Julian P Halcox

Swansea University | SWAN · Institute of Life Science "ILS"

Background Previous studies have associated pregnancy complications with a higher risk of cardiovascular disease. However, previous studies have not sufficiently evaluated the impact of broad range of pregnancy complications or common cardiovascular conditions individually. Furthermore, most previous studies have relied on data from hospital admiss...

Background Prescription of oral anticoagulants (OAC) is paramount for stroke prevention in people with atrial fibrillation (AF), but treatment decisions in older care home residents are complicated by frailty, multi-morbidity and heightened stroke and bleeding risk. There is a paucity of data on factors influencing the decision to prescribe OAC in...

Background Older care home residents are a high-risk group of people with atrial fibrillation (AF) who are under-represented in clinical trials. Improved understanding of AF epidemiology and management in this population is paramount for health and social care organisations to strategically plan services. Purpose To determine the trends in AF prev...

Background Prior evidence has suggested that pregnancy complications are associated with a higher risk of cardiovascular disease in women. However, associations between coexisting multiple pregnancy complications and incident cardiovascular disease remains unclear. Purpose To examine the risk of ischemic heart disease (IHD), stroke, atrial fibrill...

Background Population-level information on dispensed medication provides insight on the distribution of treated morbidities, particularly if linked to other population-scale data at an individual-level. Objective To evaluate the impact of COVID-19 on dispensing patterns of medications. Methods Retrospective observational study using population-sc...

Purpose Cardiometabolic risk, including arterial stiffness, is increasing in youth. Those with asthma are suggested to be particularly at risk of cardiovascular disease. Efficient and effective strategies are required to prevent the atherosclerotic process in youth. The purpose of this study was to investigate the effect of 6 months high-intensity...

Introduction Anticoagulation (AC) reduces the risk of stroke and systemic embolism (SSE) in patients with Atrial Fibrillation (AF). However, the association between changes in AF prevalence, risk factors for SSE, uptake of AC and incidence of SSE has not been documented specifically in these patients within a national population. Purpose Identifyi...

Introduction: Major bleeding events are the most serious complications of anticoagulation therapy (AC) in Atrial Fibrillation (AF) patients, with standardised bleeding risk scores used to guide therapy selection in practice. We explored whether a machine learning (ML) approach could improve bleeding risk modelling. Methods: We developed two ML-bas...

Introduction: Physical activity declines in adolescence, especially among those in deprived areas. Research suggests this may result from accessibility barriers (e.g., cost and locality). The Active Children Through Individual Vouchers Evaluation RCT aimed to improve the fitness and heart health of teenagers in Wales with the help of teenagers who...

Introduction: Statin treatment reduces cardiovascular morbidity and mortality in those with and at risk of cardiovascular disease (CVD) and is endorsed in all major clinical guidelines for the prevention of CVD. Despite the weight of high quality evidence supporting benefits of treatment versus relatively rare serious side effects, the use of stati...

Presented at Intentional Population Data Linkage (IPDLN) conference 2018.

Background Genetic programming (GP) is an evolutionary computing methodology capable of identifying complex, non-linear patterns in large data sets. Despite the potential advantages of GP over more typical, frequentist statistical approach methods, its applications to survival analyses are rare, at best. The aim of this study was to determine the u...

Introduction Atrial Fibrillation (AF) is a common abnormal heart rhythm that is associated with five times the risk of stroke and twice the risk of death. However, this risk can be reduced by approximately two thirds through the appropriate use of anticoagulation (AC). Objectives and Approach Reducing the incidence of stroke through effective mana...

Background It is recommended that young people should engage in 60 min of moderate-to-vigorous activity (MVPA) a day for health benefits, but few teenagers actually meet this recommendation. Policy-makers play a vital role in designing physical activity initiatives, but they generally do this with little or no input from the intervention recipients...

