John Cockcroft

Cardiff University | CU · School of Nursing and Midwifery Studies

Specialised pro-resolving mediators (SPMs) are endogenously produced lipid mediators that regulate the propagation of inflammation and promote tissue repair. We hypothesised that SPM production is dysregulated in COPD; and associated with disease severity, defined by patients with stable COPD (no exacerbations) versus patients with frequent exacerb...

We participated in the UK and Republic of Ireland May Measurement Month 2021 (MMM21) campaign to raise awareness about blood pressure (BP) measurement and the dangers posed by elevated BP and hypertension. In addition, the campaign aimed to collect and report levels of BP awareness and control in the community setting. The MMM21 campaign set up opp...

Background: Reduced arterial pulsatility in continuous-flow left ventricular assist devices (CF-LVAD) patients has been implicated in clinical complications. Consequently, recent improvements in clinical outcomes have been attributed to the 'artificial pulse' technology inherent to the HeartMate3 (HM3) LVAD. However, the effect of the 'artificial...

Globally, it is estimated that 10.4 million people die each year due to raised blood pressure (BP). Unfortunately, at least 40% of those with high BP globally are unaware of their condition. In the most recent UK and Ireland community-based data, 66.5% of people were unaware of their high BP(1). The UK and Ireland have taken part in the global May...

The Timed Up and Go (TUG) is a global measure of mobility and has the ability to detect frail individuals. Frail patients with chronic obstructive pulmonary disease (COPD) are usually undiagnosed. We hypothesised that the TUG would identify frail patients with COPD. Frailty was assessed in 520 patients diagnosed with COPD and 150 controls using a C...

Purpose Increased arterial stiffness is associated with an increased risk of stroke in the general population. Despite recent technological improvements, left ventricle assist device (LVAD) patients retained a high risk of stroke. In this study, we aimed to investigate whether increased arterial stiffness is associated with a higher risk of stroke...

Background Limited data exist on the circadian blood pressure (BP) and heart rate (HR) variations that occur in heart failure (HF) patients on left ventricular assist device (LVAD) support. Methods We prospectively recorded clinic and 24-hour ambulatory BP and HR data in patients on HeartMate II LVAD support. Results were compared to HF patients w...

In the UK, heart and circulatory diseases account for 29% of all deaths (14% through coronary heart disease and 8% through stroke). In 2015, the prevalence of hypertension was 20% in the UK and 23% in the Republic of Ireland. In 2019, 14% of people registered with a UK general practice had hypertension and yet it was the attributable risk factor fo...

Ationale Chronic obstructive pulmonary disease (COPD) and smoking are characterised by pulmonary inflammation. ¹⁸ F-Fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) imaging may improve knowledge of pulmonary inflammation in COPD patients and aid early development of novel therapies as an imaging biomarker. Objective...

BACKGROUND While rates of stroke have declined with the HeartMate3 (HM3) continuous flow (CF) left ventricular assist device (LVAD), the impact of non-pulsatile flow and artificial pulse physiology on cerebrovascular function is not known. We hypothesized that improved hemodynamics and artificial pulse physiology of HM3 patients would augment cereb...

Background In the general population, increased aortic stiffness is associated with an increased risk of cardiovascular events. Previous studies have demonstrated an increase in aortic stiffness in continuous-flow left ventricular assist device (CF-LVAD) patients. However, the association between aortic stiffness and common adverse events is unknow...

We participated in the UK and Republic of Ireland May Measurement Month 2021 (MMM21) campaign to raise awareness about blood pressure (BP) measurement and the dangers posed by elevated BP and hypertension. In addition, the campaign aimed to collect and report levels of BP awareness and control in the community setting. The MMM21 campaign set up opp...

Objectives Although cardiovascular disease (CVD) is a common comorbidity associated with chronic obstructive pulmonary disease (COPD), it is unknown how to improve prediction of cardiovascular (CV) risk in individuals with COPD. Traditional CV risk scores have been tested in different populations but not uniquely in COPD. The potential of alternati...

Purpose: The increased physiological demand of pregnancy results in profound adaptation of the maternal cardiovascular system, reflected by greater resting cardiac output and left ventricular (LV) deformation. Whether the increased resting demand alters acute cardiac responses to exercise in healthy pregnant women is not well understood. Methods:...

Background and objectives The Effect of a Reduction in GFR after Nephrectomy on Arterial Stiffness and Central Hemodynamics (EARNEST) study was a multicenter, prospective, controlled study designed to investigate the associations of an isolated reduction in kidney function on BP and arterial hemodynamics. Design, setting, participants, & measureme...

