, USA
| | | | - Richard John Shaw
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | | | - Jingmin Zhu
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Alun Hughes
- MRC Unit for Lifelong Health and Ageing at UCL, UCL, London, UK
| | | | - Evangelia Demou
- MRC/CSO Social and Public Health Sciences Unit, School of Health & Wellbeing, University of Glasgow, Glasgow, UK
| | - Srinivasa Vittal Katikireddi
- MRC/CSO Social and Public Health Sciences Unit, School of Health & Wellbeing, University of Glasgow, Glasgow, UK
| | - George Ploubidis
- Centre of Longitudinal Studies, University College London, London, UK
| |
Collapse
|
4
|
Leonenko G, Bauermeister S, Ghanti D, Stevenson-Hoare J, Simmonds E, Brookes K, Morgan K, Chaturvedi N, Elliott P, Thomas A, Wareham N, Gallacher J, Escott-Price V. Dementias Platform UK: Bringing genetics into life. Alzheimers Dement 2024. [PMID: 38506636 DOI: 10.1002/alz.13782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 12/21/2023] [Accepted: 01/29/2024] [Indexed: 03/21/2024]
Abstract
INTRODUCTION The Dementias Platform UK (DPUK) Data Portal is a data repository bringing together a wide range of cohorts. Neurodegenerative dementias are a group of diseases with highly heterogeneous pathology and an overlapping genetic component that is poorly understood. The DPUK collection of independent cohorts can facilitate research in neurodegeneration by combining their genetic and phenotypic data. METHODS For genetic data processing, pipelines were generated to perform quality control analysis, genetic imputation, and polygenic risk score (PRS) derivation with six genome-wide association studies of neurodegenerative diseases. Pipelines were applied to five cohorts. DISCUSSION The data processing pipelines, research-ready imputed genetic data, and PRS scores are now available on the DPUK platform and can be accessed upon request though the DPUK application process. Harmonizing genome-wide data for multiple datasets increases scientific opportunity and allows the wider research community to access and process data at scale and pace.
Collapse
Affiliation(s)
- Ganna Leonenko
- Dementia Research Institute, Cardiff University, Cardiff, UK
| | - Sarah Bauermeister
- Dementias Platform UK, Department of Psychiatry, University of Oxford, Oxford, UK
| | - Dipanwita Ghanti
- Dementias Platform UK, Department of Psychiatry, University of Oxford, Oxford, UK
| | - Joshua Stevenson-Hoare
- Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK
| | - Emily Simmonds
- Dementia Research Institute, Cardiff University, Cardiff, UK
| | - Keeley Brookes
- Biosciences, School of Science and Technology, Nottingham Trent University, Nottingham, UK
| | | | | | - Paul Elliott
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
- UK Dementia Research Institute, Imperial College London, London, UK
| | - Alan Thomas
- Translational and Clinical Research Institute, Newcastle University, Newcastle, UK
| | | | - John Gallacher
- Dementias Platform UK, Department of Psychiatry, University of Oxford, Oxford, UK
| | - Valentina Escott-Price
- Dementia Research Institute, Cardiff University, Cardiff, UK
- Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK
| |
Collapse
|
5
|
Cezard GI, Denholm RE, Knight R, Wei Y, Teece L, Toms R, Forbes HJ, Walker AJ, Fisher L, Massey J, Hopcroft LEM, Horne EMF, Taylor K, Palmer T, Arab MA, Cuitun Coronado JI, Ip SHY, Davy S, Dillingham I, Bacon S, Mehrkar A, Morton CE, Greaves F, Hyams C, Davey Smith G, Macleod J, Chaturvedi N, Goldacre B, Whiteley WN, Wood AM, Sterne JAC, Walker V. Impact of vaccination on the association of COVID-19 with cardiovascular diseases: An OpenSAFELY cohort study. Nat Commun 2024; 15:2173. [PMID: 38467603 PMCID: PMC10928172 DOI: 10.1038/s41467-024-46497-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 02/29/2024] [Indexed: 03/13/2024] Open
Abstract
Infection with SARS-CoV-2 is associated with an increased risk of arterial and venous thrombotic events, but the implications of vaccination for this increased risk are uncertain. With the approval of NHS England, we quantified associations between COVID-19 diagnosis and cardiovascular diseases in different vaccination and variant eras using linked electronic health records for ~40% of the English population. We defined a 'pre-vaccination' cohort (18,210,937 people) in the wild-type/Alpha variant eras (January 2020-June 2021), and 'vaccinated' and 'unvaccinated' cohorts (13,572,399 and 3,161,485 people respectively) in the Delta variant era (June-December 2021). We showed that the incidence of each arterial thrombotic, venous thrombotic and other cardiovascular outcomes was substantially elevated during weeks 1-4 after COVID-19, compared with before or without COVID-19, but less markedly elevated in time periods beyond week 4. Hazard ratios were higher after hospitalised than non-hospitalised COVID-19 and higher in the pre-vaccination and unvaccinated cohorts than the vaccinated cohort. COVID-19 vaccination reduces the risk of cardiovascular events after COVID-19 infection. People who had COVID-19 before or without being vaccinated are at higher risk of cardiovascular events for at least two years.
Collapse
Affiliation(s)
- Genevieve I Cezard
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Victor Phillip Dahdaleh Heart and Lung Research Institute, University of Cambridge, Cambridge, UK
| | - Rachel E Denholm
- Population Health Sciences, University of Bristol, Bristol, UK
- NIHR Bristol Biomedical Research Centre, Bristol, UK
- Health Data Research UK South-West, Bristol, UK
| | - Rochelle Knight
- Population Health Sciences, University of Bristol, Bristol, UK
- NIHR Bristol Biomedical Research Centre, Bristol, UK
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- The National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West) at University Hospitals Bristol and Weston, Bristol, UK
| | - Yinghui Wei
- Centre for Mathematical Sciences, School of Engineering, Computing and Mathematics, University of Plymouth, Plymouth, UK
| | - Lucy Teece
- Department of Population Health Sciences, University of Leicester, Leicester, UK
| | - Renin Toms
- Population Health Sciences, University of Bristol, Bristol, UK
- Population Wellbeing, School of Health Sciences, Cardiff Metropolitan University, Cardiff, UK
| | - Harriet J Forbes
- Faculty of Epidemiology and Population Health, London School of Hygiene & tropical Medicine, London, UK
| | - Alex J Walker
- The Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Louis Fisher
- The Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Jon Massey
- The Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | - Elsie M F Horne
- Population Health Sciences, University of Bristol, Bristol, UK
- NIHR Bristol Biomedical Research Centre, Bristol, UK
| | - Kurt Taylor
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Tom Palmer
- Population Health Sciences, University of Bristol, Bristol, UK
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - Marwa Al Arab
- Population Health Sciences, University of Bristol, Bristol, UK
| | | | - Samantha H Y Ip
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Victor Phillip Dahdaleh Heart and Lung Research Institute, University of Cambridge, Cambridge, UK
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Simon Davy
- The Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Iain Dillingham
- The Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Sebastian Bacon
- The Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Amir Mehrkar
- The Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Caroline E Morton
- Digital Environment Research Institute, Queen Mary University of London, London, UK
| | - Felix Greaves
- National Institute for Health and Care Excellence, London, UK
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Catherine Hyams
- Population Health Sciences, University of Bristol, Bristol, UK
| | - George Davey Smith
- Population Health Sciences, University of Bristol, Bristol, UK
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - John Macleod
- Population Health Sciences, University of Bristol, Bristol, UK
- Health Data Research UK South-West, Bristol, UK
- The National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West) at University Hospitals Bristol and Weston, Bristol, UK
| | - Nishi Chaturvedi
- MRC Unit for Lifelong Health and Ageing, University College London, London, UK
| | - Ben Goldacre
- The Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - William N Whiteley
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Angela M Wood
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Victor Phillip Dahdaleh Heart and Lung Research Institute, University of Cambridge, Cambridge, UK
- British Heart Foundation Centre of Research Excellence, University of Cambridge, Cambridge, UK
- National Institute for Health and Care Research Blood and Transplant Research Unit in Donor Health and Behaviour, University of Cambridge, Cambridge, UK
- Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, Cambridge, UK
- Cambridge Centre of Artificial Intelligence in Medicine, Cambridge, UK
| | - Jonathan A C Sterne
- Population Health Sciences, University of Bristol, Bristol, UK.
- NIHR Bristol Biomedical Research Centre, Bristol, UK.
- Health Data Research UK South-West, Bristol, UK.
| | - Venexia Walker
- Population Health Sciences, University of Bristol, Bristol, UK
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| |
Collapse
|
6
|
Jamieson A, Al Saikhan L, Alghamdi L, Hamill Howes L, Purcell H, Hillman T, Heightman M, Treibel T, Orini M, Bell R, Scully M, Hamer M, Chaturvedi N, Montgomery H, Hughes AD, Astin R, Jones S. Mechanisms underlying exercise intolerance in long COVID: An accumulation of multisystem dysfunction. Physiol Rep 2024; 12:e15940. [PMID: 38346773 PMCID: PMC10861355 DOI: 10.14814/phy2.15940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 01/10/2024] [Indexed: 02/15/2024] Open
Abstract
The pathogenesis of exercise intolerance and persistent fatigue which can follow an infection with the SARS-CoV-2 virus ("long COVID") is not fully understood. Cases were recruited from a long COVID clinic (N = 32; 44 ± 12 years; 10 (31%) men), and age-/sex-matched healthy controls (HC) (N = 19; 40 ± 13 years; 6 (32%) men) from University College London staff and students. We assessed exercise performance, lung and cardiac function, vascular health, skeletal muscle oxidative capacity, and autonomic nervous system (ANS) function. Key outcome measures for each physiological system were compared between groups using potential outcome means (95% confidence intervals) adjusted for potential confounders. Long COVID participant outcomes were compared to normative values. When compared to HC, cases exhibited reduced oxygen uptake efficiency slope (1847 (1679, 2016) vs. 2176 (1978, 2373) mL/min, p = 0.002) and anaerobic threshold (13.2 (12.2, 14.3) vs. 15.6 (14.4, 17.2) mL/kg/min, p < 0.001), and lower oxidative capacity, measured using near infrared spectroscopy (τ: 38.7 (31.9, 45.6) vs. 24.6 (19.1, 30.1) s, p = 0.001). In cases, ANS measures fell below normal limits in 39%. Long COVID is associated with reduced measures of exercise performance and skeletal muscle oxidative capacity in the absence of evidence of microvascular dysfunction, suggesting mitochondrial pathology. There was evidence of attendant ANS dysregulation in a significant proportion. These multisystem factors might contribute to impaired exercise tolerance in long COVID sufferers.
Collapse
Affiliation(s)
- Alexandra Jamieson
- MRC Unit for Lifelong Health & Ageing at UCLUniversity College LondonLondonUK
| | - Lamia Al Saikhan
- Department of Cardiac Technology, College of Applied Medial SciencesImam Abdulrahman Bin Faisal UniversityDammamSaudi Arabia
| | - Lamis Alghamdi
- MRC Unit for Lifelong Health & Ageing at UCLUniversity College LondonLondonUK
- Department of Cardiac Technology, College of Applied Medial SciencesImam Abdulrahman Bin Faisal UniversityDammamSaudi Arabia
| | - Lee Hamill Howes
- MRC Unit for Lifelong Health & Ageing at UCLUniversity College LondonLondonUK
| | - Helen Purcell
- Department of Respiratory MedicineUniversity College London Hospitals NHS Foundation TrustLondonUK
| | - Toby Hillman
- Department of Respiratory MedicineUniversity College London Hospitals NHS Foundation TrustLondonUK
- Respiratory MedicineUniversity College LondonLondonUK
| | - Melissa Heightman
- Department of Respiratory MedicineUniversity College London Hospitals NHS Foundation TrustLondonUK
| | - Thomas Treibel
- MRC Unit for Lifelong Health & Ageing at UCLUniversity College LondonLondonUK
- Barts Heart Centre, St Bartholomew's HospitalLondonUK
| | - Michele Orini
- MRC Unit for Lifelong Health & Ageing at UCLUniversity College LondonLondonUK
| | - Robert Bell
- Hatter Cardiovascular InstituteUniversity College LondonLondonUK
| | - Marie Scully
- Department of HaematologyUniversity College London Hospitals NHS Foundation TrustLondonUK
| | - Mark Hamer
- Division of Surgery and Interventional ScienceUniversity College LondonLondonUK
| | - Nishi Chaturvedi
- MRC Unit for Lifelong Health & Ageing at UCLUniversity College LondonLondonUK
| | - Hugh Montgomery
- Centre for Human Health and PerformanceUniversity College LondonLondonUK
- National Institute for Health Research (NIHR) Biomedical Research Centre (BRC)LondonUK
| | - Alun D. Hughes
- MRC Unit for Lifelong Health & Ageing at UCLUniversity College LondonLondonUK
| | - Ronan Astin
- Department of Respiratory MedicineUniversity College London Hospitals NHS Foundation TrustLondonUK
- Centre for Human Health and PerformanceUniversity College LondonLondonUK
| | - Siana Jones
- MRC Unit for Lifelong Health & Ageing at UCLUniversity College LondonLondonUK
| |
Collapse
|
7
|
Murray-Smith H, Barker S, Barkhof F, Barnes J, Brown TM, Captur G, R E Cartlidge M, Cash DM, Coath W, Davis D, Dickson JC, Groves J, Hughes AD, James SN, Keshavan A, Keuss SE, King-Robson J, Lu K, Malone IB, Nicholas JM, Rapala A, Scott CJ, Street R, Sudre CH, Thomas DL, Wong A, Wray S, Zetterberg H, Chaturvedi N, Fox NC, Crutch SJ, Richards M, Schott JM. Updating the study protocol: Insight 46 - a longitudinal neuroscience sub-study of the MRC National Survey of Health and Development - phases 2 and 3. BMC Neurol 2024; 24:40. [PMID: 38263061 PMCID: PMC10804658 DOI: 10.1186/s12883-023-03465-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 11/13/2023] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND Although age is the biggest known risk factor for dementia, there remains uncertainty about other factors over the life course that contribute to a person's risk for cognitive decline later in life. Furthermore, the pathological processes leading to dementia are not fully understood. The main goals of Insight 46-a multi-phase longitudinal observational study-are to collect detailed cognitive, neurological, physical, cardiovascular, and sensory data; to combine those data with genetic and life-course information collected from the MRC National Survey of Health and Development (NSHD; 1946 British birth cohort); and thereby contribute to a better understanding of healthy ageing and dementia. METHODS/DESIGN Phase 1 of Insight 46 (2015-2018) involved the recruitment of 502 members of the NSHD (median age = 70.7 years; 49% female) and has been described in detail by Lane and Parker et al. 2017. The present paper describes phase 2 (2018-2021) and phase 3 (2021-ongoing). Of the 502 phase 1 study members who were invited to a phase 2 research visit, 413 were willing to return for a clinic visit in London and 29 participated in a remote research assessment due to COVID-19 restrictions. Phase 3 aims to recruit 250 study members who previously participated in both phases 1 and 2 of Insight 46 (providing a third data time point) and 500 additional members of the NSHD who have not previously participated in Insight 46. DISCUSSION The NSHD is the oldest and longest continuously running British birth cohort. Members of the NSHD are now at a critical point in their lives for us to investigate successful ageing and key age-related brain morbidities. Data collected from Insight 46 have the potential to greatly contribute to and impact the field of healthy ageing and dementia by combining unique life course data with longitudinal multiparametric clinical, imaging, and biomarker measurements. Further protocol enhancements are planned, including in-home sleep measurements and the engagement of participants through remote online cognitive testing. Data collected are and will continue to be made available to the scientific community.
Collapse
Affiliation(s)
- Heidi Murray-Smith
- Dementia Research Centre, Queen Square Institute of Neurology, University College London, 1St Floor, 8-11 Queen Square, London, UK.
| | - Suzie Barker
- Dementia Research Centre, Queen Square Institute of Neurology, University College London, 1St Floor, 8-11 Queen Square, London, UK
| | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center, Amsterdam, The Netherlands
- Centre for Medical Image Computing, University College London, London, UK
- Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK
| | - Josephine Barnes
- Dementia Research Centre, Queen Square Institute of Neurology, University College London, 1St Floor, 8-11 Queen Square, London, UK
| | - Thomas M Brown
- Dementia Research Centre, Queen Square Institute of Neurology, University College London, 1St Floor, 8-11 Queen Square, London, UK
| | - Gabriella Captur
- MRC Unit for Lifelong Health and Ageing at UCL, Department of Population Science & Experimental Medicine, UCL Institute of Cardiovascular Science, University College London, London, UK
| | - Molly R E Cartlidge
- Dementia Research Centre, Queen Square Institute of Neurology, University College London, 1St Floor, 8-11 Queen Square, London, UK
| | - David M Cash
- Dementia Research Centre, Queen Square Institute of Neurology, University College London, 1St Floor, 8-11 Queen Square, London, UK
- Centre for Medical Image Computing, University College London, London, UK
| | - William Coath
- Dementia Research Centre, Queen Square Institute of Neurology, University College London, 1St Floor, 8-11 Queen Square, London, UK
| | - Daniel Davis
- MRC Unit for Lifelong Health and Ageing at UCL, Department of Population Science & Experimental Medicine, UCL Institute of Cardiovascular Science, University College London, London, UK
| | - John C Dickson
- Institute of Nuclear Medicine, University College London Hospitals, London, UK
| | - James Groves
- Dementia Research Centre, Queen Square Institute of Neurology, University College London, 1St Floor, 8-11 Queen Square, London, UK
| | - Alun D Hughes
- MRC Unit for Lifelong Health and Ageing at UCL, Department of Population Science & Experimental Medicine, UCL Institute of Cardiovascular Science, University College London, London, UK
| | - Sarah-Naomi James
- MRC Unit for Lifelong Health and Ageing at UCL, Department of Population Science & Experimental Medicine, UCL Institute of Cardiovascular Science, University College London, London, UK
| | - Ashvini Keshavan
- Dementia Research Centre, Queen Square Institute of Neurology, University College London, 1St Floor, 8-11 Queen Square, London, UK
| | - Sarah E Keuss
- Dementia Research Centre, Queen Square Institute of Neurology, University College London, 1St Floor, 8-11 Queen Square, London, UK
| | - Josh King-Robson
- Dementia Research Centre, Queen Square Institute of Neurology, University College London, 1St Floor, 8-11 Queen Square, London, UK
| | - Kirsty Lu
- Dementia Research Centre, Queen Square Institute of Neurology, University College London, 1St Floor, 8-11 Queen Square, London, UK
| | - Ian B Malone
- Dementia Research Centre, Queen Square Institute of Neurology, University College London, 1St Floor, 8-11 Queen Square, London, UK
| | - Jennifer M Nicholas
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Alicja Rapala
- MRC Unit for Lifelong Health and Ageing at UCL, Department of Population Science & Experimental Medicine, UCL Institute of Cardiovascular Science, University College London, London, UK
| | - Catherine J Scott
- Dementia Research Centre, Queen Square Institute of Neurology, University College London, 1St Floor, 8-11 Queen Square, London, UK
- Institute of Nuclear Medicine, University College London Hospitals, London, UK
| | - Rebecca Street
- Dementia Research Centre, Queen Square Institute of Neurology, University College London, 1St Floor, 8-11 Queen Square, London, UK
| | - Carole H Sudre
- Dementia Research Centre, Queen Square Institute of Neurology, University College London, 1St Floor, 8-11 Queen Square, London, UK
- Centre for Medical Image Computing, University College London, London, UK
- MRC Unit for Lifelong Health and Ageing at UCL, Department of Population Science & Experimental Medicine, UCL Institute of Cardiovascular Science, University College London, London, UK
| | - David L Thomas
- Neuroradiological Academic Unit, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Andrew Wong
- MRC Unit for Lifelong Health and Ageing at UCL, Department of Population Science & Experimental Medicine, UCL Institute of Cardiovascular Science, University College London, London, UK
| | - Selina Wray
- Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK
| | - Henrik Zetterberg
- Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK
- UK Dementia Research Institute, University College London, London, UK
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
- Hong, Kong Center for Neurodegenerative Diseases, Clear Water Bay, Hong Kong, China
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Nishi Chaturvedi
- MRC Unit for Lifelong Health and Ageing at UCL, Department of Population Science & Experimental Medicine, UCL Institute of Cardiovascular Science, University College London, London, UK
| | - Nick C Fox
- Dementia Research Centre, Queen Square Institute of Neurology, University College London, 1St Floor, 8-11 Queen Square, London, UK
| | - Sebastian J Crutch
- Dementia Research Centre, Queen Square Institute of Neurology, University College London, 1St Floor, 8-11 Queen Square, London, UK
| | - Marcus Richards
- MRC Unit for Lifelong Health and Ageing at UCL, Department of Population Science & Experimental Medicine, UCL Institute of Cardiovascular Science, University College London, London, UK
| | - Jonathan M Schott
- Dementia Research Centre, Queen Square Institute of Neurology, University College London, 1St Floor, 8-11 Queen Square, London, UK
| |
Collapse
|
8
|
Elliott J, Sloan G, Stevens L, Selvarajah D, Cruccu G, Gandhi RA, Kempler P, Fuller JH, Chaturvedi N, Tesfaye S. Female sex is a risk factor for painful diabetic peripheral neuropathy: the EURODIAB prospective diabetes complications study. Diabetologia 2024; 67:190-198. [PMID: 37870649 PMCID: PMC10709240 DOI: 10.1007/s00125-023-06025-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 09/05/2023] [Indexed: 10/24/2023]
Abstract
AIMS/HYPOTHESIS While the risk factors for diabetic peripheral neuropathy (DPN) are now well recognised, the risk factors for painful DPN remain unknown. We performed analysis of the EURODIAB Prospective Complications Study data to elucidate the incidence and risk factors of painful DPN. METHODS The EURODIAB Prospective Complications Study recruited 3250 participants with type 1 diabetes who were followed up for 7.3±0.6 (mean ± SD) years. To evaluate DPN, a standardised protocol was used, including clinical assessment, quantitative sensory testing and autonomic function tests. Painful DPN (defined as painful neuropathic symptoms in the legs in participants with confirmed DPN) was assessed at baseline and follow-up. RESULTS At baseline, 234 (25.2%) out of 927 participants with DPN had painful DPN. At follow-up, incident DPN developed in 276 (23.5%) of 1172 participants. Of these, 41 (14.9%) had incident painful DPN. Most of the participants who developed incident painful DPN were female (73% vs 48% painless DPN p=0.003) and this remained significant after adjustment for duration of diabetes and HbA1c (OR 2.69 [95% CI 1.41, 6.23], p=0.004). The proportion of participants with macro- or microalbuminuria was lower in those with painful DPN compared with painless DPN (15% vs 34%, p=0.02), and this association remained after adjusting for HbA1c, diabetes duration and sex (p=0.03). CONCLUSIONS/INTERPRETATION In this first prospective study to investigate the risk factors for painful DPN, we definitively demonstrate that female sex is a risk factor for painful DPN. Additionally, there is less evidence of diabetic nephropathy in incident painful, compared with painless, DPN. Thus, painful DPN is not driven by cardiometabolic factors traditionally associated with microvascular disease. Sex differences may therefore play an important role in the pathophysiology of neuropathic pain in diabetes. Future studies need to look at psychosocial, genetic and other factors in the development of painful DPN.
Collapse
Affiliation(s)
- Jackie Elliott
- Diabetes Research Unit, Royal Hallamshire Hospital, Sheffield, UK
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Gordon Sloan
- Diabetes Research Unit, Royal Hallamshire Hospital, Sheffield, UK
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Lynda Stevens
- Department of Epidemiology and Public Health, University College, London, UK
| | - Dinesh Selvarajah
- Diabetes Research Unit, Royal Hallamshire Hospital, Sheffield, UK
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Giorgio Cruccu
- Department of Neurological Sciences, La Sapienza University, Rome, Italy
| | - Rajiv A Gandhi
- Diabetes Research Unit, Royal Hallamshire Hospital, Sheffield, UK
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Peter Kempler
- First Department of Medicine, Semmelweis University, Budapest, Hungary
| | - John H Fuller
- Epidemiology and Public Health, Imperial College of Science, Technology & Medicine, London, UK
| | - Nishi Chaturvedi
- MRC Unit for Lifelong Health & Ageing at UCL, Institute of Cardiovascular Sciences, University College London, London, UK
| | - Solomon Tesfaye
- Diabetes Research Unit, Royal Hallamshire Hospital, Sheffield, UK.
