Mark R Nelson

Mark R Nelson
University of Tasmania · Menzies Research Institute

MBBS (Hons) MFM FRACGP FAFPHM PhD FCSANZ

About

413
Publications
45,784
Reads
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6,404
Citations
Citations since 2016
205 Research Items
4973 Citations
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201620172018201920202021202202004006008001,000
Additional affiliations
January 2005 - present
University of Tasmania
Position
  • Professorial Fellow

Publications

Publications (413)
Article
Full-text available
Clinical Trial Networks in which trialists work collaboratively enable multi-site, large-scale, high-quality clinical trials to be efficiently run. Although the benefits of Clinical Trial Networks are largely known, establishing a Clinical Trial Network can be complex. There are many factors for clinicians and researchers to consider, and there is...
Preprint
BACKGROUND Road trauma remains a significant contributor to mortality in Vietnam despite significant improvement in the last decade. The COVID-19 pandemic necessitated public health measures such as social distancing and lockdowns, which had an unforeseen benefit on road trauma in high income countries. This article aims to investigate if those red...
Article
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Objectives Data linkage can provide sufficient breadth and size of data, to draw reliable estimates of effectiveness, at a population level using real-world data. We compared differences in survival and hospital presentations following stroke or transient ischaemic attack (TIA), based on whether a Medicare funded chronic disease management plan was...
Article
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Blood pressure(BP) management interventions have been shown to be more effective when accompanied by appropriate patient education. As high BP remains poorly controlled, there may be gaps in patient knowledge and education. Therefore, this study aimed to identify specific content and delivery preferences for information to support BP management amo...
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Purpose Health-related quality of life (QoL) is poor after stroke, but may be improved with comprehensive care plans. We aimed to determine the effects of an individualized management program on QoL in people with stroke or transient ischemic attack (TIA), describe changes in QoL over time, and identify variables associated with QoL. Methods This...
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Objectives Polypharmacy and frailty are two common geriatric conditions. In community-dwelling healthy older adults, we examined whether polypharmacy is associated with frailty and affects disability-free survival (DFS), assessed as a composite of death, dementia, or persistent physical disability. Methods We included 19,114 participants (median a...
Article
Objective: To determine the association of plasma lipids with the prevalence of subclinical atherosclerosis and 10-year risk of incident cardiovascular (CV) events among healthy individuals without dyslipidemia and with low risk factor burden. Patients and methods: The analysis (June 24, 2020, through June 12, 2021) included 1204 participants fr...
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Prolonging survival in good health is a fundamental societal goal. However, the leading determinants of disability-free survival in healthy older people have not been well established. Data from ASPREE, a bi-national placebo-controlled trial of aspirin with 4.7 years median follow-up, was analysed. At enrolment, participants were healthy and withou...
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PurposeRecent epidemiological evidence has suggested that use of lipid-lowering medications, particularly statins, was associated with reduced cardiovascular disease (CVD) events and persistent physical disability in healthy older adults. However, the comparative efficacy of different statins in this group remains unclear. This study aimed to compa...
Article
Study objective The aim of this study was to identify whether physical component score (PCS) of health-related quality of life trajectories over 4.7-years predicted subsequent risk of incident fatal and non-fatal CVD events, and all-cause mortality. Methods This study included 16,871 community-dwelling people aged ≥65 years enrolled in the ASPREE...
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Background Understanding the nature of transitions from a healthy state to chronic diseases and death is important for planning health-care system requirements and interventions. We aimed to quantify the trajectories of disease and disability in a population of healthy older people. Methods We conducted a secondary analysis of data from the ASPREE...
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Background Blood testosterone concentrations in women decline during the reproductive years and reach a nadir in the seventh decade, after which concentrations increase and are restored to those of reproductive-aged women early in the eighth decade. We aimed to establish the association between the concentration of testosterone in the blood and ris...
Article
Background It is unclear whether survivors of stroke or transient ischemic attack (TIA) routinely receive, and understand, education about secondary prevention medications. Objectives To investigate whether survivors of stroke/TIA understand explanations about their prescribed prevention medications and associations with medication adherence, cont...