Rationale: chronic obstructive pulmonary disease (COPD) is a leading cause of mortality and common in older adults. The BODE Index is the most recognised mortality risk score in COPD but includes a 6-minute walk test (6MWT) that is seldom available in practise; the BODE Index may be better adopted if the 6MWT was replaced. Objectives: we investi...

Raised blood pressure (BP) was the biggest contributor to the global burden of disease in 2017, with lack of awareness and adequate control of BP identified as the main drivers of this disease burden. In 2017, an opportunistic BP screening and awareness campaign called May Measurement Month (MMM) in the UK and Republic of Ireland (RoI) highlighted...

Objective: Whether the inferior ability of atenolol to reduce central (aortic) compared to peripheral (brachial) blood pressure (BP) is related to its heart rate (HR)-dependent or -independent effects, or their combination, remains unclear. To provide further mechanistic insight into this topic, we studied the acute effects of atenolol versus nebi...

Rationale Growth and development during adolescence may modify the respiratory and vascular differences seen among extremely preterm (EP) individuals in childhood and early adolescence. Objective To assess the trajectory of respiratory and cardiovascular outcomes at transition to adulthood in a national longitudinal cohort study of births before 26...

Background Two individuals can have a similar pulse pressure (PP) but different levels of systolic blood pressure (SBP), although the underlying mechanisms have not been described. We hypothesized that, for a given level of PP, differences in SBP relate to peripheral vascular resistance (PVR); and we tested this hypothesis in a large cohort of heal...

Purpose Lack of nocturnal blood pressure (BP) reduction (BP dipping) has been associated with cerebrovascular and cardiovascular events in the general population. However, the effect of a deranged circadian BP variability between day and night has never been studied in patients on left ventricular assist device (LVAD) support, where stroke still re...

Purpose It is well established that continuous-flow left ventricular assist devices (LVAD) reduce pulsatility in the circulation. Consequently, the addition of an ‘artificial pulse’ to the HeartMate3 (HM3) LVAD has been expected to increase pulsatility. Yet, there has been no prospective study that has examined arterial hemodynamics of HM3 patients...

Purpose The optimal method for blood pressure (BP) measurement among pts implanted with HeartMate 3 (HM3), a centrifugal pump that features an artificial pulse, is presently unknown. We aimed to: 1) assess success rate and validity of Doppler opening BP (DOBP) and automated BP (ABP) monitor; 2) test a novel approach to estimate mean arterial pressu...

Purpose We previously showed that cerebrovascular reactivity (CVR) is reduced in heart failure (HF) patients and does not improve after left ventricular assist device (LVAD) HeartMate II (HMII) implantation, possibly because of low pulsatile physiology. Therefore, it is possible that the artificial pulse of the latest generation LVAD, the HeartMate...

Background: Factors associated with reduced daily physical activity (DPA) in patients with COPD are still controversial. Physical inactivity in COPD increases risk of cardiovascular disease, frequent exacerbations, reduced health status, and increased symptoms. We hypothesised that reduced DPA in patients with COPD is independent of traditional ri...

New findings: On average, aortic stiffness increases on continuous-flow left ventricular assist device (CF-LVAD) therapy. However, aortic stiffness does not increase in all patients on CF-LVAD therapy. LVAD patients who had an increased aortic stiffness had an increased risk of the composite outcome of stroke, GI bleeding and pump thrombosis. Abs...

New findings: Advanced heart failure patients who are implanted with left ventricular assist devices (LVADs) have a unique circulation that is characterised by a reduced or even absent arterial pulse. The remarkable survival of these patients is accompanied by circulatory complications, including stroke, gastro-intestinal bleeding and right-heart...

New findings: LVAD patients are predisposed to hypertension which may increase the risk of stroke. Hypertension may result from markedly elevated levels of sympathetic nerve activity, which occurs through a baroreceptor-mediated pathway in response to chronic exposure to a non-physiologic (and reduced) pulse. Cerebral autoregulatory processes appe...

New findings: Incidence of right heart failure post left ventricular assist device (LVAD) implantation is improving, as the understanding of LV-RV physiology improves. Yet, it remains one of major adverse events affecting LVAD patients. Assessment of RV failure in the context of LVAD physiology should consider its unique anatomical and physiologic...

The MOMENTUM3 trial1 has revealed superiority of the novel HeartMate3 (HM3) left ventricular assist device (LVAD) compared with the HM2, with a significantly reduced occurrence of cerebrovascular accidents. Thus, cerebral autoregulation may be improved in HM3 compared with HM II patients, possibly because of altered microcirculatory haemodynamics a...