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK.
| |
Collapse
|
9
|
Allinson JP, Chaturvedi N, Wong A, Shah I, Wedzicha JA, Hardy R. Lower respiratory tract infections in early childhood - Authors' reply. Lancet 2023; 402:2195-2196. [PMID: 38070946 DOI: 10.1016/s0140-6736(23)01620-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 08/02/2023] [Indexed: 12/18/2023]
Affiliation(s)
- James Peter Allinson
- Department of Respiratory Medicine, Royal Brompton Hospital, London, UK; National Heart and Lung Institute, Imperial College London, London SW3 6LY, UK; MRC Unit for Lifelong Health and Ageing, University College London, London, UK.
| | - Nishi Chaturvedi
- MRC Unit for Lifelong Health and Ageing, University College London, London, UK
| | - Andrew Wong
- MRC Unit for Lifelong Health and Ageing, University College London, London, UK
| | - Imran Shah
- MRC Unit for Lifelong Health and Ageing, University College London, London, UK
| | | | - Rebecca Hardy
- School of Sport, Exercise, and Health Sciences, Loughborough University, Loughborough, UK; Social Research Institute, University College London, London, UK
| |
Collapse
|
10
|
Webber M, Joy G, Bennett J, Chan F, Falconer D, Shiwani H, Davies RH, Krausz G, Tanackovic S, Guger C, Gonzalez P, Martin E, Wong A, Rapala A, Direk K, Kellman P, Pierce I, Rudy Y, Vijayakumar R, Chaturvedi N, Hughes AD, Moon JC, Lambiase PD, Tao X, Koncar V, Orini M, Captur G. Technical development and feasibility of a reusable vest to integrate cardiovascular magnetic resonance with electrocardiographic imaging. J Cardiovasc Magn Reson 2023; 25:73. [PMID: 38044439 PMCID: PMC10694972 DOI: 10.1186/s12968-023-00980-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 11/12/2023] [Indexed: 12/05/2023] Open
Abstract
BACKGROUND Electrocardiographic imaging (ECGI) generates electrophysiological (EP) biomarkers while cardiovascular magnetic resonance (CMR) imaging provides data about myocardial structure, function and tissue substrate. Combining this information in one examination is desirable but requires an affordable, reusable, and high-throughput solution. We therefore developed the CMR-ECGI vest and carried out this technical development study to assess its feasibility and repeatability in vivo. METHODS CMR was prospectively performed at 3T on participants after collecting surface potentials using the locally designed and fabricated 256-lead ECGI vest. Epicardial maps were reconstructed to generate local EP parameters such as activation time (AT), repolarization time (RT) and activation recovery intervals (ARI). 20 intra- and inter-observer and 8 scan re-scan repeatability tests. RESULTS 77 participants were recruited: 27 young healthy volunteers (HV, 38.9 ± 8.5 years, 35% male) and 50 older persons (77.0 ± 0.1 years, 52% male). CMR-ECGI was achieved in all participants using the same reusable, washable vest without complications. Intra- and inter-observer variability was low (correlation coefficients [rs] across unipolar electrograms = 0.99 and 0.98 respectively) and scan re-scan repeatability was high (rs between 0.81 and 0.93). Compared to young HV, older persons had significantly longer RT (296.8 vs 289.3 ms, p = 0.002), ARI (249.8 vs 235.1 ms, p = 0.002) and local gradients of AT, RT and ARI (0.40 vs 0.34 ms/mm, p = 0,01; 0.92 vs 0.77 ms/mm, p = 0.03; and 1.12 vs 0.92 ms/mm, p = 0.01 respectively). CONCLUSION Our high-throughput CMR-ECGI solution is feasible and shows good reproducibility in younger and older participants. This new technology is now scalable for high throughput research to provide novel insights into arrhythmogenesis and potentially pave the way for more personalised risk stratification. CLINICAL TRIAL REGISTRATION Title: Multimorbidity Life-Course Approach to Myocardial Health-A Cardiac Sub-Study of the MRC National Survey of Health and Development (NSHD) (MyoFit46). National Clinical Trials (NCT) number: NCT05455125. URL: https://clinicaltrials.gov/ct2/show/NCT05455125?term=MyoFit&draw=2&rank=1.
Collapse
Affiliation(s)
- Matthew Webber
- Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, ECIA 7BE, UK
- Institute of Cardiovascular Science, University College London, Huntley Street, London, WC1E 6DD, UK
- Centre for Inherited Heart Muscle Conditions, Department of Cardiology, Royal Free London NHS Foundation Trust, Pond Street, London, NW3 2QG, UK
- Medical Research Council Unit for Lifelong Health and Ageing at UCL, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - George Joy
- Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, ECIA 7BE, UK
- Institute of Cardiovascular Science, University College London, Huntley Street, London, WC1E 6DD, UK
| | - Jonathan Bennett
- Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, ECIA 7BE, UK
- Institute of Cardiovascular Science, University College London, Huntley Street, London, WC1E 6DD, UK
| | - Fiona Chan
- Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, ECIA 7BE, UK
- Institute of Cardiovascular Science, University College London, Huntley Street, London, WC1E 6DD, UK
| | - Debbie Falconer
- Centre for Inherited Heart Muscle Conditions, Department of Cardiology, Royal Free London NHS Foundation Trust, Pond Street, London, NW3 2QG, UK
| | - Hunain Shiwani
- Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, ECIA 7BE, UK
- Institute of Cardiovascular Science, University College London, Huntley Street, London, WC1E 6DD, UK
| | - Rhodri H Davies
- Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, ECIA 7BE, UK
- Institute of Cardiovascular Science, University College London, Huntley Street, London, WC1E 6DD, UK
| | - Gunther Krausz
- g.Tec Medical Engineering GmbH, Siernigtrabe 14, 4521, Schiedlberg, Austria
| | | | - Christoph Guger
- g.Tec Medical Engineering GmbH, Siernigtrabe 14, 4521, Schiedlberg, Austria
| | - Pablo Gonzalez
- ELEM Biotech, S.L, Barcelona, Spain
- Department of Computer Applications in Science and Engineering, Barcelona Supercomputing Center (BSC), 08034, Barcelona, Spain
- Department of Information and Communication Technologies, Physense, Universitat Pempeu Fabra, Barcrlona, Spain
| | - Emma Martin
- Medical Research Council Unit for Lifelong Health and Ageing at UCL, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Andrew Wong
- Medical Research Council Unit for Lifelong Health and Ageing at UCL, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Alicja Rapala
- Medical Research Council Unit for Lifelong Health and Ageing at UCL, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Kenan Direk
- Medical Research Council Unit for Lifelong Health and Ageing at UCL, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Peter Kellman
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Iain Pierce
- Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, ECIA 7BE, UK
- Institute of Cardiovascular Science, University College London, Huntley Street, London, WC1E 6DD, UK
- Medical Research Council Unit for Lifelong Health and Ageing at UCL, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Yoram Rudy
- Cardiac Bioelectricity and Arrhythmia Center, Washington University, St. Louis, MO, 63130, USA
- Department of Biomedical Engineering, Washington University, St. Louis, MO, 63130, USA
| | - Ramya Vijayakumar
- Cardiac Bioelectricity and Arrhythmia Center, Washington University, St. Louis, MO, 63130, USA
- Department of Biomedical Engineering, Washington University, St. Louis, MO, 63130, USA
| | - Nishi Chaturvedi
- Institute of Cardiovascular Science, University College London, Huntley Street, London, WC1E 6DD, UK
- Medical Research Council Unit for Lifelong Health and Ageing at UCL, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Alun D Hughes
- Institute of Cardiovascular Science, University College London, Huntley Street, London, WC1E 6DD, UK
- Medical Research Council Unit for Lifelong Health and Ageing at UCL, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - James C Moon
- Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, ECIA 7BE, UK
- Institute of Cardiovascular Science, University College London, Huntley Street, London, WC1E 6DD, UK
| | - Pier D Lambiase
- Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, ECIA 7BE, UK
- Institute of Cardiovascular Science, University College London, Huntley Street, London, WC1E 6DD, UK
| | - Xuyuan Tao
- École Nationale Supérieure des Arts et Industries Textiles, 2 allée Louise et Victor Champier, 59056, Roubaix CEDEX 1, France
| | - Vladan Koncar
- École Nationale Supérieure des Arts et Industries Textiles, 2 allée Louise et Victor Champier, 59056, Roubaix CEDEX 1, France
| | - Michele Orini
- Institute of Cardiovascular Science, University College London, Huntley Street, London, WC1E 6DD, UK
- Medical Research Council Unit for Lifelong Health and Ageing at UCL, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Gabriella Captur
- Institute of Cardiovascular Science, University College London, Huntley Street, London, WC1E 6DD, UK.
- Centre for Inherited Heart Muscle Conditions, Department of Cardiology, Royal Free London NHS Foundation Trust, Pond Street, London, NW3 2QG, UK.
- Medical Research Council Unit for Lifelong Health and Ageing at UCL, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK.
| |
Collapse
|
11
|
Dziopa K, Chaturvedi N, Asselbergs FW, Schmidt AF. Identifying and ranking novel independent features for cardiovascular disease prediction in people with type 2 diabetes. medRxiv 2023:2023.10.23.23297398. [PMID: 37961704 PMCID: PMC10635178 DOI: 10.1101/2023.10.23.23297398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
Background CVD prediction models do not perform well in people with diabetes. We therefore aimed to identify novel predictors for six facets of CVD, (including coronary heart disease (CHD), Ischemic stroke, heart failure (HF), and atrial fibrillation (AF)) in people with T2DM. Methods Analyses were conducted using the UK biobank and were stratified on history of CVD and of T2DM: 459,142 participants without diabetes or a history of CVD, 14,610 with diabetes but without CVD, and 4,432 with diabetes and a history of CVD. Replication was performed using a 20% hold-out set, ranking features on their permuted c-statistic. Results Out of the 600+ candidate features, we identified a subset of replicated features, ranging between 32 for CHD in people with diabetes to 184 for CVD+HF+AF in people without diabetes. Classical CVD risk factors (e.g. parental or maternal history of heart disease, or blood pressure) were relatively highly ranked for people without diabetes. The top predictors in the people with diabetes without a CVD history included: cystatin C, self-reported health satisfaction, biochemical measures of ill health (e.g. plasma albumin). For people with diabetes and a history of CVD top features were: self-reported ill health, and blood cell counts measurements (e.g. red cell distribution width). We additionally identified risk factors unique to people with diabetes, consisting of information on dietary patterns, mental health and biochemistry measures. Consideration of these novel features improved risk classification, for example per 1000 people with diabetes 133 CVD and 165 HF cases appropriately received a higher risk. Conclusion Through data-driven feature selection we identified a substantial number of features relevant for prediction of cardiovascular risk in people with diabetes, the majority of which related to non-classical risk factors such as mental health, general illness markers, and kidney disease.
Collapse
Affiliation(s)
- K Dziopa
- Institute of Health Informatics, University College London, London, United Kingdom
- Institute of Cardiovascular Science, Faculty of Population Health Sciences, University College London, London, United Kingdom
- Department of Cardiology, Amsterdam Cardiovascular Science, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - N Chaturvedi
- MRC Unit for Lifelong Health and Ageing at UCL, University College London, London, United Kingdom
| | - F W Asselbergs
- Institute of Health Informatics, University College London, London, United Kingdom
- Department of Cardiology, Amsterdam Cardiovascular Science, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
- The National Institute for Health Research UCL Hospitals Biomedical Research Centre, University College London, London, United Kingdom
| | - A F Schmidt
- Institute of Cardiovascular Science, Faculty of Population Health Sciences, University College London, London, United Kingdom
- Department of Cardiology, Amsterdam Cardiovascular Science, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
- UCL BHF Research Accelerator Centre, London, UK
| |
Collapse
|
12
|
Taylor HCM, Chaturvedi N, Davey Smith G, Ferreira DLS, Fraser A, Howe LD, Hughes AD, Lawlor DA, Timpson NJ, Park CM. Is Height 2.7 Appropriate for Indexation of Left Ventricular Mass in Healthy Adolescents? The Importance of Sex Differences. Hypertension 2023; 80:2033-2042. [PMID: 37548044 PMCID: PMC10510825 DOI: 10.1161/hypertensionaha.121.17109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 07/07/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND Left ventricular mass (LVM) is an important predictor of cardiovascular risk. In adolescence, LVM is commonly indexed to height2.7, although some evidence suggests that this may not fully account for sex differences. METHODS We investigated appropriate allometric scaling of LVM to height, total lean mass, and body surface area, in a UK birth cohort of 2039 healthy adolescents (17±1 years). Allometric relationships were determined by linear regression stratified by sex, following log transformation of x and y variables [log(y)=a+b×log(x)], b is the allometric exponent. RESULTS Log (LVM) showed linear relationships with log(height) and log(lean mass). Biased estimates of slope resulted when the sexes were pooled. The exponents were lower than the conventional estimate of 2.7 for males (mean [95% CI]=1.66 [1.30-2.03]) and females (1.58 [1.27-1.90]). When LVM was indexed to lean mass, the exponent was 1.16 (1.05-1.26) for males and 1.07 (0.97-1.16) for females. When LVM was indexed to estimated body surface area, the exponent was 1.53 (1.40-1.66) for males and 1.34 (1.24-1.45) for females. CONCLUSIONS Allometric exponents derived from pooled data, including men and women without adjustment for sex were biased, possibly due to sex differences in body composition. We suggest that when assessing LVM, clinicians should consider body size, body composition, sex, and age. Our observations may also have implications for the identification of young individuals with cardiac hypertrophy.
Collapse
Affiliation(s)
- Hannah C M Taylor
- MRC Unit for Lifelong Health and Ageing, University College London, United Kingdom (H.C.M.T., N.C., A.D.H., C.M.P.)
- Oxford Population Health (NDPH), University of Oxford, United Kingdom (H.C.M.T.)
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, United Kingdom (H.C.M.T.)
| | - Nishi Chaturvedi
- MRC Unit for Lifelong Health and Ageing, University College London, United Kingdom (H.C.M.T., N.C., A.D.H., C.M.P.)
| | - George Davey Smith
- MRC Integrative Epidemiology Unit, University of Bristol, United Kingdom (G.D.S., D.L.S.F., A.F., L.D.H., D.A.L., N.J.T.)
- Bristol Population Health Science Institute, Bristol Medical School, University of Bristol, United Kingdom (G.D.S., D.L.S.F., A.F., L.D.H., D.A.L., N.J.T.)
| | - Diana L S Ferreira
- MRC Integrative Epidemiology Unit, University of Bristol, United Kingdom (G.D.S., D.L.S.F., A.F., L.D.H., D.A.L., N.J.T.)
- Bristol Population Health Science Institute, Bristol Medical School, University of Bristol, United Kingdom (G.D.S., D.L.S.F., A.F., L.D.H., D.A.L., N.J.T.)
| | - Abigail Fraser
- MRC Integrative Epidemiology Unit, University of Bristol, United Kingdom (G.D.S., D.L.S.F., A.F., L.D.H., D.A.L., N.J.T.)
- Bristol Population Health Science Institute, Bristol Medical School, University of Bristol, United Kingdom (G.D.S., D.L.S.F., A.F., L.D.H., D.A.L., N.J.T.)
| | - Laura D Howe
- MRC Integrative Epidemiology Unit, University of Bristol, United Kingdom (G.D.S., D.L.S.F., A.F., L.D.H., D.A.L., N.J.T.)
- Bristol Population Health Science Institute, Bristol Medical School, University of Bristol, United Kingdom (G.D.S., D.L.S.F., A.F., L.D.H., D.A.L., N.J.T.)
| | - Alun D Hughes
- MRC Unit for Lifelong Health and Ageing, University College London, United Kingdom (H.C.M.T., N.C., A.D.H., C.M.P.)
| | - Debbie A Lawlor
- MRC Integrative Epidemiology Unit, University of Bristol, United Kingdom (G.D.S., D.L.S.F., A.F., L.D.H., D.A.L., N.J.T.)
- Bristol Population Health Science Institute, Bristol Medical School, University of Bristol, United Kingdom (G.D.S., D.L.S.F., A.F., L.D.H., D.A.L., N.J.T.)
| | - Nic J Timpson
- MRC Integrative Epidemiology Unit, University of Bristol, United Kingdom (G.D.S., D.L.S.F., A.F., L.D.H., D.A.L., N.J.T.)
- Bristol Population Health Science Institute, Bristol Medical School, University of Bristol, United Kingdom (G.D.S., D.L.S.F., A.F., L.D.H., D.A.L., N.J.T.)
| | - Chloe M Park
- MRC Unit for Lifelong Health and Ageing, University College London, United Kingdom (H.C.M.T., N.C., A.D.H., C.M.P.)
| |
Collapse
|
13
|
Allinson JP, Chaturvedi N, Wong A, Shah I, Donaldson GC, Wedzicha JA, Hardy R. Early childhood lower respiratory tract infection and premature adult death from respiratory disease in Great Britain: a national birth cohort study. Lancet 2023; 401:1183-1193. [PMID: 36898396 DOI: 10.1016/s0140-6736(23)00131-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 01/13/2023] [Accepted: 01/17/2023] [Indexed: 03/09/2023]
Abstract
BACKGROUND Lower respiratory tract infections (LRTIs) in early childhood are known to influence lung development and lifelong lung health, but their link to premature adult death from respiratory disease is unclear. We aimed to estimate the association between early childhood LRTI and the risk and burden of premature adult mortality from respiratory disease. METHODS This longitudinal observational cohort study used data collected prospectively by the Medical Research Council National Survey of Health and Development in a nationally representative cohort recruited at birth in March, 1946, in England, Scotland, and Wales. We evaluated the association between LRTI during early childhood (age <2 years) and death from respiratory disease from age 26 through 73 years. Early childhood LRTI occurrence was reported by parents or guardians. Cause and date of death were obtained from the National Health Service Central Register. Hazard ratios (HRs) and population attributable risk associated with early childhood LRTI were estimated using competing risks Cox proportional hazards models, adjusted for childhood socioeconomic position, childhood home overcrowding, birthweight, sex, and smoking at age 20-25 years. We compared mortality within the cohort studied with national mortality patterns and estimated corresponding excess deaths occurring nationally during the study period. FINDINGS 5362 participants were enrolled in March, 1946, and 4032 (75%) continued participating in the study at age 20-25 years. 443 participants with incomplete data on early childhood (368 [9%] of 4032), smoking (57 [1%]), or mortality (18 [<1%]) were excluded. 3589 participants aged 26 years (1840 [51%] male and 1749 [49%] female) were included in the survival analyses from 1972 onwards. The maximum follow-up time was 47·9 years. Among 3589 participants, 913 (25%) who had an LRTI during early childhood were at greater risk of dying from respiratory disease by age 73 years than those with no LRTI during early childhood (HR 1·93, 95% CI 1·10-3·37; p=0·021), after adjustment for childhood socioeconomic position, childhood home overcrowding, birthweight, sex, and adult smoking. This finding corresponded to a population attributable risk of 20·4% (95% CI 3·8-29·8) and 179 188 (95% CI 33 806-261 519) excess deaths across England and Wales between 1972 and 2019. INTERPRETATION In this prospective, life-spanning, nationally representative cohort study, LRTI during early childhood was associated with almost a two times increased risk of premature adult death from respiratory disease, and accounted for one-fifth of these deaths. FUNDING National Institute for Health and Care Research Imperial Biomedical Research Centre, Royal Brompton and Harefield National Health Service (NHS) Foundation Trust, Royal Brompton and Harefield Hospitals Charity and Imperial College Healthcare NHS Trust, UK Medical Research Council.
Collapse
Affiliation(s)
- James Peter Allinson
- Royal Brompton Hospital, London, UK; National Heart and Lung Institute, Imperial College London, London, UK.
| | - Nishi Chaturvedi
- MRC Unit for Lifelong Health and Ageing, University College London, London, UK
| | - Andrew Wong
- MRC Unit for Lifelong Health and Ageing, University College London, London, UK
| | - Imran Shah
- MRC Unit for Lifelong Health and Ageing, University College London, London, UK
| | | | | | - Rebecca Hardy
- Social Research Institute, University College London, London, UK; School of Sport, Exercise, and Health Sciences, Loughborough University, Loughborough, UK
| |
Collapse
|
14
|
Wels J, Wielgoszewska B, Moltrecht B, Booth C, Green MJ, Hamilton OKL, Demou E, Di Gessa G, Huggins C, Zhu J, Santorelli G, Silverwood RJ, Kopasker D, Shaw RJ, Hughes A, Patalay P, Steves C, Chaturvedi N, Porteous DJ, Rhead R, Katikireddi SV, Ploubidis GB. Home working and social and mental wellbeing at different stages of the COVID-19 pandemic in the UK: Evidence from 7 longitudinal population surveys. PLoS Med 2023; 20:e1004214. [PMID: 37104282 PMCID: PMC10138202 DOI: 10.1371/journal.pmed.1004214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 03/07/2023] [Indexed: 04/28/2023] Open
Abstract
BACKGROUND Home working has increased since the Coronavirus Disease 2019 (COVID-19) pandemic's onset with concerns that it may have adverse health implications. We assessed the association between home working and social and mental wellbeing among the employed population aged 16 to 66 through harmonised analyses of 7 UK longitudinal studies. METHODS AND FINDINGS We estimated associations between home working and measures of psychological distress, low life satisfaction, poor self-rated health, low social contact, and loneliness across 3 different stages of the pandemic (T1 = April to June 2020 -first lockdown, T2 = July to October 2020 -eased restrictions, T3 = November 2020 to March 2021 -second lockdown) using modified Poisson regression and meta-analyses to pool results across studies. We successively adjusted the model for sociodemographic characteristics (e.g., age, sex), job characteristics (e.g., sector of activity, pre-pandemic home working propensities), and pre-pandemic health. Among respectively 10,367, 11,585, and 12,179 participants at T1, T2, and T3, we found higher rates of home working at T1 and T3 compared with T2, reflecting lockdown periods. Home working was not associated with psychological distress at T1 (RR = 0.92, 95% CI = 0.79 to 1.08) or T2 (RR = 0.99, 95% CI = 0.88 to 1.11), but a detrimental association was found with psychological distress at T3 (RR = 1.17, 95% CI = 1.05 to 1.30). Study limitations include the fact that pre-pandemic home working propensities were derived from external sources, no information was collected on home working dosage and possible reverse association between change in wellbeing and home working likelihood. CONCLUSIONS No clear evidence of an association between home working and mental wellbeing was found, apart from greater risk of psychological distress during the second lockdown, but differences across subgroups (e.g., by sex or level of education) may exist. Longer term shifts to home working might not have adverse impacts on population wellbeing in the absence of pandemic restrictions but further monitoring of health inequalities is required.
