Naveed Sattar

University of Glasgow, Glasgow, Scotland, United Kingdom

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Publications (457)3964.75 Total impact

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    ABSTRACT: Context: The impact of adolescent nonalcoholic fatty liver disease (NAFLD) on health, independent of fat mass, is unclear. Objective: The objective of the study was to determine the independent (of total body fat) association of ultrasound scan (USS)-determined NAFLD with liver fibrosis, insulin resistance, and dyslipidemia among healthy adolescents. Design: This was a cross-sectional analysis in participants from a UK birth cohort. Participants: One thousand eight hundred seventy-four (1059 female) individuals of a mean age of 17.9 years participated in the study. Main Outcomes: USS assessed liver stiffness (shear velocity, an indicator of fibrosis) and volume, fasting glucose, insulin, triglycerides, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, alanine amino transferase, aspartate amino transferase, γ-glutamyltransferase, and haptoglobin. Results: The prevalence of NAFLD was 2.5% [95% confidence interval (CI) 1.8-3.3] and was the same in females and males. Dual-energy X-ray absorptiometry determined total body fat mass was strongly associated with USS NAFLD: odds ratio 3.15 (95% CI 2.44-4.07) per 1 SD (∼10 kg) fat mass. Those with NAFLD had larger liver volumes and greater shear velocity. They also had higher fasting glucose, insulin, triglycerides, low-density lipoprotein cholesterol, alanine amino transferase, aspartate amino transferase, γ-glutamyltransferase, and haptoglobin and lower high-density lipoprotein cholesterol. Most associations were independent of total body fat. For example, after adjustment for fat mass and other confounders, hepatic shear velocity [mean difference 22.8% (95% CI 15.6-30.5)], triglyceride levels [23.6% (95% CI 6.0-44.2)], and insulin [39.4% (95% CI 10.7-75.5)] were greater in those with NAFLD compared with those without NAFLD. Conclusion: In healthy European adolescents, 2.5% have USS-defined NAFLD. Even after accounting for total body fat, those with NAFLD have more adverse levels of liver fibrosis and cardiometabolic risk factors.
    The Journal of Clinical Endocrinology and Metabolism 01/2014; · 6.31 Impact Factor
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    ABSTRACT: On behalf of the NSHD scientific and data collection teams " Abstract Background: Previous studies have found associations between cognitive function and chronic kidney disease. We aimed to explore possible explanations for this association in the Medical Research Council National Survey of Health and Development, a prospective birth cohort representative of the general British population.
    PLoS ONE 01/2014; 9(1):e86743. · 3.53 Impact Factor
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    ABSTRACT: To assess the effect of preventive pravastatin treatment on coronary heart disease (CHD) morbidity and mortality in older persons at risk for cardiovascular disease (CVD), stratified according to plasma levels of homocysteine. A post hoc subanalysis in the PROspective Study of Pravastatin in the Elderly at Risk (PROSPER), started in 1997, which is a double-blind, randomized, placebo-controlled trial with a mean follow-up of 3.2 years. Primary care setting in two of the three PROSPER study sites (Netherlands and Scotland). Individuals (n = 3,522, aged 70-82, 1,765 male) with a history of or risk factors for CVD were ranked in three groups depending on baseline homocysteine level, sex, and study site. Pravastatin (40 mg) versus placebo. Fatal and nonfatal CHD and mortality. In the placebo group, participants with a high homocysteine level (n = 588) had a 1.8 higher risk (95% confidence interval (CI) = 1.2-2.5, P = .001) of fatal and nonfatal CHD than those with a low homocysteine level (n = 597). The absolute risk reduction in fatal and nonfatal CHD with pravastatin treatment was 1.6% (95% CI = -1.6 to 4.7%) in the low homocysteine group and 6.7% (95% CI = 2.7-10.7%) in the high homocysteine group (difference 5.2%, 95% CI = 0.11-10.3, P = .046). Therefore, the number needed to treat (NNT) with pravastatin for 3.2 years for benefit related to fatal and nonfatal CHD events was 14.8 (95% CI = 9.3-36.6) for high homocysteine and 64.5 (95% CI = 21.4-∞) for low homocysteine. In older persons at risk of CVD, those with high homocysteine are at highest risk for fatal and nonfatal CHD. With pravastatin treatment, this group has the highest absolute risk reduction and the lowest NNT to prevent fatal and nonfatal CHD.