In chronic obstructive pulmonary disease (COPD), acute exacerbation of COPD requiring hospital admission is associated with mortality and healthcare costs. The ERICA study assessed multiple clinical measures in people with COPD, including the short physical performance battery (SPPB), a simple test of physical function with 3 components (gait speed...

Background: In young adults, systolic blood pressure (SBP) and hypertension rates are significantly lower in females than males, although the extent to which this is due to differences in body size (body surface area; BSA) is unclear. Cardiac output (CO), a key haemodynamic determinant of SBP in young adults, is tightly linked with body size, and t...

Background: Chronic obstructive pulmonary disease (COPD) is characterised by airway limitation which is an independent predictor of increased cardiovascular (CV) risk and mortality [1]. COPD is associated with increased arterial stiffness [2] and increased incidence of all stroke subtypes [3]. However, the mechanism linking this association is not...

Background: The MOMENTUM3 trial1 has revealed superiority of the novel HeartMate3 (HM3) left ventricular assist device (LVAD) compared with the HM2, with a significantly reduced occurrence of cerebrovascular accidents. Thus, cerebral autoregulation may be improved in HM3 compared with HM II patients, possibly because of altered microcirculatory hae...

Background : Factors associated with reduced daily physical activity (DPA) in patients with COPD are still controversial. Physical inactivity in COPD increases risk of cardiovascular disease, frequent exacerbations, reduced health status, and increased symptoms. We hypothesised that reduced DPA in patients with COPD is independent of traditional ri...

Artificial Intelligence (AI), although well established in many areas of everyday life, has only recently been trialed in the diagnosis and management of common clinical conditions. This editorial review highlights progress to date and suggests further improvements in and trials of AI in the management of conditions such as hypertension.

Objective: To identify phenotypic factors associated with the Short Physical Performance Battery (SPPB) and its individual sub-tests: standing balance, 4‑meter gait speed (4mGS) and 5-repetition sit-to-stand (5STS). Methods: The Evaluation of the Role of Inflammation in non-pulmonary disease manifestations in Chronic Airways disease (ERICA) stud...

Central Pulse Pressure (CPP) and Aortic Pulse Wave Velocity (aPWV) share a positive relationship with cerebral pulsatility and are associated with cerebrovascular disorders including stroke. Our aim was to examine the influence of Augmentation Index (AIx) upon this relationship, first by using a cross sectional design across a wide range of CPP and...

p.p1 {margin: 0.0px 0.0px 0.0px 0.0px; text-align: justify; font: 12.0px Times} Background : Factors associated with reduced daily physical activity (DPA) in patients with COPD are still controversial. Physical inactivity in COPD increases risk of cardiovascular disease, frequent exacerbations, reduced health status, and increased symptoms. We hypo...

Background and objectives: Cardiovascular (CV) disease is a major cause of morbidity and mortality in chronic obstructive pulmonary disease (COPD). Patients with COPD have increased arterial stiffness, which may predict future CV risk. However, the development of arterial stiffness in COPD has not yet been studied prospectively. The Assessment of R...

Purpose In the normal, pulsatile circulation, the hemodynamic pattern of the middle cerebral artery (MCA) differs from the central retinal artery (CRA). Whether continuous flow from a left ventricular assist device (LVAD) alters this relationship is not known. Since serious adverse events in different end-organs, such as stroke and GI bleeding, are...

Purpose In advanced heart failure (HF) patients, a normal cardiac output is restored after continuous-flow left ventricular assist device (CF-LVAD) implantation. Previous studies have suggested that cerebral autoregulation is preserved. However, it is not known whether CF-LVAD therapy affects the cerebrovascular reactivity to a metabolic challenge....

Purpose It has been proposed that the high prevalence of bleeding events in continuous-flow left ventricular assist device (CF-LVAD) patients may be lowered by increasing von Willebrand factor-release via augmented peripheral pulsatility (PI). However, the hemostatic effects of increased PI may be offset by concomitant increases in local wall shear...

Elevated blood pressure (BP), or hypertension, is a growing burden worldwide, leading to over 10 million deaths each year. May Measurement Month (MMM) is a global initiative aimed at raising awareness of high BP and acting as a stimulus to improving screening programmes worldwide. In the United Kingdom (UK) nearly 1 in 5 people, and in the Republic...

Purpose: The association between egg consumption and cardiovascular disease (CVD) or type 2 diabetes (T2D) remains controversial. We investigated the association between egg consumption and risk of CVD (primary outcome), T2D and mortality in the Caerphilly prospective cohort study (CAPS) and National Diet and Nutritional Survey (NDNS). Methods:...

