Gregory Y H Lip

University Hospitals Birmingham NHS Foundation Trust, Birmingham, England, United Kingdom

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Publications (900)4612.57 Total impact

  • Yee C Lau, Gregory YH Lip
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    ABSTRACT: Introduction: Atrial fibrillation (AF) is the most common arrhythmia and brings about significant mortality and morbidity as a result of heart failure and ischemic stroke. Besides vitamin K antagonists (VKA), several new pharmacological agents (nonvitamin K antagonist oral anticoagulants [NOACs]) and procedures have since been developed to improve stroke prevention efforts in AF.Areas covered: This paper will discuss the antiplatelet agents, VKA and NOACs, and their efficacy and safety for stroke prevention in AF. Focus will be placed on the NOACs, their limitations and special considerations. A short assessment of other nonpharmacological antithrombotic procedures will also be made. An extensive PubMed search was used to identify suitable papers.Expert opinion: Despite the advent of NOACs, the VKAs will remain as an important oral anticoagulant due to its versatility. However, convenience and limited food or drug interactions will make NOACs attractive options. The choice between various NOACs will depend on several important factors as illustrated below. Over time, the role for antiplatelet agents will gradually diminish. Left atrial appendage occlusion devices have shown promising results and may have the potential to change the way clinicians manage thromboembolism risks related to AF.
    Expert Opinion on Pharmacotherapy 08/2014; · 2.86 Impact Factor
  • Keitaro Senoo, Yee Cheng Lau, Gregory Yh Lip
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    ABSTRACT: There is significant progress made in the field of atrial fibrillation, especially regarding stroke stratification, novel pharmacological agents and interventions for improving symptom control. The Updated NICE Guideline for management of 2014 reflects that and provided an up-to-date appraisal regarding atrial fibrillation treatment, management with consideration to overall healthcare cost economics. It emphasizes the need for individualized, patient-centered package of care, and an robust stroke and bleeding risk before decision regarding choice of oral anticoagulation to be made.
    Expert Review of Cardiovascular Therapy 07/2014;
  • Richard A Brown, Gregory Y H Lip
    Annals of internal medicine 07/2014; 161(2):JC9. · 13.98 Impact Factor
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    ABSTRACT: Aim. To characterize blood monocyte subsets in patients with different degrees of carotid atherosclerosis and pathological carotid plaque neovascularization. Methods. Assessment of carotid plaque neovascularization using contrast ultrasonography and flow cytometric quantification of monocyte subsets and their receptors involved in inflammation, angiogenesis, and tissue repair was done in 40 patients with carotid stenosis ≥ 50% and CAD (CS > 50), 40 patients with carotid stenosis < 50% and documented CAD (CS < 50), 40 hypercholesterolaemic controls (HC group), and 40 normocholesterolaemic controls (NC). Results. CS > 50 and CS < 50 groups had increased counts of Mon1 ('classical' CD14++ CD16-CCR2 + cells) compared to HCs (P = 0.03, and P = 0.009). Mon3 ('non-classical' CD14 + CD16++ CCR2- cells) were only increased in CS < 50 compared with HCs (P < 0.01). Both CS>50 and CS < 50 groups showed increased expression of proinflammatory interleukin-6 receptor on Mon1 and Mon2 ('intermediate' CD14++ CD16 + CCR2+ cells); TLR4, proangiogenic Tie2 on all subsets (P < 0.01 for all). In multivariate regression analysis only high Mon1 count was a significant predictor of carotid stenosis (P = 0.04) and intima-media thickness (P = 0.02). In multivariate regression analysis only the Mon1 subset was significantly associated with severe, grade 2 neovascularization (P = 0.034). Conclusion. In this pilot study classical monocytes (Mon1) represent the only monocyte subset predictive of the severity of carotid and systemic atherosclerosis, such as carotid intima-media thickness, degree of carotid stenosis, and presence of carotid intraplaque neovascularization.
    Annals of medicine. 07/2014;
  • Yu-Wen Chen, Stavros Apostolakis, Gregory Y H Lip
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    ABSTRACT: Sedentary lifestyle is a risk factor and a strong predictor for chronic disease and premature death. Low-grade inflammation has been proved a key player in the pathogenesis of cardiovascular disease. Inflammatory processes have been also involved in maintaining the balance between coagulation and fibrinolysis. In addition, an inverse linear dose-response relation between physical activity and mortality risks has also been reported. However, the favorable effects of structured exercise programs and the independent contribution of physical activity to cardiovascular risk are still under investigation.