    Journal of the American Geriatrics Society 01/2014; · 4.22 Impact Factor
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    ABSTRACT: Statin therapy reduces the risk of myocardial infarction, stroke, and cardiovascular death by 25% to 30% in primary as well as secondary prevention patients. Thus, statins are the pharmacologic therapy of choice for the management of high blood cholesterol levels. Prompted by examination of clinical trial data suggesting a modest, but statistically significant, increase in the incidence of new-onset type 2 diabetes mellitus with statin use, the US Food and Drug Administration in 2012 added a statement to the labels of statin medications indicating that increases in glycated hemoglobin (HbA1C) and fasting glucose levels have been reported with statin use. This labeling change has raised questions among clinicians regarding the relative benefits and risks of statin use, both among patients with diabetes mellitus and among those with diabetes risk factors. This 2014 report from the Diabetes Subpanel of the National Lipid Association Expert Panel on Statin Safety reviews the published evidence relating statin use to the hazard for diabetes mellitus or worsening glycemia, examines potential mechanisms that may mediate the relationship between statin use and diabetes mellitus risk, and suggests future research efforts. Given the well-established benefits of statin therapy in the primary and secondary prevention of cardiovascular events among those with indications for treatment, no changes to clinical practice are recommended other than the measurement of HbA1C or fasting glucose in those deemed to also be at elevated diabetes risk after initiating statin therapy, and potentially before initiation in selected patients considered to be at elevated risk of developing diabetes. The panel advocates following recommendations from the American Diabetes Association, or other relevant guidelines if outside the United States, for screening and diagnosis as well as lifestyle modification for prevention or delay of diabetes mellitus in those with prediabetes or other risk factors.
    Journal of Clinical Lipidology. 01/2014; 8(3):S17–S29.
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    ABSTRACT: Plasma fibrinogen is an acute phase protein playing an important role in the blood coagulation cascade having strong associations with smoking, alcohol consumption and body mass index (BMI). Genome-wide association studies (GWAS) have identified a variety of gene regions associated with elevated plasma fibrinogen concentrations. However, little is yet known about how associations between environmental factors and fibrinogen might be modified by genetic variation. Therefore, we conducted large-scale meta-analyses of genome-wide interaction studies to identify possible interactions of genetic variants and smoking status, alcohol consumption or BMI on fibrinogen concentration. The present study included 80,607 subjects of European ancestry from 22 studies. Genome-wide interaction analyses were performed separately in each study for about 2.6 million single nucleotide polymorphisms (SNPs) across the 22 autosomal chromosomes. For each SNP and risk factor, we performed a linear regression under an additive genetic model including an interaction term between SNP and risk factor. Interaction estimates were meta-analysed using a fixed-effects model. No genome-wide significant interaction with smoking status, alcohol consumption or BMI was observed in the meta-analyses. The most suggestive interaction was found for smoking and rs10519203, located in the LOC123688 region on chromosome 15, with a p value of 6.2×10-8. This large genome-wide interaction study including 80,607 participants found no strong evidence of interaction between genetic variants and smoking status, alcohol consumption or BMI on fibrinogen concentrations. Further studies are needed to yield deeper insight in the interplay between environmental factors and gene variants on the regulation of fibrinogen concentrations.
