Peter Elwood

Cardiff University | CU · Primary Ca4re and Public Health

Evidence on aspirin and cancer comes from two main sources: (1) the effect of aspirin upon biological mechanisms in cancer, and (2) clinical studies of patients with cancer, some of whom take aspirin. A series of systematic literature searches identified published reports relevant to these two sources. The effects of aspirin upon biological mechani...

Objective: To examine the long-term effects of amateur boxing in a representative population sample of men. Design: The sample was examined every 5 years for 35 years. Cognition was assessed repeatedly from the third examination. Previous boxing experience and dementia were assessed at the fifth examination, and dementia assessed subsequently th...

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: Several studies have shown that diabetes confers a higher relative risk of vascular mortality among women than among men, but whether this increased relative risk in women exists across age groups and within defined levels of other risk factors is uncertain. We aimed to determine whether differences in established risk factors, such as...

Background: Several candidate genes have been identified in relation to lipid metabolism, and among these, lipoprotein lipase (LPL) and apolipoprotein E (APOE) gene polymorphisms are major sources of genetically determined variation in lipid concentrations. This study investigated the association of two single nucleotide polymorphisms (SNPs) at LP...

Context: UK Biobank is a prospective study of half a million subjects, almost all aged 40–69 years, identified in 22 centres across the UK during 2006–2010. Objective: A healthy lifestyle has been described as ‘better than any pill, and no side effects [5]. We therefore examined the relationships between healthy behaviours: low alcohol intake, non-...

Context UK Biobank is a prospective study of half a million subjects, almost all aged 40–69 years, identified in 22 centres across the UK during 2006–2010. Objective A healthy lifestyle has been described as ‘better than any pill, and no side effects [5]. We therefore examined the relationships between healthy behaviours: low alcohol intake, non-s...

Interaction between lipoprotein lipase and apolipoprotein E gene polymorphisms and dietary factors on lipid traits - Volume 76 Issue OCE4 - I. Shatwan, B. Ellahi, K.H. Winther, Y. Ben-Shlomo, P.C. Elwood, I. Givens, M. Rayman, J.A. Lovegrove, K.S. Vimaleswaran

Objective Prospective data on the associations between vitamin D intake and risk of CVD and all-cause mortality are limited and inconclusive. The aim of the present study was to investigate the associations between vitamin D intake and CVD risk and all-cause mortality in the Caerphilly Prospective Cohort Study. Design The associations of vitamin D...

Background Aspirin has been shown to lower the incidence and the mortality of vascular disease and cancer but its wider adoption appears to be seriously impeded by concerns about gastrointestinal (GI) bleeding. Unlike heart attacks, stroke and cancer, GI bleeding is an acute event, usually followed by complete recovery. We propose therefore that a...

Begg’s funnel plot with estimated 95% confidence intervals for meta-analysis in Fig 2 in the text. (TIF)

Literature search on 25 August 2016. No date restrictions, no language restrictions. (DOCX)

Sensitivity analysis repeating meta-analysis in Fig 2 in the text, excluding one study at a time. The middle vertical axis indicates the overall RR and the two vertical axes indicate its 95% CI. Every hollow circle indicates the pooled RR when the left study was omitted in this meta-analysis. The two ends of every broken line represent the 95% CIs....

Begg’s funnel plot with estimated 95% confidence intervals for meta-analysis in Fig 3 in the text. (TIF)

Sensitivity analysis repeating meta-analysis in Fig 3 in the text, excluding one study at a time. The middle vertical axis indicates the overall RR and the two vertical axes indicate its 95% CI. Every hollow circle indicates the pooled RR when the left study was omitted in this meta-analysis. The two ends of every broken line represent the 95% CIs....

Results of the Cochrane risk of bias assessment. Based on: Cochrane Handbook for Systematic Reviews of Interventions. [28] (DOCX)

Low-dose aspirin has been shown to reduce the incidence of cancer, but its role in the treatment of cancer is uncertain.We conducted a systematic search of the scientific literature on aspirin taken by patients following a diagnosis of cancer, together with appropriate meta-analyses.Searches were completed in Medline and Embase in December 2015 usi...

PRISMA checklist. (DOC)

of published evidence on internal bleeding attributable to aspirin.

Implications Overall, milk consumption provides health benefits to all age groups. Effects of cheese, butter, and fat-reduced and saturated fat-reduced milk and dairy products are less clear and require more research. Public health nutrition policy related to milk consumption should be based on the evidence presented and not solely on the believ...

The 2013 Aspirin Foundation Conference covered a range of topics from clinical and medical history, epidemiology, health economics, and the current uses of aspirin in general practice and in the treatment and prevention of cancer. The use of aspirin as primary prevention in people at risk of atherosclerotic events is now well known, but its use as...