Collapse
Affiliation(s)
- Jacques Wels
- MRC Unit for Lifelong Health and Ageing, University College London, London, United Kingdom
- Centre Metices, Université libre de Bruxelles, Brussels, Belgium
| | - Bożena Wielgoszewska
- Centre for Longitudinal Studies (CLS), Social Research Institute, University College London, London, United Kingdom
| | - Bettina Moltrecht
- Centre for Longitudinal Studies (CLS), Social Research Institute, University College London, London, United Kingdom
| | - Charlotte Booth
- Centre for Longitudinal Studies (CLS), Social Research Institute, University College London, London, United Kingdom
| | - Michael J. Green
- MRC/CSO Social and Public Health Sciences Unit, School of Health and Wellbeing, University of Glasgow, Clarice Pears Building, Glasgow, United Kingdom
| | - Olivia KL Hamilton
- MRC/CSO Social and Public Health Sciences Unit, School of Health and Wellbeing, University of Glasgow, Clarice Pears Building, Glasgow, United Kingdom
| | - Evangelia Demou
- MRC/CSO Social and Public Health Sciences Unit, School of Health and Wellbeing, University of Glasgow, Clarice Pears Building, Glasgow, United Kingdom
| | - Giorgio Di Gessa
- Research Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Charlotte Huggins
- Centre for Genomic and Experimental Medicine, The University of Edinburgh Western General Hospital, Edinburgh, United Kingdom
| | - Jingmin Zhu
- Research Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Gillian Santorelli
- Bradford Teaching Hospitals NHS Foundation Trust, Bradford, United Kingdom
| | - Richard J. Silverwood
- Centre for Longitudinal Studies (CLS), Social Research Institute, University College London, London, United Kingdom
| | - Daniel Kopasker
- MRC/CSO Social and Public Health Sciences Unit, School of Health and Wellbeing, University of Glasgow, Clarice Pears Building, Glasgow, United Kingdom
| | - Richard J. Shaw
- MRC/CSO Social and Public Health Sciences Unit, School of Health and Wellbeing, University of Glasgow, Clarice Pears Building, Glasgow, United Kingdom
| | - Alun Hughes
- MRC Unit for Lifelong Health and Ageing, University College London, London, United Kingdom
| | - Praveetha Patalay
- MRC Unit for Lifelong Health and Ageing, University College London, London, United Kingdom
- Centre for Longitudinal Studies (CLS), Social Research Institute, University College London, London, United Kingdom
| | - Claire Steves
- Twin Research & Genetic Epidemiology, King’s College London, St Thomas’ Hospital London, United Kingdom
| | - Nishi Chaturvedi
- MRC Unit for Lifelong Health and Ageing, University College London, London, United Kingdom
| | - David J. Porteous
- Centre for Genomic and Experimental Medicine, The University of Edinburgh Western General Hospital, Edinburgh, United Kingdom
| | - Rebecca Rhead
- Centre for Longitudinal Studies (CLS), Social Research Institute, University College London, London, United Kingdom
| | - Srinivasa Vittal Katikireddi
- MRC/CSO Social and Public Health Sciences Unit, School of Health and Wellbeing, University of Glasgow, Clarice Pears Building, Glasgow, United Kingdom
| | - George B. Ploubidis
- Centre for Longitudinal Studies (CLS), Social Research Institute, University College London, London, United Kingdom
| |
Collapse
|
15
|
Chandrasekar R, Lacey RE, Chaturvedi N, Hughes AD, Patalay P, Khanolkar AR. Adverse childhood experiences and the development of multimorbidity across adulthood-a national 70-year cohort study. Age Ageing 2023; 52:afad062. [PMID: 37104379 PMCID: PMC10137110 DOI: 10.1093/ageing/afad062] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 02/16/2023] [Indexed: 04/28/2023] Open
Abstract
AIM To examine impact of adverse childhood experiences (ACE) on rates and development of multimorbidity across three decades in adulthood. METHODS Sample: Participants from the 1946 National Survey of Health and Development, who attended the age 36 assessment in 1982 and follow-up assessments (ages 43, 53, 63, 69; N = 3,264, 51% males). Prospectively collected data on nine ACEs was grouped into (i) psychosocial, (ii) parental health and (iii) childhood health. For each group, we calculated cumulative ACE scores, categorised into 0, 1 and ≥2 ACEs. Multimorbidity was estimated as the total score of 18 health disorders.Serial cross-sectional linear regression was used to estimate associations between grouped ACEs and multimorbidity during follow-up. Longitudinal analysis of ACE-associated changes in multimorbidity trajectories across follow-up was estimated using linear mixed-effects modelling for ACE groups (adjusted for sex and childhood socioeconomic circumstances). FINDINGS Accumulation of psychosocial and childhood health ACEs were associated with progressively higher multimorbidity scores throughout follow-up. For example, those with ≥2 psychosocial ACEs experienced 0.20(95% CI 0.07, 0.34) more disorders at age 36 than those with none, rising to 0.61(0.18, 1.04) disorders at age 69.All three grouped ACEs were associated with greater rates of accumulation and higher multimorbidity trajectories across adulthood. For example, individuals with ≥2 psychosocial ACEs developed 0.13(-0.09, 0.34) more disorders between ages 36 and 43, 0.29(0.06, 0.52) disorders between ages 53 and 63, and 0.30(0.09, 0.52) disorders between ages 63 and 69 compared with no psychosocial ACEs. INTERPRETATIONS ACEs are associated with widening inequalities in multimorbidity development in adulthood and early old age. Public health policies should aim to reduce these disparities through individual and population-level interventions.
Collapse
Affiliation(s)
| | - Rebecca E Lacey
- Research Department of Epidemiology and Public Health, University College London, London WC1E 7HB, UK
| | - Nishi Chaturvedi
- MRC Unit for Lifelong Health and Ageing at University College London, London WC1E 7HB, UK
| | - Alun D Hughes
- MRC Unit for Lifelong Health and Ageing at University College London, London WC1E 7HB, UK
| | - Praveetha Patalay
- MRC Unit for Lifelong Health and Ageing at University College London, London WC1E 7HB, UK
- Centre for Longitudinal Studies, University College London Social Research Institute, London WC1H 0AL, UK
| | - Amal R Khanolkar
- MRC Unit for Lifelong Health and Ageing at University College London, London WC1E 7HB, UK
- Department of Population Health Sciences, King’s College London, London SE1 1UL, UK
| |
Collapse
|
16
|
Routen A, O'Mahoney L, Aiyegbusi OL, Alder Y, Banerjee A, Buckland L, Brightling C, Calvert M, Camaradou J, Chaturvedi N, Chong A, Dalrymple E, Eggo RM, Elliott P, Evans RA, Gibson A, Haroon S, Herrett E, Houchen-Wolloff L, Hughes SE, Jeyes F, Matthews K, McMullan C, Morley J, Shafran R, Smith N, Stanton D, Stephenson T, Sterne J, Turner GM, Ward H, Khunti K. Patient and public involvement within epidemiological studies of long COVID in the UK. Nat Med 2023; 29:771-773. [PMID: 36932242 DOI: 10.1038/s41591-023-02251-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2023]
Affiliation(s)
- Ash Routen
- Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, UK.
| | - Lauren O'Mahoney
- Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, UK
| | - Olalekan Lee Aiyegbusi
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) West Midlands, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre (BBRC), University of Birmingham, Birmingham, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
- NIHR Oxford-Birmingham Blood and Transplant Research Unit (BTRU) in Precision Therapeutics, Birmingham, UK
| | - Yvonne Alder
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Amitava Banerjee
- Institute of Health Informatics, Faculty of Population Health Sciences, University College London (UCL), London, UK
| | - Lewis Buckland
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Chris Brightling
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - Melanie Calvert
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) West Midlands, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre (BBRC), University of Birmingham, Birmingham, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
- NIHR Oxford-Birmingham Blood and Transplant Research Unit (BTRU) in Precision Therapeutics, Birmingham, UK
- NIHR Surgical Reconstruction and Microbiology Research Centre (SRMRC), University of Birmingham, Birmingham, UK
| | - Jenny Camaradou
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Nishi Chaturvedi
- Department of Population Science and Experimental Medicine, UCL, London, UK
| | - Amy Chong
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Emma Dalrymple
- Great Ormond Street Institute of Child Health, UCL, London, UK
| | - Rosalind M Eggo
- Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Paul Elliott
- Faculty of Medicine, School of Public Health, Imperial College London, London, UK
| | - Rachael A Evans
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - Andy Gibson
- Department of Health and Social Sciences, University of West England, Bristol, UK
| | - Shamil Haroon
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Emily Herrett
- Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Sarah E Hughes
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) West Midlands, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre (BBRC), University of Birmingham, Birmingham, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
- NIHR Oxford-Birmingham Blood and Transplant Research Unit (BTRU) in Precision Therapeutics, Birmingham, UK
| | - Flic Jeyes
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Karen Matthews
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Christel McMullan
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre (BBRC), University of Birmingham, Birmingham, UK
- NIHR Oxford-Birmingham Blood and Transplant Research Unit (BTRU) in Precision Therapeutics, Birmingham, UK
- Department of Population Science and Experimental Medicine, UCL, London, UK
- Centre for Trauma Science Research, University of Birmingham, Birmingham, UK
| | - Jessica Morley
- Bennett Institute for Applied Data Science, University of Oxford, Oxford, UK
| | - Roz Shafran
- Great Ormond Street Institute of Child Health, UCL, London, UK
| | | | - David Stanton
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | - Jonathan Sterne
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Grace M Turner
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Helen Ward
- Faculty of Medicine, School of Public Health, Imperial College London, London, UK
| | - Kamlesh Khunti
- Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, UK
| |
Collapse
|
17
|
Bowyer RCE, Huggins C, Toms R, Shaw RJ, Hou B, Thompson EJ, Kwong ASF, Williams DM, Kibble M, Ploubidis GB, Timpson NJ, Sterne JAC, Chaturvedi N, Steves CJ, Tilling K, Silverwood RJ. Characterising patterns of COVID-19 and long COVID symptoms: evidence from nine UK longitudinal studies. Eur J Epidemiol 2023; 38:199-210. [PMID: 36680646 PMCID: PMC9860244 DOI: 10.1007/s10654-022-00962-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 12/26/2022] [Indexed: 01/22/2023]
Abstract
Multiple studies across global populations have established the primary symptoms characterising Coronavirus Disease 2019 (COVID-19) and long COVID. However, as symptoms may also occur in the absence of COVID-19, a lack of appropriate controls has often meant that specificity of symptoms to acute COVID-19 or long COVID, and the extent and length of time for which they are elevated after COVID-19, could not be examined. We analysed individual symptom prevalences and characterised patterns of COVID-19 and long COVID symptoms across nine UK longitudinal studies, totalling over 42,000 participants. Conducting latent class analyses separately in three groups ('no COVID-19', 'COVID-19 in last 12 weeks', 'COVID-19 > 12 weeks ago'), the data did not support the presence of more than two distinct symptom patterns, representing high and low symptom burden, in each group. Comparing the high symptom burden classes between the 'COVID-19 in last 12 weeks' and 'no COVID-19' groups we identified symptoms characteristic of acute COVID-19, including loss of taste and smell, fatigue, cough, shortness of breath and muscle pains or aches. Comparing the high symptom burden classes between the 'COVID-19 > 12 weeks ago' and 'no COVID-19' groups we identified symptoms characteristic of long COVID, including fatigue, shortness of breath, muscle pain or aches, difficulty concentrating and chest tightness. The identified symptom patterns among individuals with COVID-19 > 12 weeks ago were strongly associated with self-reported length of time unable to function as normal due to COVID-19 symptoms, suggesting that the symptom pattern identified corresponds to long COVID. Building the evidence base regarding typical long COVID symptoms will improve diagnosis of this condition and the ability to elicit underlying biological mechanisms, leading to better patient access to treatment and services.
Collapse
Affiliation(s)
- Ruth C E Bowyer
- Department of Twin Research and Genetic Epidemiology, School of Life Course and Population Sciences, King's College London, London, UK
- The Alan Turing Institute, London, UK
| | - Charlotte Huggins
- Centre for Genomic and Experimental Medicine, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK
| | - Renin Toms
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Population Wellbeing, School of Health Sciences, Cardiff Metropolitan University, Cardiff, UK
| | - Richard J Shaw
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Bo Hou
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Ellen J Thompson
- Department of Twin Research and Genetic Epidemiology, School of Life Course and Population Sciences, King's College London, London, UK
| | - Alex S F Kwong
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
- Division of Psychiatry, University of Edinburgh, Edinburgh, UK
| | - Dylan M Williams
- MRC Unit for Lifelong Health and Ageing at UCL, University College London, London, UK
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Milla Kibble
- Department of Twin Research and Genetic Epidemiology, School of Life Course and Population Sciences, King's College London, London, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
- Department of Applied Mathematics and Theoretical Physics, University of Cambridge, Cambridge, UK
| | - George B Ploubidis
- Centre for Longitudinal Studies, UCL Social Research Institute, University College London, London, UK
| | - Nicholas J Timpson
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
| | - Jonathan A C Sterne
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- NIHR Bristol Biomedical Research Centre, Bristol, UK
- Health Data Research UK South West, Bristol, UK
| | - Nishi Chaturvedi
- MRC Unit for Lifelong Health and Ageing at UCL, University College London, London, UK
| | - Claire J Steves
- Department of Twin Research and Genetic Epidemiology, School of Life Course and Population Sciences, King's College London, London, UK
- Department of Ageing and Health, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Kate Tilling
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
| | - Richard J Silverwood
- Centre for Longitudinal Studies, UCL Social Research Institute, University College London, London, UK.
| |
Collapse
|
18
|
Eastwood SV, Hughes AD, Tomlinson L, Mathur R, Smeeth L, Bhaskaran K, Chaturvedi N. Ethnic differences in hypertension management, medication use and blood pressure control in UK primary care, 2006-2019: a retrospective cohort study. Lancet Reg Health Eur 2023; 25:100557. [PMID: 36818236 PMCID: PMC9929586 DOI: 10.1016/j.lanepe.2022.100557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 11/10/2022] [Accepted: 11/14/2022] [Indexed: 12/12/2022]
Abstract
Background In the UK, previous work suggests ethnic inequalities in hypertension management. We studied ethnic differences in hypertension management and their contribution to blood pressure (BP) control. Methods We conducted a cohort study of antihypertensive-naïve individuals of European, South Asian and African/African Caribbean ethnicity with a new raised BP reading in UK primary care from 2006 to 2019, using the Clinical Practice Research Datalink (CPRD). We studied differences in: BP re-measurement after an initial hypertensive BP, antihypertensive initiation, BP monitoring, antihypertensive intensification, antihypertensive persistence/adherence and BP control one year after antihypertensive initiation. Models adjusted for socio-demographics, BP, comorbidity, healthcare usage and polypharmacy (plus antihypertensive class, BP monitoring, intensification, persistence and adherence for BP control models). Findings A total of 731,506 (93.5%), 30,379 (3.9%) and 20,256 (2.6%) people of European, South Asian and African/African Caribbean ethnicity were studied. Hypertension management indicators were similar or more favourable for South Asian than European groups (OR/HR [95% CI] in fully-adjusted models of BP re-measurement: 1.16 [1.09, 1.24]), antihypertensive initiation: 1.49 [1.37, 1.62], BP monitoring: 0.97 [0.94, 1.00] and antihypertensive intensification: 1.10 [1.04, 1.16]). For people of African/African Caribbean ethnicity, BP re-measurement rates were similar to those of European ethnicity (0.98 [0.91, 1.05]), and antihypertensive initiation rates greater (1.48 [1.32, 1.66]), but BP monitoring (0.91 [0.87, 0.95]) and intensification rates lower (0.93 [0.87, 1.00]). Persistence and adherence were lower in South Asian (0.48 [0.45, 0.51] and 0.51 [0.47, 0.56]) and African/African Caribbean (0.38 [0.35, 0.42] and 0.39 [0.36, 0.43]) than European groups. BP control was similar in South Asian and less likely in African/African Caribbean than European groups (0.98 [0.90, 1.06] and 0.81 [0.74, 0.89] in age, gender and BP adjusted models). The latter difference attenuated after adjustment for persistence (0.91 [0.82, 0.99]) or adherence (0.92 [0.83, 1.01]), and was absent for antihypertensive-adherent people (0.99 [0.88, 1.10]). Interpretation We demonstrate that antihypertensive initiation does not vary by ethnicity, but subsequent BP control was notably lower among people of African/African Caribbean ethnicity, potentially associated with being less likely to remain on regular treatment. A nationwide strategy to understand and address differences in ongoing management of people on antihypertensives is imperative. Funding Diabetes UK.
Collapse
Affiliation(s)
- Sophie V Eastwood
- MRC Unit for Lifelong Health and Aging at UCL, 1-19 Torrington Place, Floor 5, London, WC1E 7HB, UK
| | - Alun D Hughes
- MRC Unit for Lifelong Health and Aging at UCL, 1-19 Torrington Place, Floor 5, London, WC1E 7HB, UK
| | - Laurie Tomlinson
- Electronic Health Records Group, London School of Hygiene and Tropical Medicine, 2nd floor, Keppel Street, London, WC1E 7HT, UK
| | - Rohini Mathur
- Electronic Health Records Group, London School of Hygiene and Tropical Medicine, 2nd floor, Keppel Street, London, WC1E 7HT, UK
| | - Liam Smeeth
- Electronic Health Records Group, London School of Hygiene and Tropical Medicine, 2nd floor, Keppel Street, London, WC1E 7HT, UK
| | - Krishnan Bhaskaran
- Electronic Health Records Group, London School of Hygiene and Tropical Medicine, 2nd floor, Keppel Street, London, WC1E 7HT, UK
| | - Nishi Chaturvedi
- MRC Unit for Lifelong Health and Aging at UCL, 1-19 Torrington Place, Floor 5, London, WC1E 7HB, UK
| |
Collapse
|
19
|
Cheetham NJ, Kibble M, Wong A, Silverwood RJ, Knuppel A, Williams DM, Hamilton OKL, Lee PH, Bridger Staatz C, Di Gessa G, Zhu J, Katikireddi SV, Ploubidis GB, Thompson EJ, Bowyer RCE, Zhang X, Abbasian G, Garcia MP, Hart D, Seow J, Graham C, Kouphou N, Acors S, Malim MH, Mitchell RE, Northstone K, Major-Smith D, Matthews S, Breeze T, Crawford M, Molloy L, Kwong ASF, Doores K, Chaturvedi N, Duncan EL, Timpson NJ, Steves CJ. Antibody levels following vaccination against SARS-CoV-2: associations with post-vaccination infection and risk factors in two UK longitudinal studies. eLife 2023; 12:e80428. [PMID: 36692910 PMCID: PMC9940912 DOI: 10.7554/elife.80428] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 12/22/2022] [Indexed: 01/25/2023] Open
Abstract
Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibody levels can be used to assess humoral immune responses following SARS-CoV-2 infection or vaccination, and may predict risk of future infection. Higher levels of SARS-CoV-2 anti-Spike antibodies are known to be associated with increased protection against future SARS-CoV-2 infection. However, variation in antibody levels and risk factors for lower antibody levels following each round of SARS-CoV-2 vaccination have not been explored across a wide range of socio-demographic, SARS-CoV-2 infection and vaccination, and health factors within population-based cohorts. Methods Samples were collected from 9361 individuals from TwinsUK and ALSPAC UK population-based longitudinal studies and tested for SARS-CoV-2 antibodies. Cross-sectional sampling was undertaken jointly in April-May 2021 (TwinsUK, N=4256; ALSPAC, N=4622), and in TwinsUK only in November 2021-January 2022 (N=3575). Variation in antibody levels after first, second, and third SARS-CoV-2 vaccination with health, socio-demographic, SARS-CoV-2 infection, and SARS-CoV-2 vaccination variables were analysed. Using multivariable logistic regression models, we tested associations between antibody levels following vaccination and: (1) SARS-CoV-2 infection following vaccination(s); (2) health, socio-demographic, SARS-CoV-2 infection, and SARS-CoV-2 vaccination variables. Results Within TwinsUK, single-vaccinated individuals with the lowest 20% of anti-Spike antibody levels at initial testing had threefold greater odds of SARS-CoV-2 infection over the next 6-9 months (OR = 2.9, 95% CI: 1.4, 6.0), compared to the top 20%. In TwinsUK and ALSPAC, individuals identified as at increased risk of COVID-19 complication through the UK 'Shielded Patient List' had consistently greater odds (two- to fourfold) of having antibody levels in the lowest 10%. Third vaccination increased absolute antibody levels for almost all individuals, and reduced relative disparities compared with earlier vaccinations. Conclusions These findings quantify the association between antibody level and risk of subsequent infection, and support a policy of triple vaccination for the generation of protective antibodies. Funding Antibody testing was funded by UK Health Security Agency. The National Core Studies program is funded by COVID-19 Longitudinal Health and Wellbeing - National Core Study (LHW-NCS) HMT/UKRI/MRC ([MC_PC_20030] and [MC_PC_20059]). Related funding was also provided by the NIHR 606 (CONVALESCENCE grant [COV-LT-0009]). TwinsUK is funded by the Wellcome Trust, Medical Research Council, Versus Arthritis, European Union Horizon 2020, Chronic Disease Research Foundation (CDRF), Zoe Ltd and the National Institute for Health Research (NIHR) Clinical Research Network (CRN) and Biomedical Research Centre based at Guy's and St Thomas' NHS Foundation Trust in partnership with King's College London. The UK Medical Research Council and Wellcome (Grant ref: [217065/Z/19/Z]) and the University of Bristol provide core support for ALSPAC.
Collapse
Affiliation(s)
- Nathan J Cheetham
- Department of Twin Research and Genetic Epidemiology, King’s College LondonLondonUnited Kingdom
| | - Milla Kibble
- Department of Twin Research and Genetic Epidemiology, King’s College LondonLondonUnited Kingdom
- Population Health Sciences, Bristol Medical School, University of BristolBristolUnited Kingdom
- Department of Applied Mathematics and Theoretical Physics, University of CambridgeCambridgeUnited Kingdom
| | - Andrew Wong
- MRC Unit for Lifelong Health and Ageing, University College LondonLondonUnited Kingdom
| | | | - Anika Knuppel
- MRC Unit for Lifelong Health and Ageing, University College LondonLondonUnited Kingdom
| | - Dylan M Williams
- MRC Unit for Lifelong Health and Ageing, University College LondonLondonUnited Kingdom
- Department of Medical Epidemiology and Biostatistics, Karolinska InstitutetStockholmSweden
| | - Olivia KL Hamilton
- MRC/CSO Social and Public Health Sciences Unit, University of GlasgowGlasgowUnited Kingdom
| | - Paul H Lee
- Department of Health Sciences, University of LeicesterLeicesterUnited Kingdom
| | | | - Giorgio Di Gessa
- Department of Epidemiology and Public Health, University College LondonLondonUnited Kingdom
| | - Jingmin Zhu
- Department of Epidemiology and Public Health, University College LondonLondonUnited Kingdom
| | | | - George B Ploubidis
- Centre for Longitudinal Studies, University College LondonLondonUnited Kingdom
| | - Ellen J Thompson
- Department of Twin Research and Genetic Epidemiology, King’s College LondonLondonUnited Kingdom
- MRC Unit for Lifelong Health and Ageing, University College LondonLondonUnited Kingdom
| | - Ruth CE Bowyer
- Department of Twin Research and Genetic Epidemiology, King’s College LondonLondonUnited Kingdom
- Population Health Sciences, Bristol Medical School, University of BristolBristolUnited Kingdom
- AI for Science and Government, The Alan Turing InstituteLondonUnited Kingdom
| | - Xinyuan Zhang
- Department of Twin Research and Genetic Epidemiology, King’s College LondonLondonUnited Kingdom
| | - Golboo Abbasian
- Department of Twin Research and Genetic Epidemiology, King’s College LondonLondonUnited Kingdom
| | - Maria Paz Garcia
- Department of Twin Research and Genetic Epidemiology, King’s College LondonLondonUnited Kingdom
| | - Deborah Hart
- Department of Twin Research and Genetic Epidemiology, King’s College LondonLondonUnited Kingdom
| | - Jeffrey Seow
- Department of Infectious Diseases, King's College LondonLondonUnited Kingdom
| | - Carl Graham
- Department of Infectious Diseases, King's College LondonLondonUnited Kingdom
| | - Neophytos Kouphou
- Department of Infectious Diseases, King's College LondonLondonUnited Kingdom
| | - Sam Acors
- Department of Infectious Diseases, King's College LondonLondonUnited Kingdom
| | - Michael H Malim
- Department of Infectious Diseases, King's College LondonLondonUnited Kingdom
| | - Ruth E Mitchell
- Population Health Sciences, Bristol Medical School, University of BristolBristolUnited Kingdom
| | - Kate Northstone
- Population Health Sciences, Bristol Medical School, University of BristolBristolUnited Kingdom
| | - Daniel Major-Smith
- Population Health Sciences, Bristol Medical School, University of BristolBristolUnited Kingdom
| | - Sarah Matthews
- Population Health Sciences, Bristol Medical School, University of BristolBristolUnited Kingdom
| | - Thomas Breeze
- Population Health Sciences, Bristol Medical School, University of BristolBristolUnited Kingdom
| | - Michael Crawford
- Population Health Sciences, Bristol Medical School, University of BristolBristolUnited Kingdom
| | - Lynn Molloy
- Population Health Sciences, Bristol Medical School, University of BristolBristolUnited Kingdom
| | - Alex SF Kwong
- Population Health Sciences, Bristol Medical School, University of BristolBristolUnited Kingdom
- Division of Psychiatry, University of EdinburghEdinburghUnited Kingdom
| | - Katie Doores
- Department of Infectious Diseases, King's College LondonLondonUnited Kingdom
| | - Nishi Chaturvedi
- MRC Unit for Lifelong Health and Ageing, University College LondonLondonUnited Kingdom
| | - Emma L Duncan
- Department of Twin Research and Genetic Epidemiology, King’s College LondonLondonUnited Kingdom
- Guy’s & St Thomas’s NHS Foundation TrustLondonUnited Kingdom
| | - Nicholas J Timpson
- Population Health Sciences, Bristol Medical School, University of BristolBristolUnited Kingdom
| | - Claire J Steves
- Department of Twin Research and Genetic Epidemiology, King’s College LondonLondonUnited Kingdom
- Guy’s & St Thomas’s NHS Foundation TrustLondonUnited Kingdom
| |
Collapse
|
20
|
Schmidt AF, Joshi R, Gordillo-Marañón M, Drenos F, Charoen P, Giambartolomei C, Bis JC, Gaunt TR, Hughes AD, Lawlor DA, Wong A, Price JF, Chaturvedi N, Wannamethee G, Franceschini N, Kivimaki M, Hingorani AD, Finan C. Biomedical consequences of elevated cholesterol-containing lipoproteins and apolipoproteins on cardiovascular and non-cardiovascular outcomes. Commun Med (Lond) 2023; 3:9. [PMID: 36670186 PMCID: PMC9859819 DOI: 10.1038/s43856-022-00234-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 12/22/2022] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Higher concentrations of cholesterol-containing low-density lipoprotein (LDL-C) increase the risk of cardiovascular disease (CVD). The association of LDL-C with non-CVD traits remains unclear, as are the possible independent contributions of other cholesterol-containing lipoproteins and apolipoproteins. METHODS Nuclear magnetic resonance spectroscopy was used to measure the cholesterol content of high density (HDL-C), very low-density (VLDL-C), intermediate-density (IDL-C), as well as low-density lipoprotein fractions, the apolipoproteins Apo-A1 and Apo-B, as well as total triglycerides (TG), remnant-cholesterol (Rem-Chol) and total cholesterol (TC). The causal effects of these exposures were assessed against 33 outcomes using univariable and multivariable Mendelian randomization (MR). RESULTS The majority of cholesterol containing lipoproteins and apolipoproteins affect coronary heart disease (CHD), carotid intima-media thickness, carotid plaque, C-reactive protein (CRP) and blood pressure. Multivariable MR indicated that many of these effects act independently of HDL-C, LDL-C and TG, the most frequently measured lipid fractions. Higher concentrations of TG, VLDL-C, Rem-Chol and Apo-B increased heart failure (HF) risk; often independently of LDL-C, HDL-C or TG. Finally, a subset of these exposures associated with non-CVD traits such as Alzheimer's disease (AD: HDL-C, LDL-C, IDL-C, Apo-B), type 2 diabetes (T2DM: VLDL-C, IDL-C, LDL-C), and inflammatory bowel disease (IBD: LDL-C, IDL-C). CONCLUSIONS The cholesterol content of a wide range of lipoprotein and apolipoproteins associate with measures of atherosclerosis, blood pressure, CRP, and CHD, with a subset affecting HF, T2DM, AD and IBD risk. Many of the observed effects appear to act independently of LDL-C, HDL-C, and TG, supporting the targeting of lipid fractions beyond LDL-C for disease prevention.