    PLoS ONE 01/2014; 9(12):e111156. · 3.53 Impact Factor
  • Heart (British Cardiac Society) 12/2013; · 6.02 Impact Factor
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    ABSTRACT: The interleukin-6 receptor (IL-6R) blocker tocilizumab (TCZ) reduces inflammatory disease activity in rheumatoid arthritis (RA) but elevates lipid concentrations in some patients. We aimed to characterise the impact of IL-6R inhibition on established and novel risk factors in active RA. Randomised, multicentre, two-part, phase III trial (24-week double-blind, 80-week open-label), MEASURE, evaluated lipid and lipoprotein levels, high-density lipoprotein (HDL) particle composition, markers of coagulation, thrombosis and vascular function by pulse wave velocity (PWV) in 132 patients with RA who received TCZ or placebo. Median total-cholesterol, low-density lipoprotein-cholesterol (LDL-C) and triglyceride levels increased in TCZ versus placebo recipients by week 12 (12.6% vs 1.7%, 28.1% vs 2.2%, 10.6% vs -1.9%, respectively; all p<0.01). There were no significant differences in mean small LDL, mean oxidised LDL or total HDL-C concentrations. However, HDL-associated serum amyloid A content decreased in TCZ recipients. TCZ also induced reductions (>30%) in secretory phospholipase A2-IIA, lipoprotein(a), fibrinogen and D-dimers and elevation of paraoxonase (all p<0.0001 vs placebo). The ApoB/ApoA1 ratio remained stable over time in both groups. PWV decreases were greater with placebo than TCZ at 12 weeks (adjusted mean difference 0.79 m/s (95% CI 0.22 to 1.35; p=0.0067)). These data provide the first detailed evidence for the modulation of lipoprotein particles and other surrogates of vascular risk with IL-6R inhibition. When compared with placebo, TCZ induced elevations in LDL-C but altered HDL particles towards an anti-inflammatory composition and favourably modified most, but not all, measured vascular risk surrogates. The net effect of such changes for cardiovascular risk requires determination.
    Annals of the rheumatic diseases 12/2013; · 9.27 Impact Factor
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    ABSTRACT: Background and Aims: Previous studies have investigated the association between ethnicity and processes of care and intermediate outcomes of diabetes, but there are limited population-based studies available. The aim of this study was to use population-based data to investigate the relationships between ethnicity and glycaemic control in men and women with diabetes mellitus living in Scotland Methods: We used a 2008 extract from the population-based national electronic diabetes database of Scotland. The association between ethnicity with mean glycaemic control in type 2 diabetes mellitus was examined in a retrospective cohort study, including adjustment for a number of variables including age, sex, socioeconomic status, body mass index (BMI), prescribed treatment and duration of diabetes. Results: Complete data for analyses were available for 56,333 White Scottish adults, 2,535 Pakistanis, 857 Indians, 427 Chinese and 223 African-Caribbeans. All other ethnic groups had significantly (p,0.05) greater proportions of people with suboptimal glycaemic control (HbA1c .58 mmol/mol, 7.5%) compared to the White Scottish group, despite generally younger mean age and lower BMI. Fully adjusted odds ratios for suboptimal glycaemic control were significantly higher among Pakistanis and Indians (1.85, 95% CI: 1.68–2.04, and 1.62,95% CI: 1.38–1.89) respectively. Conclusions: Pakistanis and Indians with type 2 diabetes mellitus were more likely to have suboptimal glycaemic control than the white Scottish population. Further research on health services and self-management are needed to understand the association between ethnicity and glycaemic control to address ethnic disparities in glycaemic control. Copyright: ß 2013 Negandhi et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Funding: The authors have no support or funding to report. Competing Interests: HMC received monies from Pfizer for attending symposia, a speaker's bureau, as a member of staff and for consultancy. HMC has received research funds from Pfizer, Roche, Eli-Lilly, Boehringer Ingelheim (BI) and Astra Zeneca. HMC has shares in Roche. JAM is the PI for drug studies for Novo Nordisk, Eli Lilly and BI (contracts relating to this work are through JAM's NHS employer R&D department). JAM received monies 2 years ago from BI for organising the ethics application for their study and attending the meeting relating to this. JAM has received support to attend meetings from the above companies as well as from Takeda. This does not alter the authors' adherence to all PLOS ONE policies on sharing materials.