Article
Background Antihypertensives and lipid-lowering therapy (LLT) are often used concurrently. Objectives To determine whether there was a difference in clinical outcomes when older patients with LLT were prescribed angiotensin-converting-enzyme-inhibitors (ACE-Is) compared with diuretics. Methods This analysis included 648 LLT older users free of ca...
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Background: The model of trauma in Vietnam has been changed significantly over last decade and required reforming the medical education to deal with new circumstance. Our aim is to evaluate this transition regarding its new target by analysis trauma and medical training system as whole. Objective: To establish if medical training in Vietnam has ada...
Article
Background The use of a polygenic risk score (PRS) to improve risk prediction of coronary heart disease (CHD) events has been demonstrated to have clinical utility in the general adult population. However, the prognostic value of a PRS for CHD has not been examined specifically in older populations of individuals aged ≥70 years, who comprise a dist...
Article
Background and purpose: Primary care physicians provide ongoing management after stroke. However, little is known about how best to measure physician encounters with reference to longer term outcomes. We aimed to compare methods for measuring regularity and continuity of primary care physician encounters, based on survival following stroke using l...
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Background Poor social health is associated with increased risk of cardiovascular disease (CVD). Recent research suggests that different social health domains should be considered separately as the implications for health and possible interventions may differ. Aim To assess social isolation, low social support and loneliness as predictors of CVD....
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Identification of individuals with increased risk of major adverse cardiovascular events (MACE) is important. However, algorithms specific to the elderly are lacking. Data were analysed from a randomised trial involving 18,548 participants ≥ 70 years old (mean age 75.4 years), without prior cardiovascular disease events, dementia or physical disabi...
Article
Aims The aim of this study was to assess the impact and cost-effectiveness of offering population genomic screening to all young adults in Australia to detect heterozygous familial hypercholesterolaemia (FH). Methods and results We designed a decision analytic Markov model to compare the current standard of care for heterozygous FH diagnosis in Au...
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Introduction: Treatment with several therapeutic classes of medication is recommended for secondary prevention of stroke. We analysed the associations between the number of classes of prevention medications supplied within 90 days post-discharge for ischemic stroke (IS)/transient ischemic attack (TIA) and survival. Patients and methods: Retrospe...
Article
BACKGROUND Frailty is associated with chronic inflammation, which may be modified by aspirin. The purpose of this study was to determine whether low dose aspirin reduces incident frailty in healthy older adult participants of the ASPirin in Reducing Events in the Elderly (ASPREE) trial. METHODS In the U.S and Australia, 19,114 community-dwelling i...
Preprint
BACKGROUND - OBJECTIVE To establish if medical training in Vietnam has adapted to a new disease pattern emerging in a developing country economy, that of road trauma. METHODS A review of Vietnamese medical schools, Ministry of Health, and Ministry of Education and Training literature on trauma education. RESULTS The trauma training component in...
Article
Full-text available
Background: The model of trauma in Vietnam has been changed significantly over last decade and required reforming the medical education to deal with new circumstance. Our aim is to evaluate this transition regarding its new target by analysis trauma and medical training system as whole. Objective: To establish if medical training in Vietnam has...
Article
Background Heterozygous familial hypercholesterolemia (FH) is a highly-penetrant, autosomal dominant monogenic disorder that causes elevated plasma low-density cholesterol (LDL-C) levels and risk of premature coronary heart disease (CHD). To date, the cost-effectiveness of the emerging strategy of genomic screening of adult populations for FH has n...
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Late-life depression is common and often inadequately managed using existing therapies. Depression is also associated with increased markers of inflammation, suggesting a potential role for anti-inflammatory agents. ASPREE-D is a sub-study of ASPREE, a large multi-centre, population-based, double-blind, placebo-controlled trial of aspirin vs placeb...
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Background Health-related quality of life (HRQoL) is a measure of an individual’s self-perceived health status. Few studies have examined HRQoL as a risk factor for mortality. This study examined whether HRQoL predicts all-cause mortality in older community-dwelling individuals from Australia and the United States enrolled in the Aspirin in Reducin...