Collapse
Affiliation(s)
- Amand F Schmidt
- Institute of Cardiovascular Science, Faculty of Population Health, University College London, London, UK.
- UCL BHF Research Accelerator Centre, London, UK.
- Department of Cardiology, Division Heart and Lungs, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
- Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
| | - Roshni Joshi
- Institute of Cardiovascular Science, Faculty of Population Health, University College London, London, UK
- UCL BHF Research Accelerator Centre, London, UK
| | - Maria Gordillo-Marañón
- Institute of Cardiovascular Science, Faculty of Population Health, University College London, London, UK
- UCL BHF Research Accelerator Centre, London, UK
| | - Fotios Drenos
- Institute of Cardiovascular Science, Faculty of Population Health, University College London, London, UK
- Department of Life Sciences, College of Health, Medicine and Life Sciences, Brunel University London, Uxbridge, UK
| | - Pimphen Charoen
- Institute of Cardiovascular Science, Faculty of Population Health, University College London, London, UK
- Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Bangkok, 10400, Thailand
- Integrative Computational BioScience (ICBS) Center, Mahidol University, Bangkok, 10400, Thailand
| | - Claudia Giambartolomei
- Istituto Italiano di Tecnologia, Non-coding RNAs and RNA-based Therapeutics, Via Morego, 30, 16163, Genova, Italy
| | - Joshua C Bis
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Tom R Gaunt
- MRC Integrative Epidemiology Unit, Bristol Medical School, University of Bristol, Bristol, BS8 2BN, UK
- NIHR Bristol Biomedical Research Centre, University Hospitals Bristol National Health Service Foundation Trust and University of Bristol, Bristol, UK
| | - Alun D Hughes
- Institute of Cardiovascular Science, Faculty of Population Health, University College London, London, UK
- UCL BHF Research Accelerator Centre, London, UK
- MRC Unit for Lifelong Health and Ageing, University College London, London, UK
| | - Deborah A Lawlor
- MRC Integrative Epidemiology Unit, Bristol Medical School, University of Bristol, Bristol, BS8 2BN, UK
- NIHR Bristol Biomedical Research Centre, University Hospitals Bristol National Health Service Foundation Trust and University of Bristol, Bristol, UK
- Population Health, Bristol Medical School, University of Bristol, Bristol, UK
| | - Andrew Wong
- MRC Unit for Lifelong Health and Ageing, University College London, London, UK
| | | | - Nishi Chaturvedi
- Institute of Cardiovascular Science, Faculty of Population Health, University College London, London, UK
- MRC Unit for Lifelong Health and Ageing, University College London, London, UK
| | - Goya Wannamethee
- Primary Care and Population Health, University College London, London, UK
| | - Nora Franceschini
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Mika Kivimaki
- Department of Mental Health of Older People, Division of Brain Sciences, University College London, London, UK
| | - Aroon D Hingorani
- Institute of Cardiovascular Science, Faculty of Population Health, University College London, London, UK
- UCL BHF Research Accelerator Centre, London, UK
| | - Chris Finan
- Institute of Cardiovascular Science, Faculty of Population Health, University College London, London, UK
- UCL BHF Research Accelerator Centre, London, UK
- Department of Cardiology, Division Heart and Lungs, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| |
Collapse
|
21
|
Kuan V, Denaxas S, Patalay P, Nitsch D, Mathur R, Gonzalez-Izquierdo A, Sofat R, Partridge L, Roberts A, Wong ICK, Hingorani M, Chaturvedi N, Hemingway H, Hingorani AD. Identifying and visualising multimorbidity and comorbidity patterns in patients in the English National Health Service: a population-based study. Lancet Digit Health 2023; 5:e16-e27. [PMID: 36460578 DOI: 10.1016/s2589-7500(22)00187-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 09/10/2022] [Accepted: 09/19/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND Globally, there is a paucity of multimorbidity and comorbidity data, especially for minority ethnic groups and younger people. We estimated the frequency of common disease combinations and identified non-random disease associations for all ages in a multiethnic population. METHODS In this population-based study, we examined multimorbidity and comorbidity patterns stratified by ethnicity or race, sex, and age for 308 health conditions using electronic health records from individuals included on the Clinical Practice Research Datalink linked with the Hospital Episode Statistics admitted patient care dataset in England. We included individuals who were older than 1 year and who had been registered for at least 1 year in a participating general practice during the study period (between April 1, 2010, and March 31, 2015). We identified the most common combinations of conditions and comorbidities for index conditions. We defined comorbidity as the accumulation of additional conditions to an index condition over an individual's lifetime. We used network analysis to identify conditions that co-occurred more often than expected by chance. We developed online interactive tools to explore multimorbidity and comorbidity patterns overall and by subgroup based on ethnicity, sex, and age. FINDINGS We collected data for 3 872 451 eligible patients, of whom 1 955 700 (50·5%) were women and girls, 1 916 751 (49·5%) were men and boys, 2 666 234 (68·9%) were White, 155 435 (4·0%) were south Asian, and 98 815 (2·6%) were Black. We found that a higher proportion of boys aged 1-9 years (132 506 [47·8%] of 277 158) had two or more diagnosed conditions than did girls in the same age group (106 982 [40·3%] of 265 179), but more women and girls were diagnosed with multimorbidity than were boys aged 10 years and older and men (1 361 232 [80·5%] of 1 690 521 vs 1 161 308 [70·8%] of 1 639 593). White individuals (2 097 536 [78·7%] of 2 666 234) were more likely to be diagnosed with two or more conditions than were Black (59 339 [60·1%] of 98 815) or south Asian individuals (93 617 [60·2%] of 155 435). Depression commonly co-occurred with anxiety, migraine, obesity, atopic conditions, deafness, soft-tissue disorders, and gastrointestinal disorders across all subgroups. Heart failure often co-occurred with hypertension, atrial fibrillation, osteoarthritis, stable angina, myocardial infarction, chronic kidney disease, type 2 diabetes, and chronic obstructive pulmonary disease. Spinal fractures were most strongly non-randomly associated with malignancy in Black individuals, but with osteoporosis in White individuals. Hypertension was most strongly associated with kidney disorders in those aged 20-29 years, but with dyslipidaemia, obesity, and type 2 diabetes in individuals aged 40 years and older. Breast cancer was associated with different comorbidities in individuals from different ethnic groups. Asthma was associated with different comorbidities between males and females. Bipolar disorder was associated with different comorbidities in younger age groups compared with older age groups. INTERPRETATION Our findings and interactive online tools are a resource for: patients and their clinicians, to prevent and detect comorbid conditions; research funders and policy makers, to redesign service provision, training priorities, and guideline development; and biomedical researchers and manufacturers of medicines, to provide leads for research into common or sequential pathways of disease and inform the design of clinical trials. FUNDING UK Research and Innovation, Medical Research Council, National Institute for Health and Care Research, Department of Health and Social Care, Wellcome Trust, British Heart Foundation, and The Alan Turing Institute.
Collapse
Affiliation(s)
- Valerie Kuan
- Institute of Health Informatics, University College London, London, UK; Health Data Research UK, University College London, London, UK.
| | - Spiros Denaxas
- Institute of Health Informatics, University College London, London, UK; Health Data Research UK, University College London, London, UK; UCL BHF Research Accelerator, University College London, London, UK; Alan Turing Institute, London, UK; University College London Hospitals NIHR Biomedical Research Centre, London, UK; British Heart Foundation Data Science Centre, HDR UK, London, UK
| | - Praveetha Patalay
- Centre for Longitudinal Studies, University College London, London, UK; MRC Unit for Lifelong Health and Ageing at UCL, University College London, London, UK
| | - Dorothea Nitsch
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Rohini Mathur
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK; Centre for Primary Care, Wolfson Institute of Primary Care, Queen Mary University of London, London, UK
| | - Arturo Gonzalez-Izquierdo
- Institute of Health Informatics, University College London, London, UK; Health Data Research UK, University College London, London, UK
| | - Reecha Sofat
- Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool, UK; British Heart Foundation Data Science Centre, HDR UK, London, UK
| | - Linda Partridge
- Institute of Healthy Ageing, Department of Genetics, Evolution and Environment, University College London, London, UK; Max Planck Institute for Biology of Ageing, Cologne, Germany
| | - Amanda Roberts
- Nottingham Support Group for Carers of Children with Eczema, Nottingham, UK
| | - Ian C K Wong
- School of Pharmacy, University College London, London, UK; Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, University of Hong Kong, Hong Kong Special Administrative Region, China; Aston Pharmacy School, Aston University, Birmingham, UK
| | | | - Nishi Chaturvedi
- MRC Unit for Lifelong Health and Ageing at UCL, University College London, London, UK
| | - Harry Hemingway
- Institute of Health Informatics, University College London, London, UK; Health Data Research UK, University College London, London, UK; University College London Hospitals NIHR Biomedical Research Centre, London, UK
| | - Aroon D Hingorani
- UCL BHF Research Accelerator, University College London, London, UK; Institute of Cardiovascular Science, University College London, London, UK; University College London Hospitals NIHR Biomedical Research Centre, London, UK
| | | |
Collapse
|
22
|
Elliott HR, Burrows K, Min JL, Tillin T, Mason D, Wright J, Santorelli G, Davey Smith G, Lawlor DA, Hughes AD, Chaturvedi N, Relton CL. Characterisation of ethnic differences in DNA methylation between UK-resident South Asians and Europeans. Clin Epigenetics 2022; 14:130. [PMID: 36243740 PMCID: PMC9571473 DOI: 10.1186/s13148-022-01351-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 09/20/2022] [Indexed: 11/10/2022] Open
Abstract
Ethnic differences in non-communicable disease risk have been described between individuals of South Asian and European ethnicity that are only partially explained by genetics and other known risk factors. DNA methylation is one underexplored mechanism that may explain differences in disease risk. Currently, there is little knowledge of how DNA methylation varies between South Asian and European ethnicities. This study characterised differences in blood DNA methylation between individuals of self-reported European and South Asian ethnicity from two UK-based cohorts: Southall and Brent Revisited and Born in Bradford. DNA methylation differences between ethnicities were widespread throughout the genome (n = 16,433 CpG sites, 3.4% sites tested). Specifically, 76% of associations were attributable to ethnic differences in cell composition with fewer effects attributable to smoking and genetic variation. Ethnicity-associated CpG sites were enriched for EWAS Catalog phenotypes including metabolites. This work highlights the need to consider ethnic diversity in epigenetic research.
Collapse
Affiliation(s)
- Hannah R. Elliott
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Kimberley Burrows
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Josine L. Min
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Therese Tillin
- Department of Population Science and Experimental Medicine, Institute of Cardiovascular Science, University College London, London, UK
- MRC Unit for Lifelong Health and Ageing, University College London, London, UK
| | - Dan Mason
- Bradford Institute for Health Research, Bradford, UK
| | - John Wright
- Bradford Institute for Health Research, Bradford, UK
| | | | - George Davey Smith
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Deborah A. Lawlor
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Alun D. Hughes
- Department of Population Science and Experimental Medicine, Institute of Cardiovascular Science, University College London, London, UK
- MRC Unit for Lifelong Health and Ageing, University College London, London, UK
| | - Nishi Chaturvedi
- Department of Population Science and Experimental Medicine, Institute of Cardiovascular Science, University College London, London, UK
- MRC Unit for Lifelong Health and Ageing, University College London, London, UK
| | - Caroline L. Relton
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| |
Collapse
|
23
|
Maddock J, Parsons S, Di Gessa G, Green MJ, Thompson EJ, Stevenson AJ, Kwong AS, McElroy E, Santorelli G, Silverwood RJ, Captur G, Chaturvedi N, Steves CJ, Steptoe A, Patalay P, Ploubidis GB, Katikireddi SV. Inequalities in healthcare disruptions during the COVID-19 pandemic: evidence from 12 UK population-based longitudinal studies. BMJ Open 2022; 12:e064981. [PMID: 36229151 PMCID: PMC9561494 DOI: 10.1136/bmjopen-2022-064981] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES We investigated associations between multiple sociodemographic characteristics (sex, age, occupational social class, education and ethnicity) and self-reported healthcare disruptions during the early stages of the COVID-19 pandemic. DESIGN Coordinated analysis of prospective population surveys. SETTING Community-dwelling participants in the UK between April 2020 and January 2021. PARTICIPANTS Over 68 000 participants from 12 longitudinal studies. OUTCOMES Self-reported healthcare disruption to medication access, procedures and appointments. RESULTS Prevalence of healthcare disruption varied substantially across studies: between 6% and 32% reported any disruption, with 1%-10% experiencing disruptions in medication, 1%-17% experiencing disruption in procedures and 4%-28% experiencing disruption in clinical appointments. Females (OR 1.27; 95% CI 1.15 to 1.40; I2=54%), older persons (eg, OR 1.39; 95% CI 1.13 to 1.72; I2=77% for 65-75 years vs 45-54 years) and ethnic minorities (excluding white minorities) (OR 1.19; 95% CI 1.05 to 1.35; I2=0% vs white) were more likely to report healthcare disruptions. Those in a more disadvantaged social class were also more likely to report healthcare disruptions (eg, OR 1.17; 95% CI 1.08 to 1.27; I2=0% for manual/routine vs managerial/professional), but no clear differences were observed by education. We did not find evidence that these associations differed by shielding status. CONCLUSIONS Healthcare disruptions during the COVID-19 pandemic could contribute to the maintenance or widening of existing health inequalities.
Collapse
Affiliation(s)
- Jane Maddock
- MRC Unit for Lifelong Health and Ageing, UCL, London, UK
| | - Sam Parsons
- Centre for Longitudinal Studies, Social Research Institute, UCL, London, UK
| | | | - Michael J Green
- MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Ellen J Thompson
- Department of Twin Research and Genetic Epidemiology, School of Life Course & Population Sciences, King's College London, London, UK
| | - Anna J Stevenson
- Centre for Genomic and Experimental Medicine, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK
| | - Alex Sf Kwong
- Division of Psychiatry, University of Edinburgh, Edinburgh, UK
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - Eoin McElroy
- Department of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester, UK
| | | | | | | | | | - Claire J Steves
- Department of Twin Research and Genetic Epidemiology, School of Life Course & Population Sciences, King's College London, London, UK
| | - Andrew Steptoe
- Department of Epidemiology and Public Health, UCL, London, UK
| | - Praveetha Patalay
- MRC Unit for Lifelong Health and Ageing, UCL, London, UK
- Centre for Longitudinal Studies, Social Research Institute, UCL, London, UK
| | - George B Ploubidis
- Centre for Longitudinal Studies, Social Research Institute, UCL, London, UK
| | | |
Collapse
|
24
|
Topriceanu C, Weber M, Fiona C, Moon JC, Chaturvedi N, Hughes AD, Schott J, Richards M, Captur G. Heterozygous APOE ε4 carriage associates with improved myocardial efficiency in older age. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Carriage of the ancestral APOE ε4 allele confers a risk of developing Alzheimer's and coronary artery disease, but its persistence in human populations also suggests some potential survival advantages. To date it remains unclear whether APOE ε4 carriage independently associates with a better or worse long-term cardiac phenotype.
Purpose
Using data from the 1946 National Survey of Health and Development (NSHD) birth cohort, we investigated whether APOE ε4 carriage associates with adverse or beneficial left ventricular (LV) size and function parameters by echocardiography in older age.
Methods
Based on the presence or absence of APOE ε4, genotypes were divided into: non-APOE ε4 (ε2ε2, ε2ε3, ε3ε3), heterozygous-APOE ε4 (ε2ε4 and ε3ε4) and homozygous-APOE ε4 (ε4ε4). Echocardiographic data at 60–64 years included: left ventricular ejection fraction (LV EF), E/e', systolic and diastolic LV posterior wall and interventricular septal thickness (LVPWTs/d, IVSs/d), and body-surface area indexed LV mass (LVmassi) and myocardial contraction fraction (MCFi). Generalized linear models explored associations between APOE ε4 genotypes as exposures and echocardiographic biomarkers as outcomes. As a combination of gene variants, APOE ε genotype is expected to be an instrumental variable and therefore unconfounded. Thus, Model 1 was unadjusted. To obtain more precise regression estimates, Model 2 was adjusted for factors associated with the outcome, namely sex and socio-economic position (SEP). To explore the mechanistic pathway downstream of APOE ε genotype but upstream of the echocardiographic outcomes, subsequent models were adjusted for mediators as follows: Model 3 for body mass index, Model 4 for the presence of cardiovascular disease (CVD), Model 5 for diabetes, Model 6 for high cholesterol and Model 7 for hypertension.
Results
1464 participants were included. Compared to non-APOE ε4 and homozygous groups, heterozygous-APOE ε4 individuals had similar cardiac phenotypes in terms of EF, E/e', LVPWTs/d, IVSs/d and LVmassi but had a 7% higher MCFi 95% confidence interval [CI]: 1%-13%, p=0.017) which persisted even after adjustment for sex and SEP (95% CI 1%-12%, p=0.026) that was attenuated to 6% after adjustment for CVD (95% CI 0–13% p=0.050) and hypertension (95% CI 1–13% p=0.022).
Conclusion
The heterozygous-APOE ε4 state associates with improved myocardial shortening in older age resulting in greater LV stroke volume generation per 1 mL of myocardium. As we found no association between APOE ε4 carriage and LVPWTs/d, IVSs/d or LVmassi, MCFi enhancement may be mediated by improved myocardial energetics and contractility, with calcium and androgens potentially implicated, rather than through pathological ventricular thickening. Although a dose relationship is normally expected with ε4 carriage, any benefit from increased energetics and contractility is likely to be counterbalances by the higher risk of CVD and cardiovascular risk factors.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): UK Medical Research Council British Heart Foundation
Collapse
Affiliation(s)
- C Topriceanu
- University College London, UCL Institute of Cardiovascular Science , London , United Kingdom
| | - M Weber
- University College London, UCL Institute of Cardiovascular Science , London , United Kingdom
| | - C Fiona
- University College London, UCL Institute of Cardiovascular Science , London , United Kingdom
| | - J C Moon
- Barts Heart Centre , London , United Kingdom
| | - N Chaturvedi
- University College London, UCL MRC Unit of Lifelong Health and Ageing , London , United Kingdom
| | - A D Hughes
- University College London, UCL MRC Unit of Lifelong Health and Ageing , London , United Kingdom
| | - J Schott
- University College London, UCL MRC Unit of Lifelong Health and Ageing , London , United Kingdom
| | - M Richards
- University College London, UCL MRC Unit of Lifelong Health and Ageing , London , United Kingdom
| | - G Captur
- University College London, UCL MRC Unit of Lifelong Health and Ageing , London , United Kingdom
| |
Collapse
|
25
|
Green MJ, Maddock J, Di Gessa G, Wielgoszewska B, Parsons S, Griffith GJ, Croft J, Stevenson AJ, Huggins CF, Booth C, Wels J, Silverwood RJ, Patalay P, Hughes AD, Chaturvedi N, Howe LD, Fitzsimons E, Katikireddi SV, Ploubidis GB. The UK Coronavirus Job Retention Scheme and smoking, alcohol consumption and vaping during the COVID-19 pandemic: evidence from eight longitudinal population surveys. BMC Med 2022; 20:345. [PMID: 36127702 PMCID: PMC9489267 DOI: 10.1186/s12916-022-02511-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 08/02/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Employment disruptions can impact smoking and alcohol consumption. During the COVID-19 pandemic, many countries implemented furlough schemes to prevent job loss. We examine how furlough was associated with smoking, vaping and alcohol consumption in the UK. METHODS Data from 27,841 participants in eight UK adult longitudinal surveys were analysed. Participants self-reported employment status and current smoking, current vaping and alcohol consumption (>4 days/week or 5+ drinks per typical occasion) both before and during the early stages of the pandemic (April-July 2020). Risk ratios were estimated within each study using modified Poisson regression, adjusting for a range of potential confounders, including pre-pandemic behaviour. Findings were synthesised using random effects meta-analysis. RESULTS Compared to stable employment and after adjustment for pre-pandemic characteristics, furlough was not associated with smoking (ARR = 1.05; 95% CI: 0.95-1.16; I2: 10%), vaping (ARR = 0.89; 95% CI: 0.74-1.08; I2: 0%) or drinking (ARR = 1.03; 95% CI: 0.94-1.13; I2: 48%). There were similar findings for no longer being employed, and stable unemployment, though this varied by sex: stable unemployment was associated with smoking for women (ARR = 1.35; 95% CI: 1.00-1.82; I2: 47%) but not men (0.84; 95% CI: 0.67-1.05; I2: 0%). No longer being employed was associated with vaping among women (ARR = 2.74; 95% CI: 1.59-4.72; I2: 0%) but not men (ARR = 1.25; 95% CI: 0.83-1.87; I2: 0%). CONCLUSIONS We found no clear evidence of furlough or unemployment having adverse impacts on smoking, vaping or drinking behaviours during the early stages of the COVID-19 pandemic in the UK. Differences in risk compared to those who remained employed were largely explained by pre-pandemic characteristics.