    Annals of medicine. 07/2014;
  • 07/2014;
  • Gregory Yh Lip, Deirdre A Lane
    Circulation journal : official journal of the Japanese Circulation Society. 07/2014;
  • Yee C Lau, Gregory Y H Lip
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    ABSTRACT: Oral anticoagulation (OAC) remains the mainstay for prevention of ischaemic stroke in atrial fibrillation. This article reviews the latest evidence and development of new oral anticoagulants for the prevention of ischaemic stroke, as well as bleeding risk assessment, mitigation and management.
    Current opinion in cardiology. 07/2014; 29(4):293-300.
  • Gregory Yh Lip, Eduard Shantsila
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    ABSTRACT: Advances in pharmacological and devices therapy have greatly improved prognosis in patients with systolic heart failure. Despite this congestive heart failure still bears a very grim prognosis, particularly in patients with more advances stages of the disease that are so frequently seen on hospital wards. Which pathogenic pathways may need to be addressed to improve prognosis in heart failure? The current treatment of this condition is primarily focused on performance of the heart itself, and aims to inhibit unfavorable cardiac remodeling (e.g., amelioration of impact of activated catecholamine and renin-angiotensin-aldosterone systems), optimization of cardiac hemodynamics (e.g., cardiac resynchronization therapy) and prevention of life threatening arrhythmia (e.g., insertion of implantable defibrillators). However, accumulating evidence suggests that thrombotic complications may play a major role in morbidity and outcomes in heart failure patients, especially as the cardiac 'targets' (largely neurohuneral) are being better managed.
    Circulation 06/2014; · 15.20 Impact Factor
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    ABSTRACT: Sex differences in the epidemiology and clinical management of AF are evident. Of note, females are more symptomatic and if age >65, are at higher risk of thromboembolism if incident AF develops, compared with males.
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    ABSTRACT: Background Our objective was to determine stroke and thromboembolism event rates in patients with atrial fibrillation (AF) classified as 'low risk' using the ATRIA score, and to ascertain event rates in this group in relation to the stroke risk assessment advocated in the 2012 European Society of Cardiology (ESC) guidelines (based on the CHA2DS2-VASc score). We tested the hypothesis that the stroke risk assessment scheme advocated in the ESC guidelines would be able to further refine stroke risk stratification in the 'low risk' category defined by the ATRIA score. Methods and ResultsIn our cohort of 207,543 incident AF patients from 1999-2012, we identified 72,452 subjects who had an ATRIA score of 0-5 ('low risk').Even amongst these patients categorised as 'low risk' using the ATRIA score, the 1 year stroke/thromboembolic event rate ranged from 1.13 to 36.94 per 100 person-years, when subdivided by CHA2DS2-VASc scores.In patients with an ATRIA score 0-5, c-statistics at 1 year follow up in the Cox regression model were significantly improved from 0.626 (95% CI 0.612-0.640) to 0.665 (95% CI 0.651-0.679) when the CHA2DS2-VASc score was used for categorising stroke risk instead of the ATRIA score (p<0.001). Conclusion Patients categorised as 'low risk' using an ATRIA score 0-5 are not necessarily 'low risk', with 1 year event rates as high as 36.94 per 100 person-years. Thus, the stroke risk stratification scheme recommended in the ESC guidelines (based on the CHA2DS2-VASc score) would be best at identifying the 'truly low risk' AF subjects who do not need any antithrombotic therapy.
