%0 Journal Article %~ PubMed %A Wong, Muh Geot %A Perkovic, Vlado %A Woodward, Mark %A Chalmers, John %A Li, Qiang %A Hillis, Graham S %A Yaghobian Azari, Dania %A Jun, Min %A Poulter, Neil %A Hamet, Pavel %A Williams, Bryan %A Neal, Bruce %A Mancia, Giuseppe %A Cooper, Mark %A Pollock, Carol A %T Circulating bone morphogenetic protein-7 and transforming growth factor-β1 are better predictors of renal end points in patients with type 2 diabetes mellitus. %B Kidney International %D 2013 %C United Kingdom, United States %I Nature Publishing Group %V 83 %N 2 %P 278-284 %@ 0085-2538 %X %Z FOR Codes: 1103 %0 Journal Article %~ PubMed %A Celermajer, David S %A Neal, Bruce %T Excessive Sodium Intake and Cardiovascular Disease: A-Salting Our Vessels. %B Journal of the American College of Cardiology %D 2013 %C United States %I Elsevier Inc. %V 61 %N 3 %P 344-345 %@ 0735-1097 %X %Z FOR Codes: 110399 %0 Journal Article %~ PubMed %A Batty, G-D %A Li, Q %A Huxley, R %A Zoungas, S %A Taylor, B-A %A Neal, B %A de Galan, B %A Woodward, M %A Harrap, S-B %A Colagiuri, S %A Patel, A %A Chalmers, J %A , On behalf of the ADVANCE Collaborative group %T Oral disease in relation to future risk of dementia and cognitive decline: Prospective cohort study based on the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified-Release Controlled Evaluation (ADVANCE) trial. %B European Psychiatry %D 2013 %C France %I Elsevier Masson %V 28 %N 1 %P 49-52 %@ 1778-3585 %X OBJECTIVE: Examine the association of oral disease with future dementia/cognitive decline in a cohort of people with type 2 diabetes. METHODS: A total of 11,140 men and women aged 55-88 years at study induction with type 2 diabetes participated in a baseline medical examination when they reported the number of natural teeth and days of bleeding gums. Dementia and cognitive decline were ascertained periodically during a 5-year follow-up. RESULTS: Relative to the group with the greatest number of teeth (more than or equal to 22), having no teeth was associated with the highest risk of both dementia (hazard ratio; 95% confidence interval: 1.48; 1.24, 1.78) and cognitive decline (1.39; 1.21, 1.59). Number of days of bleeding gums was unrelated to these outcomes. CONCLUSIONS: Tooth loss was associated with an increased risk of both dementia and cognitive decline. %Z FOR Codes: 110201 110306 111716 %0 Journal Article %~ PubMed %A Lim, Stephen S %A Vos, Theo %A Flaxman, Abraham D %A Danaei, Goodarz %A Shibuya, Kenji %A Adair-Rohani, Heather %A Amann, Markus %A Anderson, H Ross %A Andrews, Kathryn G %A Aryee, Martin %A Atkinson, Charles %A Bacchus, Loraine J %A Bahalim, Adil N %A Balakrishnan, Kalpana %A Balmes, John %A Barker-Collo, Suzanne %A Baxter, Amanda %A Bell, Michelle L %A Blore, Jed D %A Blyth, Fiona %A Bonner, Carissa %A Borges, Guilherme %A Bourne, Rupert %A Boussinesq, Michel %A Brauer, Michael %A Brooks, Peter %A Bruce, Nigel G %A Brunekreef, Bert %A Bryan-Hancock, Claire %A Bucello, Chiara %A Buchbinder, Rachelle %A Bull, Fiona %A Burnett, Richard T %A Byers, Tim E %A Calabria, Bianca %A Carapetis, Jonathan %A Carnahan, Emily %A Chafe, Zoe %A Charlson, Fiona %A Chen, Honglei %A Chen, Jian Shen %A Cheng, Andrew Tai-Ann %A Child, Jennifer Christine %A Cohen, Aaron %A Colson, K Ellicott %A Cowie, Benjamin C %A Darby, Sarah %A Darling, Susan %A Davis, Adrian %A Degenhardt, Louisa %A Dentener, Frank %A Des Jarlais, Don C %A Devries, Karen %A Dherani, Mukesh %A Ding, Eric L %A Dorsey, E Ray %A Driscoll, Tim %A Edmond, Karen %A Ali, Suad Eltahir %A Engell, Rebecca E %A Erwin, Patricia J %A Fahimi, Saman %A Falder, Gail %A Farzadfar, Farshad %A Ferrari, Alize %A Finucane, Mariel M %A Flaxman, Seth %A Fowkes, Francis Gerry R %A Freedman, Greg %A Freeman, Michael K %A Gakidou, Emmanuela %A Ghosh, Santu %A Giovannucci, Edward %A Gmel, Gerhard %A Graham, Kathryn %A Grainger, Rebecca %A Grant, Bridget %A Gunnell, David %A Gutierrez, Hialy R %A Hall, Wayne %A Hoek, Hans W %A Hogan, Anthony %A Hosgood, H Dean %A Hoy, Damian %A Hu, Howard %A Hubbell, Bryan J %A Hutchings, Sally J %A Ibeanusi, Sydney E %A Jacklyn, Gemma L %A Jasrasaria, Rashmi %A Jonas, Jost B %A Kan, Haidong %A Kanis, John A %A Kassebaum, Nicholas %A Kawakami, Norito %A Khang, Young-Ho %A Khatibzadeh, Shahab %A Khoo, Jon-Paul %A Kok, Cindy %A Laden, Francine %A Lalloo, Ratilal %A Lan, Qing %A Lathlean, Tim %A Leasher, Janet L %A Leigh, James %A Li, Yang %A Lin, John Kent %A Lipshultz, Steven E %A London, Stephanie %A Lozano, Rafael %A Lu, Yuan %A Mak, Joelle %A Malekzadeh, Reza %A Mallinger, Leslie %A Marcenes, Wagner %A March, Lyn %A Marks, Robin %A Martin, Randall %A McGale, Paul %A McGrath, John %A Mehta, Sumi %A Mensah, George A %A Merriman, Tony R %A Micha, Renata %A Michaud, Catherine %A Mishra, Vinod %A Hanafiah, Khayriyyah Mohd %A Mokdad, Ali A %A Morawska, Lidia %A Mozaffarian, Dariush %A Murphy, Tasha %A Naghavi, Mohsen %A Neal, Bruce %A Nelson, Paul K %A Nolla, Joan Miquel %A Norman, Rosana %A Olives, Casey %A Omer, Saad B %A Orchard, Jessica %A Osborne, Richard %A Ostro, Bart %A Page, Andrew %A Pandey, Kiran D %A Parry, Charles D H %A Passmore, Erin %A Patra, Jayadeep %A Pearce, Neil %A Pelizzari, Pamela M %A Petzold, Max %A Phillips, Michael R %A Pope, Dan %A Pope, C Arden %A Powles, John %A Rao, Mayuree %A Razavi, Homie %A Rehfuess, Eva A %A Rehm, Jürgen T %A Ritz, Beate %A Rivara, Frederick P %A Roberts, Thomas %A Robinson, Carolyn %A Rodriguez-Portales, Jose A %A Romieu, Isabelle %A Room, Robin %A Rosenfeld, Lisa C %A Roy, Ananya %A Rushton, Lesley %A Salomon, Joshua A %A Sampson, Uchechukwu %A Sanchez-Riera, Lidia %A Sanman, Ella %A Sapkota, Amir %A Seedat, Soraya %A Shi, Peilin %A Shield, Kevin %A Shivakoti, Rupak %A Singh, Gitanjali M %A Sleet, David A %A Smith, Emma %A Smith, Kirk R %A Stapelberg, Nicolas J C %A Steenland, Kyle %A Stöckl, Heidi %A Stovner, Lars Jacob %A Straif, Kurt %A Straney, Lahn %A Thurston, George D %A Tran, Jimmy H %A Van Dingenen, Rita %A van Donkelaar, Aaron %A Veerman, J Lennert %A Vijayakumar, Lakshmi %A Weintraub, Robert %A Weissman, Myrna M %A White, Richard A %A Whiteford, Harvey %A Wiersma, Steven T %A Wilkinson, James D %A Williams, Hywel C %A Williams, Warwick %A Wilson, Nicholas %A Woolf, Anthony D %A Yip, Paul %A Zielinski, Jan M %A Lopez, Alan D %A Murray, Christopher J L %A Ezzati, Majid %T A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. %B Lancet %D 2012 %C United Kingdom %I The Lancet Publishing Group %V 380 %N 9859 %P 2224-2260 %@ 0140-6736 %X %Z FOR Codes: 1117 %0 Journal Article %~ PubMed %A Zoungas, S %A Chalmers, J %A Ninomiya, T %A Li, Q %A Cooper, M E %A Colagiuri, S %A Fulcher, G %A de Galan, B E %A Harrap, S %A Hamet, P %A Heller, S %A Macmahon, S %A Marre, M %A Poulter, N %A Travert, F %A Patel, A %A Neal, B %A Woodward, M %A , for the ADVANCE Collaborative Group %T Association of HbA(1c) levels with vascular complications and death in patients with type 2 diabetes: evidence of glycaemic thresholds. %B Diabetologia %D 2012 %C Germany %I Springer %V 55 %N 3 %P 636-643 %@ 0012-186X %X AIMS/HYPOTHESIS: There is conflicting evidence regarding appropriate glycaemic targets for patients with type 2 diabetes. Here, we investigate the relationship between HbA(1c) and the risks of vascular complications and death in such patients. METHODS: Eleven thousand one hundred and forty patients were randomised to intensive or standard glucose control in the Action in Diabetes and Vascular disease: Preterax and Diamicron Modified Release Controlled Evaluation (ADVANCE) trial. Glycaemic exposure was assessed as the mean of HbA(1c) measurements during follow-up and prior to the first event. Adjusted risks for each HbA(1c) decile were estimated using Cox models. Possible differences in the association between HbA(1c) and risks at different levels of HbA(1c) were explored using linear spline models. RESULTS: There was a non-linear relationship between mean HbA(1c) during follow-up and the risks of macrovascular events, microvascular events and death. Within the range of HbA(1c) studied (5.5-10.5%), there was evidence of ''thresholds'', such that below HbA(1c) levels of 7.0% for macrovascular events and death, and 6.5% for microvascular events, there was no significant change in risks (all p???>???0.8). Above these thresholds, the risks increased significantly: every 1% higher HbA(1c) level was associated with a 38% higher risk of a macrovascular event, a 40% higher risk of a microvascular event and a 38% higher risk of death (all p???25% and/or history of macrovascular disease). Endpoints were macrovascular and microvascular events. RESULTS: The mean age of participants was 66 years (42.5% female). 1000 macrovascular and 916 microvascular events were recorded over follow-up of 4.3 years. Relative treatment effects were similar across risk groups, (all P-values for heterogeneity ???0.38). Hazard ratios for combined macro- and microvascular events were 0.89 (0.77-1.03) for the moderate-high risk and 0.92 (0.81-1.03) for the very high risk. Absolute treatment effects tended to be greater in the high risk groups although differences were not statistically significant (P>0.05). CONCLUSIONS: Relative effects of blood pressure lowering with perindopril-indapamide on cardiovascular outcomes were similar across risk groups whilst absolute effects trended to be greater in the high risk group. %Z FOR Codes: 1117 %0 Journal Article %~ PubMed %A Lv, Jicheng %A Neal, Bruce %A Ehteshami, Parya %A Ninomiya, Toshiharu %A Woodward, Mark %A Rodgers, Anthony %A Wang, Haiyan %A Macmahon, Stephen %A Turnbull, Fiona %A Hillis, Graham %A Chalmers, John %A Perkovic, Vlado %T Effects of intensive blood pressure lowering on cardiovascular and renal outcomes: a systematic review and meta-analysis. %B PLoS Medicine %D 2012 %C United States %I Public Library of Science %V 9 %N 8 %P e1001293 %@ 1549-1676 %X Guidelines recommend intensive blood pressure (BP) lowering in patients at high risk. While placebo-controlled trials have demonstrated 22% reductions in coronary heart disease (CHD) and stroke associated with a 10-mmHg difference in systolic BP, it is unclear if more intensive BP lowering strategies are associated with greater reductions in risk of CHD and stroke. We did a systematic review to assess the effects of intensive BP lowering on vascular, eye, and renal outcomes. %Z FOR Codes: 110201 110312 %0 Journal Article %~ PubMed %A Dunford, Elizabeth %A Webster, Jacqui %A Metzler, Adriana Blanco %A Czernichow, Sebastien %A Ni Mhurchu, Cliona %A Wolmarans, Petro %A Snowdon, Wendy %A L'abbe, Mary %A Li, Nicole %A Maulik, Pallab K %A Barquera, Simon %A Schoj, Verónica %A Allemandi, Lorena %A Samman, Norma %A Wenzel de Menezes, Elizabete %A Hassell, Trevor %A Ortiz, Johana %A Salazar de Ariza, Julieta %A Rahman, A Rashid %A de Núñez, Leticia %A Garcia, Maria Reyes %A van Rossum, Caroline %A Thiam, Lim Meng %A Macgregor, Graham %A Neal, Bruce %T International collaborative project to compare and monitor the nutritional composition of processed foods. %B European Journal of Cardiovascular Prevention & Rehabilitation %D 2012 %C United Kingdom %I Sage Publications Ltd. %V 19 %N 6 %P 1326-1332 %@ 1741-8267 %X Background: Chronic diseases are the leading cause of premature death and disability in the world with overnutrition a primary cause of diet-related ill health. Excess energy intake, saturated fat, sugar, and salt derived from processed foods are a major cause of disease burden. Our objective is to compare the nutritional composition of processed foods between countries, between food companies, and over time. Design: Surveys of processed foods will be done in each participating country using a standardized methodology. Information on the nutrient composition for each product will be sought either through direct chemical analysis, from the product label, or from the manufacturer. Foods will be categorized into 14 groups and 45 categories for the primary analyses which will compare mean levels of nutrients at baseline and over time. Initial commitments to collaboration have been obtained from 21 countries. Conclusions: This collaborative approach to the collation and sharing of data will enable objective and transparent tracking of processed food composition around the world. The information collected will support government and food industry efforts to improve the nutrient composition of processed foods around the world. %Z FOR Codes: 111104 111799 111199 %0 Journal Article %A Dunford, Elizabeth %A Ortiz, Johana %A Snowdon, Wendy %A Czernichow, Sebastien %A Salazar de Ariza, Julieta %A Neal, Bruce %A Allemandi, Lorena %A Samman, Norma %A Hassell, Trevor %A Wenzel de Menezes, Elizabete %A L'Abbe, Mary %A Yan, Li %A Blanco-Metzler, Adriana %A Valdes, Lourdes %A Maulik, Pallab %A Rahman, Rashid %A Barquera, Simon %A Bayandorjt, Tsoogi %A Govind, Salik %A Ni Mhurchu, Cliona %A de Nunez, Leticia %A Reyes Garcia, Maria %A Lin, Gladis %A Wolmarans, Petro %A Varela-Moreiras, Gregorio %A van Rossum, Caroline %A MacGregor, Graham %A Jebb, Susan %T International collaborative project to compare and track the nutritional composition of fast foods %B BMC Public Health %D 2012 %C United Kingdom %I BioMed Central Ltd. %V 12 %N %P 559 %@ 1471-2458 %X %Z FOR Codes: 111104 %0 Journal Article %~ PubMed %A Kotwal, Sradha %A Jun, Min %A Sullivan, David %A Perkovic, Vlado %A Neal, Bruce %T Omega 3 Fatty Acids and Cardiovascular Outcomes: Systematic Review and Meta-Analysis. %B Circulation. Cardiovascular Quality and Outcomes %D 2012 %C United States %I Lippincott Williams & Wilkins %V 5 %N 6 %P 808-818 %@ 1941-7705 %X %Z FOR Codes: 110104 110201 %0 Journal Article %~ PubMed %A Donkin, L %A Hickie, I B %A Christensen, H %A Naismith, S L %A Neal, B %A Cockayne, N L %A Glozier, N %T Sampling bias in an internet treatment trial for depression. %B Translational Psychiatry %D 2012 %C United Kingdom %I Nature Publishing Group %V 2 %N %P e174 %@ 2158-3188 %X %Z FOR Codes: 111706 110319 %0 Journal Article %~ PubMed %A Justin Zaman, M %A Patel, Anushka %A Jan, Stephen %A Hillis, Graham S %A Raju, P Krishnam %A Neal, Bruce %A Chow, Clara K %T Socio-economic distribution of cardiovascular risk factors and knowledge in rural India. %B International Journal of Epidemiology %D 2012 %C United Kingdom %I Oxford University Press %V 41 %N 5 %P 1302-1314 %@ 0300-5771 %X BACKGROUND: To investigate the prevalence, screening and knowledge of cardiovascular risk factors (CVRFs) by socio-economic position (SEP) in rural India. METHODS: An age- and sex-stratified random sample of 4535 adults was recruited from rural Andhra Pradesh and a questionnaire was administered to assess prevalence, screening and knowledge of CVRFs and record recent attempts to modify behaviour. Education, income and occupation were used to measure SEP. RESULTS: Lower fruit intake and higher tobacco and alcohol use were found in those with lower SEP. Overweight, physical inactivity, diabetes, hypertension, family history of cardiovascular disease (CVD) and previous CVD (men only) were greater in higher SEP participants. Lower SEP participants had less blood pressure, glucose or cholesterol screening and less knowledge of nine CVRFs. Regardless of SEP, participants knowledgeable of the harms of a CVRF were more likely to have attempted to modify behaviour. For example, knowledge of benefits of smoking cessation was associated with an increased odds ratio (OR) for attempting to quit: in educated participants-OR 3.67, 95% confidence interval (CI) 2.10-6.42; in participants with no education-OR 3.98, 95% CI 2.27-6.97. CONCLUSIONS: Some biological CVRFs were worse in higher SEP participants while some behavioural risk factors were worse in lower SEP participants. Lower SEP participants had less CVRF screening and knowledge of CVRFs. Those with knowledge of CVRFs were more likely to make healthy behavioural changes. Our findings suggest equipping rural Indians with knowledge about CVRFs may ameliorate projected future increases in CVD. %Z FOR Codes: 111706 %0 Journal Article %~ PubMed %A Joshi, Rohina %A Chow, Clara K %A Raju, P Krishnam %A Raju, K Rama %A Gottumukkala, Arun Kumar %A Reddy, K Srinath %A Macmahon, Stephen %A Heritier, Stephane %A Li, Qiang %A Dandona, Rakhi %A Neal, Bruce %T The Rural Andhra Pradesh Cardiovascular Prevention Study (RAPCAPS): a cluster randomized trial. %B Journal of the American College of Cardiology %D 2012 %C United States %I Elsevier Inc. %V 59 %N 13 %P 1188-1196 %@ 0735-1097 %X %Z FOR Codes: 110203 1117 %0 Journal Article %~ PubMed %A Wong, Germaine %A Zoungas, Sophia %A Lo, Serigne %A Chalmers, John %A Cass, Alan %A Neal, Bruce %A Woodward, Mark %A Perkovic, Vlado %A Glasziou, Paul %A Williams, Bryan %A Howard, Kirsten %A Chapman, Jeremy R %A Craig, Jonathan C %T The risk of cancer in people with diabetes and chronic kidney disease. %B Nephrology, Dialysis, Transplantation %D 2012 %C United Kingdom %I Oxford University Press %V 27 %N 8 %P 3337-3344 %@ 1460-2385 %X BACKGROUND: Diabetes and chronic kidney disease (CKD) are both associated with an increased risk of cancer but it is unclear whether diabetes complicated by CKD further augments an individual''s cancer risk. The aim of our study was to determine the association of CKD [defined as an estimated glomerular filtration rate (eGFR) < 60 mL/min] with the overall and site-specific risks of incident cancers among individuals with Type 2 diabetes.METHODS: Cox proportional hazard regression models and competing risk analyses were used to examine the univariate and multivariate adjusted associations between reduced kidney function and the overall and site-specific risks of cancer in participants enrolled in the Action in Diabetes and Vascular disease: Preterax and Diamicron MR controlled evaluation (ADVANCE) trial.RESULTS: Over a median follow-up of 5.0 years, 700 malignant neoplasms occurred in the 11???140 (6.4%) participants. There was no increase in overall cancer risk [adjusted hazard ratio: 1.07 (95% confidence interval: 0.89-1.29, P = 0.50)] or site-specific cancer risk for individuals with CKD (defined as eGFR <60 mL/min) compared to those without CKD at baseline. These results were robust to multiple methods and thresholds used to estimate CKD.CONCLUSIONS: Mild to moderate CKD does not increase the risk of cancer in people with Type 2 diabetes. ADVANCE is registered with ClincalTrial.gov (number NCT00145925). %Z FOR Codes: 110312 110306 %0 Journal Article %~ PubMed %A Dunford, Elizabeth %A Webster, Jacqueline %A Woodward, Mark %A Czernichow, Sebastien %A Yuan, Wen Lun %A Jenner, Katharine %A Ni Mhurchu, Cliona %A Jacobson, Michael %A Campbell, Norm %A Neal, Bruce %T The variability of reported salt levels in fast foods across six countries: opportunities for salt reduction. %B CMAJ %D 2012 %C Canada %I Canadian Medical Association %V 184 %N 9 %P 1023-1028 %@ 1488-2329 %X Several fast food companies have made commitments to reduce the levels of salt in the foods they serve, but technical issues are often cited as a barrier to achieving substantial reductions. Our objective was to examine the reported salt levels for products offered by leading multinational fast food chains. %Z FOR Codes: 111716 %0 Journal Article %~ PubMed %A Perkovic, Vlado %A Neal, Bruce %T Trials in Kidney Disease - Time to EVOLVE. %B New England Journal of Medicine %D 2012 %C United States %I Massachusetts Medical Society %V 367 %N 26 %P 2541-2542 %@ 1533-4406 %X %Z FOR Codes: 110312 110299 %0 Journal Article %~ PubMed %A Neal, Bruce %T White rice and risk of type 2 diabetes. %B BMJ %D 2012 %C United Kingdom %I BMJ Group %V 344 %N %P e2021 %@ 1756-1833 %X %Z FOR Codes: 111104 %0 Journal Article %~ PubMed %A Donkin, Liesje %A Christensen, Helen %A Naismith, Sharon L %A Neal, Bruce %A Hickie, Ian B %A Glozier, Nick %T A Systematic Review of the Impact of Adherence on the Effectiveness of e-Therapies. %B Journal of Medical Internet Research %D 2011 %C Canada %I Journal of Medical Internet Research %V 13 %N 3 %P e52 %@ 1438-8871 %X As the popularity of e-therapies grows, so too has the body of literature supporting their effectiveness. However, these interventions are often plagued by high attrition rates and varying levels of user adherence. Understanding the role of adherence may be crucial to understanding how program usage influences the effectiveness of e-therapy interventions. %Z FOR Codes: 1701 %0 Journal Article %~ PubMed %A , PILL Collaborative Group %A Rodgers, Anthony %A Patel, Anushka %A Berwanger, Otavio %A Bots, Michiel %A Grimm, Richard %A Grobbee, Diederick E %A Jackson, Rod %A Neal, Bruce %A Neaton, Jim %A Poulter, Neil %A Rafter, Natasha %A Raju, P Krishnam %A Reddy, Srinath %A Thom, Simon %A Vander Hoorn, Stephen %A Webster, Ruth %T An international randomised placebo-controlled trial of a four-component combination pill ("polypill") in people with raised cardiovascular risk. %B PLoS One %D 2011 %C United States %I Public Library of Science %V 6 %N 5 %P e19857 %@ 1932-6203 %X There has been widespread interest in the potential of combination cardiovascular medications containing aspirin and agents to lower blood pressure and cholesterol (''polypills'') to reduce cardiovascular disease. However, no reliable placebo-controlled data are available on both efficacy and tolerability. %Z FOR Codes: 110201 %0 Journal Article %~ PubMed %A Dunford, Elizabeth K %A Eyles, Helen %A Ni Mhurchu, Cliona %A Webster, Jacqui L %A Neal, Bruce C %T Changes in the sodium content of bread in Australia and New Zealand between 2007 and 2010: implications for policy. %B The Medical Journal of Australia %D 2011 %C Australia %I Australasian Medical Publishing Company Pty. Ltd. %V 195 %N 6 %P 346-349 %@ 1326-5377 %X To define the effectiveness of recent efforts by the Australian Division of World Action on Salt and Health, and the Heart Foundation in New Zealand to reduce sodium levels in breads in Australia and New Zealand. %Z FOR Codes: 111104 %0 Journal Article %~ PubMed %A Salomon, Joshua A %A Patel, Anushka %A Neal, Bruce %A Glasziou, Paul %A Grobbee, Diederick E %A Chalmers, John %A Clarke, Philip M %T Comparability of Patient-reported Health Status: Multicountry Analysis of EQ-5D Responses in Patients With Type 2 Diabetes. %B Medical Care %D 2011 %C United States %I Lippincott Williams & Wilkins %V 49 %N 10 %P 962-970 %@ 1537-1948 %X Valid and comparable measures of health outcomes are needed for clinical trials, studies on quality of healthcare, and population health monitoring. %Z FOR Codes: 111799 %0 Journal Article %~ PubMed %A Ritchie, Georgia E %A Kengne, Andre Pascal %A Joshi, Rohina %A Chow, Clara %A Neal, Bruce %A Patel, Anushka %A Zoungas, Sophia %T Comparison of near-patient capillary glucose measurement and a risk assessment questionnaire in screening for type 2 diabetes in a high-risk population in rural India. %B Diabetes Care %D 2011 %C United States %I American Diabetes Association %V 34 %N 1 %P 44-49 %@ 0149-5992 %X OBJECTIVE To assess the utility of a point-of-care (POC) capillary blood glucose measurement as compared with routine clinical parameters in predicting undiagnosed diabetes in a low-resource rural India setting. RESEARCH DESIGN AND METHODS Nine hundred and ninety-four participants aged >30 years and stratified by age and sex were randomly selected from 20 villages in India. A clinical questionnaire, sampling for laboratory venous fasting plasma glucose (FPG), and POC capillary blood glucose assay were performed simultaneously. Diabetes diagnosis was based on the World Health Organization (WHO) definition using FPG. The capacity of the POC glucose to predict the presence of diabetes was assessed and compared with the questionnaire using area under the receiver operating characteristic curves (AUCs). RESULTS The AUC for POC glucose alone in predicting diabetes was 0.869 (95% CI 0.810-0.929). This was significantly better (P < 0.001 for AUC comparison) than the models based upon clinical variables alone (AUC for the best clinical model including age, BMI, hypertension, waist circumference: 0.694 [95% CI 0.621-0.766]). POC glucose appropriately reclassified the risk of up to one-third of participants ranked according to the clinical models. Adding the clinical variables to the POC glucose assay did not significantly improve the discriminatory capability beyond that achieved with the POC glucose measurement alone (all P > 0.37). CONCLUSIONS POC glucose testing appears to be a simple and reliable tool for identifying undiagnosed diabetes in a high-risk, resource-poor rural population. However, studies evaluating the cost effectiveness of introducing POC glucose testing are needed prior to widespread implementation. %Z FOR Codes: 111706 110306 110306 %0 Journal Article %~ PubMed %A Czernichow, Sebastian %A Kengne, Andre-Pascal %A Huxley, Rachel R %A Batty, George David %A de Galan, Bastiaan %A Grobbee, Diederick %A Pillai, Avinesh %A Zoungas, Sophia %A Marre, Michel %A Woodward, Mark %A Neal, Bruce %A Chalmers, John %A , on behalf of the ADVANCE Collaborative Group %T Comparison of waist-to-hip ratio and other obesity indices as predictors of cardiovascular disease risk in people with type-2 diabetes: a prospective cohort study from ADVANCE. %B European journal of cardiovascular prevention and rehabilitation : official journal of the European Society of Cardiology, Working Groups on Epidemiology & Prevention and Cardiac Rehabilitation and Exercise Physiology %D 2011 %C United States, Franc %I Lippincott Williams & Wilkins %V 18 %N 2 %P 312-9 %@ 1741-8275 %X The aim of this study was to compare the strength of associations and discrimination capability of body mass index (BMI), waist circumference (WC) and waist-to-hip ratio (WHR) with cardiovascular disease risk in individuals with type-2 diabetes. %Z FOR Codes: 110201 %0 Journal Article %~ PubMed %A Kengne, Andre Pascal %A Patel, Anushka %A Marre, Michel %A Travert, Florence %A Lievre, Michel %A Zoungas, Sophia %A Chalmers, John %A Colagiuri, Stephen %A Grobbee, Diederick E %A Hamet, Pavel %A Heller, Simon %A Neal, Bruce %A Woodward, Mark %T Contemporary model for cardiovascular risk prediction in people with type 2 diabetes. %B European journal of cardiovascular prevention and rehabilitation : official journal of the European Society of Cardiology, Working Groups on Epidemiology & Prevention and Cardiac Rehabilitation and Exercise Physiology %D 2011 %C United States %I Sage Publications Ltd. %V 18 %N 3 %P 393-8 %@ 1741-8275 %X Existing cardiovascular risk prediction equations perform non-optimally in different populations with diabetes. Thus, there is a continuing need to develop new equations that will reliably estimate cardiovascular disease (CVD) risk and offer flexibility for adaptation in various settings. This report presents a contemporary model for predicting cardiovascular risk in people with type 2 diabetes mellitus. %Z FOR Codes: 111706 %0 Journal Article %~ PubMed %A Woodward, Mark %A Patel, Anushka %A Zoungas, Sophia %A Liu, Lisheng %A Pan, Changyu %A Poulter, Neil %A Januszewicz, Andrzej %A Tandon, Nikhil %A Joshi, Prashant %A Heller, Simon %A Neal, Bruce %A Chalmers, John %T Does Glycemic Control Offer Similar Benefits Among Patients With Diabetes in Different Regions of the World?: Results from the ADVANCE trial. %B Diabetes care %D 2011 %C United States %I American Diabetes Association %V 34 %N 12 %P 2491-5 %@ 0149-5992 %X Participants in ADVANCE were drawn from many countries. We examined whether the effects of intensive glycemic control on major outcomes in ADVANCE differ between participants from Asia, established market economies (EMEs), and eastern Europe. %Z FOR Codes: 110201 110306 111716 %0 Journal Article %~ PubMed %A Neal, Bruce C %T Don't spare the salt? %B The Medical Journal of Australia %D 2011 %C Australia %I Australasian Medical Publishing Company Pty. Ltd. %V 195 %N 3 %P 111-112 %@ 1326-5377 %X How can implementing a population-wide salt-reduction program be so hard? %Z FOR Codes: 111104 111706 110201 %0 Journal Article %~ PubMed %A Arima, Hisatomi %A Anderson, Craig %A Omae, Teruo %A Woodward, Mark %A Hata, Jun %A Murakami, Yoshitaka %A Macmahon, Stephen %A Neal, Bruce %A Chalmers, John %A , for the PROGRESS Collaborative Group %T Effects of Blood Pressure Lowering on Major Vascular Events Among Patients With Isolated Diastolic Hypertension: The Perindopril Protection Against Recurrent Stroke Study (PROGRESS) Trial. %B Stroke; a journal of cerebral circulation %D 2011 %C United States %I Lippincott Williams & Wilkins %V 42 %N 8 %P 2339-41 %@ 1524-4628 %X Despite clear evidence that blood pressure (BP) lowering is effective for prevention of cardiovascular events among patients with isolated systolic hypertension and systolic-diastolic hypertension, there is ongoing uncertainty about its effects in those with isolated diastolic hypertension. The objective of the present analysis is to determine whether BP lowering provides benefits to patients with isolated diastolic hypertension. %Z FOR Codes: 110201 110306 111716 %0 Journal Article %~ PubMed %A Joshi, Rohina %A Praveen, Devarsetty %A Chow, Clara %A Neal, Bruce %T Effects on the estimated cause-specific mortality fraction of providing physician reviewers with different formats of verbal autopsy data. %B Population Health Metrics %D 2011 %C United Kingdom %I BioMed Central Ltd. %V 9 %N 1 %P 33 %@ 1478-7954 %X ABSTRACT: BACKGROUND: The process of data collection and the methods used to assign the cause of death vary significantly among different verbal autopsy protocols, but there are few data to describe the consequences of the choices made. The aim of this study was to objectively define the impact of the format of data presented to physician reviewers on the cause-specific mortality fractions defined by a verbal autopsy-based mortality-surveillance system. METHODS: Verbal autopsies were done by primary health care workers for all deaths between October 2006 and September 2007 in a community in rural Andhra Pradesh, India (total population about 180,162). Each questionnaire had a structured section, composed of a series of check boxes, and a free-text section, in which a narrative description of the events leading to death was recorded. For each death, a physician coder was presented first with one section and then the other in random order with a 20- to 40-day interval between. A cause of death was recorded for each data format at the level of ICD 10 chapter headings or else the death was documented as unclassified. After another 20- to 40-day interval, both the structured and free-text sections of the questionnaire were presented together and an index cause of death was assigned. RESULTS: In all, 1,407 verbal autopsies were available for analysis, representing 94% of all deaths recorded in the population that year. An index cause of death was assigned using the combined data for 1,190 with the other 217 remaining unclassified. The observed cause-specific mortality fractions were the same regardless of whether the structured, free-text or combined data sources were used. At the individual level, the assignments made using the structured format matched the index in 1,012 (72%) of cases with a kappa statistic of 0.66. For the free-text format, the corresponding figures were 989 (70%) and 0.64. CONCLUSIONS: The format of the verbal autopsy data used to assign a cause of death did not substantively influence the pattern of mortality estimated. Substantially abbreviated and simplified verbal autopsy questionnaires might provide robust information about high-level mortality patterns. %Z FOR Codes: 111711 111799 %0 Journal Article %~ PubMed %A Madhavan, Srinivas R %A Reddy, Sathish %A Panuganti, Pradeep K %A Joshi, Rohina %A Mallidi, Jaya %A Raju, Krishnam %A Raju, K Rama %A Iyengar, Srinivas %A Reddy, K Srinath %A Patel, Anushka %A Neal, Bruce %A Calambur, Narasimhan %A Tandri, Harikrishna %T Epidemiology of sudden cardiac death in rural South India - insights from the andhra pradesh rural health initiative. %B Indian Pacing and Electrophysiology Journal %D 2011 %C India %I Indian Heart Rhythm Society %V 11 %N 4 %P 93-102 %@ 0972-6292 %X Sudden cardiac death (SCD) is a common initial presentation of coronary artery disease (CAD). Despite the growing epidemic of CAD in India, the epidemiology of SCD is largely unknown. %Z FOR Codes: 111706 %0 Journal Article %~ PubMed %A Campbell, N R C %A Neal, B C %A MacGregor, G A %T Interested in developing a national programme to reduce dietary salt? %B Journal of Human Hypertension %D 2011 %C United Kingdom %I Nature Publishing Group %V 25 %N 12 %P 705-710 %@ 1476-5527 %X High dietary salt is a major contributor to increased blood pressure, the leading risk for death worldwide. In several countries, national programmes to reduce dietary salt have been implemented with leadership and involvement of hypertension experts. Other hypertension experts may be interested in assisting or leading a national programme to reduce dietary salt, however, may not have the experience or training to do so. The article is based on the experiences of three hypertension experts who have led the development of national dietary salt reduction programmes in the United Kingdom, Australia and Canada. The article advises developing leadership and a coalition, conducting a nation-specific environmental scan of facilitators and barriers, estimating the national health and financial costs of high dietary salt and the benefits of reducing salt intake, obtaining core documents