Healthy lifestyles based on non-smoking, an acceptable BMI, a high fruit and vegetable intake, regular physical activity, and low/moderate alcohol intake, are associated with reductions in the incidence of certain chronic diseases, but to date there is limited evidence on cognitive function and dementia. In 1979 healthy behaviours were recorded on...

Colon cancer is the third most common cancer worldwide. Sigmoidoscopy and colonoscopy, with the removal of rectal and colon polyps, are proven strategies for the prevention of colon cancer, and testing for fecal occult blood helps to identify subjects suitable for endoscopy. Evidence that low-dose aspirin is associated with a substantial reduction...

There appear to be widespread misconceptions about the relationship between the consumption of milk and dairy foods and the risk of vascular disease. Searches of the literature identified 41 relevant cohort studies with incident disease outcomes: heart disease, ischaemic and haemorrhagic stroke and type II diabetes. Metaanalyses of the results of t...

A valuable item in these UN Conferences has been poster demonstrations. This year there were a large number, displaying work going on in the area. A poster of particular interest featured “The Eden Alternative Care”, a registered charity dedicated to improving the experience of aging and disability, which focuses on creating person-centred communit...

Does Dairy Food Intake Predict Arterial Stiffness and Blood Pressure in Men? Evidence from the Caerphilly Prospective Study - Volume 71 Issue OCE3 - K. M. Livingstone, J. A. Lovegrove, J. R. Cockcroft, P. C. Elwood, J. E. Pickering, D. I Givens

Substantial evidence from randomized trials confirms benefit from aspirin in the secondary reduction of vascular disease but there is debate about its use in primary prevention. More recently, evidence from long-term follow up and other studies indicates a reduction in cancer by aspirin. The undesirable effects of aspirin include gastrointestinal b...

Arterial stiffness is an independent predictor of cardiovascular disease events and mortality, and like blood pressure, may be influenced by dairy food intake. Few studies have investigated the effects of consumption of these foods on prospective measures of arterial stiffness. The present analysis aimed to investigate the prospective relationship...

This study was undertaken to investigate the association of auditory threshold with cognitive decline and dementia. The 1,057 surviving men of the Caerphilly cohort with audiometric data at baseline were followed for 17 years for cognitive outcomes. Pure-tone unaided audiometric threshold was assessed at 0.5, 1, 2, and 4 KHz at baseline and after 9...

There is convincing evidence of a reduction in vascular disease by aspirin, and highly persuasive evidence of a reduction in cancer, in particular colorectal cancer. Aspirin also increases the risk of gastrointestinal and cerebral bleeding. However, overviews of randomised trial data suggests that gastrointestinal bleeding attributable to aspirin i...

On November 23rd 2011, the Aspirin Foundation held a meeting at the Royal Society of Medicine in London to review current thinking on the potential role of aspirin in preventing cardiovascular disease and reducing the risk of cancer in older people. The meeting was supported by Bayer Pharma AG and Novacyl.

Considerable evidence supports the effectiveness of aspirin for chemoprevention of colorectal cancer (CRC) in addition to its well-established benefits in the prevention of vascular disease. Epidemiologic studies have consistently observed an inverse association between aspirin use and risk of CRC. A recent pooled analysis of a long-term posttrial...

Benzodiazepine use is widespread in older people, although its benefit is uncertain. To investigate the long-term effect of benzodiazepine use upon dementia risk. A prospective cohort of men seen on five occasions over 22 years with full medication histories, repeat measures of cognitive function and a clinical diagnosis of dementia. Of 1134 men wi...

Disturbed sleep is common throughout the community and is associated with an increase in daytime sleepiness, both of which, in turn are associated with an increased risk of ischaemic vascular disease. The hypothesis that sleep disturbances are predictive of dementia, and in particular vascular dementia was tested in a large community-based cohort o...

The preservation of health is ultimately the responsibility of each individual person. It differs fundamentally from the treatment of disease, which has been delegated to health-care professionals. In this paper I consider certain health-care behaviours, and then comment on issues relevant to prophylactic medicines.

Current dietary recommendations advise reducing the intake of saturated fatty acids (SFAs) to reduce coronary heart disease (CHD) risk, but recent findings question the role of SFAs. This expert panel reviewed the evidence and reached the following conclusions: the evidence from epidemiologic, clinical, and mechanistic studies is consistent in find...

As the incidence of obesity is reaching 'epidemic' proportions, there is currently widespread interest in the impact of dietary components on body-weight and food intake regulation. The majority of data available from both epidemiological and intervention studies provide evidence of a negative but modest association between milk and dairy product c...