Article
Background The ASPirin in Reducing Events in the Elderly (ASPREE) study randomised healthy older individuals to 100mg aspirin or placebo, with clinical outcomes and disability-free survival endpoints. Detailed baseline data provides a rare opportunity to explore cancer burden and association with known cancer risk factors in this population. Metho...
Article
We often lament the lack of confirmatory studies that can either reassure us all that the previous evidence for a trialed intervention is robust or indicate that the evidence is questionable. Zhang and colleagues have conducted such a study — the STEP trial¹ — which in essence investigates the veracity of the findings of the previous trial SPRINT,²...
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Background The mid-life emergence of higher levels of total cholesterol (TC) for women than for men has been observed in different Western and Asian populations. The aim of this study was to investigate whether there is evidence of this in Vietnam and, if so, whether it can be explained by ageing, by body size and fatness, or by socio-demographic c...
Article
Background Treatment inertia is a recognised barrier to blood pressure control, and simpler, more effective treatment strategies are needed. We hypothesised that a hypertension management strategy starting with a single pill containing ultra-low-dose quadruple combination therapy would be more effective than a strategy of starting with monotherapy....
Article
Background Lower health-related quality of life (HRQoL) has been shown to predict a higher risk of hospital readmission and mortality in patients with cardiovascular disease (CVD). Few studies have explored the associations between HRQoL and incident CVD. We explored the associations between baseline HRQoL and incident and fatal CVD in community-dw...
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Background Blood pressure variability (BPV) in midlife increases risk of late‐life dementia, but the impact of BPV on the cognition of adults who have already reached older ages free of major cognitive deficits is unknown. We examined the risk of incident dementia and cognitive decline associated with long‐term, visit‐to‐visit BPV in a post hoc ana...
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PurposeStudy drug discontinuation is commonplace in clinical trials of older populations. Little is known about why older participants discontinue the study drug. This qualitative study aimed to understand factors contributing to permanent study drug discontinuation among participants aged ≥ 70 years within an ongoing primary prevention trial of st...
Article
Background The neurocognitive effect of statins in older adults remain uncertain. Objectives The aim of this study was to investigate the associations of statin use with cognitive decline and incident dementia among older adults. Methods This analysis included 18,846 participants ≥65 years of age in a randomized trial of aspirin, who had no prior...
Article
Background and Purpose Polygenic risk scores (PRSs) can be used to predict ischemic stroke (IS). However, further validation of PRS performance is required in independent populations, particularly older adults in whom the majority of strokes occur. Methods We predicted risk of incident IS events in a population of 12 792 healthy older individuals...
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Background Health and medical research funding agencies are increasingly interested in measuring the impact of funded research. We present a research impact case study for the first four years of an Australian National Health and Medical Research Council funded Centre of Research Excellence in Cardiovascular Outcomes Improvement (2016–2020). The pr...
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Purpose Previous research has demonstrated that lower health-related quality of life (HRQoL) is associated with higher morbidity and mortality, especially in-patient groups. The association of HRQoL with all-cause mortality in community samples requires further investigation. This study aimed to examine whether HRQoL predicts all-cause mortality in...
Article
Background Absolute cardiovascular disease (aCVD) risk assessment is recommended in CVD prevention guidelines. Yet, General Practitioners (GPs) often focus on single risk factors, including blood pressure (BP). Pathology services may be suitable to undertake high‐quality automated unobserved BP (AOBP) measurement and aCVD risk assessment. This stud...
Preprint
Full-text available
Background: The use of a polygenic risk score (PRS) to predict coronary heart disease (CHD) events has been demonstrated in the general adult population. However, whether predictive performance extends to older individuals is unclear. Aim: To evaluate the predictive value of a PRS for incident CHD events in a prospective cohort of individuals aged...
Article
Objectives To assess the efficacy of a pro‐active, absolute cardiovascular risk‐guided approach to opportunistically modifying cardiovascular risk factors in patients without coronary ischaemia attending a chest pain clinic. Design Prospective, randomised, open label, blinded endpoint study. Setting The rapid access chest pain clinic of Royal Hob...
Article
To investigate the effect of night-time BP-lowering drug treatment on the risk of major CVD and mortality, we systematically reviewed randomized controlled trials comparing night-time versus morning dosing. Two studies were found relevant to the clinical question (the MAPEC and Hygia trials). They were similar in study design and population and wer...