    PLoS ONE 12/2013; · 3.53 Impact Factor
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    ABSTRACT: Expert bodies and health organisations recommend that adults undertake at least 150 min.week(-1) of moderate-intensity physical activity (MPA). However, the underpinning data largely emanate from studies of populations of European descent. It is unclear whether this level of activity is appropriate for other ethnic groups, particularly South Asians, who have increased cardio-metabolic disease risk compared to Europeans. The aim of this study was to explore the level of MPA required in South Asians to confer a similar cardio-metabolic risk profile to that observed in Europeans undertaking the currently recommended MPA level of 150 min.week(-1). Seventy-five South Asian and 83 European men, aged 40-70, without cardiovascular disease or diabetes had fasted blood taken, blood pressure measured, physical activity assessed objectively (using accelerometry), and anthropometric measures made. Factor analysis was used to summarise measured risk biomarkers into underlying latent 'factors' for glycaemia, insulin resistance, lipid metabolism, blood pressure, and overall cardio-metabolic risk. Age-adjusted regression models were used to determine the equivalent level of MPA (in bouts of ≥10 minutes) in South Asians needed to elicit the same value in each factor as Europeans undertaking 150 min.week(-1) MPA. For all factors, except blood pressure, equivalent MPA values in South Asians were significantly higher than 150 min.week(-1); the equivalent MPA value for the overall cardio-metabolic risk factor was 266 (95% CI 185-347) min.week(-1). South Asian men may need to undertake greater levels of MPA than Europeans to exhibit a similar cardio-metabolic risk profile, suggesting that a conceptual case can be made for ethnicity-specific physical activity guidance. Further study is needed to extend these findings to women and to replicate them prospectively in a larger cohort.
    PLoS ONE 12/2013; 8(12):e82568. · 3.53 Impact Factor
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    ABSTRACT: We investigated 3 hypotheses: (1) N-terminal pro-B-type natriuretic peptide (NT-proBNP) predicts cardiovascular disease events in patients with hypertension, (2) NT-proBNP is associated with blood pressure variability, and (3) NT-proBNP predicts benefit from antihypertensive regimens. The Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT) randomized a subset of 6549 patients at risk with no history of coronary heart disease to either atenolol-based or amlodipine-based blood pressure-lowering treatment. During 5.5 years of follow-up, 485 cardiovascular disease cases accrued and were matched with 1367 controls. Baseline and 6-month in-trial NT-proBNP were measured. The results show that NT-proBNP improves cardiovascular disease risk prediction beyond established predictors, continuous net reclassification improvement of 22.3% (P<0.0001). Furthermore, a 1-mm Hg increase in the SD of systolic blood pressure was associated with 2% higher baseline NT-proBNP in a multivariable regression analysis (P<0.0001). However, NT-proBNP predicted cardiovascular disease risk independently of blood pressure variation (odds ratio per SD increase in log NT-proBNP 1.24; 95% confidence interval, 1.06-1.45; P=0.007). Atenolol-based treatment led to a 69.6% increase in NT-proBNP at 6 months (P<0.0001). In contrast, amlodipine-based treatment reduced NT-proBNP by 36.5% (P<0.0001). Amlodipine recipients who achieved a 6-month NT-proBNP below the median (61 pg/mL) were at lower risk of cardiovascular disease when compared with those who did not (odds ratio, 0.58; 95% confidence interval, 0.37-0.91) after adjustment for confounders inclusive of baseline NT-proBNP and achieved blood pressure. If confirmed, these novel results suggest that NT-proBNP, as well as aiding cardiovascular disease risk assessment, may also help assess the efficacy of specific antihypertensive regimens. Further relevant studies seem warranted.