to provide the scientific rational for the programme, developing a policy statement to outline the required actions to be undertaken, engaging government and industry, using media to gain public support, overcoming industry supported opposition and sustaining the effort long term. Resources and potential sources for international collaboration are provided as well as caveats for developing the programme within the specific nations'' context and overall effort to improve health. Developing and leading a national salt reduction programme is a major commitment, however, reducing dietary salt is estimated to be one of the most effective strategies to improve a nation''s health. %Z FOR Codes: 111716 %0 Journal Article %~ PubMed %A Cockayne, Nicole L %A Glozier, Nick %A Naismith, Sharon L %A Christensen, Helen %A Neal, Bruce %A Hickie, Ian B %T Internet-based treatment for older adults with depression and co-morbid cardiovascular disease: protocol for a randomised, double-blind, placebo controlled trial. %B BMC Psychiatry %D 2011 %C United Kingdom %I BioMed Central Ltd. %V 11 %N %P 10 %@ 1471-244X %X Depression, cardiovascular disease (CVD) risk factors and cognitive impairment are important causes of disability and poor health outcomes. In combination they lead to an even worse prognosis. Internet or web-based interventions have been shown to deliver efficacious psychological intervention programs for depression on a large scale, yet no published studies have evaluated their impact among patients with co-existing physical conditions. The aims of this randomised controlled trial are to determine the effects of an evidence-based internet intervention program for depression on depressive mood symptoms, cognitive function and treatment adherence in patients at risk of CVD. %Z FOR Codes: 110319 %0 Journal Article %~ PubMed %A Campbell, N %A Correa-Rotter, R %A Neal, B %A Cappuccio, F P %T New evidence relating to the health impact of reducing salt intake. %B Nutrition, Metabolism & Cardiovascular Diseases %D 2011 %C United Kingdom %I Elsevier Ltd %V 21 %N 9 %P 617-619 %@ 1590-3729 %X This paper is a Position Statement from an ''ad hoc'' Scientific Review Subcommittee of the PAHO/WHO Regional Expert Group on Cardiovascular Disease Prevention through Dietary Salt Reduction. It is produced in response to requests from representatives of countries of the Pan-American Region of WHO needing clarification on two recent publications casting doubts on the appropriateness of population wide policies to reduce salt intake for the prevention of cardiovascular disease. The paper provides a brief background, a critical appraisal of the recent reports and explanations as why the implications have been mis-interpreted. The paper concludes that the benefits of salt reduction are clear and consistent, and reinforces the recommendations outlined by PAHO/WHO and other organizations worldwide for a population reduction in salt intake to prevent strokes, heart attacks and other cardiovascular events. %Z FOR Codes: 1111 %0 Journal Article %~ PubMed %A Neal, Bruce C %A Irwig, Les %T Not much need for ambulatory blood pressure monitoring. %B The Medical journal of Australia %D 2011 %C Australia %I Australasian Medical Publishing Company Pty. Ltd. %V 195 %N 11/12 %P 634-5 %@ 1326-5377 %X %Z FOR Codes: 110201 111706 111716 %0 Journal Article %~ PubMed %A Murray, Christopher Jl %A Lopez, Alan D %A Black, Robert %A Ahuja, Ramesh %A Ali, Said Mohd %A Baqui, Abdullah %A Dandona, Lalit %A Dantzer, Emily %A Das, Vinita %A Dhingra, Usha %A Dutta, Arup %A Fawzi, Wafaie %A Flaxman, Abraham D %A Gómez, Sara %A Hernández, Bernardo %A Joshi, Rohina %A Kalter, Henry %A Kumar, Aarti %A Kumar, Vishwajeet %A Lozano, Rafael %A Lucero, Marilla %A Mehta, Saurabh %A Neal, Bruce %A Ohno, Summer Lockett %A Prasad, Rajendra %A Praveen, Devarsetty %A Premji, Zul %A Ramírez-Villalobos, Dolores %A Remolador, Hazel %A Riley, Ian %A Romero, Minerva %A Said, Mwanaidi %A Sanvictores, Diozele %A Sazawal, Sunil %A Tallo, Veronica %T Population Health Metrics Research Consortium gold standard verbal autopsy validation study: design, implementation, and development of analysis datasets. %B Population Health Metrics %D 2011 %C United Kingdom %I BioMed Central Ltd. %V 9 %N %P 27 %@ 1478-7954 %X ABSTRACT: %Z FOR Codes: 111711 %0 Journal Article %~ PubMed %A Wood, Anna %A Pell, Jill %A Patel, Anushka %A Neal, Bruce %A Raju, P Krishnam %A Chow, Clara K %T Prevention of cardiovascular disease in a rural region of India and strategies to address the unmet need. %B Heart (British Cardiac Society) %D 2011 %C United Kingdom %I BMJ Group %V 97 %N 17 %P 1373-8 %@ 1468-201X %X To determine levels of cardiovascular disease (CVD) prevention and to model the potential impact of improved prevention strategies for a large rural Indian region. %Z FOR Codes: 110201 111706 111716 110201 %0 Journal Article %~ PubMed %A Webster, Jacqueline L %A Dunford, Elizabeth K %A Hawkes, Corinna %A Neal, Bruce C %T Salt reduction initiatives around the world. %B Journal of Hypertension %D 2011 %C United Kingdom, United States %I Lippincott Williams & Wilkins, Ltd. %V 29 %N 6 %P 1043-1050 %@ 0263-6352 %X To provide an overview of national salt reduction initiatives around the world, describe core characteristics and develop a framework for future strategy development. %Z FOR Codes: 111104 %0 Journal Article %~ PubMed %A Ni Mhurchu, Cliona %A Capelin, Cathy %A Dunford, Elizabeth K %A Webster, Jacqueline L %A Neal, Bruce C %A Jebb, Susan A %T Sodium content of processed foods in the United Kingdom: analysis of 44,000 foods purchased by 21,000 households. %B American Journal of Clinical Nutrition %D 2011 %C United States %I American Society for Nutrition %V 93 %N 3 %P 594-600 %@ 1938-3207 %X In the United Kingdom, sodium reduction targets have been set for a large number of processed food categories. Assessment and monitoring are essential to evaluate progress. %Z FOR Codes: 1111 %0 Journal Article %~ PubMed %A Czernichow, Sébastien %A Zanchetti, Alberto %A Turnbull, Fiona %A Barzi, Federica %A Ninomiya, Toshiaru %A Kengne, André-Pascal %A Lambers Heerspink, Hiddo J %A Perkovic, Vlado %A Huxley, Rachel %A Arima, Hisatomi %A Patel, Anushka %A Chalmers, John %A Woodward, Mark %A Macmahon, Stephen %A Neal, Bruce %A , on behalf of the Blood Pressure Lowering Treatment Trialists?? Collaboration %T The effects of blood pressure reduction and of different blood pressure-lowering regimens on major cardiovascular events according to baseline blood pressure: meta-analysis of randomized trials. %B Journal of hypertension %D 2011 %C United Kingdom, United States %I Lippincott Williams & Wilkins, Ltd. %V 29 %N 1 %P 4-16 %@ 0263-6352 %X The benefits of reducing blood pressure are well established, but there remains uncertainty about whether the magnitude of the effect varies with the initial blood pressure level. The objective was to compare the risk reductions achieved by different blood pressure-lowering regimens among individuals with different baseline blood pressures. %Z FOR Codes: 1102 %0 Journal Article %~ PubMed %A Baigent, Colin %A Landray, Martin J %A Reith, Christina %A Emberson, Jonathan %A Wheeler, David C %A Tomson, Charles %A Wanner, Christoph %A Krane, Vera %A Cass, Alan %A Craig, Jonathan %A Neal, Bruce %A Jiang, Lixin %A Hooi, Lai Seong %A Levin, Adeera %A Agodoa, Lawrence %A Gaziano, Mike %A Kasiske, Bertram %A Walker, Robert %A Massy, Ziad A %A Feldt-Rasmussen, Bo %A Krairittichai, Udom %A Ophascharoensuk, Vuddidhej %A Fellström, Bengt %A Holdaas, Hallvard %A Tesar, Vladimir %A Wiecek, Andrzej %A Grobbee, Diederick %A de Zeeuw, Dick %A Grönhagen-Riska, Carola %A Dasgupta, Tanaji %A Lewis, David %A Herrington, William %A Mafham, Marion %A Majoni, William %A Wallendszus, Karl %A Grimm, Richard %A Pedersen, Terje %A Tobert, Jonathan %A Armitage, Jane %A Baxter, Alex %A Bray, Christopher %A Chen, Yiping %A Chen, Zhengming %A Hill, Michael %A Knott, Carol %A Parish, Sarah %A Simpson, David %A Sleight, Peter %A Young, Alan %A Collins, Rory %A , SHARP Investigators %T The effects of lowering LDL cholesterol with simvastatin plus ezetimibe in patients with chronic kidney disease (Study of Heart and Renal Protection): a randomised placebo-controlled trial. %B Lancet %D 2011 %C United Kingdom %I The Lancet Publishing Group %V 377 %N 9784 %P 2181-2192 %@ 0140-6736 %X Lowering LDL cholesterol with statin regimens reduces the risk of myocardial infarction, ischaemic stroke, and the need for coronary revascularisation in people without kidney disease, but its effects in people with moderate-to-severe kidney disease are uncertain. The SHARP trial aimed to assess the efficacy and safety of the combination of simvastatin plus ezetimibe in such patients. %Z FOR Codes: 110312 %0 Journal Article %~ PubMed %A Webster, Jacqueline L %A Dunford, Elizabeth K %A Neal, Bruce C %T A systematic survey of the sodium contents of processed foods. %B The American journal of clinical nutrition %D 2010 %C United States %I American Society for Nutrition %V 91 %N 2 %P 413-20 %@ 1938-3207 %X Processed foods are major contributors to population dietary salt intake. Parts of the Australian food industry have started to decrease salt in a number of products. A definitive baseline assessment of current sodium concentrations in foods is key to targeting reformulation strategies and monitoring progress. %Z FOR Codes: 110201 %0 Journal Article %~ PubMed %A Lee, C C %A Stolk, R P %A Adler, A I %A Patel, A %A Chalmers, J %A Neal, B %A Poulter, N %A Harrap, S %A Woodward, M %A Marre, M %A Grobbee, D E %A Beulens, J W %A , on behalf of the AdRem project team and ADVANCE management committee %T Association between alcohol consumption and diabetic retinopathy and visual acuity-the AdRem Study. %B Diabetic Medicine %D 2010 %C United Kingdom, Unit %I Wiley-Blackwell Publishing Ltd. %V 27 %N 10 %P 1130-1137 %@ 1464-5491 %X Diabet. Med. 27, 1130-1137 (2010) ABSTRACT: Aims??? We investigated the association between alcohol consumption and diabetic retinopathy and deterioration of visual acuity in individuals with Type???2 diabetes. Methods??? We conducted a cohort analysis of 1239 participants with Type???2 diabetes aged 55-81???years enrolled in the AdRem study, a sub-study of the Action in Diabetes and Vascular Disease: Preterax and Diamicron MR Controlled Evaluation (ADVANCE) trial. Current and past consumption of wine, spirits and beer was measured by self-report. Moderate and heavy alcohol consumption was defined as 1-14 and >???14???drinks/week, respectively. Diabetic retinopathy, measured by mydriatic stereoscopic seven-field retinal photography, was defined by a 2-step progression in the Early Treatment of Diabetic Retinopathy Study (ETDRS) score or the presence of any retinal vascular lesions. Deterioration of visual acuity was defined by a decrease of two lines in best vision in either eye, measured corrected, or through a pinhole using a Snellen chart. Results??? In a mean follow-up of 5.5???years, we identified 182 participants with a 2-step progression in the ETDRS score, 640 participants with the presence of any retinal vascular lesions and 693 participants