Background: Sickle-cell disease increases the risk of malnutrition. Low arginine and nitric oxide bioavailability are implicated in morbidity related to sickle-cell disease. Simple interventions are required, especially in low-income settings. We aimed to test the hypotheses that: (1) supplementary arginine, citrulline, and daily chloroquine incre...

Background: Reports are conflicting on whether serum uric acid (sUA) levels are independently associated with increased cardiovascular (CV) death risk. Methods: This post hoc analysis assessed the relationship between sUA levels and CV death risk score in 7531 patients from the cross-sectional, multinational EURIKA study (NCT00882336). Patients...

Objective Vascular disease is highly prevalent in the elderly. This study aimed to evaluate arterial phenotype in elderly men and compare carotid–femoral pulse wave velocity (cfPWV) assessed by two techniques (Sphygmocor (S)and Vicorder (V)). Methods 1722 men (72–92 years), participants in the British Regional Heart Study, underwent ultrasound ass...

Objective To describe the changes in prescribing of oral anticoagulant (AC) and antiplatelet (AP) agents in patients with non-valvular atrial fibrillation (NVAF) in the UK and to identify the characteristics associated with deviation from guideline-based recommendations. Design Five cross-sectional analyses in a large retrospective population-base...

Background: Asymptomatic atrial fibrillation (AF) is increasingly common in the aging population and implicated in many ischemic strokes. Earlier identification of AF with appropriate anticoagulation may decrease stroke morbidity and mortality. Methods: We conducted a randomized controlled trial of AF screening using an AliveCor Kardia monitor a...

Background Many teenagers are insufficiently active despite the health benefits of physical activity (PA). There is strong evidence to show that inactivity and low fitness levels increase the risk of non-communicable diseases such as coronary heart disease (CHD), type 2 diabetes and breast and colon cancers (Lee et al. Lancet 380:219–29, 2012). A m...

Background and aims: The soluble receptor for advanced glycation end products (sRAGE) has been implicated in diabetic vascular complications. We have examined the association between sRAGE and cardiac markers [NT-proBNP and cardiac troponin T (cTnT)] and subclinical vascular markers in older men with and without diabetes. Methods: We performed a...

Background: Atherogenic dyslipidemia is associated with poor cardiovascular outcomes, yet markers of this condition are often ignored in clinical practice. Here, we address a clear evidence gap by assessing the prevalence and treatment of two markers of atherogenic dyslipidemia: elevated triglyceride levels and low levels of high-density lipoprote...

Studyobjectives Daytime sleep has been associated with increased risk of cardiovascular disease and heart failure (HF), but the mechanisms remain unclear. We have investigated the association between daytime and night-time sleep patterns and cardiovascular risk markers in older adults including cardiac markers and subclinical markers of atheroscler...

Background Cardiovascular (CV) mortality in patients with rheumatoid arthritis (RA) is up to 50% higher than the general population. Whilst traditional CV risk factors such as smoking, diabetes and hypertension contribute to this increased mortality in RA, they do not fully explain the increase in risk. The British Society for Rheumatology, Nationa...

Objective: To determine whether treatment with clarithromycin for respiratory tract infections was associated with an increased risk of cardiovascular (CV) events, arrhythmias or all-cause mortality compared with other antibiotics. Design: Retrospective cohort design comparing clarithromycin monotherapy for lower (LRTI) or upper respiratory trac...

This consensus statement addresses the current three main modalities of treatment of homozygous familial hypercholesterolaemia (HoFH): pharmacotherapy, lipoprotein (Lp) apheresis and liver transplantation. HoFH may cause very premature atheromatous arterial disease and death, despite treatment with Lp apheresis combined with statin, ezetimibe and b...

Stress influences the risk of cardiovascular disease. Acute mental stress can induce both low-grade inflammation and endothelial dysfunction. The relationship between inflammatory responses to stress and future endothelial function is unexplored. Knowledge on the impact of other cardiovascular risk factors, such as dyslipidaemia, on such relationsh...