    Chest 06/2014; · 5.85 Impact Factor
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    ABSTRACT: ABSTRACT BACKGROUND Much of the epidemiology of atrial fibrillation (AF) is based on data from Western populations. Despite the huge population of Asia, data on the clinical epidemiology of AF in Asian countries are limited. OBJECTIVE The present study aimed to investigate the prevalence and incidence of newly diagnosed (ie. incident) AF, as well as lifetime risk in China, and to determine the clinical risk factors contributing to its development. METHODS Using a medical insurance database involving in more than 10 million individuals for the years 2001 to 2012 in the Southwest of China, trends in incident AF were calculated using Kaplan-Meier analysis and Cox regression. The usefulness of the CHADS2 and CHA2DS2-VASc scores was tested in predicting the occurrence of incident AF. RESULTS There were 471,446 individuals (aged ≥20 years) studied, with 1,924,975 person-years experience. We identified 921 patients with incident AF (62% males, mean age 62 years). The prevalence of incident AF in subjects age ≥20 years was 0.2 per 100 persons, with an incidence of AF of 0.05 per 100 person-years overall. Over an 11-year period, the prevalence of AF increased 20-fold, while AF-related stroke increased 13-fold. The lifetime risk for AF was approximately 1 in 5 amongst Chinese adults, which increased with advancing age. The CHA2DS2-VASc score was superior to CHADS2 in predicting the risk for incident AF in our Chinese population (DeLong test, Z=6.621, P<0.001). CONCLUSION AF burden, as well as the risk of AF-related stroke, has increased significantly over past 11 years in the southwest of China. The public health burden of AF and its complications ere greatest in the very elderly, with major implications for healthcare systems given the global burden of this common arrhythmia.
    Chest 06/2014; · 5.85 Impact Factor
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    ABSTRACT: Studies have shown higher in-hospital mortality for female patients and ethnic minorities admitted to hospital with acute ST elevation myocardial infarction (STEMI). Pre-hospital delay is associated with increased in-hospital mortality. We assessed the impact of gender and ethnicity on symptom-to-door-time in patients presenting with STEMI.
    Heart (British Cardiac Society) 06/2014; 100(Suppl 3):A18. · 5.01 Impact Factor
  • Yee C Lau, Gregory Y H Lip
    Annals of internal medicine 05/2014; 160(10):JC5. · 13.98 Impact Factor
  • Gregory Y H Lip, Giancarlo Agnelli
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    ABSTRACT: Long-term anticoagulation treatment with warfarin has been associated with a number of limitations in clinical practice and there is a need for more convenient long-term anticoagulation treatment. One of the non-vitamin K oral anticoagulants in development is edoxaban, a factor Xa inhibitor that is administered once daily. The pharmacological properties of edoxaban have various advantages in anticoagulant therapy. Edoxaban quickly reaches peak plasma concentrations in 1.5 h, has a half-life of 10-14 h, has relatively high bioavailability of 62% and exhibits highly selective, competitive, concentration-dependent inhibition of human factor Xa. The plasma concentrations of edoxaban are also closely correlated with suppression of thrombin generation and a range of platelet activation parameters (fragment 1+2, thrombin-antithrombin complex, and β-thromboglobulin), which edoxaban has been shown to rapidly inhibit. The anticoagulant activity of edoxaban is not affected by food intake or ethnicity and a number of drug-drug interaction studies have been performed. Co-administration of edoxaban with strong P-glycoprotein inhibitors, such as dronedarone, quinidine, and verapamil requires edoxaban dose-reduction by 50% to avoid the risk of over-exposure. The exposure of edoxaban may also increase in patients with a body weight ≤60 kg and moderate renal impairment. This meant a dose-reduction strategy in patients at risk of over-exposure was utilized in Phase III clinical studies. In conclusion, the pharmacological properties of edoxaban provide rapid and specific inhibition of factor Xa, which is closely related to plasma concentrations. Given the limitations with long-term warfarin therapy, once-daily edoxaban may provide a convenient long-term alternative for patients.
    European Heart Journal 05/2014; · 14.10 Impact Factor
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    ABSTRACT: ABSTRACT BACKGROUND Ischemic events (IEs) and intracranial hemorrhages (ICHs) are feared complications of atrial fibrillation (AF) and of antithrombotic treatment in such patients. METHODS AF patients admitted to the Emergency Units of the Bologna area (Italy) with acute IE or ICH were prospectively recorded over a 6 month period. RESULTS 178 patients (60 male; median age 85 y) presented with acute IE, antithrombotic therapy was: a) vitamin K antagonists (VKAs) in 31(17.4%), INR at admission: <2.0 in 16, 2.0-3.0 ( range) 13, and > 3.0 in 2); b) aspirin (ASA) in 107 (60.1%); c) no treatment in 40 (22.5%), mainly because AF was not diagnosed. Twenty patients (8 male; median age 82 y) presented with acute ICH: 13 (65%) received VKAs (INR 2.0-3.0 in 11, >3.0 in 2); whilst 6 (30%) received ASA. Most IEs (88%) and ICH (95%) occurred in patients aged >70 y.A modeling analysis of patients aged >70 y was used to estimate annual incidence in subjects anticoagulated with VKAs in our Network of Anticoagulation Centers (NACs), or those expected to have AF but not included in NACs. The expected incidence of IE was 12.0%/year (95% CI 10.7-13.3) in non-NACs and 0.57 %/year (95% CI 0.42-0.76) in NACs (ARR: 11.4%/year ; RRR: 95%, p<0.0001). The incidence of ICH was 0.63%/year (95% CI 0.34-1.04) and 0.30%/year (95% CI 0.19-0.44), respectively (ARR: 0.33%/year; RRR: 52.4%/year, p= 0.04). CONCLUSION IEs occurred mainly in elderly patients who received ASA or no treatment. Half of anticoagulated patients with IEs had subtherapeutic INRs. Therapeutic approaches to elderly subjects with AF require an effective anticoagulant treatment strategy.