with a deterioration of visual acuity. Current moderate consumption of alcohol, compared with no current consumption, was not associated with presence or progression of diabetic retinopathy; however, it was associated with higher risk of deterioration of visual acuity (multivariable-adjusted OR 1.83; 95% CI 1.34-2.48; P???0.3). Over 5 years, active treatment was estimated to prevent one primary outcome in every 21, 71 and 118 patients of at least 75, 65-74 and below 65 years, respectively. Similar patterns of benefits were observed for secondary outcomes. There were no differences in the tolerability between randomized allocations across age groups (all P heterogeneity >0.6) CONCLUSION: Routine administration of perindopril-indapamide lowers blood pressure safely and reduces the risk of major clinical outcomes in patients of at least 75 years with type 2 diabetes. The greater absolute benefits in older patients in this age group were not offset by an increased risk of side effects. %Z FOR Codes: 1102 %0 Journal Article %~ PubMed %A Batty, G David %A Li, Qiang %A Czernichow, Sébastien %A Neal, Bruce %A Zoungas, Sophia %A Huxley, Rachel %A Patel, Anushka %A de Galan, Bastiaan E %A Woodward, Mark %A Hamet, Pavel %A Harrap, Stephen B %A Poulter, Neil %A Chalmers, John %A , ADVANCE Collaborative Group %T Erectile Dysfunction and Later Cardiovascular Disease in Men With Type 2 Diabetes Prospective Cohort Study Based on the ADVANCE (Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified-Release Controlled Evaluation) Trial. %B Journal of the American College of Cardiology %D 2010 %C United States %I Elsevier Inc. %V 56 %N 23 %P 1908-1913 %@ 0735-1097 %X OBJECTIVES: The aim of this study was to examine the relationship between erectile problems in men and cardiovascular disease (CVD) mortality. BACKGROUND: Although there are plausible mechanisms linking erectile dysfunction (ED) with coronary heart disease (CHD) and stroke, studies are scarce. METHODS: In a cohort analysis of the ADVANCE (Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified-Release Controlled Evaluation) trial population, 6,304 men age 55 to 88 years with type 2 diabetes participated in a baseline medical examination when inquiries were made about ED. Over 5 years of follow-up, during which study members attended repeat clinical examinations, the presence of fatal and nonfatal CVD outcomes, cognitive decline, and dementia was ascertained. RESULTS: After adjusting for a range of covariates, including existing illness, psychological health, and classic CVD risk factors, relative to those who were free of the condition, baseline ED was associated with an elevated risk of all CVD events (hazard ratio: 1.19; 95% confidence interval: 1.08 to 1.32), CHD (hazard ratio: 1.35; 95% confidence interval: 1.16 to 1.56), and cerebrovascular disease (hazard ratio: 1.36; 95% confidence interval: 1.11 to 1.67). Men who experienced ED at baseline and at 2-year follow-up had the highest risk for these outcomes. CONCLUSIONS: In this cohort of men with type 2 diabetes, ED was associated with a range of CVD events. %Z FOR Codes: 110201 110306 111706 %0 Journal Article %~ PubMed %A Patel, Anushka %A Neal, Bruce %A Chalmers, John %T Event rates in trials of patients with type 2 diabetes. %B Journal of the American Medical Association %D 2010 %C United States %I American Medical Association %V 303 %N 8 %P 732 %@ 1538-3598 %X %Z FOR Codes: 110306 %0 Journal Article %~ PubMed %A Czernichow, Sebastian %A Ninomiya, Toshiharu %A Huxley, Rachel %A Kengne, Andre-Pascal %A Batty, G David %A Grobbee, Diederick E %A Woodward, Mark %A Neal, Bruce %A Chalmers, John %T Impact of blood pressure lowering on cardiovascular outcomes in normal weight, overweight, and obese individuals: the Perindopril Protection Against Recurrent Stroke Study trial. %B Hypertension %D 2010 %C United States %I Lippincott Williams & Wilkins %V 55 %N 5 %P 1193-1198 %@ 0194-911X %X There is considerable uncertainty regarding the efficacy of blood pressure-lowering therapy in reducing cardiovascular risk in obese people. In this report we examine the effects of blood pressure lowering according to baseline body mass index (kilograms per meter squared) in the Perindopril Protection Against Recurrent Stroke Study. A total of 6105 participants with cerebrovascular disease were randomized to perindopril-based blood pressure-lowering therapy or placebo. The overall mean difference in systolic/diastolic blood pressure between participants assigned active therapy or placebo was 9/4 mm Hg (SE: 0.5/0.3 mm Hg), with no difference by body mass index quarters (<23.1, 23.1 to 25.3, 25.4 to 27.8, and > or = 27.9 kg/m(2)). A consistent treatment benefit was demonstrated for protection against major vascular events across quarters with the following hazard ratios (95% CIs): 0.80 (0.62 to 1.02), 0.78 (0.61 to 1.01), 0.67 (0.53 to 0.86), 0.69 (0.54 to 0.88), and 0.74 (0.66 to 0.84; P for heterogeneity=0.16). Similar results were apparent for stroke and stroke subtypes (all P for heterogeneity > or = 0.07) or with the standard definitions of overweight and obesity (<25, 25 to 29, and > or = 30 kg/m(2); all P for heterogeneity > or = 0.28). The absolute effects of treatment were, however, more than twice that in the highest compared with the lowest body mass index quartile. Across increasing quarters of body mass index over 5 years, active therapy prevented 1 major vascular event among every 28, 23, 13, and 13 patients treated. In conclusion, blood pressure-lowering therapy produced comparable risk reductions in vascular disease across the whole range of body mass indices in participants with a history of stroke. However, the greater baseline level of cardiovascular risk in those with higher body mass index meant that these patients obtained the greatest benefit. %Z FOR Codes: 111716 %0 Journal Article %~ PubMed %A Webster, Jacqui %A Dunford, Elizabeth %A Barzi, Federica %A Neal, Bruce %T Just add a pinch of salt!--current directions for the use of salt in recipes in Australian magazines. %B European journal of public health %D 2010 %C United Kingdom, Neth %I Oxford University Press %V 20 %N 1 %P 96-9 %@ 1464-360X %X Australians currently consume too much salt causing adverse consequences for health. The media play an important role in the provision of nutrition advice to consumers. Previous research shows that many foods advertized in consumer magazines are high in salt, but little research has examined magazine recipes in this context. The aim of this project was to summarize directions for salt use in recipes in leading Australian magazines. %Z FOR Codes: 111799 %0 Journal Article %~ PubMed %A Arima, Hisatomi %A Anderson, Craig S %A Wang, Ji Guang %A Huang, Yining %A Heeley, Emma %A Neal, Bruce %A Woodward, Mark %A Skulina, Christian %A Parsons, Mark W %A Peng, Bin %A Tao, Qing Ling %A Li, Yue Chun %A Jiang, Jian Dong %A Tai, Li Wen %A Zhang, Jin Li %A Xu, En %A Cheng, Yan %A Morgenstern, Lewis B %A Chalmers, John %A , for the Intensive Blood Pressure Reduction in Acute Cerebral Haemorrhage Trial Investigators %T Lower Treatment Blood Pressure Is Associated With Greatest Reduction in Hematoma Growth After Acute Intracerebral Hemorrhage. %B Hypertension %D 2010 %C United States %I Lippincott Williams & Wilkins %V 56 %N %P 852-8 %@ 0194-911X %X The pilot phase of the Intensive Blood Pressure Reduction in Acute Cerebral Haemorrhage Trial (INTERACT) showed that rapid blood pressure (BP) lowering can attenuate hematoma growth in acute intracerebral hemorrhage. We sought to define the systolic BP level associated with greatest attenuation of hematoma growth. INTERACT included 404 patients with computed tomographic-confirmed intracerebral hemorrhage, elevated systolic BP (150 to 220 mm Hg), and capacity to commence BP lowering treatment within 6 hours of onset. Computed tomography was done at baseline and at 24 hours using standardized techniques, with digital images analyzed centrally, blinded to clinical data. Associations of baseline and achieved on-treatment (mean during the first 24 hours) systolic BP levels with the primary outcome of increase in hematoma volume were explored. There were 346 patients with duplicate computed tomographic scans. There was no significant association between baseline systolic BP levels and either the absolute or proportional growth in hematoma volume (P trend=0.26 and 0.12, respectively). By contrast, achieved on-treatment systolic BP levels in the first 24 hours were clearly associated with both absolute and proportional hematoma growth (both P trend=0.03). Maximum reduction in hematoma growth occurred in the one third of participants with the lowest on-treatment systolic BP levels (median: 135 mm Hg). Intensive BP reduction to systolic levels between 130 and 140 mm Hg is likely to provide the maximum protection against hematoma growth after intracerebral hemorrhage. %Z FOR Codes: 1109 %0 Journal Article %~ PubMed %A Hayen, Andrew %A Bell, Katy %A Glasziou, Paul %A Neal, Bruce %A Irwig, Les %T Monitoring Adherence to Medication by Measuring Change in Blood Pressure. %B Hypertension %D 2010 %C United States %I Lippincott Williams & Wilkins %V 56 %N 4 %P 612-6 %@ 0194-911X %X After starting antihypertensives, blood pressure is monitored for several reasons, including assessment of adherence. We aimed to estimate the accuracy of blood pressure monitoring for detecting early nonadherence. We conducted a secondary analysis of the Perindopril Protection Against Recurrent Stroke Study (PROGRESS), a large randomized trial of blood pressure lowering to reduce the risk of recurrent stroke. We compared change in blood pressure 3 months after randomization in people who had discontinued treatment (nonadherent) with those who stayed on treatment (adherent). We also used an indirect method, assessing whether change in blood pressure discriminated between active (adherent) and placebo (nonadherent) groups. Both methods gave similar results. For the 3433 subjects, the mean (SD) of the change in systolic blood pressure was -15.8 mm Hg (SD 18.7 mm Hg) in the adherent group and -4.2 mm Hg (SD 18.1 mm Hg) in the nonadherent group. After recalibration of the mean change in the nonadherent group to 0 mm Hg and in the adherent group to -11.6 mm Hg, the absence of a fall in systolic blood pressure at 3 months had a sensitivity of 50% and a specificity of 80% for detecting nonadherence (50% of nonadherent patients and 20% of adherent patients had a rise in blood pressure). Discriminatory power was modest over the range of cutoffs (area under the receiver-operator curve 0.67). Monitoring blood pressure is poor at detecting nonadherence to blood pressure-lowering treatment. Further research should look at other methods of assessing adherence. %Z FOR Codes: 1102 1117 %0 Journal Article %~ PubMed %A Bell, Katy J L %A Hayen, Andrew %A Macaskill, Petra %A Craig, Jonathan C %A Neal, Bruce C %A Fox, Kim M %A Remme, Willem J %A Asselbergs, Folkert W %A van Gilst, Wiek H %A Macmahon, Stephen %A Remuzzi, Giuseppe %A Ruggenenti, Piero %A Teo, Koon K %A Irwig, Les %T Monitoring Initial Response to Angiotensin-Converting Enzyme