Article
Introduction: Modelling of associations of systolic blood pressure (BP) and blood glucose (BG) with their explanatory factors in separate regressions treats them as having independent biological mechanisms. This can lead to statistical inferences that are unreliable because the substantial overlap in their etiologic and disease mechanisms is ignor...
Article
Background Cerebrovascular events, dementia and cancer can contribute to physical disability with activities of daily living (ADL). It is unclear whether low-dose aspirin reduces this burden in aging populations. In a secondary analysis, we now examine aspirin’s effects on incident and persistent ADL disability within a primary prevention aspirin t...
Article
Introduction and Purpose Chronic Disease Management (CDM) plans are used by general practitioners to manage chronic diseases such as stroke. However, there is limited evidence that being on these plans improve adherence to secondary prevention medications after stroke. We aimed to assess the association of the duration on a CDM plan in improving ad...
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Purpose To describe the baseline participant characteristics in the ASPREE-AMD study, investigating the effect of aspirin on AMD incidence and progression. Methods Australian participants from the ASPirin in Reducing Events in the Elderly (ASPREE) trial, randomized to 100 mg aspirin daily or placebo, had non-mydriatic, digital color fundus images...
Article
Objective: Cardiovascular disease (CVD) primary prevention guidelines recommend absolute CVD risk estimation to guide blood pressure and lipid therapy recommendations but are inconsistent despite relying on similar evidence. This study aimed to compare the populations recommended for treatment according to guidelines in Australia, England and the U...
Article
Introduction: Study drug discontinuation is commonplace in clinical trials of older populations and poses a major challenge to trial investigators. Little is known about why older participants discontinue the study drug. This study aimed to understand factors contributing to permanent study drug discontinuation among participants aged ≥70 years wit...
Article
Background: The effectiveness of specific statins for the primary prevention of cardiovascular disease (CVD) in older adults is not well-characterized. Objective: To assess whether specific statin subclasses according to type, potency and solubility are associated with lower risk of CVD, all-cause mortality and improved disability-free survival in...
Article
High office blood pressure variability (OBPV) in midlife increases the risk of cardiovascular disease (CVD), but the impact of OBPV in older adults without previous CVD is unknown. We conducted a post hoc analysis of ASPREE trial (Aspirin in Reducing Events in the Elderly) participants aged 70-years and older (65 for US minorities) without history...
Article
Full-text available
Cardiovascular drugs impact many pathways involved in depression pathophysiology and treatment. However, their distinct impact on mood is underrecognized and the literature is conflicting. Therefore, using a very large and well-characterised sample of older adults with hypertension, we aimed to investigate the prevalence of depressive symptoms in u...
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Background The majority of patients attending chest pain clinics are found not to have a cardiac cause of their symptoms, but have a high burden of cardiovascular risk factors that may be opportunistically addressed. Absolute risk calculators are recommended to guide risk factor management, although it is uncertain to what extent these calculations...
Article
High blood pressure is the leading cause of preventable morbidity and mortality globally. Many patients remain on single-drug treatment with poor control although guidelines recognize that most require combination therapy for blood pressure control. Our hypothesis is that a single-pill combination of four blood pressure- lowering agents each at a q...
Article
Objective Evaluate the Pain Impact Index, a simple, brief, easy‐to‐use and novel tool to assess the impact of chronic pain in community‐dwelling older adults. Methods A Rasch modelling analysis was undertaken in Stata using a partial credit model suited to the Likert‐type items that comprised the Index. The Index was evaluated for: ordering of cat...
Article
Background: Guidelines for cardiovascular disease (CVD) prevention recommend assessment of absolute CVD risk to guide clinical management. Despite this, use among general practitioners (GPs) remains limited. Objective: Pathology services may provide an appropriate setting to assess and report absolute CVD risk in patients attending for cholester...
Article
Background: Efforts to minimize medication risks among older adults include avoidance of potentially inappropriate medications. Contemporary analysis of medication use in community-dwelling older people compared with the general population is lacking. Participants: A total of 19,114 community-dwelling adults in Australia and the United States ag...