    Chest 05/2014; · 5.85 Impact Factor
  • Yee C Lau, Gregory Yh Lip, Pilar Gallego
    Hypertension Research 05/2014; · 2.79 Impact Factor
  • Source
    Chest 05/2014; 145(5):1177-8. · 5.85 Impact Factor
  • Masahiro Yasaka, Gregory Y H Lip
    Stroke 04/2014; · 6.16 Impact Factor
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    ABSTRACT: To investigate the impact of atrial fibrillation (AF) and antithrombotic treatment on prognosis in patients with heart failure (HF) as well as vascular disease. HF, vascular disease and AF are pathophysiological related and understanding antithrombotic treatment in these conditions is crucial. In hospitalized patients with HF and co-existing vascular disease (coronary artery disease or peripheral arterial disease) followed from 1997-2009, AF status was categorized as prevalent incident and no AF. Risk of thromboembolism (TE), myocardial infarction (MI) and serious bleeding was assessed by Cox regression models (hazard ratio (HR) with [95% confidence interval (CI)]) with antithrombotic therapy and AF as time-dependent variables. A total of 37,464 patients were included (mean age 74.5 [SD 10.7] years, 36.3% females) with a mean follow-up of 3.0 years during which 20.7% were categorized as prevalent AF and 17.2% as incident AF. In comparison to VKA in prevalent AF, VKA plus antiplatelet was not associated with decreased risk of TE (HR 0.91 [0.73-1.12] or MI 1.11 [0.96-1.28] while bleeding risk was significantly increased (HR 1.31 [1.09-1.57]). Corresponding estimates for incident AF were HR 0.77 [0.56-1.06], 1.07 [0.89-1.28] and 2.71 [1.33-2.21], respectively. In no AF patients, no statistical differences were seen between antithrombotic therapies on TE or MI risk while bleeding risk was significantly raised for VKA with or without single antiplatelet therapy. In AF patients with co-existing HF and vascular disease, adding single antiplatelet on top of VKA therapy is not associated with additional benefit on thromboembolic or coronary risk, but notably increased bleeding risk.
    Journal of the American College of Cardiology 04/2014; · 14.09 Impact Factor

Publication Stats

17k Citations
4,612.57 Total Impact Points


  • 1997–2014
    • University Hospitals Birmingham NHS Foundation Trust
      • Department of Medicine
      Birmingham, England, United Kingdom
  • 1996–2014
    • University of Birmingham
      • • Centre for Cardiovascular Sciences
      • • Department of Primary Care Clinical Sciences
      • • School of Sport and Exercise Sciences
      Birmingham, England, United Kingdom
  • 2013
    • Attikon University Hospital
      Athínai, Attica, Greece
    • Aalborg University Hospital
      • Department of Cardiology
      Aalborg, Region North Jutland, Denmark
    • University of Leipzig
      Leipzig, Saxony, Germany
    • Queen Mary, University of London
      • Centre for Primary Care and Public Health
      London, ENG, United Kingdom
    • Azienda Ospedaliera Santa Maria della Misericordia
      Udine, Friuli Venezia Giulia, Italy
  • 2012–2013
    • Aalborg University
      • Faculty of Medicine
      Ålborg, North Denmark, Denmark
    • Chinese PLA General Hospital (301 Hospital)
      Peping, Beijing, China
    • Hospital General Universitario Morales Meseguer
      Murcia, Murcia, Spain
    • Karolinska Institutet
      • Institutionen för klinisk forskning och utbildning, Södersjukhuset
      Stockholm, Stockholm, Sweden
    • Boehringer Ingelheim
      Ingelheim, Rheinland-Pfalz, Germany
    • Università di Pisa
      Pisa, Tuscany, Italy
    • University of Belgrade
      • Chair of Pharmacology, Clinical Pharmacology and Toxicology
      Beograd, Central Serbia, Serbia
    • University of Iowa
      Iowa City, Iowa, United States
    • University of Bonn