    Hypertension 12/2013; · 7.63 Impact Factor
  • David Preiss, Naveed Sattar
    Current opinion in lipidology 12/2013; 24(6):532-533. · 5.80 Impact Factor
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    ABSTRACT: There is evidence that South Asian individuals have higher fat mass for a given weight than Europeans. One study reported that the greater fatness for a given birthweight may increase with increasing birthweight, suggesting that any attempt to increase mean birthweight in South Asians would markedly increase their fatness. Our objective was to examine whether differences in cord leptin values between White British and Pakistani infants vary by birthweight category.Method We examined the difference in cord leptin levels between 659 White British and 823 Pakistani infants recruited to the Born in Bradford cohort study, by clinical categories and thirds of the birthweight distribution. Pakistani infants had a lower mean birthweight but higher cord leptin levels than White British infants [ratio of geometric mean (RGM) of cord leptin adjusted for birthweight = 1.36 (95% CI 1.26, 1.46)]. Birthweight was positively associated with cord leptin levels in both groups, with no evidence that the regression lines in the two groups diverged from each other with increasing birthweight. The relative ethnic difference in cord leptin was similar in low (<2500 g), normal and high (≥4000 g) birthweight infants (P-value for interaction = 0.91). It was also similar across thirds of the birthweight distribution [RGM (95% CI) in lowest, mid and highest thirds were 1.37 (1.20, 1.57), 1.36 (1.20, 1.54) and 1.31 (1.16, 1.52), respectively, P-interaction = 0.51]. We found marked differences in cord leptin levels between Pakistani and White British infants but no evidence that this difference increases with increasing birthweight.
    International Journal of Epidemiology 11/2013; · 9.20 Impact Factor
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    ABSTRACT: We have investigated the role of muscle mass, natriuretic peptides and adipokines in explaining the obesity paradox. The obesity paradox relates to the association between obesity and increased survival in patients with coronary heart disease (CHD) or heart failure (HF). Prospective study of 4046 men aged 60-79years followed up for a mean period of 11years, during which 1340 deaths occurred. The men were divided according to the presence of doctor diagnosed CHD and HF: (i) no CHD or HF ii), with CHD (no HF) and (iii) with HF. Overweight (BMI 25-9.9kg/m(2)) and obesity (BMI≥30kg/m(2)) were associated with lower mortality risk compared to men with normal weight (BMI 18.5-24.9kg/m(2)) in those with CHD [hazards ratio (HR) 0.71 (0.56,0.91) and 0.77 (0.57,1.04); p=0.04 for trend] and in those with HF [HR 0.57 (0.28,1.16) and 0.41 (0.16,1.09; p=0.04 for trend). Adjustment for muscle mass and NT-proBNP attenuated the inverse association in those with CHD (no HF) [HR 0.78 (0.61,1.01) and 0.96 (0.68,1.36) p=0.60 for trend) but made minor differences to those with HF [p=0.05]. Leptin related positively to mortality in men without HF but inversely to mortality in those with HF; adjustment for leptin abolished the BMI mortality association in men with HF [HR 0.82 (0.31,2.20) and 0.99 (0.27,3.71); p=0.98 for trend]. The lower mortality risk associated with excess weight in men with CHD without HF may be due to higher muscle mass. In men with HF, leptin (possibly reflecting cachexia) explain the inverse association.
    International journal of cardiology 11/2013; · 6.18 Impact Factor
  • Naveed Sattar, George D Kitas
    Nature Reviews Rheumatology 11/2013; · 9.75 Impact Factor
  • Duncan Porter, James Dale, Naveed Sattar
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    ABSTRACT: Treat-to-target strategies have been widely adopted as the standard of care for the management of patients with rheumatoid arthritis. The concept of 'tight control' is prevalent in other disciplines, particularly in diabetes and cardiovascular risk management. In these disciplines, evidence has accumulated that the utility of tight control strategies must be carefully weighed against the disutility that may arise from multiple interventions, particularly in patients at low risk. There is a lively debate in rheumatology circles about whether treatment should be targeted at achieving low disease activity, clinical remission or imaging remission. As rheumatologists we should learn the lessons from other disciplines, and ensure that we expand the evidence base to ensure our recommendations are securely underpinned by robust evidence.