Aspirin therapy should be an adjunct to the medical management of patients who have had a vascular event but the role of aspirin prophylaxis in the primary prevention of vascular events is less clear. This benefit-versus-risk balance may, however, be influenced by evidence that aspirin reduces bowel cancer risk. Wider aspirin use could lead to more...

Honey is a broad spectrum antimicrobial agent which can enhance wound healing. A beneficial effect in cancer has been shown in cell cultures and in animal studies and a number of further nutritional and physiological effects of relevance to health and function have been shown for honey. A representative sub-sample of 665 men within the Caerphilly C...

The health effects of milk and dairy food consumption would best be determined in randomised controlled trials. No adequately powered trial has been reported and none is likely because of the numbers required. The best evidence comes, therefore, from prospective cohort studies with disease events and death as outcomes. Medline was searched for pros...

Low-dose aspirin is of value in the long-term management of vascular disease, and the giving of aspirin to patients believed to be experiencing an acute myocardial infarction (AMI) is standard practice for paramedics and doctors in most countries. Given during infarction, aspirin may disaggregate platelet microthrombi and may reduce the size of a d...

Associations between dairy-product consumption and body composition: results from the Caerphilly study - Volume 69 Issue OCE1 - A. Dougkas, A. M. Minihane, C. K. Reynolds, P. C. Elwood, D. I. Givens

The association between cognitive function and mortality is of increasing interest. We followed 1870 men aged 55–69 years at cognitive assessment for 16 years to establish associations with all case and cause specific mortality. Cognitive assessment included AH4, 4 choice reaction time (used as estimates of mid-life cognition) and the National Adul...

Medicines are likely to assume an increasingly important role in helping people to remain healthy. But there are few indications as to what information and other support people want when assessing the risks and benefits of medicines; what role they feel government and healthcare professionals should play in informing, advising and encouraging healt...

A paper published in the March 2004 edition of the European Journal of Public Health evaluated the evidence on aspirin and colorectal cancer using the nine causality criteria originally put forward by Sir Austin Bradford-Hill in 1965.1 Using this framework, the evidence that aspirin might reduce the risk of colorectal cancer by 20–30% was evaluated...

One difficulty in performing meta-analyses of observational cohort studies is that the availability of confounders may vary between cohorts, so that some cohorts provide fully adjusted analyses while others only provide partially adjusted analyses. Commonly, analyses of the association between an exposure and disease either are restricted to cohort...

Evidence from a wide range of sources suggests that individuals taking aspirin and related non-steroidal anti-inflammatory drugs have reduced risk of large bowel cancer. Work in animals supports cancer reduction with aspirin, but no long-term randomised clinical trials exist in human beings, and randomisation would be ethically unacceptable because...

As part of the Caerphilly and the Speedwell collaborative heart disease studies, associations between outdoor traffic noise level, risk factors for ischemic heart disease, and prevalence and incidence of ischemic heart disease were studied in two samples of 2,512 and 2,348 men, respectively, who were 45-63 y of age. Compared with the lowest noise c...

To conduct a detailed evaluation, with meta-analyses, of the published evidence on milk and dairy consumption and the incidence of vascular diseases and diabetes. Also to summarise the evidence on milk and dairy consumption and cancer reported by the World Cancer Research Fund and then to consider the relevance of milk and dairy consumption to surv...

Epidemiological evidence based on both case–control and prospective cohort studies points to an overall positive relationship between consumption of milk/dairy products and the risk of developing prostate cancer. There are inconsistencies in the data, but taken together, the increased relative risk does not seem to be high. A number of mechanisms h...

The POPADAD trial shows no benefit from daily prophylactic aspirin (hazard ratio 0.98; P=0.87) in people who have diabetes and early peripheral arterial disease. However, no firm conclusions should be drawn from a single trial, but the result be incorporated in a meta-analysis of all available evidence from relevant trials.1The absence of evidence...

The idea that low-dose aspirin could be recommended for vascular protection on the grounds of age alone, irrespective of the levels of other vascular risk factors, seems to have been first suggested by the Editor of Archives of Internal Medicine, who, in 1991 wrote: 'In my opinion, aspirin therapy is indicated in US men aged 50 years or older and i...

The first randomised controlled trial of aspirin in the prevention of vascular events was conducted in South Wales in 1974.1 Since then overviews of numerous trials2 3 have established aspirin, used in cardiovascular disease, as the most thoroughly tested and the most highly cost effective drug available in clinical practice. Aspirin is now a stand...