Objectives: Several studies have suggested a positive association between serum lipid levels and blood pressure (BP). This study investigated this association in a large population from 12 European countries. Methods: Data were taken from the European Study on Cardiovascular Risk Prevention and Management in Usual Daily Practice (ClinicalTrials....

Background: The prevalence of and factors associated with uncontrolled hypertension and apparent resistant hypertension were assessed in the European Study on Cardiovascular Risk Prevention and Management in Usual Daily Practice (EURIKA; NCT00882336). Methods: EURIKA was a cross-sectional observational study including patients being treated for...

Low physical activity (PA) and high levels of sedentary time (ST) are associated with higher cardiovascular disease (CVD) risk among older people. However, their independent contribution and importance of duration of PA and ST bouts remain unclear. We investigated associations between objectively measured PA, ST and non-invasive vascular measures,...

Background: Associations between bouts of physical activity (PA), sedentary behaviour (SB) and cardiovascular disease, and their mutual independence are not well defined. A low ankle brachial index (ABI ≤0.9) indicates peripheral arterial disease (PAD) and is predictive of cardiovascular events and functional impairment. We investigated the indepe...

Aims: To determine the proportion of people with diabetes who have HbA1c measured, what proportion achieve an HbA1c level of < 58 mmol/mol (7.5%), the frequency of testing and if there was any change in HbA1c level in the year before and the year after an incident stroke. Methods: This study used the Secure Anonymised Information Linkage (SAIL)...

Background It is increasingly recognised that cardiovascular disease (CVD) and cardiovascular ageing are processes which may begin well before later life. However, few prospective epidemiological studies have distinguished the influence of key cardiovascular risk factor exposures at different stages of the life course to relevant markers of cardiov...

Reactive hyperaemia induces a slowing of pulse wave velocity (PWV) in conduit arteries of healthy subjects (flow-mediated slowing (FMS)). This could be an alternative method for assessing peripheral vasomotor function to the gold standard method of flow-mediated dilatation (FMD) a more expensive and technically demanding technique. We aimed to asse...

To analyse the treatment and control of dyslipidaemia in patients at high and very high cardiovascular risk being treated for the primary prevention of cardiovascular disease (CVD) in Europe. Data were assessed from the European Study on Cardiovascular Risk Prevention and Management in Usual Daily Practice (EURIKA, ClinicalTrials.gov identifier: NC...

Ready-to-use supplementary food supplements improve endothelial function, hemoglobin and growth in Tanzanian children with sickle cell anaemia: The Vascular Function Intervention Study (V-FIT), a random order crossover trial

Introduction: Endothelial function is impaired in sickle cell anemia (SCA) and may be prognostic of severity of pathophysiology underlying many complications. Poor nutritional status is documented in SCA in all income settings, yet no strategies exist to improve nutrition. Poor nutritional status and hemoglobin predict death and hospitalization in...

Abstract Individuals with mixed atherogenic dyslipidemia, type 2 diabetes mellitus (T2DM), and metabolic syndrome are at high risk of developing cardiovascular disease (CVD) and can often benefit greatly from preventive lifestyle and medical interventions. These conditions typically co-exist in an individual, and the lipid profiles associated with...

Aims: Clinical and observational studies have shown an increased risk of cardiovascular events and death associated with sulphonylureas versus metformin. However, it has never been determined whether this was due to the beneficial effects of metformin or detrimental effects of sulphonylureas. The objective of this study was therefore to compare al...

STUDY QUESTION: Are arterial stiffness, carotid intima-media thickness and diastolic dysfunction increased in young women with polycysticovary syndrome (PCOS) independently of the effects of obesity? SUMMARY ANSWER: Insulin resistance and central obesity are associated with subclinical cardiovascular dysfunction in young women, but adiagnosis of PC...