    Annals of the rheumatic diseases 11/2013; · 9.27 Impact Factor
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    ABSTRACT: Objective Diabetes is associated with left ventricular diastolic and systolic dysfunction. South Asians may be at particular risk of developing LV dysfunction due to a high prevalence of diabetes. We investigated the role of diabetes and hyperglycaemia in LV dysfunction in a community-based cohort of older South Asians and White Europeans.Research Design and Methods Conventional and Doppler echocardiography was performed in 999 participants (542 Europeans, 457 South Asians aged 58-86 years) in a population-based study. Anthropometry, fasting bloods, coronary artery calcification scoring, blood pressure and renal function were measured.ResultsDiabetes, and hyperglycaemia across the spectrum of HbA1c had a greater adverse effect on LV function in South Asians than Europeans (NT-proBNP beta±SE 0.09±0.04, p=0.01 versus -0.04±0.05, p=0.4, p for HbA1c/ethnicity interaction 0.02), diastolic function (E/e' 0.69±0.12, p<0.0001 versus 0.09±0.2, p=0.6, p interaction 0.005, and systolic function (s' -0.11±0.06, p=0.04 versus 0.14±0.09, p=0.1, p interaction 0.2). Multivariable adjustment for hypertension, microvascular disease, LV mass, coronary disease and dyslipidaemia only partially accounted for the ethnic differences. Adverse LV function in diabetic South Asians could not be accounted for by poorer glycaemic control or longer diabetes duration.Conclusions Diabetes and hyperglycaemia have a greater adverse effect on LV function in South Asians than Europeans incompletely explained by adverse risk factors. South Asians may require earlier, and more aggressive treatment of their cardiometabolic risk factors to reduce risks of LV dysfunction.
    Diabetes care 11/2013; · 7.74 Impact Factor
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    ABSTRACT: To evaluate QRISK2 and Framingham cardiovascular disease (CVD) risk scores in a tri-ethnic UK population. Cohort study. West London. Randomly selected from primary care lists. Follow-up data were available for 87% of traced participants, comprising 1866 white Europeans, 1377 South Asians, and 578 African Caribbeans, aged 40-69 years at baseline (1998-1991). First CVD events: myocardial infarction, coronary revascularisation, angina, transient ischaemic attack or stroke reported by participant, primary care or hospital records or death certificate. During follow-up, 387 CVD events occurred in men (14%) and 78 in women (8%). Both scores underestimated risk in European and South Asian women (ratio of predicted to observed risk: European women: QRISK2: 0.73, Framingham: 0.73; South Asian women: QRISK2: 0.52, Framingham: 0.43). In African Caribbeans, Framingham over-predicted in men and women and QRISK2 over-predicted in women. Framingham classified 28% of participants as high risk, predicting 54% of all such events. QRISK2 classified 19% as high risk, predicting 42% of all such events. Both scores performed poorly in identifying high risk African Caribbeans; QRISK2 and Framingham identified as high risk only 10% and 24% of those who experienced events. Neither score performed consistently well in all ethnic groups. Further validation of QRISK2 in other multi-ethnic datasets, and better methods for identifying high risk African Caribbeans and South Asian women, are required.
    Heart (British Cardiac Society) 11/2013; · 6.02 Impact Factor
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    ABSTRACT: To examine the association of total cerebral blood flow (CBF) with all-cause, noncardiovascular, and cardiovascular mortality in older subjects at risk of cardiovascular disease. We included 411 subjects with a mean age of 74.5 years from the MRI substudy of the Prospective Study of Pravastatin in the Elderly at Risk. Total CBF was measured at baseline, and occurrence of death was recorded in an average follow-up period of 11.8 years. For each participant, total CBF was standardized for brain parenchymal volume. Cox regression models were used to estimate risk of all-cause, noncardiovascular, and cardiovascular mortality in relation to CBF. Mortality rates among participants in low, middle, and high thirds of total CBF were 52.1, 41.5, and 28.7 per 1,000 person-years, respectively. Compared with participants in the high third of CBF, participants in the low third had 1.88-fold (95% confidence interval [CI]: 1.30-2.72) higher risk of all-cause mortality, 1.66-fold (95% CI: 1.06-2.59) higher risk of noncardiovascular mortality, and 2.50-fold (95% CI: 1.28-4.91) higher risk of cardiovascular mortality. Likewise, compared with participants in the high third of CBF, participants in the middle third had 1.44-fold (95% CI: 0.98-2.11) higher risk of all-cause mortality, 1.29-fold (95% CI: 0.82-2.04) higher risk of noncardiovascular mortality, and 1.86-fold (95% CI: 0.93-3.74) higher risk of cardiovascular mortality. These associations were independent of prevalent vascular status and risk factors. Low total CBF is linked with higher risk of all-cause, noncardiovascular, and cardiovascular mortality in older people independent of clinical cardiovascular status.