Background: Chronic obstructive pulmonary disease (COPD) is an inflammatory condition associated with increased cardiovascular risk. COPD patients have increased aortic stiffness and increased risk of stroke. In addition, increased mid cerebral artery pulsatility index (MCAPI) is associated with increased arterial stiffness and risk of stroke in pa...

Background: In heart failure patients with continuous-flow left ventricular assist devices (CF-LVAD), arterial pulsatility in the brain is reduced and diastolic blood velocities (Vmin) are maintained. The effects of such altered hemodynamics on kinetic energy and, importantly, energy loss in the cerebral circulation have never been studied. Methods...

Background: Cardiovascular (CV) disease is a major cause of morbidity and mortality in COPD 1 . Aortic pulse wave velocity (AoPWV), an independent predictor of CV risk, is elevated in COPD 2 , however, there have been no longitudinal studies of AoPWV in COPD. The Assessment of Risk in Chronic Airways Disease Evaluation (ARCADE) aims to study CV ris...

Background: The relationship between Blood Pressure (BP) and cardiovascular risk is continuous. Here, we examined haemodynamic characteristics across a range of BP categories, to determine kihaemodynamic mechanisms associated with early elevations of BP and whether these differ by gender. Methods: 2618 apparently healthy subjects aged 18–40 years w...

Chronic obstructive pulmonary disease (COPD) is a multisystem disease that resembles the accumulation of multiple impairments seen in aging. A comprehensive geriatric assessment (CGA) captures multisystem deficits, from which a frailty index (FI) can be derived. We hypothesized that patients with COPD would be frailer than a comparator group free f...

Introduction: Healthy pregnancy causes significant changes in maternal hemodynamics that lead to structural and functional adaptation of a woman's heart. Reductions in ejection fraction have been reported in healthy pregnancy; however, this measure of cardiac contractile function is over simplistic and insensitive to the underpinning hemodynamic l...

Background: Elevated blood pressure (BP) has been linked to adverse events during left ventricular assist device support. In this study we investigated the association between outpatient BP and stroke or suspected pump thrombosis among HeartMate II (HMII) recipients. Methods: We retrospectively studied 220 HMII patients. Serial outpatient BP mea...

Supplemental Material, CGA_questionairre - Frailty: A global measure of the multisystem impact of COPD

Essential hypertension is often viewed and treated as a uniform condition. However, the condition encompasses a number of distinct patterns of blood pressure (BP) elevation such as isolated systolic (ISH), systolic diastolic (SDH) and isolated diastolic hypertension (IDH), which appear to vary in prevalence across the adult age‐span. We hypothesize...

Blood pressure (BP) in young adults predicts BP in later life. We aimed to identify metabolic, hemodynamic, and autonomic characteristics associated with raised BP in young adults and whether these differ between males and females. Three thousand one hundred forty-five healthy subjects, aged 18 to 40 years, were grouped according to sex and BP cate...

New findings: What is the central question of this study? Common carotid artery (CCA) two-dimensional strain imaging detects intrinsic arterial wall properties beyond conventional measures of arterial stiffness, but the effect of cardiorespiratory fitness on two-dimensional strain-derived indices of CCA stiffness is unknown. What is the main findi...

Stiffening of the aorta is an important independent risk factor for myocardial infarction and stroke. Yet its genetics is complex and little is known about its molecular drivers. We have identified for the first time, tagSNPs in the genes for extracellular matrix proteins, aggrecan and fibulin-1, that modulate stiffness in young healthy adults. We...

Abstract Background Chronic obstructive pulmonary disease (COPD) is a complex inflammatory condition in which an important extra-pulmonary manifestation is cardiovascular disease. We hypothesized that COPD patients would have increased aortic inflammation and stiffness, as candidate mechanisms mediating increased cardiovascular risk, compared to tw...

Current distance measurement techniques for pulse wave velocity (PWV) calculation are susceptible to intercentre variability. The aim of this study was to derive and validate a formula for this distance measurement. Based on carotid femoral distance in 1,183 whole body magnetic resonance angiograms (WB-MRAs), a formula was derived for calculating d...

Background: Increased blood pressure is the biggest contributor to the global burden of disease and mortality. Data suggest that less than half of the population with hypertension is aware of it. May Measurement Month was initiated to raise awareness of the importance of blood pressure and as a pragmatic interim solution to the shortfall in screen...

Cardiovascular and skeletal muscle manifestations constitute important comorbidities in COPD, with systemic inflammation proposed as a common mechanistic link. Fibrinogen has prognostic role in COPD. We aimed to determine whether aortic stiffness and quadriceps weakness are linked in COPD, and whether they are associated with the systemic inflammat...