Collapse
Affiliation(s)
- Michael J Green
- MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, Glasgow, UK.
| | - Jane Maddock
- MRC Unit for Lifelong Health and Ageing, University College London, London, UK
| | - Giorgio Di Gessa
- Institute of Epidemiology and Health Care, University College London, London, UK
| | - Bożena Wielgoszewska
- Centre for Longitudinal Studies, UCL Social Research Institute, University College London, London, UK
| | - Sam Parsons
- Centre for Longitudinal Studies, UCL Social Research Institute, University College London, London, UK
| | - Gareth J Griffith
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - Jazz Croft
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - Anna J Stevenson
- Centre for Genomic and Experimental Medicine, University of Edinburgh, Edinburgh, UK
| | - Charlotte F Huggins
- Centre for Genomic and Experimental Medicine, University of Edinburgh, Edinburgh, UK
| | - Charlotte Booth
- Centre for Longitudinal Studies, UCL Social Research Institute, University College London, London, UK
| | - Jacques Wels
- MRC Unit for Lifelong Health and Ageing, University College London, London, UK
| | - Richard J Silverwood
- Centre for Longitudinal Studies, UCL Social Research Institute, University College London, London, UK
| | - Praveetha Patalay
- MRC Unit for Lifelong Health and Ageing, University College London, London, UK.,Centre for Longitudinal Studies, UCL Social Research Institute, University College London, London, UK
| | - Alun D Hughes
- MRC Unit for Lifelong Health and Ageing, University College London, London, UK
| | - Nishi Chaturvedi
- MRC Unit for Lifelong Health and Ageing, University College London, London, UK
| | - Laura D Howe
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - Emla Fitzsimons
- Centre for Longitudinal Studies, UCL Social Research Institute, University College London, London, UK
| | | | - George B Ploubidis
- Centre for Longitudinal Studies, UCL Social Research Institute, University College London, London, UK
| |
Collapse
|
26
|
Knight R, Walker V, Ip S, Cooper JA, Bolton T, Keene S, Denholm R, Akbari A, Abbasizanjani H, Torabi F, Omigie E, Hollings S, North TL, Toms R, Jiang X, Angelantonio ED, Denaxas S, Thygesen JH, Tomlinson C, Bray B, Smith CJ, Barber M, Khunti K, Davey Smith G, Chaturvedi N, Sudlow C, Whiteley WN, Wood AM, Sterne JA. Association of COVID-19 With Major Arterial and Venous Thrombotic Diseases: A Population-Wide Cohort Study of 48 Million Adults in England and Wales. Circulation 2022; 146:892-906. [PMID: 36121907 PMCID: PMC9484653 DOI: 10.1161/circulationaha.122.060785] [Citation(s) in RCA: 84] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) induces a prothrombotic state, but long-term effects of COVID-19 on incidence of vascular diseases are unclear. METHODS We studied vascular diseases after COVID-19 diagnosis in population-wide anonymized linked English and Welsh electronic health records from January 1 to December 7, 2020. We estimated adjusted hazard ratios comparing the incidence of arterial thromboses and venous thromboembolic events (VTEs) after diagnosis of COVID-19 with the incidence in people without a COVID-19 diagnosis. We conducted subgroup analyses by COVID-19 severity, demographic characteristics, and previous history. RESULTS Among 48 million adults, 125 985 were hospitalized and 1 319 789 were not hospitalized within 28 days of COVID-19 diagnosis. In England, there were 260 279 first arterial thromboses and 59 421 first VTEs during 41.6 million person-years of follow-up. Adjusted hazard ratios for first arterial thrombosis after COVID-19 diagnosis compared with no COVID-19 diagnosis declined from 21.7 (95% CI, 21.0-22.4) in week 1 after COVID-19 diagnosis to 1.34 (95% CI, 1.21-1.48) during weeks 27 to 49. Adjusted hazard ratios for first VTE after COVID-19 diagnosis declined from 33.2 (95% CI, 31.3-35.2) in week 1 to 1.80 (95% CI, 1.50-2.17) during weeks 27 to 49. Adjusted hazard ratios were higher, for longer after diagnosis, after hospitalized versus nonhospitalized COVID-19, among Black or Asian versus White people, and among people without versus with a previous event. The estimated whole-population increases in risk of arterial thromboses and VTEs 49 weeks after COVID-19 diagnosis were 0.5% and 0.25%, respectively, corresponding to 7200 and 3500 additional events, respectively, after 1.4 million COVID-19 diagnoses. CONCLUSIONS High relative incidence of vascular events soon after COVID-19 diagnosis declines more rapidly for arterial thromboses than VTEs. However, incidence remains elevated up to 49 weeks after COVID-19 diagnosis. These results support policies to prevent severe COVID-19 by means of COVID-19 vaccines, early review after discharge, risk factor control, and use of secondary preventive agents in high-risk patients.
Collapse
Affiliation(s)
- Rochelle Knight
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, UK (R.K., V.W., J.A.C., R.D., T.-L.N., R.T., G.D.S., J.A.C.S.)
- NIHR Bristol Biomedical Research Centre, UK (R.K., J.A.C., R.D., J.A.C.S.)
- NIHR Applied Research Collaboration West, Bristol, UK (R.K.)
- MRC Integrative Epidemiology Unit, Bristol, UK (R.K., V.W., G.D.S.)
| | - Venexia Walker
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, UK (R.K., V.W., J.A.C., R.D., T.-L.N., R.T., G.D.S., J.A.C.S.)
- MRC Integrative Epidemiology Unit, Bristol, UK (R.K., V.W., G.D.S.)
| | - Samantha Ip
- British Heart Foundation Cardiovascular Epidemiology Unit (S.I., T.B., S.K., X.J., E.D.A., A.M.W.), University of Cambridge, UK
- Centre for Cancer Genetic Epidemiology (S.I.), University of Cambridge, UK
| | - Jennifer A. Cooper
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, UK (R.K., V.W., J.A.C., R.D., T.-L.N., R.T., G.D.S., J.A.C.S.)
- NIHR Bristol Biomedical Research Centre, UK (R.K., J.A.C., R.D., J.A.C.S.)
| | - Thomas Bolton
- British Heart Foundation Cardiovascular Epidemiology Unit (S.I., T.B., S.K., X.J., E.D.A., A.M.W.), University of Cambridge, UK
- Department of Public Health and Primary Care, NIHR Blood and Transplant Research Unit in Donor Health and Genomics (T.B., S.K., E.D.A., A.M.W.), University of Cambridge, UK
- British Heart Foundation Data Science Centre (T.B., C.S.), London
| | - Spencer Keene
- British Heart Foundation Cardiovascular Epidemiology Unit (S.I., T.B., S.K., X.J., E.D.A., A.M.W.), University of Cambridge, UK
- Department of Public Health and Primary Care, NIHR Blood and Transplant Research Unit in Donor Health and Genomics (T.B., S.K., E.D.A., A.M.W.), University of Cambridge, UK
| | - Rachel Denholm
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, UK (R.K., V.W., J.A.C., R.D., T.-L.N., R.T., G.D.S., J.A.C.S.)
- NIHR Bristol Biomedical Research Centre, UK (R.K., J.A.C., R.D., J.A.C.S.)
- Health Data Research UK South-West, Bristol (R.D., J.A.C.S.)
| | - Ashley Akbari
- Population Data Science, Swansea University Medical School, Swansea University, Wales, UK (A.A., H.A., F.T.)
| | - Hoda Abbasizanjani
- Population Data Science, Swansea University Medical School, Swansea University, Wales, UK (A.A., H.A., F.T.)
| | - Fatemeh Torabi
- Population Data Science, Swansea University Medical School, Swansea University, Wales, UK (A.A., H.A., F.T.)
| | - Efosa Omigie
- National Health Service Digital, Leeds, UK (E.O., S.H.)
| | - Sam Hollings
- National Health Service Digital, Leeds, UK (E.O., S.H.)
| | - Teri-Louise North
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, UK (R.K., V.W., J.A.C., R.D., T.-L.N., R.T., G.D.S., J.A.C.S.)
| | - Renin Toms
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, UK (R.K., V.W., J.A.C., R.D., T.-L.N., R.T., G.D.S., J.A.C.S.)
- School of Health Sciences, Cardiff Metropolitan University, UK (R.T.)
| | - Xiyun Jiang
- British Heart Foundation Cardiovascular Epidemiology Unit (S.I., T.B., S.K., X.J., E.D.A., A.M.W.), University of Cambridge, UK
| | - Emanuele Di Angelantonio
- British Heart Foundation Cardiovascular Epidemiology Unit (S.I., T.B., S.K., X.J., E.D.A., A.M.W.), University of Cambridge, UK
- Department of Public Health and Primary Care, NIHR Blood and Transplant Research Unit in Donor Health and Genomics (T.B., S.K., E.D.A., A.M.W.), University of Cambridge, UK
- British Heart Foundation Centre of Research Excellence (E.D.A., A.M.W.), University of Cambridge, UK
- Wellcome Genome Campus, Health Data Research UK Cambridge (E.D.A., A.M.W.)
| | - Spiros Denaxas
- Health Data Research UK (S.D.), London
- Institute of Health Informatics (S.D., J.H.T., C.T.), University College London, UK
- University College London Hospitals Biomedical Research Centre (C.T., S.D.), University College London, UK
- BHF Accelerator, London, UK (S.D.)
| | - Johan H. Thygesen
- Institute of Health Informatics (S.D., J.H.T., C.T.), University College London, UK
| | - Christopher Tomlinson
- Institute of Health Informatics (S.D., J.H.T., C.T.), University College London, UK
- UK Research and Innovation Centre for Doctoral Training in AI-Enabled Healthcare Systems (C.T.), University College London, UK
- University College London Hospitals Biomedical Research Centre (C.T., S.D.), University College London, UK
| | - Ben Bray
- School of Population Health and Environmental Sciences, King’s College London, UK (B.B.)
| | - Craig J. Smith
- Geoffrey Jefferson Brain Research Centre, Manchester Centre for Clinical Neurosciences, Northern Care Alliance National Health Service Foundation Trust, Salford Royal Hospital, UK (C.J.S.)
- Division of Cardiovascular Sciences, Manchester Academic Health Science Centre, University of Manchester, UK (C.J.S.)
| | | | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, UK (K.K.)
| | - George Davey Smith
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, UK (R.K., V.W., J.A.C., R.D., T.-L.N., R.T., G.D.S., J.A.C.S.)
- MRC Integrative Epidemiology Unit, Bristol, UK (R.K., V.W., G.D.S.)
| | - Nishi Chaturvedi
- MRC Unit for Lifelong Health and Ageing at UCL, Institute of Cardiovascular Science (N.C.), University College London, UK
| | - Cathie Sudlow
- British Heart Foundation Data Science Centre (T.B., C.S.), London
| | - William N. Whiteley
- Centre for Clinical Brain Sciences, University of Edinburgh, UK (W.N.W.)
- Nuffield Department of Population Health, University of Oxford, UK (W.N.W.)
| | - Angela M. Wood
- British Heart Foundation Cardiovascular Epidemiology Unit (S.I., T.B., S.K., X.J., E.D.A., A.M.W.), University of Cambridge, UK
- Department of Public Health and Primary Care, NIHR Blood and Transplant Research Unit in Donor Health and Genomics (T.B., S.K., E.D.A., A.M.W.), University of Cambridge, UK
- British Heart Foundation Centre of Research Excellence (E.D.A., A.M.W.), University of Cambridge, UK
- Wellcome Genome Campus, Health Data Research UK Cambridge (E.D.A., A.M.W.)
- NIHR Cambridge Biomedical Research Centre, UK (A.M.W.)
- Cambridge Centre for AI in Medicine, UK (A.M.W.)
| | - Jonathan A.C. Sterne
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, UK (R.K., V.W., J.A.C., R.D., T.-L.N., R.T., G.D.S., J.A.C.S.)
- NIHR Bristol Biomedical Research Centre, UK (R.K., J.A.C., R.D., J.A.C.S.)
- Health Data Research UK South-West, Bristol (R.D., J.A.C.S.)
| |
Collapse
|
27
|
Molinari M, Cremaschi A, De Iorio M, Chaturvedi N, Hughes A, Tillin T. Bayesian dynamic network modelling: an application to metabolic associations in cardiovascular diseases. J Appl Stat 2022; 51:114-138. [PMID: 38179161 PMCID: PMC10763914 DOI: 10.1080/02664763.2022.2116746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 08/14/2022] [Indexed: 10/14/2022]
Abstract
We propose a novel approach to the estimation of multiple Graphical Models to analyse temporal patterns of association among a set of metabolites over different groups of patients. Our motivating application is the Southall And Brent REvisited (SABRE) study, a tri-ethnic cohort study conducted in the UK. We are interested in identifying potential ethnic differences in metabolite levels and associations as well as their evolution over time, with the aim of gaining a better understanding of different risk of cardio-metabolic disorders across ethnicities. Within a Bayesian framework, we employ a nodewise regression approach to infer the structure of the graphs, borrowing information across time as well as across ethnicities. The response variables of interest are metabolite levels measured at two time points and for two ethnic groups, Europeans and South-Asians. We use nodewise regression to estimate the high-dimensional precision matrices of the metabolites, imposing sparsity on the regression coefficients through the dynamic horseshoe prior, thus favouring sparser graphs. We provide the code to fit the proposed model using the software Stan, which performs posterior inference using Hamiltonian Monte Carlo sampling, as well as a detailed description of a block Gibbs sampling scheme.
Collapse
Affiliation(s)
- Marco Molinari
- Department of Statistical Science, University College, London, London, UK
| | | | - Maria De Iorio
- Department of Statistical Science, University College, London, London, UK
- Singapore Institute for Clinical Sciences, A*STAR, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Nishi Chaturvedi
- Department of Population Science and Experimental Medicine, University College London, London, UK
| | - Alun Hughes
- Department of Population Science and Experimental Medicine, University College London, London, UK
| | - Therese Tillin
- Department of Population Science and Experimental Medicine, University College London, London, UK
| |
Collapse
|
28
|
Jones S, Schultz MG, Park C, Tillin T, Chaturvedi N, Hughes AD. Antihypertensive treatment effect on exercise blood pressure and exercise capacity in older adults. J Hypertens 2022; 40:1682-1691. [PMID: 35881442 DOI: 10.1097/hjh.0000000000003201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND An exaggerated blood pressure (BP) response to exercise and low exercise capacity are risk factors for cardiovascular disease (CVD). The effect of pharmacological antihypertensive treatment on exercise BP in older adults is largely unknown. This study investigates these effects accounting for differences in exercise capacity. METHODS Participants enrolled in the Southall and Brent Revisited (SABRE) study undertook a 6-min stepper test with expired gas analysis and BP measured throughout exercise. Participants were stratified by antihypertensive treatment status and resting BP control. Exercise systolic and diastolic BP (exSBP and exDBP) were compared between groups using potential outcome means [95% confidence intervals (CIs)] adjusted for exercise capacity. Exercise capacity was also compared by group. RESULTS In total, 659 participants were included (mean age ± SD: 73 ± 6.6 years, 57% male). 31% of normotensive and 23% of hypertensive older adults with controlled resting BP had an exaggerated exercise BP. ExSBP was similar between normotensive and treated/controlled individuals [mean (95%CI): 180 (176 184) mmHg vs. 177 (173 181) mmHg, respectively] but was higher in treated/uncontrolled and untreated/uncontrolled individuals [mean (95% CI): 194 (190 197) mmHg, P < 0.001 and 199 (194 204) mmHg, P < 0.001, respectively]; these differences persisted after adjustment for exercise capacity and other confounders. Exercise capacity was lower in treated vs. normotensive individuals [mean (95% CI) normotensive: 16.7 (16.0,17.4) ml/kg/min]; treated/controlled: 15.5 (14.8,16.1) ml/kg/min, P = 0.009; treated/uncontrolled: [15.1 (14.5,15.7) ml/kg per min, P = 0.001] but was not reduced in untreated/uncontrolled individuals [mean (95% CI): 17.0 (16.1,17.8) ml/kg per min, P = 0.621]. CONCLUSION Irrespective of resting BP control and despite performing less exercise, antihypertensive treatment does not fully mitigate an exaggerated BP response to exercise suggesting residual CVD risk in older adults.
Collapse
Affiliation(s)
- Siana Jones
- MRC Unit for Lifelong Health & Ageing at UCL, Department of Population Science & Experimental Medicine, Institute for Cardiovascular Science, University College London, UK
| | - Martin G Schultz
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Chloe Park
- MRC Unit for Lifelong Health & Ageing at UCL, Department of Population Science & Experimental Medicine, Institute for Cardiovascular Science, University College London, UK
| | - Therese Tillin
- MRC Unit for Lifelong Health & Ageing at UCL, Department of Population Science & Experimental Medicine, Institute for Cardiovascular Science, University College London, UK
| | - Nishi Chaturvedi
- MRC Unit for Lifelong Health & Ageing at UCL, Department of Population Science & Experimental Medicine, Institute for Cardiovascular Science, University College London, UK
| | - Alun D Hughes
- MRC Unit for Lifelong Health & Ageing at UCL, Department of Population Science & Experimental Medicine, Institute for Cardiovascular Science, University College London, UK
| |
Collapse
|
29
|
Jacques Wels, Booth C, Wielgoszewska B, Green MJ, Di Gessa G, Huggins CF, Griffith GJ, Kwong ASF, Bowyer RCE, Maddock J, Patalay P, Silverwood RJ, Fitzsimons E, Shaw R, Thompson EJ, Steptoe A, Hughes A, Chaturvedi N, Steves CJ, Katikireddi SV, Ploubidis GB. Mental and social wellbeing and the UK coronavirus job retention scheme: Evidence from nine longitudinal studies. Soc Sci Med 2022; 308:115226. [PMID: 35932537 PMCID: PMC9296227 DOI: 10.1016/j.socscimed.2022.115226] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 07/15/2022] [Accepted: 07/15/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND The COVID-19 pandemic has led to major economic disruptions. In March 2020, the UK implemented the Coronavirus Job Retention Scheme - known as furlough - to minimize the impact of job losses. We investigate associations between change in employment status and mental and social wellbeing during the early stages of the pandemic. METHODS Data were from 25,670 respondents, aged 17-66, across nine UK longitudinal studies. Furlough and other employment changes were defined using employment status pre-pandemic and during the first lockdown (April-June 2020). Mental and social wellbeing outcomes included psychological distress, life satisfaction, self-rated health, social contact, and loneliness. Study-specific modified Poisson regression estimates, adjusting for socio-demographic characteristics and pre-pandemic mental and social wellbeing, were pooled using meta-analysis. Associations were also stratified by sex, age, education, and household composition. RESULTS Compared to those who remained working, furloughed workers were at greater risk of psychological distress (adjusted risk ratio, ARR = 1.12; 95%CI: 0.97, 1.29), low life satisfaction (ARR = 1.14; 95%CI: 1.07, 1.22), loneliness (ARR = 1.12; 95%CI: 1.01, 1.23), and poor self-rated health (ARR = 1.26; 95%CI: 1.05, 1.50). Nevertheless, compared to furloughed workers, those who became unemployed had greater risk of psychological distress (ARR = 1.30; 95%CI: 1.12, 1.52), low life satisfaction (ARR = 1.16; 95%CI: 0.98, 1.38), and loneliness (ARR = 1.67; 95%CI: 1.08, 2.59). Effects were not uniform across all sub-groups. CONCLUSIONS During the early stages of the pandemic, those furloughed had increased risk of poor mental and social wellbeing, but furloughed workers fared better than those who became unemployed, suggesting that furlough may have partly mitigated poorer outcomes.
Collapse
Affiliation(s)
- Jacques Wels
- MRC Unit for Lifelong Health and Ageing, University College London, UK.
| | - Charlotte Booth
- Centre for Longitudinal Studies, Social Research Institute, University College London, UK
| | - Bożena Wielgoszewska
- Centre for Longitudinal Studies, Social Research Institute, University College London, UK
| | - Michael J Green
- MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, UK
| | - Giorgio Di Gessa
- Institute of Epidemiology and Health Care, University College London, UK
| | | | | | - Alex S F Kwong
- MRC Integrative Epidemiology Unit, University of Bristol, UK
| | - Ruth C E Bowyer
- Department of Twin Research & Genetic Epidemiology, King's College London, UK
| | - Jane Maddock
- MRC Unit for Lifelong Health and Ageing, University College London, UK
| | - Praveetha Patalay
- MRC Unit for Lifelong Health and Ageing, University College London, UK; Centre for Longitudinal Studies, Social Research Institute, University College London, UK
| | - Richard J Silverwood
- Centre for Longitudinal Studies, Social Research Institute, University College London, UK
| | - Emla Fitzsimons
- Centre for Longitudinal Studies, Social Research Institute, University College London, UK
| | - Richard Shaw
- MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, UK
| | - Ellen J Thompson
- Department of Twin Research & Genetic Epidemiology, King's College London, UK
| | - Andrew Steptoe
- Institute of Epidemiology and Health Care, University College London, UK
| | - Alun Hughes
- MRC Unit for Lifelong Health and Ageing, University College London, UK
| | - Nishi Chaturvedi
- MRC Unit for Lifelong Health and Ageing, University College London, UK
| | - Claire J Steves
- Department of Twin Research & Genetic Epidemiology, King's College London, UK
| | | | - George B Ploubidis
- Centre for Longitudinal Studies, Social Research Institute, University College London, UK
| |
Collapse
|
30
|
Joshi R, Wannamethee G, Engmann J, Gaunt T, Lawlor D, Price J, Tillin T, Chaturvedi N, Kivimaki M, Hughes A, Wong A, Hingorani A, Schmidt A. Association of triglyceride and cholesterol content in fourteen lipoprotein subfractions with coronary heart disease: A mendelian randomisation analysis. Atherosclerosis 2022. [DOI: 10.1016/j.atherosclerosis.2022.06.425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
31
|
Wielgoszewska B, Maddock J, Green MJ, Di Gessa G, Parsons S, Griffith GJ, Croft J, Stevenson AJ, Booth C, Silverwood RJ, Bann D, Patalay P, Hughes AD, Chaturvedi N, Howe LD, Fitzsimons E, Katikireddi SV, Ploubidis GB. Correction: The UK Coronavirus Job Retention Scheme and diet, physical activity, and sleep during the COVID-19 pandemic: evidence from eight longitudinal population surveys. BMC Med 2022; 20:285. [PMID: 35907837 PMCID: PMC9338472 DOI: 10.1186/s12916-022-02502-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Bożena Wielgoszewska
- Centre for Longitudinal Studies, UCL Social Research Institute, University College London, Gower St, Bloomsbury, London, WC1E 6BT, UK
| | - Jane Maddock
- MRC Unit for Lifelong Health and Ageing, University College London, Gower St, Bloomsbury, London, WC1E 6BT, UK.
| | - Michael J Green
- MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Giorgio Di Gessa
- Institute of Epidemiology and Health Care, University College London, London, UK
| | - Sam Parsons
- Centre for Longitudinal Studies, UCL Social Research Institute, University College London, Gower St, Bloomsbury, London, WC1E 6BT, UK
| | - Gareth J Griffith
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - Jazz Croft
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - Anna J Stevenson
- Centre for Genomic and Experimental Medicine, University of Edinburgh, Edinburgh, UK
| | - Charlotte Booth
- Centre for Longitudinal Studies, UCL Social Research Institute, University College London, Gower St, Bloomsbury, London, WC1E 6BT, UK
| | - Richard J Silverwood
- Centre for Longitudinal Studies, UCL Social Research Institute, University College London, Gower St, Bloomsbury, London, WC1E 6BT, UK
| | - David Bann
- Centre for Longitudinal Studies, UCL Social Research Institute, University College London, Gower St, Bloomsbury, London, WC1E 6BT, UK
| | - Praveetha Patalay
- Centre for Longitudinal Studies, UCL Social Research Institute, University College London, Gower St, Bloomsbury, London, WC1E 6BT, UK.,MRC Unit for Lifelong Health and Ageing, University College London, Gower St, Bloomsbury, London, WC1E 6BT, UK
| | - Alun D Hughes
- MRC Unit for Lifelong Health and Ageing, University College London, Gower St, Bloomsbury, London, WC1E 6BT, UK
| | - Nishi Chaturvedi
- MRC Unit for Lifelong Health and Ageing, University College London, Gower St, Bloomsbury, London, WC1E 6BT, UK
| | - Laura D Howe
- Institute of Epidemiology and Health Care, University College London, London, UK
| | - Emla Fitzsimons
- Centre for Longitudinal Studies, UCL Social Research Institute, University College London, Gower St, Bloomsbury, London, WC1E 6BT, UK
| | | | - George B Ploubidis
- Centre for Longitudinal Studies, UCL Social Research Institute, University College London, Gower St, Bloomsbury, London, WC1E 6BT, UK.
| |
Collapse
|
32
|
Jones S, Tillin T, Williams S, Rapala A, Chaturvedi N, Hughes AD. Skeletal Muscle Tissue Saturation Changes Measured Using Near Infrared Spectroscopy During Exercise Are Associated With Post-Occlusive Reactive Hyperaemia. Front Physiol 2022; 13:919754. [PMID: 35874520 PMCID: PMC9304617 DOI: 10.3389/fphys.2022.919754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 06/17/2022] [Indexed: 11/22/2022] Open
Abstract
Measuring local haemodynamics in skeletal muscle has the potential to provide valuable insight into the oxygen delivery to tissue, especially during high demand situations such as exercise. The aim of this study was to compare the skeletal muscle microvascular response during post-occlusive reactive hyperaemia (PORH) with the response to exercise, each measured using near-infrared spectroscopy (NIRS) and to establish if associations exist between muscle measures and exercise capacity or sex. Participants were from a population-based cohort study, the Southall and Brent Revisited (SABRE) study. Skeletal muscle measures included changes in tissue saturation index at the onset of exercise (∆TSIBL-INC) and across the whole of exercise (∆TSIBL-EE), time to 50%, 95% and 100% PORH, rate of PORH recovery, area under the curve (AUC) and total oxygenated Haemoglobin (oxy-Hb) change during PORH. Exercise capacity was measured using a 6-min stepper test (6MST). Analysis was by multiple linear regression. In total, 558 participants completed the 6MST with NIRS measures of TSI (mean age±SD: 73 ± 7years, 59% male). A sub-set of 149 participants also undertook the arterial occlusion. Time to 100% PORH, recovery rate, AUC and ∆oxy-Hb were all associated with ∆TSIBL-EE (β-coefficient (95%CI): 0.05 (0.01, 0.09), p = 0.012; -47 (-85, -9.9), p = 0.014; 1.7 (0.62, 2.8), p = 0.002; 0.04 (0.002.0.108), p = 0.041, respectively). Time to 95% & 100% PORH, AUC and ∆oxy-Hb were all associated with ∆TSIBL-INC (β-coefficient (95%CI): -0.07 (-0.12,-0.02), p = 0.02; -0.03 (-0.05, -0.003), p = 0.028; 0.85 (0.18, 1.5), p = 0.013 & 0.05 (0.02, 0.09), p = 0.001, respectively). AUC and ∆Oxy-Hb were associated with steps achieved (β-coefficient (95%CI): 18.0 (2.3, 33.7), p = 0.025; 0.86 (0.10, 1.6), p = 0.027). ∆TSIBL-EE was associated with steps and highest VO2 (1.7 (0.49, 2.9), p = 0.006; 7.7 (3.2, 12.3), p = 0.001). ∆TSIBL-INC was associated with steps and VO2 but this difference was attenuated towards the null after adjustment for age, sex and ethnicity. ∆TSIBL-EE was greater in women (3.4 (0.4, 8.9) versus 2.1 (0.3, 7.4), p = 0.017) and ∆TSIBL-INC was lower in women versus men (2.4 (0.2, 10.2) versus 3.2 (0.2, 18.2), p = 0.016). These Local microvascular NIRS-measures are associated with exercise capacity in older adults and several measures can detect differences in microvascular reactivity between a community-based sample of men and women.