    Neurology 10/2013; · 8.30 Impact Factor
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    ABSTRACT: Lower maternal vitamin D status in pregnancy may be associated with increased offspring cardiovascular risk in later life, but evidence for this is scant. We examined associations of maternal total 25-hydroxyvitamin D (25(OH)D) in pregnancy with offspring cardiovascular risk factors assessed in childhood and adolescence. A longitudinal, prospective study. The study was based on data from mother-offspring pairs in the Avon Longitudinal Study of Parents and Children (ALSPAC), a UK prospective population-based birth cohort (N=4109). Offspring cardiovascular risk factors were measured in childhood (mean age 9.9 years) and in adolescence (mean age 15.4 years): blood pressure, lipids, apolipoproteins (at 9.9 years only), glucose and insulin (at 15.4 years only), C reactive protein (CRP), and interleukin 6 (at 9.9 years only) were measured. After adjustments for potential confounders (maternal age, education, body mass index (BMI), smoking, physical activity, parity, socioeconomic position, ethnicity, and offspring gestational age at 25(OH)D sampling; gender, age, and BMI at outcome assessment), maternal 25(OH)D was inversely associated with systolic blood pressure (-0.48 mm Hg difference per 50 nmol/L increase in 25(OH)D; 95% CI -0.95 to -0.01), Apo-B (-0.01 mg/dL difference; 95% CI -0.02 to -0.001), and CRP (-6.1% difference; 95% CI -11.5% to -0.3%) at age 9.9 years. These associations were not present for risk factors measured at 15.4 years, with the exception of a weak inverse association with CRP (-5.5% difference; 95% CI -11.4% to 0.8%). There was no strong evidence of associations with offspring triglycerides, glucose or insulin. Our findings suggest that fetal exposure to 25(OH)D is unlikely to influence cardiovascular risk factors of individuals later in life.
    Heart (British Cardiac Society) 10/2013; · 6.02 Impact Factor
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    ABSTRACT: Objective Current methods of risk-stratification in patients with type 2 diabetes are suboptimal. The current study assesses the ability of N-terminal pro-B-type natriuretic peptide (NT-proBNP) and high sensitivity cardiac troponin T (hs-cTnT) to improve the prediction of cardiovascular events and death in patients with type 2 diabetes.Research Design and MethodsA nested case-cohort study was performed in 3,862 patients who participated in the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation trial.ResultsSeven hundred and nine (18%) patients experienced a major cardiovascular event (composite of cardiovascular death, non-fatal myocardial infarction or non-fatal stroke) and 706 (18%) died during a median of 5 years follow-up. In Cox regression models, adjusting for all established risk predictors, the hazard ratio [HR] for cardiovascular events for NT-proBNP was 1.95 per 1 standard deviation [SD] increase (95% confidence interval [CI] 1.72-2.20) and the HR for hs-cTnT was 1.50 per 1 SD increase (95% CI 1.36-1.65). The HRs for death were 1.97 (95% CI 1.73-2.24) and 1.52 (95% CI 1.37-1.67), respectively. The addition of either marker improved 5-year risk classification for cardiovascular events (net reclassification index in continuous model, 39% for NT-proBNP and 46% for hs-cTnT). Likewise, both markers greatly improved the accuracy with which the 5-year risk of death was predicted. The combination of both markers provided optimal risk discrimination.ConclusionNT-proBNP and hs-cTnT appear to greatly improve the accuracy with which the risk of cardiovascular events or death can be estimated in patients with type 2 diabetes.