Unlabelled: Preterm birth, low birth weight and poor foetal nutrition have been linked to cardiovascular disease, but the underlying mechanisms remain unclear. We explored prematurity and vascular function by studying a UK cohort of 14 049 children and conducting a systematic review. Conclusion: Systolic blood pressure was higher in subjects bor...

The iPOWER study aims at determining whether routine assessment of coronary microvascular dysfunction (CMD) in women with angina and no obstructive coronary artery disease is feasible and identifies women at risk. All women with angina referred to invasive angiographic assessment in Eastern Denmark are invited to join the study according to in- and...

In recent years, it has become evident that the level of guideline adherence in patients presenting with acute coronary syndrome (ACS) is highly correlated with patient outcomes. Unfortunately, guideline adherence is low in some geographic areas and especially in those patients at high-risk. Regional networks including ambulance systems and hospita...

The vascular endothelium plays a vital role in maintaining blood vessel homeostasis. A balance between endothelial-derived relaxing factors, including nitric oxide (NO), and constricting factors helps to maintain its normal vasomotor function. In diabetes, contributors including hyperglycaemia, insulin resistance, and dyslipidemia can all increase...

A substantial evidence base supports a direct association between low-density lipoprotein cholesterol (LDL-C) levels and morbidity and mortality from cardiovascular disease (CVD).1 Meta-analyses of the many randomised controlled clinical trials (RCTs) suggest that the clinical impact is directly related to the magnitude of reduction and achieved le...

Background: Polycystic ovary syndrome (PCOS) is characterised by a high prevalence of obesity and insulin resistance, leading to an increased risk of type 2 diabetes. However, it is unclear whether cardiovascular risk (CVR) is increased in PCOS independently of these metabolic disturbances. Aims: To establish whether PCOS is associated with arteria...

Elevated C-reactive protein (CRP) levels are associated with high cardiovascular risk, and might identify patients who could benefit from more carefully adapted risk factor management. We have assessed the prevalence of elevated CRP levels in patients with one or more traditional cardiovascular risk factors. Data were analysed from the European Stu...

Introduction: Endothelial function is impaired in adults with sickle cell anaemia (SCA), but limited data exists in children. Endothelial damage occurs from chronic inflammation, oxidant damage, immune cell activation and ischemia-reperfusion injury. In addition, availability of nitric oxide (NO) as the major vasodilator is thought to be reduced as...

Chronic disease not only impairs patients' psycho-social well-being but also influences major life-changing decisions (MLCDs). There is little information about the types of MLCDs affected and the long-term consequences. The aims were to identify the MLCDs influenced by chronic disease, to define 'MLCD' and to suggest support strategies for patient...

Data from the European Study on Cardiovascular Risk Prevention and Management in Usual Daily Practice (EURIKA; ClinicalTrials.gov; NCT00882336) was used to assess the proportions of patients aged 50-65 years free of diabetes and not receiving lipid-lowering therapy (LLT) considered to be at low (<1%), intermediate (1% to <5%) and high (≥5%) 10-year...

Objectives: Assessment of pulse wave velocity (PWV) is normally used as a measure of arterial stiffness. However, measurement of change in PWV before and after a period of reactive hyperaemia may enable the technique to be harnessed as a measure of endothelial function as flow-mediated slowing (FMS). The aim of this study was to validate this appro...

Purpose: To evaluate the management of dyslipidaemia and hypertension in primary care in relation to current guidelines in the UK. Methods: This is a sub-analysis of UK patient data from a European cross sectional study (NCT00882336). 69 randomly selected General Practitioners participated: 46% of them worked in an urban, 28% in a suburban and 26%...

Objective: Polycystic ovary syndrome (PCOS) is characterised by obesity and a high prevalence of insulin resistance (IR) but this may not translate into increased cardiovascular events. The energy and timing of waves in large arteries may be quantified by separated wave analysis from wave intensity (WI) signals. This study characterised ventricular...

Purpose: To investigate the relationships between regional adiposity, adiponectin (APN), insulin resistance and cardiovascular funct