Collapse
Affiliation(s)
- Siana Jones
- MRC Unit for Lifelong Health & Ageing at UCL, Department of Population Science and Experimental Medicine, Institute for Cardiovascular Science, University College London, London, United Kingdom
| | | | | | | | | | | |
Collapse
|
33
|
Kuusisto S, Karjalainen MK, Tillin T, Kangas AJ, Holmes MV, Kähönen M, Lehtimäki T, Viikari J, Perola M, Chaturvedi N, Salomaa V, Raitakari OT, Järvelin MR, Kettunen J, Ala-Korpela M. Genetic and observational evidence: No independent role for cholesterol efflux over static high-density lipoprotein concentration measures in coronary heart disease risk assessment. J Intern Med 2022; 292:146-153. [PMID: 35289444 PMCID: PMC9311699 DOI: 10.1111/joim.13479] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Observational findings for high-density lipoprotein (HDL)-mediated cholesterol efflux capacity (HDL-CEC) and coronary heart disease (CHD) appear inconsistent, and knowledge of the genetic architecture of HDL-CEC is limited. OBJECTIVES A large-scale observational study on the associations of HDL-CEC and other HDL-related measures with CHD and the largest genome-wide association study (GWAS) of HDL-CEC. PARTICIPANTS/METHODS Six independent cohorts were included with follow-up data for 14,438 participants to investigate the associations of HDL-related measures with incident CHD (1,570 events). The GWAS of HDL-CEC was carried out in 20,372 participants. RESULTS HDL-CEC did not associate with CHD when adjusted for traditional risk factors and HDL cholesterol (HDL-C). In contradiction, almost all HDL-related concentration measures associated consistently with CHD after corresponding adjustments. There were no genetic loci associated with HDL-CEC independent of HDL-C and triglycerides. CONCLUSION HDL-CEC is not unequivocally associated with CHD in contrast to HDL-C, apolipoprotein A-I, and most of the HDL subclass particle concentrations.
Collapse
Affiliation(s)
- Sanna Kuusisto
- Computational Medicine, Faculty of Medicine, University of Oulu, Oulu, Finland.,Center for Life Course Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland.,NMR Metabolomics Laboratory, School of Pharmacy, University of Eastern Finland, Kuopio, Finland.,Biocenter Oulu, University of Oulu, Oulu, Finland
| | - Minna K Karjalainen
- Computational Medicine, Faculty of Medicine, University of Oulu, Oulu, Finland.,Center for Life Course Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland.,Biocenter Oulu, University of Oulu, Oulu, Finland.,Northern Finland Birth Cohorts, Arctic Biobank, Infrastructure for Population Studies, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Therese Tillin
- MRC Unit for Lifelong Health and Ageing at UCL, Institute of Cardiovascular Science, University College London, London, UK
| | | | - Michael V Holmes
- Medical Research Council Population Health Research Unit, University of Oxford, Oxford, UK
| | - Mika Kähönen
- Department of Clinical Physiology, Tampere University Hospital and Finnish Cardiovascular Research Center Tampere, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Terho Lehtimäki
- Department of Clinical Chemistry, Fimlab Laboratories and Finnish Cardiovascular Research Center Tampere, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Jorma Viikari
- Department of Medicine, University of Turku, Turku, Finland.,Division of Medicine, Turku University Hospital, Turku, Finland
| | - Markus Perola
- Research Programs Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland.,Estonian Genome Center, University of Tartu, Tartu, Estonia.,Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Nishi Chaturvedi
- MRC Unit for Lifelong Health and Ageing at UCL, Institute of Cardiovascular Science, University College London, London, UK
| | - Veikko Salomaa
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Olli T Raitakari
- Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland.,Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland.,Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital, Turku, Finland
| | - Marjo-Riitta Järvelin
- Center for Life Course Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland.,Biocenter Oulu, University of Oulu, Oulu, Finland.,Unit of Primary Health Care, Oulu University Hospital (OYS), Oulu, Finland.,Department of Epidemiology and Biostatistics, MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College London, London, UK.,Department of Life Sciences, College of Health and Life Sciences, Brunel University London, London, UK
| | - Johannes Kettunen
- Computational Medicine, Faculty of Medicine, University of Oulu, Oulu, Finland.,Center for Life Course Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland.,Biocenter Oulu, University of Oulu, Oulu, Finland.,Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Mika Ala-Korpela
- Computational Medicine, Faculty of Medicine, University of Oulu, Oulu, Finland.,Center for Life Course Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland.,NMR Metabolomics Laboratory, School of Pharmacy, University of Eastern Finland, Kuopio, Finland.,Biocenter Oulu, University of Oulu, Oulu, Finland
| |
Collapse
|
34
|
Thompson EJ, Williams DM, Walker AJ, Mitchell RE, Niedzwiedz CL, Yang TC, Huggins CF, Kwong ASF, Silverwood RJ, Di Gessa G, Bowyer RCE, Northstone K, Hou B, Green MJ, Dodgeon B, Doores KJ, Duncan EL, Williams FMK, Steptoe A, Porteous DJ, McEachan RRC, Tomlinson L, Goldacre B, Patalay P, Ploubidis GB, Katikireddi SV, Tilling K, Rentsch CT, Timpson NJ, Chaturvedi N, Steves CJ. Long COVID burden and risk factors in 10 UK longitudinal studies and electronic health records. Nat Commun 2022; 13:3528. [PMID: 35764621 PMCID: PMC9240035 DOI: 10.1038/s41467-022-30836-0] [Citation(s) in RCA: 170] [Impact Index Per Article: 85.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 05/19/2022] [Indexed: 12/14/2022] Open
Abstract
The frequency of, and risk factors for, long COVID are unclear among community-based individuals with a history of COVID-19. To elucidate the burden and possible causes of long COVID in the community, we coordinated analyses of survey data from 6907 individuals with self-reported COVID-19 from 10 UK longitudinal study (LS) samples and 1.1 million individuals with COVID-19 diagnostic codes in electronic healthcare records (EHR) collected by spring 2021. Proportions of presumed COVID-19 cases in LS reporting any symptoms for 12+ weeks ranged from 7.8% and 17% (with 1.2 to 4.8% reporting debilitating symptoms). Increasing age, female sex, white ethnicity, poor pre-pandemic general and mental health, overweight/obesity, and asthma were associated with prolonged symptoms in both LS and EHR data, but findings for other factors, such as cardio-metabolic parameters, were inconclusive.
Collapse
Affiliation(s)
- Ellen J Thompson
- Department of Twin Research and Genetic Epidemiology, School of Life Course Sciences, King's College London, London, UK.
| | - Dylan M Williams
- MRC Unit for Lifelong Health and Ageing at UCL, University College London, London, UK.
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
| | - Alex J Walker
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxfort, UK
| | - Ruth E Mitchell
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Tiffany C Yang
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, BD9 6RJ, UK
| | - Charlotte F Huggins
- Centre for Genomic and Experimental Medicine, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK
| | - Alex S F Kwong
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
- Division of Psychiatry, University of Edinburgh, Edinburgh, UK
| | - Richard J Silverwood
- Centre for Longitudinal Studies, UCL Social Research Institute, University College London, London, UK
| | - Giorgio Di Gessa
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Ruth C E Bowyer
- Department of Twin Research and Genetic Epidemiology, School of Life Course Sciences, King's College London, London, UK
| | - Kate Northstone
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Bo Hou
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, BD9 6RJ, UK
| | - Michael J Green
- MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Brian Dodgeon
- Centre for Longitudinal Studies, UCL Social Research Institute, University College London, London, UK
| | - Katie J Doores
- School of Immunology & Microbial Sciences, King's College London, London, UK
| | - Emma L Duncan
- Department of Twin Research and Genetic Epidemiology, School of Life Course Sciences, King's College London, London, UK
| | - Frances M K Williams
- Department of Twin Research and Genetic Epidemiology, School of Life Course Sciences, King's College London, London, UK
| | - Andrew Steptoe
- Department of Epidemiology and Public Health, University College London, London, UK
| | - David J Porteous
- Centre for Genomic and Experimental Medicine, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK
| | - Rosemary R C McEachan
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, BD9 6RJ, UK
| | - Laurie Tomlinson
- Electronic Health Records Research Group, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Ben Goldacre
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxfort, UK
| | - Praveetha Patalay
- MRC Unit for Lifelong Health and Ageing at UCL, University College London, London, UK
- Centre for Longitudinal Studies, UCL Social Research Institute, University College London, London, UK
| | - George B Ploubidis
- Centre for Longitudinal Studies, UCL Social Research Institute, University College London, London, UK
| | | | - Kate Tilling
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
| | - Christopher T Rentsch
- Electronic Health Records Research Group, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
- VA Connecticut Healthcare System, West Haven, CT, USA
| | - Nicholas J Timpson
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Nishi Chaturvedi
- MRC Unit for Lifelong Health and Ageing at UCL, University College London, London, UK
| | - Claire J Steves
- Department of Twin Research and Genetic Epidemiology, School of Life Course Sciences, King's College London, London, UK.
- Department of Ageing and Health, Guys and St Thomas's NHS Foundation Trust, London, UK.
| |
Collapse
|
35
|
Molinari M, Cremaschi A, De Iorio M, Chaturvedi N, Hughes AD, Tillin T. Bayesian nonparametric modelling of multiple graphs with an application to ethnic metabolic differences. J R Stat Soc Ser C Appl Stat 2022. [DOI: 10.1111/rssc.12570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | - Andrea Cremaschi
- Singapore Institute of Clinical SciencesAgency for Science, Technology and Research SingaporeSingapore
| | - Maria De Iorio
- Department of Statistical ScienceUCL LondonUK
- Singapore Institute of Clinical SciencesAgency for Science, Technology and Research SingaporeSingapore
- Yong Loo Lin School of MedicineNational University of Singapore SingaporeSingapore
- Yale‐NUS College SingaporeSingapore
| | - Nishi Chaturvedi
- Department of Population Science & Experimental MedicineInstitute of Cardiovascular ScienceUCL LondonUK
| | - Alun D. Hughes
- Department of Population Science & Experimental MedicineInstitute of Cardiovascular ScienceUCL LondonUK
| | - Therese Tillin
- Department of Population Science & Experimental MedicineInstitute of Cardiovascular ScienceUCL LondonUK
| |
Collapse
|
36
|
Charalambous C, Moon JC, Holly JMP, Chaturvedi N, Hughes AD, Captur G. Declining Levels and Bioavailability of IGF-I in Cardiovascular Aging Associate With QT Prolongation-Results From the 1946 British Birth Cohort. Front Cardiovasc Med 2022; 9:863988. [PMID: 35528832 PMCID: PMC9072634 DOI: 10.3389/fcvm.2022.863988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 03/21/2022] [Indexed: 11/30/2022] Open
Abstract
Background As people age, circulating levels of insulin-like growth factors (IGFs) and IGF binding protein 3 (IGFBP-3) decline. In rat cardiomyocytes, IGF-I has been shown to regulate sarcolemmal potassium channel activity and late sodium current thus impacting cardiac repolarization and the heart rate-corrected QT (QTc). However, the relationship between IGFs and IGFBP-3 with the QTc interval in humans, is unknown. Objectives To examine the association of IGFs and IGFBP-3 with QTc interval in an older age population-based cohort. Methods Participants were from the 1946 Medical Research Council (MRC) National Survey of Health and Development (NSHD) British birth cohort. Biomarkers from blood samples at age 53 and 60-64 years (y, exposures) included IGF-I/II, IGFBP-3, IGF-I/IGFBP-3 ratio and the change (Δ) in marker levels between the 60-64 and 53y sampled timepoints. QTc (outcome) was recorded from electrocardiograms at the 60-64y timepoint. Generalized linear multivariable models with adjustments for relevant demographic and clinical factors, were used for complete-cases and repeated after multiple imputation. Results One thousand four hundred forty-eight participants were included (48.3% men; QTc mean 414 ms interquartile range 26 ms). Univariate analysis revealed an association between low IGF-I and IGF-I/IGFBP-3 ratio at 60-64y with QTc prolongation [respectively: β -0.30 ms/nmol/L, (95% confidence intervals -0.44, -0.17), p < 0.001; β-28.9 ms/unit (-41.93, -15.50), p < 0.001], but not with IGF-II or IGFBP-3. No association with QTc was found for IGF biomarkers sampled at 53y, however both ΔIGF-I and ΔIGF-I/IGFBP-3 ratio were negatively associated with QTc [β -0.04 ms/nmol/L (-0.08, -0.008), p = 0.019; β -2.44 ms/unit (-4.17, -0.67), p = 0.007] while ΔIGF-II and ΔIGFBP-3 showed no association. In fully adjusted complete case and imputed models (reporting latter) low IGF-I and IGF-I/IGFBP-3 ratio at 60-64y [β -0.21 ms/nmol/L (-0.39, -0.04), p = 0.017; β -20.14 ms/unit (-36.28, -3.99), p = 0.015], steeper decline in ΔIGF-I [β -0.05 ms/nmol/L/10 years (-0.10, -0.002), p = 0.042] and shallower rise in ΔIGF-I/IGFBP-3 ratio over a decade [β -2.16 ms/unit/10 years (-4.23, -0.09), p = 0.041], were all independently associated with QTc prolongation. Independent associations with QTc were also confirmed for other previously known covariates: female sex [β 9.65 ms (6.65, 12.65), p < 0.001], increased left ventricular mass [β 0.04 ms/g (0.02, 0.06), p < 0.001] and blood potassium levels [β -5.70 ms/mmol/L (-10.23, -1.18) p = 0.014]. Conclusion Over a decade, in an older age population-based cohort, declining levels and bioavailability of IGF-I associate with prolongation of the QTc interval. As QTc prolongation associates with increased risk for sudden death even in apparently healthy people, further research into the antiarrhythmic effects of IGF-I on cardiomyocytes is warranted.
Collapse
Affiliation(s)
- Christos Charalambous
- UCL MRC Unit for Lifelong Health and Ageing, University College London, London, United Kingdom
| | - James C. Moon
- UCL Institute of Cardiovascular Science, University College London, London, United Kingdom
- Cardiac MRI Unit, Barts Heart Centre, London, United Kingdom
| | - Jeff M. P. Holly
- National Institute for Health Research (NIHR) Bristol Nutrition Biomedical Research Unit, Level 3, University Hospitals Bristol Education and Research Centre, Bristol, United Kingdom
- Faculty of Health Sciences, School of Translational Health Sciences, Bristol Medical School, Southmead Hospital, University of Bristol, Bristol, United Kingdom
| | - Nishi Chaturvedi
- UCL MRC Unit for Lifelong Health and Ageing, University College London, London, United Kingdom
| | - Alun D. Hughes
- UCL MRC Unit for Lifelong Health and Ageing, University College London, London, United Kingdom
- UCL Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Gabriella Captur
- UCL MRC Unit for Lifelong Health and Ageing, University College London, London, United Kingdom
- UCL Institute of Cardiovascular Science, University College London, London, United Kingdom
- Cardiology Department, Centre for Inherited Heart Muscle Conditions, The Royal Free Hospital, London, United Kingdom
| |
Collapse
|
37
|
Anbar R, Sultan SR, Al Saikhan L, Alkharaiji M, Chaturvedi N, Hardy R, Richards M, Hughes A. Is carotid artery atherosclerosis associated with poor cognitive function assessed using the Mini-Mental State Examination? A systematic review and meta-analysis. BMJ Open 2022; 12:e055131. [PMID: 35440451 PMCID: PMC9020283 DOI: 10.1136/bmjopen-2021-055131] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 03/29/2022] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVES To determine associations between carotid atherosclerosis assessed by ultrasound and the Mini-Mental State Examination (MMSE), a measure of global cognitive function. DESIGN Systematic review and meta-analysis. METHODS MEDLINE and EMBASE databases were searched up to 1 May 2020 to identify studies assessed the associations between asymptomatic carotid atherosclerosis and the MMSE. Studies reporting OR for associations between carotid plaque or intima-media thickness (cIMT) and dichotomised MMSE were meta-analysed. Publication bias of included studies was assessed. RESULTS A total of 31 of 378 reviewed articles met the inclusion criteria; together they included 27 738 participants (age 35-95 years). Fifteen studies reported some evidence of a positive association between measures of atherosclerosis and poorer cognitive performance in either cross-sectional or longitudinal studies. The remaining 16 studies found no evidence of an association. Seven cross-sectional studies provided data suitable for meta-analysis. Meta-analysis of three studies that assessed carotid plaque (n=3549) showed an association between the presence of plaque and impaired MMSE with pooled estimate for the OR (95% CI) being 2.72 (0.85 to 4.59). An association between cIMT and impaired MMSE was reported in six studies (n=4443) with a pooled estimate for the OR (95% CI) being 1.13 (1.04 to 1.22). Heterogeneity across studies was moderate to small (carotid plaque with MMSE, I2=40.9%; cIMT with MMSE, I2=4.9%). There was evidence of publication bias for carotid plaque studies (p=0.02), but not cIMT studies (p=0.2). CONCLUSIONS There is some, limited cross-sectional evidence indicating an association between cIMT and poorer global cognitive function assessed with MMSE. Estimates of the association between plaques and poor cognition are too imprecise to draw firm conclusions and evidence from studies of longitudinal associations between carotid atherosclerosis and MMSE is limited. PROSPERO REGISTRATION NUMBER CRD42021240077.
Collapse
Affiliation(s)
- Rayan Anbar
- Diagnostic Radiology, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Makkah, Saudi Arabia
- MRC Unit for Lifelong Health and Aging, UCL Institute of Cardiovascular Science, University College London, London, UK
| | - Salahaden R Sultan
- Diagnostic Radiology, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Makkah, Saudi Arabia
| | - Lamia Al Saikhan
- College of Applied Medial Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Mohammed Alkharaiji
- Department of Public Health, Saudi Electronic University, Riyadh, Saudi Arabia
| | - Nishi Chaturvedi
- MRC Unit for Lifelong Health and Aging, UCL Institute of Cardiovascular Science, University College London, London, UK
| | - Rebecca Hardy
- Social Research Institute, UCL Institute of Education, University College London, London, UK
| | - Marcus Richards
- MRC Unit for Lifelong Health and Aging, UCL Institute of Cardiovascular Science, University College London, London, UK
| | - Alun Hughes
- MRC Unit for Lifelong Health and Aging, UCL Institute of Cardiovascular Science, University College London, London, UK
- Department of Population Science & Experimental Medicine, UCL Institute of Cardiovascular Science, University College London, London, UK
| |
Collapse
|
38
|
Wielgoszewska B, Maddock J, Green MJ, Di Gessa G, Parsons S, Griffith GJ, Croft J, Stevenson AJ, Booth C, Silverwood RJ, Bann D, Patalay P, Hughes AD, Chaturvedi N, Howe LD, Fitzsimons E, Katikireddi SV, Ploubidis GB. The UK Coronavirus Job Retention Scheme and diet, physical activity, and sleep during the COVID-19 pandemic: evidence from eight longitudinal population surveys. BMC Med 2022; 20:147. [PMID: 35387639 PMCID: PMC8984671 DOI: 10.1186/s12916-022-02343-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 03/15/2022] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND In March 2020, the UK implemented the Coronavirus Job Retention Scheme (furlough) to minimise job losses. Our aim was to investigate associations between furlough and diet, physical activity, and sleep during the early stages of the COVID-19 pandemic. METHODS We analysed data on 25,092 participants aged 16-66 years from eight UK longitudinal studies. Changes in employment, including being furloughed, were based on employment status before and during the first lockdown. Health behaviours included fruit and vegetable consumption, physical activity, and sleep. Study-specific estimates obtained using modified Poisson regression, adjusting for socio-demographic characteristics and pre-pandemic health and health behaviours, were statistically pooled using random effects meta-analysis. Associations were also stratified by sex, age, and education. RESULTS Across studies, between 8 and 25% of participants were furloughed. Compared to those who remained working, furloughed workers were slightly less likely to be physically inactive (RR = 0.85; [95% CI 0.75-0.97]; I 2 = 59%) and did not differ overall with respect to low fruit and vegetable consumption or atypical sleep, although findings for sleep were heterogenous (I 2 = 85%). In stratified analyses, furlough was associated with lower fruit and vegetable consumption among males (RR = 1.11; [1.01-1.22]; I 2 = 0%) but not females (RR = 0.84; [0.68-1.04]; I 2 = 65%). Considering changes in quantity, furloughed workers were more likely than those who remained working to report increases in fruit and vegetable consumption, exercise, and hours of sleep. CONCLUSIONS Those furloughed exhibited similar health behaviours to those who remained in employment during the initial stages of the pandemic. There was little evidence to suggest that adoption of such social protection policies in the post-pandemic recovery period and during future economic crises had adverse effects on population health behaviours.