    Diabetes care 10/2013; · 7.74 Impact Factor

Publication Stats

14k Citations
3,964.75 Total Impact Points


  • 2002–2014
    • University of Glasgow
      • Institute of Cardiovascular and Medical Sciences
      Glasgow, Scotland, United Kingdom
    • West Georgia Obstetrics and Gynecology
      Georgetown, Georgia, United States
  • 2011–2013
    • St George's, University of London
      • Division of Population Health Sciences and Education
      London, ENG, United Kingdom
    • Imperial College London
      • International Centre for Circulatory Health
      London, ENG, United Kingdom
    • University Hospitals Of Leicester NHS Trust
      Leiscester, England, United Kingdom
    • Chelsea and Westminster Hospital NHS Foundation Trust
      Londinium, England, United Kingdom
  • 2009–2013
    • Leiden University Medical Centre
      • • Department of Gerontology and Geriatrics
      • • Department of Cardiology
      Leiden, South Holland, Netherlands
    • East Coast Community Healthcare CIC
      Beccles, England, United Kingdom
  • 2005–2013
    • University College London
      • • Department of Primary Care and Population Health (PCPH)
      • • Institute of Child Health
      London, ENG, United Kingdom
    • University of Bristol
      • MRC Centre for Causal Analyses in Translational Epidemiology
      Bristol, England, United Kingdom
  • 2003–2013
    • London School of Hygiene and Tropical Medicine
      • • Department of Non-communicable Disease Epidemiology
      • • Faculty of Epidemiology and Population Health
      London, ENG, United Kingdom
    • University of Texas Health Science Center at San Antonio
      • Division of Hospital Medicine
      San Antonio, TX, United States
  • 2012
    • University of London
      Londinium, England, United Kingdom
    • Heinrich-Heine-Universität Düsseldorf
      • Deutsches Diabetes-Zentrum DDZ
      Düsseldorf, North Rhine-Westphalia, Germany
    • Celera
      Alameda, California, United States
    • University of Lausanne
      Lausanne, Vaud, Switzerland
    • UK Department of Health
      Londinium, England, United Kingdom
  • 2009–2012
    • VU University Medical Center
      • Department of Rheumatology
      Amsterdam, North Holland, Netherlands
  • 2009–2011
    • The Dudley Group NHS Foundation Trust
      Dudley, England, United Kingdom
  • 2007–2011
    • University of Cambridge
      • Department of Public Health and Primary Care
      Cambridge, ENG, United Kingdom
    • Queen Elizabeth Hospital Birmingham
      Birmingham, England, United Kingdom
  • 2006–2011
    • The University of Edinburgh
      • Centre for Population Health Sciences
      Edinburgh, SCT, United Kingdom
    • University of Aberdeen
      • Health Services Research Unit
      Aberdeen, Scotland, United Kingdom
  • 2010
    • UCL Eastman Dental Institute
      Londinium, England, United Kingdom
    • Erasmus MC
      • Department of Epidemiology
      Rotterdam, South Holland, Netherlands
  • 2003–2009
    • Ninewells Hospital
      Dundee, Scotland, United Kingdom
  • 2008
    • King's College London
      Londinium, England, United Kingdom
    • Loughborough University
      • School of Sport, Exercise and Health Sciences
      Loughborough, England, United Kingdom
    • Centers for Disease Control and Prevention
      • National Center for Chronic Disease Prevention and Health Promotion
      Druid Hills, GA, United States
    • University of Dundee
      • Division of Neuroscience
      Dundee, SCT, United Kingdom
  • 2003–2008
    • The Bracton Centre, Oxleas NHS Trust
      Дартфорде, England, United Kingdom
  • 2004
    • McGill University Health Centre
      Montréal, Quebec, Canada
  • 1998
    • Copenhagen University Hospital Hvidovre
      Hvidovre, Capital Region, Denmark