      Bonn, North Rhine-Westphalia, Germany
    • University of Oxford
      • Department of Primary Care Health Sciences
      Oxford, ENG, United Kingdom
    • Vilnius University Hospital Santariškių Klinikos
      Vil'nyus, Vilniaus Apskritis, Lithuania
    • Copenhagen University Hospital Gentofte
      • Department of Dermato-Allergology
      Hellebæk, Capital Region, Denmark
    • Universität Heidelberg
      • Department of Clinical Pharmacology and Pharmacoepidemiology
      Heidelberg, Baden-Wuerttemberg, Germany
  • 2011–2013
    • University of Murcia
      Murcia, Murcia, Spain
    • Sapienza University of Rome
      • Department of Experimental Medicine
      Roma, Latium, Italy
    • Klinički centar Srbije
      • Institute for Cardiovascular Diseases
      Beograd, Central Serbia, Serbia
    • Aston University
      • School of Life and Health Sciences
      Birmingham, ENG, United Kingdom
    • University of Bologna
      • Institute of Cardiology
      Bologna, Emilia-Romagna, Italy
    • Centre Hospitalier Universitaire de Tours
      Tours, Centre, France
    • Oulu University Hospital
      • Department of Surgery
      Oulu, Oulu, Finland
    • National Health Service
      Radditch, England, United Kingdom
    • Universitätsklinikum Münster
      Muenster, North Rhine-Westphalia, Germany
    • Maastricht Universitair Medisch Centrum
      Maestricht, Limburg, Netherlands
    • Uppsala University
      • Department of Medical Sciences
      Uppsala, Uppsala, Sweden
    • Turku University Hospital
      • Turku PET Centre
      Turku, Province of Western Finland, Finland
    • Azienda Ospedaliero Universitaria Careggi
      • Department of Heart and Vessels
      Firenzuola, Tuscany, Italy
  • 2008–2013
    • Hospital Universitario Virgen de la Arrixaca
      • Departamento de Cardiología
      Murcia, Murcia, Spain
    • Royal College of Physicians
      Londinium, England, United Kingdom
    • University Hospital of Heraklion
      Irákleio, Attica, Greece
  • 2006–2013
    • Hospital General Universitario de Alicante
      • Departamento de Cardiología
      Alicante, Valencia, Spain
    • University of California, San Diego
      • Moores Cancer Center/Oncology
      San Diego, California, United States
  • 2007–2011
    • Maastricht University
      • Cardiologie
      Maastricht, Provincie Limburg, Netherlands
  • 2005–2011
    • Sandwell and West Birmingham Hospitals NHS Trust
      Birmingham, England, United Kingdom
    • The Bracton Centre, Oxleas NHS Trust
      Дартфорде, England, United Kingdom
    • Hospital Universitario San Juan De Alicante
      Alicante, Valencia, Spain
    • Otto-von-Guericke-Universität Magdeburg
      • Clinic for Cardiology, Angiology and Pneumology
      Magdeburg, Saxony-Anhalt, Germany
  • 2010
    • Baker IDI Heart and Diabetes Institute
      Melbourne, Victoria, Australia
  • 2009
    • University Hospitals Coventry and Warwickshire NHS Trust
      • Department of Cardiology
      Coventry, England, United Kingdom
    • The University of Hong Kong
      • Department of Medicine
      Hong Kong, Hong Kong
  • 2008–2009
    • Justus-Liebig-Universität Gießen
      Gieben, Hesse, Germany
  • 1996–2006
    • Birmingham City University
      Birmingham, England, United Kingdom
  • 2004
    • St. George's School
      Middletown, Rhode Island, United States
  • 2003
    • Medical University of Vienna
      • Universitätsklinik für Klinische Pharmakologie
      Vienna, Vienna, Austria
    • WWF United Kingdom
      Londinium, England, United Kingdom
    • The University of Edinburgh
      • Division of Clinical Neurosciences
      Edinburgh, SCT, United Kingdom
  • 2002
    • McMaster University
      • Department of Medicine
      Hamilton, Ontario, Canada