Collapse
Affiliation(s)
- Bożena Wielgoszewska
- Centre for Longitudinal Studies, UCL Social Research Institute, University College, London, UK
| | - Jane Maddock
- MRC Unit for Lifelong Health and Ageing, University College London, London, UK.
| | - Michael J Green
- MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Giorgio Di Gessa
- Institute of Epidemiology and Health Care, University College London, London, UK
| | - Sam Parsons
- Centre for Longitudinal Studies, UCL Social Research Institute, University College, London, UK
| | - Gareth J Griffith
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - Jazz Croft
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - Anna J Stevenson
- Centre for Genomic and Experimental Medicine, University of Edinburgh, Edinburgh, UK
| | - Charlotte Booth
- Centre for Longitudinal Studies, UCL Social Research Institute, University College, London, UK
| | - Richard J Silverwood
- Centre for Longitudinal Studies, UCL Social Research Institute, University College, London, UK
| | - David Bann
- Centre for Longitudinal Studies, UCL Social Research Institute, University College, London, UK
| | - Praveetha Patalay
- Centre for Longitudinal Studies, UCL Social Research Institute, University College, London, UK.,MRC Unit for Lifelong Health and Ageing, University College London, London, UK
| | - Alun D Hughes
- MRC Unit for Lifelong Health and Ageing, University College London, London, UK
| | - Nishi Chaturvedi
- MRC Unit for Lifelong Health and Ageing, University College London, London, UK
| | - Laura D Howe
- Institute of Epidemiology and Health Care, University College London, London, UK
| | - Emla Fitzsimons
- Centre for Longitudinal Studies, UCL Social Research Institute, University College, London, UK
| | | | - George B Ploubidis
- Centre for Longitudinal Studies, UCL Social Research Institute, University College, London, UK.
| |
Collapse
|
39
|
Sliz E, Shin J, Ahmad S, Williams DM, Frenzel S, Gauß F, Harris SE, Henning AK, Hernandez MV, Hu YH, Jiménez B, Sargurupremraj M, Sudre C, Wang R, Wittfeld K, Yang Q, Wardlaw JM, Völzke H, Vernooij MW, Schott JM, Richards M, Proitsi P, Nauck M, Lewis MR, Launer L, Hosten N, Grabe HJ, Ghanbari M, Deary IJ, Cox SR, Chaturvedi N, Barnes J, Rotter JI, Debette S, Ikram MA, Fornage M, Paus T, Seshadri S, Pausova Z. Circulating Metabolome and White Matter Hyperintensities in Women and Men. Circulation 2022; 145:1040-1052. [PMID: 35050683 PMCID: PMC9645366 DOI: 10.1161/circulationaha.121.056892] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 12/02/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND White matter hyperintensities (WMH), identified on T2-weighted magnetic resonance images of the human brain as areas of enhanced brightness, are a major risk factor of stroke, dementia, and death. There are no large-scale studies testing associations between WMH and circulating metabolites. METHODS We studied up to 9290 individuals (50.7% female, average age 61 years) from 15 populations of 8 community-based cohorts. WMH volume was quantified from T2-weighted or fluid-attenuated inversion recovery images or as hypointensities on T1-weighted images. Circulating metabolomic measures were assessed with mass spectrometry and nuclear magnetic resonance spectroscopy. Associations between WMH and metabolomic measures were tested by fitting linear regression models in the pooled sample and in sex-stratified and statin treatment-stratified subsamples. Our basic models were adjusted for age, sex, age×sex, and technical covariates, and our fully adjusted models were also adjusted for statin treatment, hypertension, type 2 diabetes, smoking, body mass index, and estimated glomerular filtration rate. Population-specific results were meta-analyzed using the fixed-effect inverse variance-weighted method. Associations with false discovery rate (FDR)-adjusted P values (PFDR)<0.05 were considered significant. RESULTS In the meta-analysis of results from the basic models, we identified 30 metabolomic measures associated with WMH (PFDR<0.05), 7 of which remained significant in the fully adjusted models. The most significant association was with higher level of hydroxyphenylpyruvate in men (PFDR.full.adj=1.40×10-7) and in both the pooled sample (PFDR.full.adj=1.66×10-4) and statin-untreated (PFDR.full.adj=1.65×10-6) subsample. In men, hydroxyphenylpyruvate explained 3% to 14% of variance in WMH. In men and the pooled sample, WMH were also associated with lower levels of lysophosphatidylcholines and hydroxysphingomyelins and a larger diameter of low-density lipoprotein particles, likely arising from higher triglyceride to total lipids and lower cholesteryl ester to total lipids ratios within these particles. In women, the only significant association was with higher level of glucuronate (PFDR=0.047). CONCLUSIONS Circulating metabolomic measures, including multiple lipid measures (eg, lysophosphatidylcholines, hydroxysphingomyelins, low-density lipoprotein size and composition) and nonlipid metabolites (eg, hydroxyphenylpyruvate, glucuronate), associate with WMH in a general population of middle-aged and older adults. Some metabolomic measures show marked sex specificities and explain a sizable proportion of WMH variance.
Collapse
Affiliation(s)
- Eeva Sliz
- The Hospital for Sick Children, and Departments of Physiology and Nutritional Sciences, University of Toronto, Toronto, ON, Canada
| | - Jean Shin
- The Hospital for Sick Children, and Departments of Physiology and Nutritional Sciences, University of Toronto, Toronto, ON, Canada
| | - Shahzad Ahmad
- Department of Epidemiology, Erasmus Medical Centre, Rotterdam, The Netherlands
- Division of Systems Biomedicine and Pharmacology, Leiden Academic Centre for Drug Research, Leiden University, Leiden, The Netherlands
| | - Dylan M. Williams
- MRC Unit for Lifelong Health and Ageing at UCL, University College London, London, UK
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Stefan Frenzel
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany
| | - Friederike Gauß
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Sarah E. Harris
- Lothian Birth Cohorts group, Department of Psychology, University of Edinburgh, Edinburgh, UK
| | - Ann-Kristin Henning
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Maria Valdes Hernandez
- Centre for Clinical Brain Sciences, UK Dementia Research Institute at the University of Edinburgh, Edinburgh, UK
| | - Yi-Han Hu
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, Baltimore, MD, USA
| | - Beatriz Jiménez
- National Phenome Centre, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Muralidharan Sargurupremraj
- University of Bordeaux, Inserm, Bordeaux Population Health Research Center, team VINTAGE, UMR 1219, 33000 Bordeaux, France
| | - Carole Sudre
- MRC Unit for Lifelong Health and Ageing at UCL, University College London, London, UK
- Centre for Medical Image Computing, Department of Computer Science, University College London
- School of Biomedical Engineering & Imaging Sciences, King’s College London
| | - Ruiqi Wang
- Department of Biostatistics, Boston University, Boston, MA, USA
| | - Katharina Wittfeld
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany
- Germany Center for Neurodegenerative Diseases (DZNE), partner site Rostock/Greifswald, Greifswald, Germany
| | - Qiong Yang
- Department of Biostatistics, Boston University, Boston, MA, USA
| | - Joanna M. Wardlaw
- Centre for Clinical Brain Sciences, UK Dementia Research Institute at the University of Edinburgh, Edinburgh, UK
| | - Henry Völzke
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Meike W. Vernooij
- Department of Epidemiology, Erasmus Medical Centre, Rotterdam, The Netherlands
- Department of Radiology and Nuclear Medicine, and Department of Neurology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Jonathan M Schott
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Marcus Richards
- MRC Unit for Lifelong Health and Ageing at UCL, University College London, London, UK
| | - Petroula Proitsi
- King’s College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Matthias Nauck
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Matthew R. Lewis
- National Phenome Centre, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Lenore Launer
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, Baltimore, MD, USA
| | - Norbert Hosten
- Institute of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Germany
| | - Hans J. Grabe
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany
- Germany Center for Neurodegenerative Diseases (DZNE), partner site Rostock/Greifswald, Greifswald, Germany
| | - Mohsen Ghanbari
- Department of Epidemiology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Ian J. Deary
- Lothian Birth Cohorts group, Department of Psychology, University of Edinburgh, Edinburgh, UK
| | - Simon R. Cox
- Lothian Birth Cohorts group, Department of Psychology, University of Edinburgh, Edinburgh, UK
| | - Nishi Chaturvedi
- MRC Unit for Lifelong Health and Ageing at UCL, University College London, London, UK
| | - Josephine Barnes
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Jerome I. Rotter
- The Institute for Translational Genomics and Population Sciences, Department of Pediatrics, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA USA
| | - Stephanie Debette
- University of Bordeaux, Inserm, Bordeaux Population Health Research Center, team VINTAGE, UMR 1219, 33000 Bordeaux, France
| | - M. Arfan Ikram
- Department of Epidemiology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Myriam Fornage
- University of Texas Health Science Center at Houston McGovern Medical School, Houston, TX, USA
| | - Tomas Paus
- Departments of Psychiatry and Neuroscience and Centre Hospitalier Universitaire Sainte-Justine, University of Montreal, Montreal, QC, Canada
- ECOGENE-21, Chicoutimi, QC, Canada
- Departments of Psychology and Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Sudha Seshadri
- The Framingham Heart Study, Framingham, MA, USA
- Department of Neurology, Boston University School of Medicine, Boston, MA, USA
| | - Zdenka Pausova
- The Hospital for Sick Children, and Departments of Physiology and Nutritional Sciences, University of Toronto, Toronto, ON, Canada
| | | |
Collapse
|
40
|
Webber M, Falconer D, AlFarih M, Joy G, Chan F, Davie C, Hamill Howes L, Wong A, Rapala A, Bhuva A, Davies RH, Morton C, Aguado-Sierra J, Vazquez M, Tao X, Krausz G, Tanackovic S, Guger C, Xue H, Kellman P, Pierce I, Schott J, Hardy R, Chaturvedi N, Rudy Y, Moon JC, Lambiase PD, Orini M, Hughes AD, Captur G. Study protocol: MyoFit46-the cardiac sub-study of the MRC National Survey of Health and Development. BMC Cardiovasc Disord 2022; 22:140. [PMID: 35365075 PMCID: PMC8972905 DOI: 10.1186/s12872-022-02582-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 03/23/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The life course accumulation of overt and subclinical myocardial dysfunction contributes to older age mortality, frailty, disability and loss of independence. The Medical Research Council National Survey of Health and Development (NSHD) is the world's longest running continued surveillance birth cohort providing a unique opportunity to understand life course determinants of myocardial dysfunction as part of MyoFit46-the cardiac sub-study of the NSHD. METHODS We aim to recruit 550 NSHD participants of approximately 75 years+ to undertake high-density surface electrocardiographic imaging (ECGI) and stress perfusion cardiovascular magnetic resonance (CMR). Through comprehensive myocardial tissue characterization and 4-dimensional flow we hope to better understand the burden of clinical and subclinical cardiovascular disease. Supercomputers will be used to combine the multi-scale ECGI and CMR datasets per participant. Rarely available, prospectively collected whole-of-life data on exposures, traditional risk factors and multimorbidity will be studied to identify risk trajectories, critical change periods, mediators and cumulative impacts on the myocardium. DISCUSSION By combining well curated, prospectively acquired longitudinal data of the NSHD with novel CMR-ECGI data and sharing these results and associated pipelines with the CMR community, MyoFit46 seeks to transform our understanding of how early, mid and later-life risk factor trajectories interact to determine the state of cardiovascular health in older age. TRIAL REGISTRATION Prospectively registered on ClinicalTrials.gov with trial ID: 19/LO/1774 Multimorbidity Life-Course Approach to Myocardial Health- A Cardiac Sub-Study of the MCRC National Survey of Health and Development (NSHD).
Collapse
Affiliation(s)
- Matthew Webber
- Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, ECIA 7BE, UK
- Institute of Cardiovascular Science, University College London, Huntley Street, London, WC1E 6DD, UK
- Centre for Inherited Heart Muscle Conditions, Department of Cardiology, Royal Free London NHS Foundation Trust, Pond Street, London, NW3 2QG, UK
- Medical Research Council Unit for Lifelong Health and Ageing at UCL, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Debbie Falconer
- Centre for Inherited Heart Muscle Conditions, Department of Cardiology, Royal Free London NHS Foundation Trust, Pond Street, London, NW3 2QG, UK
| | - Mashael AlFarih
- Institute of Cardiovascular Science, University College London, Huntley Street, London, WC1E 6DD, UK
| | - George Joy
- Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, ECIA 7BE, UK
- Institute of Cardiovascular Science, University College London, Huntley Street, London, WC1E 6DD, UK
| | - Fiona Chan
- Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, ECIA 7BE, UK
- Institute of Cardiovascular Science, University College London, Huntley Street, London, WC1E 6DD, UK
| | - Clare Davie
- Medical Research Council Unit for Lifelong Health and Ageing at UCL, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Lee Hamill Howes
- Medical Research Council Unit for Lifelong Health and Ageing at UCL, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Andrew Wong
- Medical Research Council Unit for Lifelong Health and Ageing at UCL, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Alicja Rapala
- Medical Research Council Unit for Lifelong Health and Ageing at UCL, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Anish Bhuva
- Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, ECIA 7BE, UK
- Institute of Cardiovascular Science, University College London, Huntley Street, London, WC1E 6DD, UK
- Institute of Health Informatics, UCL, Euston Road, London, UK
| | - Rhodri H Davies
- Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, ECIA 7BE, UK
- Institute of Cardiovascular Science, University College London, Huntley Street, London, WC1E 6DD, UK
| | | | - Jazmin Aguado-Sierra
- ELEM Biotech, S.L, Bristol, BS1 6QH, UK
- Barcelona Supercomputing Center (BSC), 08034, Barcelona, Spain
| | - Mariano Vazquez
- ELEM Biotech, S.L, Bristol, BS1 6QH, UK
- Barcelona Supercomputing Center (BSC), 08034, Barcelona, Spain
| | - Xuyuan Tao
- École Nationale Supérieure Des Arts Et Industries Textiles, 2 allée Louise et Victor Champier, 59056, Roubaix Cedex 1, France
| | - Gunther Krausz
- g.Tec Medical Engineering GmbH, Siernigtrabe 14, 4521, Schiedlberg, Austria
| | | | - Christoph Guger
- g.Tec Medical Engineering GmbH, Siernigtrabe 14, 4521, Schiedlberg, Austria
| | - Hui Xue
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Peter Kellman
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Iain Pierce
- Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, ECIA 7BE, UK
- Institute of Cardiovascular Science, University College London, Huntley Street, London, WC1E 6DD, UK
| | - Jonathan Schott
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, UK
| | | | - Nishi Chaturvedi
- Medical Research Council Unit for Lifelong Health and Ageing at UCL, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Yoram Rudy
- Cardiac Bioelectricity and Arrhythmia Center, Washington University, St. Louis, MO, 63130, USA
- Department of Biomedical Engineering, Washington University, St. Louis, MO, 63130, USA
| | - James C Moon
- Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, ECIA 7BE, UK
- Institute of Cardiovascular Science, University College London, Huntley Street, London, WC1E 6DD, UK
| | - Pier D Lambiase
- Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, ECIA 7BE, UK
- Institute of Cardiovascular Science, University College London, Huntley Street, London, WC1E 6DD, UK
| | - Michele Orini
- Institute of Cardiovascular Science, University College London, Huntley Street, London, WC1E 6DD, UK
- Medical Research Council Unit for Lifelong Health and Ageing at UCL, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Alun D Hughes
- Institute of Cardiovascular Science, University College London, Huntley Street, London, WC1E 6DD, UK
- Medical Research Council Unit for Lifelong Health and Ageing at UCL, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Gabriella Captur
- Institute of Cardiovascular Science, University College London, Huntley Street, London, WC1E 6DD, UK.
- Centre for Inherited Heart Muscle Conditions, Department of Cardiology, Royal Free London NHS Foundation Trust, Pond Street, London, NW3 2QG, UK.
- Medical Research Council Unit for Lifelong Health and Ageing at UCL, 1-19 Torrington Place, London, WC1E 7HB, UK.
| |
Collapse
|
41
|
Dziopa K, Asselbergs FW, Gratton J, Chaturvedi N, Schmidt AF. Cardiovascular risk prediction in type 2 diabetes: a comparison of 22 risk scores in primary care settings. Diabetologia 2022; 65:644-656. [PMID: 35032176 PMCID: PMC8894164 DOI: 10.1007/s00125-021-05640-y] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 11/04/2021] [Indexed: 12/23/2022]
Abstract
AIMS/HYPOTHESIS We aimed to compare the performance of risk prediction scores for CVD (i.e., coronary heart disease and stroke), and a broader definition of CVD including atrial fibrillation and heart failure (CVD+), in individuals with type 2 diabetes. METHODS Scores were identified through a literature review and were included irrespective of the type of predicted cardiovascular outcome or the inclusion of individuals with type 2 diabetes. Performance was assessed in a contemporary, representative sample of 168,871 UK-based individuals with type 2 diabetes (age ≥18 years without pre-existing CVD+). Missing observations were addressed using multiple imputation. RESULTS We evaluated 22 scores: 13 derived in the general population and nine in individuals with type 2 diabetes. The Systemic Coronary Risk Evaluation (SCORE) CVD rule derived in the general population performed best for both CVD (C statistic 0.67 [95% CI 0.67, 0.67]) and CVD+ (C statistic 0.69 [95% CI 0.69, 0.70]). The C statistic of the remaining scores ranged from 0.62 to 0.67 for CVD, and from 0.64 to 0.69 for CVD+. Calibration slopes (1 indicates perfect calibration) ranged from 0.38 (95% CI 0.37, 0.39) to 0.74 (95% CI 0.72, 0.76) for CVD, and from 0.41 (95% CI 0.40, 0.42) to 0.88 (95% CI 0.86, 0.90) for CVD+. A simple recalibration process considerably improved the performance of the scores, with calibration slopes now ranging between 0.96 and 1.04 for CVD. Scores with more predictors did not outperform scores with fewer predictors: for CVD+, QRISK3 (19 variables) had a C statistic of 0.68 (95% CI 0.68, 0.69), compared with SCORE CVD (six variables) which had a C statistic of 0.69 (95% CI 0.69, 0.70). Scores specific to individuals with diabetes did not discriminate better than scores derived in the general population: the UK Prospective Diabetes Study (UKPDS) scores performed significantly worse than SCORE CVD (p value <0.001). CONCLUSIONS/INTERPRETATION CVD risk prediction scores could not accurately identify individuals with type 2 diabetes who experienced a CVD event in the 10 years of follow-up. All 22 evaluated models had a comparable and modest discriminative ability.
Collapse
Affiliation(s)
- Katarzyna Dziopa
- Health Data Research UK and Institute of Health Informatics, University College London, London, UK.
| | - Folkert W Asselbergs
- Health Data Research UK and Institute of Health Informatics, University College London, London, UK
- Institute of Cardiovascular Science, Faculty of Population Health Sciences, University College London, London, UK
- Department of Cardiology, Division Heart and Lungs, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Jasmine Gratton
- Institute of Cardiovascular Science, Faculty of Population Health Sciences, University College London, London, UK
| | - Nishi Chaturvedi
- Institute of Cardiovascular Science, Faculty of Population Health Sciences, University College London, London, UK
- MRC Unit for Lifelong Health and Ageing at UCL, University College London, London, UK
| | - Amand F Schmidt
- Institute of Cardiovascular Science, Faculty of Population Health Sciences, University College London, London, UK
- Department of Cardiology, Division Heart and Lungs, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
| |
Collapse
|
42
|
Durdin R, Parsons C, Dennison EM, Williams S, Tillin T, Chaturvedi N, Cooper C, Harvey NC, Ward KA. Inflammatory status, body composition and ethnic differences in bone mineral density: The Southall and Brent Revisited Study. Bone 2022; 155:116286. [PMID: 34890861 PMCID: PMC8755916 DOI: 10.1016/j.bone.2021.116286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 11/19/2021] [Accepted: 12/02/2021] [Indexed: 11/25/2022]
Abstract
Ethnic differences in bone mineral density (BMD) and fracture risk are well-described; the aim of this study was to investigate whether central adiposity or inflammatory status contribute to these ethnic differences in BMD in later life. The Southall and Brent Revisited study (SABRE) is a UK-based tri-ethnic cohort of men and women of European, South Asian or African Caribbean origin. At the most recent SABRE follow-up (2014-2018), in addition to measures of cardiometabolic phenotype, participants had dual-energy X-ray absorptiometry (DXA) bone and body composition scans. Multiple linear regression was used to determine whether markers of body composition, central adiposity or inflammatory status contributed to ethnic differences in BMD. In men and women, age- and height-adjusted BMD at all sites was higher in African Caribbeans compared to Europeans (femoral neck: standardised β (95% confidence interval): men: 1.00SD (0.75, 1.25); women: 0.77SD (0.56, 0.99)). South Asian men had higher BMD than European men at the hip (femoral neck: 0.34SD (95%CI: 0.15, 0.54)). Although adjustment for body mass index (BMI) or lean mass index (LMI) at the lumbar spine reduced the size of the difference in BMD between African Caribbean and European men (age and height adjusted difference: 0.35SD (0.08, 0.62); age and BMI adjusted difference: 0.25SD (-0.02, 0.51)), in both men and women ethnic differences remained after adjustment for measures of central adiposity (estimated visceral adipose tissue mass (VAT mass) and android to gynoid ratio) and inflammation (interleukin-6 (logIL-6) and C-reactive protein (logCRP)). Furthermore, in women, we observed ethnic differences in the relationship between BMI (overall interaction: p = 0.04), LMI (p = 0.04) or VAT mass (p = 0.009) and standardised lumbar spine BMD. In this tri-ethnic cohort, ethnic differences in BMD at the femoral neck, total hip or lumbar spine were not explained by BMI, central adiposity or inflammatory status. Given ethnic differences in fracture incidence, it is important to further investigate why ethnic differences in BMD exist.
Collapse
Affiliation(s)
- Ruth Durdin
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Southampton, UK; National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Camille Parsons
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Southampton, UK
| | - Elaine M Dennison
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Southampton, UK; National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Suzanne Williams
- MRC Unit for Lifelong Health and Ageing, University College London, London, UK
| | - Therese Tillin
- MRC Unit for Lifelong Health and Ageing, University College London, London, UK
| | - Nishi Chaturvedi
- MRC Unit for Lifelong Health and Ageing, University College London, London, UK
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Southampton, UK; National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK; Institute of Musculoskeletal Science, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science, University of Oxford, Oxford, UK
| | - Nicholas C Harvey
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Southampton, UK; National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK; Institute of Musculoskeletal Science, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science, University of Oxford, Oxford, UK
| | - Kate A Ward
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Southampton, UK; National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK.
| |
Collapse
|
43
|
Routen A, O'Mahoney L, Ayoubkhani D, Banerjee A, Brightling C, Calvert M, Chaturvedi N, Diamond I, Eggo R, Elliott P, Evans RA, Haroon S, Herret E, O'Hara ME, Shafran R, Stanborough J, Stephenson T, Sterne J, Ward H, Khunti K. Understanding and tracking the impact of long COVID in the United Kingdom. Nat Med 2022; 28:11-15. [PMID: 34811549 DOI: 10.1038/s41591-021-01591-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- Ash Routen
- Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, UK
| | - Lauren O'Mahoney
- Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, UK
| | | | - Amitava Banerjee
- Faculty of Population Health Sciences, Institute of Health Informatics, University College London, London, UK
| | - Chris Brightling
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - Melanie Calvert
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK.,National Institute for Health Research Applied Research Centre West Midlands, Birmingham, UK.,National Institute for Health Research Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, UK.,Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK.,National Institute for Health Research Surgical Reconstruction and Microbiology Research Centre, University of Birmingham, Birmingham, UK
| | - Nishi Chaturvedi
- Department of Population Science and Experimental Medicine, University College London, London, UK
| | - Ian Diamond
- Office for National Statistics, Government Buildings, Newport, UK
| | - Rosalind Eggo
- Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Paul Elliott
- Faculty of Medicine, School of Public Health, Imperial College London, London, UK
| | - Rachael A Evans
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - Shamil Haroon
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Emily Herret
- Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Roz Shafran
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | | | - Terence Stephenson
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Jonathan Sterne
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Helen Ward
- Faculty of Medicine, School of Public Health, Imperial College London, London, UK
| | - Kamlesh Khunti
- Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, UK.
| |
Collapse
|
44
|
McPhillie R, Barnes J, Tillin T, Chaturvedi N, Hughes AD, Jäger HR, Sudre CH. Beyond WMH volume: Coalescence score as a new measure of cerebral small‐vessel disease pattern. Alzheimers Dement 2021. [DOI: 10.1002/alz.053034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | - Jo Barnes
- Dementia Research Centre UCL Queen Square Institute of Neurology London United Kingdom
| | | | | | | | | | - Carole H. Sudre
- University College London London United Kingdom
- School of Biomedical Engineering and Imaging Sciences King’s College London London United Kingdom
| |
Collapse
|
45
|
Gordillo-Marañón M, Zwierzyna M, Charoen P, Drenos F, Chopade S, Shah T, Engmann J, Chaturvedi N, Papacosta O, Wannamethee G, Wong A, Sofat R, Kivimaki M, Price JF, Hughes AD, Gaunt TR, Lawlor DA, Gaulton A, Hingorani AD, Schmidt AF, Finan C. Validation of lipid-related therapeutic targets for coronary heart disease prevention using human genetics. Nat Commun 2021; 12:6120. [PMID: 34675202 PMCID: PMC8531035 DOI: 10.1038/s41467-021-25731-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 08/26/2021] [Indexed: 12/14/2022] Open
Abstract
Drug target Mendelian randomization (MR) studies use DNA sequence variants in or near a gene encoding a drug target, that alter the target's expression or function, as a tool to anticipate the effect of drug action on the same target. Here we apply MR to prioritize drug targets for their causal relevance for coronary heart disease (CHD). The targets are further prioritized using independent replication, co-localization, protein expression profiles and data from the British National Formulary and clinicaltrials.gov. Out of the 341 drug targets identified through their association with blood lipids (HDL-C, LDL-C and triglycerides), we robustly prioritize 30 targets that might elicit beneficial effects in the prevention or treatment of CHD, including NPC1L1 and PCSK9, the targets of drugs used in CHD prevention. We discuss how this approach can be generalized to other targets, disease biomarkers and endpoints to help prioritize and validate targets during the drug development process.