Inhibitor-Based Regimens. An Individual Patient Data Meta-Analysis From Randomized, Placebo-Controlled Trials. %B Hypertension %D 2010 %C United States %I Lippincott Williams & Wilkins %V 56 %N 3 %P 533-9 %@ 0194-911X %X Most clinicians monitor blood pressure to estimate a patient''s response to blood pressure-lowering therapy. However, the apparent change may not actually reflect the effect of the treatment, because a person''s blood pressure varies considerably even without the administration of drug therapy. We estimated random background within-person variation, apparent between-person variation, and true between-person variation in blood pressure response to angiotensin-converting enzyme inhibitors after 3 months. We used meta-analytic mixed models to analyze individual patient data from 28 281 participants in 7 randomized, controlled trials from the Blood Pressure Lowering Trialists Collaboration. The apparent between-person variation in response was large, with SDs for change in systolic blood pressure/diastolic blood pressure of 15.2/8.5 mm Hg. Within-person variation was also large, with SDs for change in systolic blood pressure/diastolic blood pressure of 14.9/8.45 mm Hg. The true between-person variation in response was small, with SDs for change in systolic blood pressure/diastolic blood pressure of 2.6/1.0 mm Hg. The proportion of the apparent between-person variation in response that was attributed to true between-person variation was only 3% for systolic blood pressure and 1% for diastolic blood pressure. In conclusion, most of the apparent variation in response is not because of true variation but is a consequence of background within-person fluctuation in day-to-day blood pressure levels. Instead of monitoring an individual''s blood pressure response, a better approach may be to simply assume the mean treatment effect. %Z FOR Codes: 110201 %0 Journal Article %~ PubMed %A Dunford, Elizabeth %A Webster, Jacqui %A Barzi, Federica %A Neal, Bruce %T Nutrient content of products served by leading Australian fast food chains. %B Appetite %D 2010 %C Netherlands %I Elsevier BV %V 55 %N 3 %P 484-9 %@ 1095-8304 %X With more consumers purchasing meals outside the home, fast food products contribute substantially to daily energy intakes. Improving the nutrient composition of fast food would have significant health benefits. Nutrient content data for menu items provided by nine companies representing >90% of the fast food market in Australia were collected. Mean nutrient levels were compared between product categories and compared to currently accepted criteria for healthy foods. The majority of fast food products did not meet criteria for healthy options. Breakfast items had the highest mean sugar content (7.8 g/100 g) and saturated fat (5.5 g/100 g), and chicken items the highest total fat (13.2 g/100 g) and sodium (586 mg/100 g). There was marked variation in nutrient levels between similar products. There was a 10-fold variation in the total fat, saturated fat and sugar content of sandwiches, an 8-fold variation in saturated fat in burgers and >20-fold variation in the sugar and total fat content of salads. Differences were even greater per serve. The considerable variation in the nutrient content of comparable products suggests significant potential for reformulation. Even small improvements in composition could produce important health gains if implemented across all product categories by all companies in unison. %Z FOR Codes: 111104 111712 110201 %0 Journal Article %~ PubMed %A Li, Q %A Chalmers, J %A Czernichow, S %A Neal, B %A Taylor, B A %A Zoungas, S %A Poulter, N %A Woodward, M %A Patel, A %A de Galan, B %A Batty, G D %A , on behalf of the ADVANCE Collaborative group %T Oral disease and subsequent cardiovascular disease in people with type 2 diabetes: a prospective cohort study based on the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified-Release Controlled Evaluation (ADVANCE) trial. %B Diabetologia %D 2010 %C Germany %I Springer %V 53 %N 11 %P 2320-7 %@ 0012-186X %X While there are plausible biological mechanisms linking oral health with cardiovascular disease (CVD) and mortality rates, no study, to our knowledge, has examined this association in a representative population of people with type 2 diabetes. %Z FOR Codes: 30401 %0 Journal Article %~ PubMed %A Arima, Hisatomi %A Anderson, Craig %A Omae, Teruo %A Liu, Lisheng %A Tzourio, Christophe %A Woodward, Mark %A Macmahon, Stephen %A Neal, Bruce %A Rodgers, Anthony %A Chalmers, John %A , for the PROGRESS Collaborative Group %T Perindopril-based blood pressure lowering reduces major vascular events in Asian and Western participants with cerebrovascular disease: the PROGRESS trial. %B Journal of hypertension %D 2010 %C United Kingdom, United States %I Lippincott Williams & Wilkins, Ltd. %V 28 %N 2 %P 395-400 %@ 0263-6352 %X To assess the benefits of blood pressure (BP) lowering on vascular events separately for Asian and for Western participants with particular emphasis on stroke subtypes and cardiac outcomes. %Z FOR Codes: 110201 110306 111716 %0 Book %A Chalmers, John %A Colagiuri, Stephen %A Cooper, Mark %A Grobbee, Diederick %A Hamet, Pavel %A Kengne, Andre %A MacMahon, Stephen %A Marre, Michel %A Mogensen, Carl Erik %A Neal, Bruce %A Patel, Anushka %A Perkovic, Vlado %A Poulter, Neil %A Zoungas, Sophia %T Prevention of vascular outcomes in type 2 diabetes: benefits of intensive blood pressure and blood glucose control with Preterax and Diamicron MR. Issue III %B %D 2010 %C Australia %I Wolters Kluwer %V %N %P %@ 97829181720204 %X %Z FOR Codes: 110201 %0 Journal Article %~ PubMed %A Liu, Hueiming %A Patel, Anushka %A Brown, Alex %A Eades, Sandra %A Hayman, Noel %A Jan, Stephen %A Ring, Ian %A Stewart, Greg %A Tonkin, Andrew %A Weeramanthri, Tarun %A Wade, Vicki %A Rodgers, Anthony %A Usherwood, Tim %A Neal, Bruce %A Peiris, David %A Burke, Hugh %A Reid, Christopher %A Cass, Alan %A , the Kanyini Vascular Collaboration and Kanyini GAP Study Team %T Rationale and design of the Kanyini guidelines adherence with the polypill (Kanyini-GAP) study: a randomised controlled trial of a polypill-based strategy amongst Indigenous and non Indigenous people at high cardiovascular risk. %B BMC Public Health %D 2010 %C United Kingdom %I BioMed Central Ltd. %V 10 %N 1 %P 458 %@ 1471-2458 %X ABSTRACT: BACKGROUND: The Kanyini Guidelines Adherence with the Polypill (Kanyini-GAP) Study aims to examine whether a polypill-based strategy (using a single capsule containing aspirin, a statin and two blood pressure-lowering agents) amongst Indigenous and non-Indigenous people at high risk of experiencing a cardiovascular event will improve adherence to guideline-indicated therapies, and lower blood pressure and cholesterol levels. METHODS/DESIGN: The study is an open, randomised, controlled, multi-centre trial involving 1000 participants at high risk of cardiovascular events recruited from mainstream general practices and Aboriginal Medical Services, followed for an average of 18 months. The participants will be randomised to one of two versions of the polypill, the version chosen by the treating health professional according to clinical features of the patient, or to usual care. The primary study outcomes will be changes, from baseline measures, in serum cholesterol and systolic blood pressure and self-reported current use of aspirin, a statin and at least two blood pressure lowering agents. Secondary study outcomes include cardiovascular events, renal outcomes, self-reported barriers to indicated therapy, prescription of indicated therapy, occurrence of serious adverse events and changes in quality-of-life. The trial will be supplemented by formal economic and process evaluations. DISCUSSION: The Kanyini-GAP trial will provide new evidence as to whether or not a polypill-based strategy improves adherence to effective cardiovascular medications amongst individuals in whom these treatments are indicated. TRIAL REGISTRATION: This trial is registered with the Australian New Zealand Clinical Trial Registry ACTRN126080005833347. %Z FOR Codes: 110201 110399 111701 %0 Journal Article %~ PubMed %A Zoungas, Sophia %A Patel, Anushka %A Chalmers, John %A de Galan, Bastiaan E %A Li, Qiang %A Billot, Laurent %A Woodward, Mark %A Ninomiya, Toshiharu %A Neal, Bruce %A MacMahon, Stephen %A Grobbee, Diederick E %A Kengne, Andre Pascal %A Marre, Michel %A Heller, Simon %A , ADVANCE Collaborative Group %T Severe hypoglycemia and risks of vascular events and death. %B New England Journal of Medicine %D 2010 %C United States %I Massachusetts Medical Society %V 363 %N 15 %P 1410-1418 %@ 1533-4406 %X BACKGROUND: Severe hypoglycemia may increase the risk of a poor outcome in patients with type 2 diabetes assigned to an intensive glucose-lowering intervention. We analyzed data from a large study of intensive glucose lowering to explore the relationship between severe hypoglycemia and adverse clinical outcomes. METHODS: We examined the associations between severe hypoglycemia and the risks of macrovascular or microvascular events and death among 11,140 patients with type 2 diabetes, using Cox proportional-hazards models with adjustment for covariates measured at baseline and after randomization. RESULTS: During a median follow-up period of 5 years, 231 patients (2.1%) had at least one severe hypoglycemic episode; 150 had been assigned to intensive glucose control (2.7% of the 5571 patients in that group), and 81 had been assigned to standard glucose control (1.5% of the 5569 patients in that group). The median times from the onset of severe hypoglycemia to the first major macrovascular event, the first major microvascular event, and death were 1.56 years (interquartile range, 0.84 to 2.41), 0.99 years (interquartile range, 0.40 to 2.17), and 1.05 years (interquartile range, 0.34 to 2.41), respectively. During follow-up, severe hypoglycemia was associated with a significant increase in the adjusted risks of major macrovascular events (hazard ratio, 2.88; 95% confidence interval [CI], 2.01 to 4.12), major microvascular events (hazard ratio, 1.81; 95% CI, 1.19 to 2.74), death from a cardiovascular cause (hazard ratio, 2.68; 95% CI, 1.72 to 4.19), and death from any cause (hazard ratio, 2.69; 95% CI, 1.97 to 3.67) (P<0.001 for all comparisons). Similar associations were apparent for a range of nonvascular outcomes, including respiratory, digestive, and skin conditions (P<0.01 for all comparisons). No relationship was found between repeated episodes of severe hypoglycemia and vascular outcomes or death. CONCLUSIONS: Severe hypoglycemia was strongly associated with increased risks of a range of adverse clinical outcomes. It is possible that severe hypoglycemia contributes to adverse outcomes, but these analyses indicate that hypoglycemia is just as likely to be a marker of vulnerability to such events. (Funded by Servier and the National Health and Medical Research Council of Australia; ClinicalTrials.gov number, NCT00145925.). %Z FOR Codes: 110306 %0 Journal Article %~ PubMed %A Kengne, A P %A Patel, A %A Colagiuri, S %A Heller, S %A Hamet, P %A Marre, M %A Pan, C Y %A Zoungas, S %A Grobbee, D