The idea that low-dose aspirin could be recommended for vascular protection on the grounds of age alone, irrespective of the levels of other vascular risk factors, seems to have been first suggested by the Editor of Archives of Internal Medicine, who, in 1991 wrote: ‘In my opinion, aspirin therapy is indicated in US men aged 50 years or older and i...

A survey of the diets of a random sample of 81 women in one of the South Wales' valleys was conducted in 1966. The results are compared with a similar survey conducted in 1983. Total energy intake was 16% lower in 1983 than in 1966, the proportion of this obtained from fat hardly differed (42 and 41% in 1966 and 1983, respectively). The average con...

The increased risk of vascular disease in a subgroup of patients judged to be “resistant” to aspirin led Krasopoulos et al to propose that there could be beneficial effect of aspirin of greater than 50% in aspirin sensitive patients.1The problem is identifying subjects “resistant” to aspirin. Krasopoulos et al accepted evidence from the authors of...

To report a negative association between milk or dairy consumption and the metabolic syndrome and to examine associations within the Caerphilly cohort. A representative sample of men aged 45-59 years in Caerphilly, UK. PARTICIPANTS AND DATA: Data on fasting blood glucose and plasma insulin, fasting plasma triglycerides and high-density lipoprotein...

Additional material for this article is available from the James Lind Library website [http://www.jameslindlibrary.org], where this paper was previously published.

The benefit of aspirin as a prophylactic after a thrombotic event was first observed 30 years ago. Its use after coronary or cerebral thrombosis, and in patients judged to be at increased risk of a thrombotic event, is now virtually mandatory, unless there are signs of intolerance. The present policy in the UK for cardiovascular protection by low-d...

Using two population-based cohorts of men aged 45-59, we sought to derive and validate a prediction rule for identifying heavy consumers of alcohol. Eighty-five percent of eligible men on electoral rolls in Caerphilly, Wales (derivation set, N = 2512) and 90% of eligible men on the practice lists of 16 Speedwell, England, general practitioners part...

To test the hypothesis that sleep disorders are relevant to the risk of ischaemic stroke and ischaemic heart disease events in older men. A cohort study. The Caerphilly cohort, a representative population sample of older men in South Wales, UK. 1986 men aged 55-69 years completed a questionnaire on sleep patterns with help from their partners. This...

Aspirin is of little interest to pharmaceutical companies and it therefore appears to receive relatively little promotion in vascular prophylaxis. A survey of aspirin taking by patients known to be at high vascular risk was therefore conducted in 12 general medical practices across Wales. Random samples of approximately 25 patients within each of s...

Plasma fibrinogen levels may be associated with the risk of coronary heart disease (CHD) and stroke. To assess the relationships of fibrinogen levels with risk of major vascular and with risk of nonvascular outcomes based on individual participant data. Relevant studies were identified by computer-assisted searches, hand searches of reference lists...

The Caerphilly Prospective Study demonstrates a paradoxical association of increased ischaemic stroke risk with decreased whole blood adenosine diphosphate (ADP) induced platelet sensitivity. A reanalysis of this association examines whether other haematological indices and prevalent disease at baseline may explain this finding. There were 1506 men...

To compare vascular and glucose related mechanisms of type 2 diabetes on cognitive performance. A cross-sectional observational study of type 2 diabetes defined by non insulin dependant self-report diabetes or fasting blood glucose < or = 7.0 mmol/l of 2205 men eligible for the third phase of the Caerphilly Collaborative Heart Disease Study. Men we...

There is a popular belief that chronic stress causes heart disease through psychoneuroendocrine mechanisms. We have examined whether an elevated circulating cortisol-to-testosterone ratio increases the risk of ischemic heart disease. We undertook a prospective cohort study of 2512 men aged 45 to 59 years between 1979 and 1983 from Caerphilly, South...

Editor—The case for the wider use of aspirin in vascular prophylaxis arises from the belief that subjects should be empowered to make their own decision about protecting their own health. This will be achieved only if information on the risks and benefits of preventive measures, including low dose aspirin, is widely available. Granted, the numeric...

Born in 1909 in Galashiels, UK; died in 1988 in Dorset, UK. Cochrane is best known for his dedication to improving epidemiological methodology, and for being instrumental in establishing the Cochrane Collaboration, which facilitates access to the results of health care interventions. Keywords: Cochrane collaboration; epidemiological methods; fiel...

Milk drinking causes a rise in serum cholesterol level and it is therefore assumed that this will increase vascular disease risk. At the same time, a reduction in blood pressure by milk is largely ignored. An overview of large, long-term cohort studies gives no evidence of an increase, but rather, a significant reduction in vascular disease risk in...