Collapse
Affiliation(s)
- María Gordillo-Marañón
- Institute of Cardiovascular Science, Faculty of Population Health, University College London, London, WC1E 6BT, UK.
| | - Magdalena Zwierzyna
- Institute of Cardiovascular Science, Faculty of Population Health, University College London, London, WC1E 6BT, UK
- UCL British Heart Foundation Research Accelerator, London, UK
| | - Pimphen Charoen
- Institute of Cardiovascular Science, Faculty of Population Health, University College London, London, WC1E 6BT, UK
- Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Bangkok, 10400, Thailand
- Integrative Computational BioScience (ICBS) Center, Mahidol University, Bangkok, 10400, Thailand
| | - Fotios Drenos
- Institute of Cardiovascular Science, Faculty of Population Health, University College London, London, WC1E 6BT, UK
- Department of Life Sciences, College of Health, Medicine, and Life Sciences, Brunel University London, Uxbridge, UK
| | - Sandesh Chopade
- Institute of Cardiovascular Science, Faculty of Population Health, University College London, London, WC1E 6BT, UK
- UCL British Heart Foundation Research Accelerator, London, UK
| | - Tina Shah
- Institute of Cardiovascular Science, Faculty of Population Health, University College London, London, WC1E 6BT, UK
- UCL British Heart Foundation Research Accelerator, London, UK
| | - Jorgen Engmann
- Institute of Cardiovascular Science, Faculty of Population Health, University College London, London, WC1E 6BT, UK
- UCL British Heart Foundation Research Accelerator, London, UK
| | - Nishi Chaturvedi
- Institute of Cardiovascular Science, Faculty of Population Health, University College London, London, WC1E 6BT, UK
- MRC Unit for Lifelong Health and Ageing, University College London, London, WC1E 7HB, UK
| | - Olia Papacosta
- Primary Care and Population Health, University College London, London, NW3 2PF, UK
| | - Goya Wannamethee
- Primary Care and Population Health, University College London, London, NW3 2PF, UK
| | - Andrew Wong
- MRC Unit for Lifelong Health and Ageing, University College London, London, WC1E 7HB, UK
| | - Reecha Sofat
- Institute of Health Informatics, University College London, London, WC1E 6BT, UK
| | - Mika Kivimaki
- Department of Epidemiology and Public Health, University College London, London, WC1E 6BT, UK
| | - Jackie F Price
- Usher Institute, University of Edinburgh, Edinburgh, EH8 9AG, UK
| | - Alun D Hughes
- Institute of Cardiovascular Science, Faculty of Population Health, University College London, London, WC1E 6BT, UK
- UCL British Heart Foundation Research Accelerator, London, UK
- MRC Unit for Lifelong Health and Ageing, University College London, London, WC1E 7HB, UK
| | - Tom R Gaunt
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, BS8 2BN, UK
- Population Health, Bristol Medical School, University of Bristol, Bristol, BS8 2PS, UK
- Bristol NIHR Bristol Biomedical Research Centre, University Hospitals Bristol National Health Service Foundation Trust and University of Bristol, Bristol, BS8 2BN, UK
| | - Deborah A Lawlor
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, BS8 2BN, UK
- Population Health, Bristol Medical School, University of Bristol, Bristol, BS8 2PS, UK
- Bristol NIHR Bristol Biomedical Research Centre, University Hospitals Bristol National Health Service Foundation Trust and University of Bristol, Bristol, BS8 2BN, UK
| | - Anna Gaulton
- European Molecular Biology Laboratory, European Bioinformatics Institute (EMBL-EBI), Wellcome Genome Campus, Hinxton, Cambridge, CB10 1SD, UK
| | - Aroon D Hingorani
- Institute of Cardiovascular Science, Faculty of Population Health, University College London, London, WC1E 6BT, UK
- UCL British Heart Foundation Research Accelerator, London, UK
| | - Amand F Schmidt
- Institute of Cardiovascular Science, Faculty of Population Health, University College London, London, WC1E 6BT, UK
- UCL British Heart Foundation Research Accelerator, London, UK
- Department of Cardiology, Division Heart and Lungs, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Chris Finan
- Institute of Cardiovascular Science, Faculty of Population Health, University College London, London, WC1E 6BT, UK
- UCL British Heart Foundation Research Accelerator, London, UK
- Department of Cardiology, Division Heart and Lungs, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| |
Collapse
|
46
|
Al Saikhan L, Park C, Tillin T, Williams S, Jones S, Manisty C, Mayet J, Chaturvedi N, Hughes A. Myocardial strain by 3D-speckle tracking echocardiography predicts long-term risk of cardiovascular morbidity and mortality in the general population: the Southall And Brent Revisited (SABRE) study. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Both left ventricular (LV) ejection fraction (EF) and Global Longitudinal Strain (GLS) by 2D-echocardiography predict mortality and cardiac events, and GLS may be superior to EF. 3D-speckle tracking echocardiography (3D-STE), a recently validated method, allows simultaneous assessment of EF, GLS and principal tangential strain (PTS), but its prognostic utility in the general population is unknown.
Purpose
We hypothesized that 3D-STE derived LV myocardial strains predict a composite of cardiac endpoints, and that GLS would be a better prognostic marker than EF. We also investigated the utility of PTS compared with GLS and EF.
Methods
A total of 529 individuals (69±6y; 76.6% male) from SABRE study, a UK-based tri-ethnic community cohort, underwent health examinations. The association between 3D-STE EF or multidirectional myocardial strains and a composite cardiac endpoints comprising coronary heart disease (fatal/non-fatal), heart failure hospitalization, new-onset arrhythmia was determined using Cox proportional hazards models with and without adjustment for potential confounders and Harrell's C statistics were calculated. Associations with cardiovascular (CV) mortality was examined as a secondary objective. The incremental value of 3D-STE EF, GLS and PTS in improving CV risk stratification by the established Framingham risk score (FRS) was investigated using a likelihood ratio test on a series of nested Cox proportional hazards models.
Results
During follow-up (median, 8y), there were 56 composite cardiac endpoints and 24 CV deaths. EF and radial strain were negatively associated, while GLS, global circumferential strain and PTS were positively associated with the composite cardiac endpoints in unadjusted models (Table 1). Associations were only marginally affected by adjustment for potential confounders although confidence intervals of the estimate increased slightly (Table 1). There was little difference in the C-statistics for EF, GLS or PTS for the composite cardiac endpoints (Table 1). Associations with CV mortality were generally weaker and only GLS showed some evidence of a positive association with CV mortality in unadjusted and adjusted models (Table 1). Compared to EF and GLS, PTS most improved the predictive value (model fit) of FRS for composite cardiac endpoints (Table 2). None of the measures convincingly improved calibration for CV mortality.
Conclusions
3D-STE-derived LV myocardial strains predicted adverse cardiac events and CV mortality in a multi-ethnic sample of the UK general population. PTS/3D-strain was an independent predictor of cardiac events with some evidence of it being a slightly better predictor than conventional indices of LV function (GLS and EF). Future prospective studies are needed to confirm and extend these findings.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): The main SABRE study is supported by the Wellcome Trust and BHF.
Collapse
Affiliation(s)
- L Al Saikhan
- University College London, Institute of Cardiovascular Sciences/MRC Unit for LHA/School of Life and Medical Sciences, London, United Kingdom
| | - C Park
- University College London, Institute of Cardiovascular Sciences/MRC Unit for LHA/School of Life and Medical Sciences, London, United Kingdom
| | - T Tillin
- University College London, Institute of Cardiovascular Sciences/MRC Unit for LHA/School of Life and Medical Sciences, London, United Kingdom
| | - S Williams
- University College London, Institute of Cardiovascular Sciences/MRC Unit for LHA/School of Life and Medical Sciences, London, United Kingdom
| | - S Jones
- University College London, Institute of Cardiovascular Sciences/MRC Unit for LHA/School of Life and Medical Sciences, London, United Kingdom
| | - C Manisty
- University College London, Institute of Cardiovascular Sciences/MRC Unit for LHA/School of Life and Medical Sciences, London, United Kingdom
| | - J Mayet
- Imperial College London, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - N Chaturvedi
- University College London, Institute of Cardiovascular Sciences/MRC Unit for LHA/School of Life and Medical Sciences, London, United Kingdom
| | - A Hughes
- University College London, Institute of Cardiovascular Sciences/MRC Unit for LHA/School of Life and Medical Sciences, London, United Kingdom
| | | |
Collapse
|
47
|
Walford HCJ, Hughes AH, Charakida M, Chaturvedi N, Deanfield JE, Howe LD, Lawlor DA, Rapala A, Relton CL, Park CM. Arterial stiffness increase from adolescence to young adulthood is accelerated by smoking and alcohol use. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Smoking tobacco and drinking alcohol are associated with increased arterial stiffness, a critical intermediate endpoint for cardiovascular disease, in adults and in teenagers. The relationship between these risky behaviours and changes in arterial stiffness from late adolescence to early adulthood is not known.
Purpose
To investigate associations between smoking and drinking habits and the change in arterial stiffness between ages 17 and 24 using a large population-based cohort.
Methods
Participants underwent repeated measurements of arterial stiffness (carotid-femoral pulse wave velocity (cfPWV)), anthropometrics, resting blood pressure and blood biomarkers, at ages 17 and 24 years. Participants were grouped and scored by alcohol (never, medium intensity (MI): ≤4 drinks on a typical day of drinking, high intensity (HI): >5) and smoking (never, past, MI, <10 cigarettes a day HI, ≥10) exposure at both clinics. Average scores between clinics were taken (scores 0–5) and composite alcohol (never, MI, HI) and smoking (never, past, MI, HI) groups were created. Multivariable regression analysis was performed to investigate associations between smoking/drinking habits and change in cfPWV from 17 to 24 years (ΔPWV). Associations were adjusted for age, gender, and socioeconomic status (model 1). Model 2 was additionally adjusted for body mass index, systolic blood pressure, LDL cholesterol, glucose, and C-reactive protein at age 24. Data are presented as means (95% confidence intervals).
Results
1,655 participants (1,013 females and 642 males) had cfPWV recorded at both ages. cfPWV increased from 17 to 24 years in both women (ΔPWV 0.56m/s (0.50, 0.62), p<0.001) and men (0.65m/s (0.56, 0.74), p<0.001). There was a 0.05m/s (0.00, 0.10) increase in ΔPWV per 1 unit increase in average alcohol score (p=0.039). Compared to never drinkers, ΔPWV increased by 0.18m/s (−0.03, 0.38) in MI (p=0.09), and 0.21m/s (−0.01, 0.41) in HI drinkers (p=0.055). There was no association between ΔPWV and average smoking score (β=0.03m/s (−0.03, 0.08), p=0.4). Compared to never smokers, HI smokers had a slightly greater ΔPWV (0.17m/s (−0.08, 0.42), p=0.18). After stratifying by sex, this difference was evident in women (0.32m/s (0.04, 0.60), p=0.028) while no association was seen in men (−0.12m/s (−0.59, 0.35), p=0.6). No differences were found between never-smokers and ex-smokers (difference = 0.04m/s (−0.08, 0.16), p=0.5). Adjustment for potential confounders (model 2) did not attenuate these associations. Figure shows estimated marginal means for ΔPWV between (a) alcohol and (b) smoking groups from model 1. Error bars represent 95% confidence intervals.
Conclusion
Smoking and alcohol use in young adulthood is associated with an accelerated increase in arterial stiffness, with evidence of a graded adverse association for alcohol. Our findings also suggest that adverse effects of smoking in youth may be reversible with smoking cessation.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): British Heart Foundation
Collapse
Affiliation(s)
- H C J Walford
- University College London, Institute of Cardiovascular Science, London, United Kingdom
| | - A H Hughes
- University College London, Institute of Cardiovascular Science, London, United Kingdom
| | - M Charakida
- University College London, Institute of Cardiovascular Science, London, United Kingdom
| | - N Chaturvedi
- University College London, Institute of Cardiovascular Science, London, United Kingdom
| | - J E Deanfield
- University College London, Institute of Cardiovascular Science, London, United Kingdom
| | - L D Howe
- University of Bristol, MRC Integrative Epidemiology Unit, Bristol, United Kingdom
| | - D A Lawlor
- University of Bristol, MRC Integrative Epidemiology Unit, Bristol, United Kingdom
| | - A Rapala
- University College London, Institute of Cardiovascular Science, London, United Kingdom
| | - C L Relton
- University of Bristol, MRC Integrative Epidemiology Unit, Bristol, United Kingdom
| | - C M Park
- University College London, Institute of Cardiovascular Science, London, United Kingdom
| |
Collapse
|
48
|
Topriceanu CC, Wong A, Moon JC, Hughes AD, Chaturvedi N, Conti G, Bann D, Patalay P, Captur G. Impact of lockdown on key workers: findings from the COVID-19 survey in four UK national longitudinal studies. J Epidemiol Community Health 2021; 75:955-962. [PMID: 33837048 PMCID: PMC8042596 DOI: 10.1136/jech-2020-215889] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 02/14/2021] [Accepted: 02/19/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Key workers played a pivotal role during the national lockdown in the UK's response to the COVID-19 pandemic. Although protective measures have been taken, the impact of the pandemic on key workers is yet to be fully elucidated. METHODS Participants were from four longitudinal age-homogeneous British cohorts (born in 2001, 1990, 1970 and 1958). A web-based survey provided outcome data during the first UK national lockdown (May 2020) on COVID-19 infection status, changes in financial situation, trust in government, conflict with people around, household composition, psychological distress, alcohol consumption, smoking and sleep duration. Generalised linear models with logit link assessed the association between being a key worker and the above outcomes. Adjustment was made for cohort design, non-response, sex, ethnicity, adult socioeconomic position (SEP), childhood SEP, the presence of a chronic illness and receipt of a shielding letter. Meta-analyses were performed across the cohorts. FINDINGS 13 736 participants were included. During lockdown, being a key worker was associated with increased chances of being infected with COVID-19 (OR 1.43, 95% CI 1.22 to 1.68) and experiencing conflict with people around (OR 1.19, 95% CI 1.03 to 1.37). However, key workers were less likely to be worse off financially (OR 0.32, 95% CI 0.24 to 0.65), to consume more alcohol (OR 0.88, 95% CI 0.79 to 0.98) or to smoke more (OR 0.60, 95% CI 0.44 to 0.80) during lockdown. Interestingly, being a key worker was not associated with psychological distress (OR 0.95, 95% CI 0.85 to 1.05). INTERPRETATION Being a key worker during the first UK COVID-19 lockdown was a double-edged sword, with both benefits and downsides. The UK government had the basic duty to protect its key workers from SARS-CoV-2 infection, but it may have failed to do so, and there is an urgent need to rectify this in light of the ongoing third wave.
Collapse
Affiliation(s)
| | - Andrew Wong
- MRC Unit for Lifelong Health and Ageing, University College London, London, UK
| | - James C Moon
- Institute of Cardiovascular Science, University College London, London, UK
- Cardiac MRI Unit, Barts Heart Center, London, UK
| | - Alun D Hughes
- MRC Unit for Lifelong Health and Ageing, University College London, London, UK
| | - Nishi Chaturvedi
- MRC Unit for Lifelong Health and Ageing, University College London, London, UK
| | - Gabriella Conti
- Department of Economics and UCL Social Research Institute, University College London, London, UK
| | - David Bann
- Centre for Longitudinal Studies, Social Research Institute, University College London, London, UK
| | - Praveetha Patalay
- MRC Unit for Lifelong Health and Ageing, University College London, London, UK
- Centre for Longitudinal Studies, Social Research Institute, University College London, London, UK
| | - Gabriella Captur
- MRC Unit for Lifelong Health and Ageing, University College London, London, UK
- Institute of Cardiovascular Science, University College London, London, UK
- Center for Inherited Heart Muscle Conditions, Royal Free Hospital, London, UK
| |
Collapse
|
49
|
Schmidt AF, Hunt NB, Gordillo-Marañón M, Charoen P, Drenos F, Kivimaki M, Lawlor DA, Giambartolomei C, Papacosta O, Chaturvedi N, Bis JC, O'Donnell CJ, Wannamethee G, Wong A, Price JF, Hughes AD, Gaunt TR, Franceschini N, Mook-Kanamori DO, Zwierzyna M, Sofat R, Hingorani AD, Finan C. Cholesteryl ester transfer protein (CETP) as a drug target for cardiovascular disease. Nat Commun 2021; 12:5640. [PMID: 34561430 PMCID: PMC8463530 DOI: 10.1038/s41467-021-25703-3] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 08/23/2021] [Indexed: 02/08/2023] Open
Abstract
Development of cholesteryl ester transfer protein (CETP) inhibitors for coronary heart disease (CHD) has yet to deliver licensed medicines. To distinguish compound from drug target failure, we compared evidence from clinical trials and drug target Mendelian randomization of CETP protein concentration, comparing this to Mendelian randomization of proprotein convertase subtilisin/kexin type 9 (PCSK9). We show that previous failures of CETP inhibitors are likely compound related, as illustrated by significant degrees of between-compound heterogeneity in effects on lipids, blood pressure, and clinical outcomes observed in trials. On-target CETP inhibition, assessed through Mendelian randomization, is expected to reduce the risk of CHD, heart failure, diabetes, and chronic kidney disease, while increasing the risk of age-related macular degeneration. In contrast, lower PCSK9 concentration is anticipated to decrease the risk of CHD, heart failure, atrial fibrillation, chronic kidney disease, multiple sclerosis, and stroke, while potentially increasing the risk of Alzheimer's disease and asthma. Due to distinct effects on lipoprotein metabolite profiles, joint inhibition of CETP and PCSK9 may provide added benefit. In conclusion, we provide genetic evidence that CETP is an effective target for CHD prevention but with a potential on-target adverse effect on age-related macular degeneration.
Collapse
Affiliation(s)
- Amand F Schmidt
- Institute of Cardiovascular Science, Faculty of Population Health, University College London, London, UK.
- UCL British Heart Foundation Research Accelerator, London, UK.
- Department of Cardiology, Division Heart and Lungs, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - Nicholas B Hunt
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, The Netherlands
| | - Maria Gordillo-Marañón
- Institute of Cardiovascular Science, Faculty of Population Health, University College London, London, UK
- UCL British Heart Foundation Research Accelerator, London, UK
| | - Pimphen Charoen
- Institute of Cardiovascular Science, Faculty of Population Health, University College London, London, UK
- Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Integrative Computational BioScience (ICBS) Center, Mahidol University, Bangkok, Thailand
| | - Fotios Drenos
- Institute of Cardiovascular Science, Faculty of Population Health, University College London, London, UK
- Department of Life Sciences, College of Health, Medicine, and Life Sciences, Brunel University London, Uxbridge, UK
| | - Mika Kivimaki
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Deborah A Lawlor
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
- Population Health, Bristol Medical School, University of Bristol, Bristol, UK
- Bristol NIHR Bristol Biomedical Research Centre, University Hospitals Bristol National Health Service Foundation Trust and University of Bristol, Bristol, UK
| | | | - Olia Papacosta
- Primary Care and Population Health, University College London, London, UK
| | - Nishi Chaturvedi
- Institute of Cardiovascular Science, Faculty of Population Health, University College London, London, UK
- MRC Unit for Lifelong Health and Ageing at UCL, London, UK
| | - Joshua C Bis
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Christopher J O'Donnell
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Medicine, VA Boston Healthcare System, Boston, MA, USA
| | - Goya Wannamethee
- Primary Care and Population Health, University College London, London, UK
| | - Andrew Wong
- MRC Unit for Lifelong Health and Ageing at UCL, London, UK
| | | | - Alun D Hughes
- Institute of Cardiovascular Science, Faculty of Population Health, University College London, London, UK
- UCL British Heart Foundation Research Accelerator, London, UK
- MRC Unit for Lifelong Health and Ageing at UCL, London, UK
| | - Tom R Gaunt
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
- Population Health, Bristol Medical School, University of Bristol, Bristol, UK
- Bristol NIHR Bristol Biomedical Research Centre, University Hospitals Bristol National Health Service Foundation Trust and University of Bristol, Bristol, UK
| | - Nora Franceschini
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Dennis O Mook-Kanamori
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Magdalena Zwierzyna
- Institute of Cardiovascular Science, Faculty of Population Health, University College London, London, UK
- UCL British Heart Foundation Research Accelerator, London, UK
| | - Reecha Sofat
- Institute of Health Informatics, University College London, London, UK
| | - Aroon D Hingorani
- Institute of Cardiovascular Science, Faculty of Population Health, University College London, London, UK
- UCL British Heart Foundation Research Accelerator, London, UK
- Health Data Research UK, London, UK
| | - Chris Finan
- Institute of Cardiovascular Science, Faculty of Population Health, University College London, London, UK
- UCL British Heart Foundation Research Accelerator, London, UK
- Department of Cardiology, Division Heart and Lungs, University Medical Center Utrecht, Utrecht, The Netherlands
- Health Data Research UK, London, UK
| |
Collapse
|
50
|
Khanolkar AR, Chaturvedi N, Kuan V, Davis D, Hughes A, Richards M, Bann D, Patalay P. Socioeconomic inequalities in prevalence and development of multimorbidity across adulthood: A longitudinal analysis of the MRC 1946 National Survey of Health and Development in the UK. PLoS Med 2021; 18:e1003775. [PMID: 34520470 PMCID: PMC8601600 DOI: 10.1371/journal.pmed.1003775] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 11/18/2021] [Accepted: 08/19/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND We aimed to estimate multimorbidity trajectories and quantify socioeconomic inequalities based on childhood and adulthood socioeconomic position (SEP) in the risks and rates of multimorbidity accumulation across adulthood. METHODS AND FINDINGS Participants from the UK 1946 National Survey of Health and Development (NSHD) birth cohort study who attended the age 36 years assessment in 1982 and any one of the follow-up assessments at ages 43, 53, 63, and 69 years (N = 3,723, 51% males). Information on 18 health conditions was based on a combination of self-report, biomarkers, health records, and prescribed medications. We estimated multimorbidity trajectories and delineated socioeconomic inequalities (based on childhood and adulthood social class and highest education) in multimorbidity at each age and in longitudinal trajectories. Multimorbidity increased with age (0.7 conditions at 36 years to 3.7 at 69 years). Multimorbidity accumulation was nonlinear, accelerating with age at the rate of 0.08 conditions/year (95% CI 0.07 to 0.09, p < 0.001) at 36 to 43 years to 0.19 conditions/year (95% CI 0.18 to 0.20, p < 0.001) at 63 to 69 years. At all ages, the most socioeconomically disadvantaged had 1.2 to 1.4 times greater number of conditions on average compared to the most advantaged. The most disadvantaged by each socioeconomic indicator experienced an additional 0.39 conditions (childhood social class), 0.83 (adult social class), and 1.08 conditions (adult education) at age 69 years, independent of all other socioeconomic indicators. Adverse adulthood SEP was associated with more rapid accumulation of multimorbidity, resulting in 0.49 excess conditions in partly/unskilled compared to professional/intermediate individuals between 63 and 69 years. Disadvantaged childhood social class, independently of adulthood SEP, was associated with accelerated multimorbidity trajectories from age 53 years onwards. Study limitations include that the NSHD cohort is composed of individuals of white European heritage only, and findings may not be generalizable to the non-white British population of the same generation and did not account for other important dimensions of SEP such as income and wealth. CONCLUSIONS In this study, we found that socioeconomically disadvantaged individuals have earlier onset and more rapid accumulation of multimorbidity resulting in widening inequalities into old age, with independent contributions from both childhood and adulthood SEP.
Collapse
Affiliation(s)
- Amal R. Khanolkar
- MRC Unit for Lifelong Health and Ageing at UCL, London, United Kingdom
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Nishi Chaturvedi
- MRC Unit for Lifelong Health and Ageing at UCL, London, United Kingdom
| | - Valerie Kuan
- Institute of Health Informatics, UCL, London, United Kingdom
- Institute of Cardiovascular Science, UCL, London, United Kingdom
| | - Daniel Davis
- MRC Unit for Lifelong Health and Ageing at UCL, London, United Kingdom
| | - Alun Hughes
- MRC Unit for Lifelong Health and Ageing at UCL, London, United Kingdom
| | - Marcus Richards
- MRC Unit for Lifelong Health and Ageing at UCL, London, United Kingdom
| | - David Bann
- Centre for Longitudinal Studies, UCL, London, United Kingdom
| | - Praveetha Patalay
- MRC Unit for Lifelong Health and Ageing at UCL, London, United Kingdom
- Centre for Longitudinal Studies, UCL, London, United Kingdom
- * E-mail:
| |
Collapse
|