E %A Neal, B %A Chalmers, J %A Woodward, M %A , ADVANCE Collaborative Group %T The Framingham and UK Prospective Diabetes Study (UKPDS) risk equations do not reliably estimate the probability of cardiovascular events in a large ethnically diverse sample of patients with diabetes: the Action in Diabetes and Vascular Disease: Preterax and Diamicron-MR Controlled Evaluation (ADVANCE) Study. %B Diabetologia %D 2010 %C Germany %I Springer %V 53 %N 5 %P 821-831 %@ 0012-186X %X AIMS/HYPOTHESIS: Available multivariable equations for cardiovascular risk assessment in people with diabetes have been derived either from the general population or from populations with diabetes. Their utility and comparative performance in a contemporary group of patients with type 2 diabetes are not well established. The aim of this study was to evaluate the performance of the Framingham and UK Prospective Diabetes Study (UKPDS) risk equations in participants who took part in the Action in Diabetes and Vascular disease: Preterax and Diamicron-MR Controlled Evaluation (ADVANCE) trial. METHODS: The 4-year risks of cardiovascular disease (CVD) and its constituents were estimated using two published Framingham and the UKPDS risk equations in 7,502 individuals with type 2 diabetes without prior known CVD at their enrolment in the trial. RESULTS: The risk of major CVD was overestimated by 170% (95% CI 146-195%) and 202% (176-231%) using the two Framingham equations. The risk of major coronary heart disease was overestimated by 198% (162-238%) with the UKPDS, and by 146% (117-179%) and 289% (243-341%) with the two different Framingham equations, respectively. The risks of stroke events were also overestimated with the UKPDS and one of the Framingham equations. The ability of these equations to rank risk among ADVANCE participants was modest, with c-statistics ranging from 0.57 to 0.71. Results stratified by sex, treatment allocation and ethnicity were broadly similar. CONCLUSIONS/INTERPRETATION: Application of the Framingham and UKPDS risk equations to a contemporary treated group of patients with established type 2 diabetes is likely to substantially overestimate cardiovascular risk. %Z FOR Codes: 1701 1106 1117 %0 Journal Article %~ PubMed %A Zoungas, S %A Chalmers, J %A Kengne, A P %A Pillai, A %A Billot, L %A de Galan, B %A Marre, M %A Neal, B %A Harrap, S %A Poulter, N %A Patel, A %T The efficacy of lowering glycated haemoglobin with a gliclazide modified release-based intensive glucose lowering regimen in the ADVANCE trial. %B Diabetes research and clinical practice %D 2010 %C Ireland, Belgium %I Elsevier Ireland Ltd %V 89 %N 2 %P 126-33 %@ 0168-8227 %X The aim of these analyses was to examine the efficacy of the intensive gliclazide MR-based glucose lowering regimen used in the ADVANCE trial in lowering the level of glycated haemoglobin (HbA1c). All 11,140 randomised patients were included in analyses of treatment efficacy. Treatment efficacy was also examined in subgroups defined by baseline characteristics and treatments. At the end of 5 years follow-up, the mean HbA1c was reduced from 7.5% at baseline to 6.5% in those on intensive glucose control and to 7.3% in those on standard glucose control. With intensive glucose lowering greater proportions achieved HbA1c levels of < or =7.0%, < or =6.5% and < or =6.0%. With intensive glucose lowering substantial reductions in HbA1c were observed across subgroups defined by baseline age, sex, duration of diabetes, BMI, HbA1c or treatment regimen (p<0.0001). The main independent predictors of reduction in HbA1c during follow-up were baseline HbA1c, duration of diabetes and BMI. There was no weight gain in the intensive glucose control group and severe hypoglycaemia was uncommon, though more frequent than in the standard control group. Intensive glucose control with a gliclazide MR-based regimen was well tolerated and consistently effective in lowering HbA1c across a broad range of patient with type 2 diabetes. %Z FOR Codes: 110201 110306 111716 %0 Journal Article %~ PubMed %A van Dieren, Susan %A Beulens, Joline W J %A van der Schouw, Yvonne T %A Grobbee, Diederick E %A Neal, Bruce %T The global burden of diabetes and its complications: an emerging pandemic. %B European Journal of Cardiovascular Prevention and Rehabilitation %D 2010 %C United States, Franc %I Lippincott Williams & Wilkins %V 17 %N Suppl 1 %P S3-S8 %@ 1741-8275 %X The number of patients with type 2 diabetes is increasing rapidly in both developed and developing countries around the world. The emerging pandemic is driven by the combined effects of population ageing, rising levels of obesity and inactivity, and greater longevity among patients with diabetes that is attributable to improved management. The vascular complications of type 2 diabetes account for the majority of the social and economic burden among patients and society more broadly. This review summarizes the burden of type 2 diabetes, impaired glucose tolerance, and their vascular complications. It is projected that by 2025 there will be 380 million people with type 2 diabetes and 418 million people with impaired glucose tolerance. Diabetes is a major global cause of premature mortality that is widely underestimated, because only a minority of persons with diabetes dies from a cause uniquely related to the condition. Approximately one half of patients with type 2 diabetes die prematurely of a cardiovascular cause and approximately 10% die of renal failure. Global excess mortality attributable to diabetes in adults was estimated to be 3.8 million deaths. %Z FOR Codes: 110201 %0 Journal Article %~ PubMed %A Delcourt, C %A Huang, Y %A Wang, J %A Heeley, E %A Lindley, R %A Stapf, C %A Tzourio, C %A Arima, H %A Parsons, M %A Sun, J %A Neal, B %A Chalmers, J %A Anderson, C %A , INTERACT2 Investigators %T The second (main) phase of an open, randomised, multicentre study to investigate the effectiveness of an intensive blood pressure reduction in acute cerebral haemorrhage trial (INTERACT2). %B International Journal of Stroke %D 2010 %C Australia, Switzerla %I Wiley-Blackwell Publishing Asia %V 5 %N 2 %P 110-116 %@ 1747-4949 %X RATIONALE: The INTERACT pilot study demonstrated the feasibility of the protocol, safety of early intensive blood pressure lowering and effects on haematoma expansion within 6 h of onset of intracerebral haemorrhage. This article describes the design of the second, main phase, INTERACT2. AIMS: To compare the effects of a management strategy of early intensive blood pressure lowering with a more conservative guideline-based blood pressure management policy in patients with acute intracerebral hemorrhage. DESIGN: INTERACT2 is a prospective, randomized, open label, assessor-blinded end-point (PROBE). Patients with a systolic blood pressure greater than 150 mmHg and no definite indication for or contraindication to blood pressure-lowering treatment are centrally randomised to either of two treatment groups within 6 h onset of intracerebral haemorrhage. Those allocated to intensive blood pressure lowering will receive primarily intravenous, hypotensive agents to achieve a systolic blood pressure target of <140 mmHg within 1 h of randomisation and to maintain this level for up to 7 days in hospital. The control group will receive blood pressure-lowering treatment to a target systolic blood pressure of <180 mmHg. Both groups are to receive similar acute stroke unit care, therapy and active management. Oral antihypertensive therapy is recommended in patients before hospital discharge with a long-term systolic blood pressure goal of 140 mmHg according to secondary stroke prevention guidelines. A projected 2800 subjects are to be enrolled from approximately 140 centres worldwide to provide 90% power (alpha 0.05) to detect a 14% difference in the risk of death and dependency between the groups, which equates to one or more cases of a poor outcome prevented in every 15 patients treated. STUDY OUTCOMES: The primary outcome is the combined end-point of death and dependency according to the modified Rankin Scale at 90 days. The secondary outcomes are the separate components of the primary end-point in patients treated <4 hours of ICH onset, grades of physical function on the modified Rankin Scale, health-related quality of life on the EuroQoL, recurrent stroke and other vascular events, days of hospitalisation, requirement for permanent residential care and unexpected serious adverse events. %Z FOR Codes: 1109 %0 Journal Article %~ PubMed %A Patel, Anushka %A Chalmers, John %A MacMahon, Stephen %A Neal, Bruce %T ADVANCE: blood pressure lowering in diabetes. %B Journal of Clinical Hypertension %D 2009 %C United States %I Le Jacq Communications, Inc. %V 11 %N 2 %P 108 %@ 1751-7176 %X %Z FOR Codes: 110306 %0 Journal Article %~ PubMed %A Ninomiya, Toshiharu %A Perkovic, Vlado %A de Galan, Bastiaan E %A Zoungas, Sophia %A Pillai, Avinesh %A Jardine, Meg %A Patel, Anushka %A Cass, Alan %A Neal, Bruce %A Poulter, Neil %A Mogensen, Carl-Erik %A Cooper, Mark %A Marre, Michel %A Williams, Bryan %A Hamet, Pavel %A Mancia, Giuseppe %A Woodward, Mark %A Macmahon, Stephen %A Chalmers, John %A , ADVANCE Collaborative Group %T Albuminuria and Kidney Function Independently Predict Cardiovascular and Renal Outcomes in Diabetes. %B Journal of the American Society of Nephrology %D 2009 %C United States %I American Society of Nephrology %V 20 %N 8 %P 1813-1821 %@ 1046-6673 %X There are limited data regarding whether albuminuria and reduced estimated GFR (eGFR) are separate and independent risk factors for cardiovascular and renal events among individuals with type 2 diabetes. The Action in Diabetes and Vascular disease: preterAx and diamicroN-MR Controlled Evaluation (ADVANCE) study examined the effects of routine BP lowering on adverse outcomes in type 2 diabetes. We investigated the effects of urinary albumin-to-creatinine ratio (UACR) and eGFR on the risk for cardiovascular and renal events in 10,640 patients with available data. During an average 4.3-yr follow-up, 938 (8.8%) patients experienced a cardiovascular event and 107 (1.0%) experienced a renal event. The multivariable-adjusted hazard ratio for cardiovascular events was 2.48 (95% confidence interval 1.74 to 3.52) for every 10-fold increase in baseline UACR and 2.20 (95% confidence interval 1.09 to 4.43) for every halving of baseline eGFR, after adjustment for regression dilution. There was no evidence of interaction between the effects of higher UACR and lower eGFR. Patients with both UACR >300 mg/g and eGFR <60 ml/min per 1.73 m(2) at baseline had a 3.2-fold higher risk for cardiovascular events and a 22.2-fold higher risk for renal events, compared with patients with neither of these risk factors. In conclusion, high albuminuria and low eGFR are independent risk factors for cardiovascular and renal events among patients with type 2 diabetes. %Z FOR Codes: 110201 %0 Journal Article %~ PubMed %A Kengne, Andre-Pascal %A Czernichow, Sébastien %A Huxley, Rachel %A Grobbee, Diederick %A Woodward, Mark %A Neal, Bruce %A Zoungas, Sophia %A Cooper, Mark %A Glasziou, Paul %A Hamet, Pavel %A Harrap, Stephen B %A Mancia, Giuseppe %A Poulter, Neil %A Williams, Bryan %A Chalmers, John %A , on behalf of the ADVANCE Collaborative Group %T Blood Pressure Variables and Cardiovascular Risk. New Findings From ADVANCE. %B Hypertension %D 2009 %C United States %I Lippincott Williams & Wilkins %V 54 %N 2 %P 399-404 %@ 1524-4563 %X The relative importance of various blood pressure indices on cardiovascular risk in people with type 2 diabetes mellitus has not been established. This study compares the strengths of the associations between different baseline blood pressure variables (systolic blood pressure [SBP], diastolic blood pressure [DBP], pulse pressure [PP], and mean arterial pressure) and the 4.3-year risk of major cardiovascular events in the Action in Diabetes and Vascular Disease: Preterax and Diamicron-Modified Release Controlled Evaluation Study. Mean (SD) age for the 11 140 participants was 65.8 years (6.4 years). During follow-up, 1000 major cardiovascular events, 559 major coronary events, and 468 cardiovascular deaths were recorded. After adjustment for age, sex, and treatment allocation, the hazard ratios (95% CIs) associated with 1 increment in SD for the risk of major cardiovascular events were 1.17 (1.10 to 1.24) for SBP; 1.20 (1.13 to 1.28) for PP; 1.12 (1.05 to 1.19) for mean arterial pressure; and 1.04 (0.98 to 1.11) for DBP. The areas under the receiver operating characteristic curve were slightly higher for SBP and PP compared with mean arterial pressure and DBP for major cardiovascular and coronary events. Using achieved instead of baseline blood pressure values marginally improved the effect estimates for SBP, DBP, and mean arterial pressure, with no significant differences in the areas under the receiver operating characteristic curve between models with SBP and those with PP. In conclusion, SBP and PP are the 2 best and DBP is the least effective determinant of the risk of major cardiovascular outcomes in the relatively old patients with type 2 diabetes mellitus participating in the Action in Diabetes and Vascular Disease: Preterax and Diamicron-Modified Release Controlled Evaluation Study. However, SBP may be the simplest and most useful predictor across a wider range of age groups and populations. %Z FOR Codes: 110201 110306 111716 %0 Journal Article %~ PubMed %A de Galan, B %A Zoungas, S %A Chalmers, J %A Anderson, C %A Dufouil, C %A Pillai, A %A Cooper, M %A Grobbee, D %A Hackett, M %A Hamet, P %A Heller, S %A Lisheng, L %A Macmahon, S %A Mancia, G %A Neal, B %A Pan, C %A Patel, A %A Poulter, N %A Travert, F %A Woodward, M %A , for the ADVANCE Collaborative group %T Cognitive function and risks of cardiovascular disease and hypoglycaemia in patients with type 2 diabetes: the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation (ADVANCE) trial. %B Diabetologia %D 2009 %C Germany %I Springer %V 52 %N 11 %P 2328-2336 %@ 0012-186X %X AIMS/HYPOTHESIS: The relationship between cognitive function, cardiovascular disease and premature death is not well established in patients with type 2 diabetes. We assessed the effects of cognitive function in 11,140 patients with type 2 diabetes who participated in the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation (ADVANCE) trial. Furthermore, we tested whether level of cognitive function altered the beneficial effects of the BP-lowering and glycaemic-control regimens in the trial. METHODS: Cognitive function was assessed using the Mini Mental State Examination at baseline, and defined by scores 28-30 (''normal'', n = 8,689), 24-27 (''mild dysfunction'', n = 2,231) and <24 (''severe dysfunction'', n = 212). Risks of major cardiovascular events, death and hypoglycaemia and interactions with treatment were assessed using Cox proportional hazards analysis. RESULTS: Relative to normal function, both mild and severe cognitive dysfunction significantly increased the multiple-adjusted risks of major cardiovascular events (HR 1.27, 95% CI 1.11-1.46 and 1.42, 95% CI 1.01-1.99; both p < 0.05), cardiovascular death (1.41, 95% CI 1.16-1.71 and 1.56, 95% CI 0.99-2.46; both p 0.3). There was likewise no detectable effect of reclassification of diagnoses for the effect estimates calculated for myocardial infarction or the main causes of death (all P homogeneity >0.5). CONCLUSIONS: The EPAC process had no discernible impact on the trial conclusions. Very large trials powered to detect effects on stroke subtypes might obtain real scientific gain from an EPAC, but in the case of PROGRESS, the value of the EPAC was in the reassurance it provided. %Z FOR Codes: 110201 110306 111716 %0 Journal Article %~ PubMed %A Joshi, Rohina %A Chow, Clara K %A Raju, P Krishnam %A Raju, Rama %A Reddy, K Srinath %A Macmahon, Stephen %A Lopez, Alan D %A Neal, Bruce %T Fatal and nonfatal cardiovascular disease and the use of therapies for secondary prevention in a rural region of India. %B Circulation %D 2009 %C United States %I Lippincott Williams & Wilkins %V 119 %N 14 %P 1950-1955 %@ 0009-7322 %X BACKGROUND: The rate of cardiovascular disease is widely considered to be increasing throughout India. Precise and reliable data on fatal and nonfatal cardiovascular disease, however, are few, and little is known about the use of preventive therapies. This is particularly true for rural regions. METHODS AND RESULTS: Data were collected from 53 villages in the Godavari region of Andhra Pradesh. Mortality data were obtained from a verbal autopsy-based mortality surveillance system during a 12-month period in 2003 to 2004. The prevalence of nonfatal cardiovascular disease and the use of preventive therapies were estimated from a stratified random sample of 4535 adults (> or =30 years of age) in 2005. Cardiovascular disease was the leading cause of mortality, accounting for at least 32% of all deaths. The average age at cardiovascular death was 65 years, and 51% of all cardiovascular deaths occurred in patients <70 years of age. Among adults, the prevalence of coronary heart disease was estimated to be 4.8% (95% CI, 4.1 to 5.5), and the prevalence of cerebrovascular disease was estimated at 2.0% (95% CI, 1.5 to 2.4). Among individuals with either diagnosis, 14% (95% CI, 10 to 18) reported taking aspirin, 41% (95% CI, 36 to 47) took a blood pressure-lowering medication, and 5% (95% CI, 3 to 7) reported using a cholesterol-lowering medication. CONCLUSIONS: This region has a large disease burden attributable to cardiovascular disease with significant underuse of proven, low-cost preventive medications. %Z FOR Codes: 1111 110201 %0 Journal Article %A Huxley, Rachel %A Clifton, Peter %A Perkovic, Vlado %A Woodward, Mark %A Neal, Bruce %T How many Australian deaths from heart disease and stroke could be avoided by a small reduction in population cholesterol levels? %B Nutrition and Dietetics %D 2009 %C Australia %I Wiley-Blackwell %V 66 %N 3 %P 158-163 %@ 1446-6368 %X %Z FOR Codes: 110201 111102 %0 Journal Article %~ PubMed %A Turnbull, F %A Abraira, C %A Anderson, R %A Byington, R %A Chalmers, J %A Duckworth, W %A Evans, G %A Gerstein, H %A Holman, R %A Moritz, T %A Neal, B %A Ninomiya, T %A Patel, A %A Paul, S %A Travert, F %A Woodward, M %T Intensive glucose control and macrovascular outcomes in type 2 diabetes. %B Diabetologia %D 2009 %C Germany %I Springer %V 52 %N 11 %P 2288-98 %@ 0012-186X %X Improved glucose control in type 2 diabetes is known to reduce the risk of microvascular events. There is, however, continuing uncertainty about its impact on macrovascular disease. The aim of these analyses was to generate more precise estimates of the effects of more-intensive, compared with less-intensive, glucose control on the risk of major cardiovascular events amongst patients with type 2 diabetes. %Z FOR Codes: 110201 %0 Journal Article %~ PubMed %A Keenan, Katherine %A Hayen, Andrew %A Neal, Bruce C %A Irwig, Les %T Long term monitoring in patients receiving treatment to lower blood pressure: analysis of data from placebo controlled randomised controlled trial. %B BMJ (Clinical research ed.) %D 2009 %C United Kingdom %I BMJ Publishing Group %V 338 %N %P b1492 %@ 1468-5833 %X OBJECTIVE: To determine the value of monitoring blood pressure by quantifying the probability that observed changes in blood pressure reflect true changes. DESIGN: Analysis of blood pressure measurements of patients in the perindopril protection against recurrent stroke study (PROGRESS). SETTING: Randomised placebo controlled trial carried out in 172 centres in Asia, Australasia, and Europe. PARTICIPANTS: 1709 patients with history of stroke or transient ischaemic attack randomised to fixed doses of perindopril and indapamide. Measurements Mean of two blood pressure measurements in patients receiving treatment recorded to the nearest 2 mm Hg with a standard mercury sphygmomanometer at baseline and then at three months, six months, nine months, and 15 months and then every six months to 33 months. RESULTS: There was no change in the mean blood pressure of the cohort during the 33 month follow-up. Six months after blood pressure was stabilised on treatment, if systolic blood pressure was measured as having increased by >10 mm Hg, six of those measurements would be false positives for every true increase of >or=10 mm Hg. The corresponding value for an increase of 20 mm Hg was over 200. Values for 5 mm Hg and 10 mm Hg increases in diastolic blood pressure were 3.5 and 39, respectively. The likelihood that observed increases in blood pressure reflected true increases rose with the time between measurements such that the ratio of true positives to false positives reached parity at 21 months. CONCLUSIONS: Usual clinical approaches to the monitoring of patients taking drugs to lower blood pressure have a low probability of yielding reliable information about true changes in blood pressure. Evidence based guidelines for monitoring treatment response are urgently required to guide clinical practice. Trial registration Australia and New Zealand Clinical Trial Registry. %Z FOR Codes: 110201 111706 %0 Journal Article %~ PubMed %A de Galan, Bastiaan E %A Perkovic, Vlado %A Ninomiya, Toshiharu %A Pillai, Avinesh %A Patel, Anushka %A Cass, Alan %A Neal, Bruce %A Poulter, Neil %A Harrap, Stephen %A Mogensen, Carl-Erik %A Cooper, Mark %A Marre, Michel %A Williams, Bryan %A Hamet, Pavel %A Mancia, Giuseppe %A Woodward, Mark %A Glasziou, Paul %A Grobbee, Diederick E %A MacMahon, Stephen %A Chalmers, John %A , ADVANCE Collaborative Group %T Lowering blood pressure reduces renal events in type 2 diabetes. %B Journal of the American Society of Nephrology %D 2009 %C United States %I Lippincott Williams & Wilkins %V 20 %N 4 %P 883-892 %@ 1046-6673 %X BP is an important determinant of kidney disease among patients with diabetes. The recommended thresholds to initiate treatment to lower BP are 130/80 and 125/75 mmHg for people with diabetes and nephropathy, respectively. We sought to determine the effects of lowering BP below these currently recommended thresholds on renal outcomes among 11,140 patients who had type 2 diabetes and participated in the Action in Diabetes and Vascular disease: preterAx and diamicroN-MR Controlled Evaluation (ADVANCE) study. Patients were randomly assigned to fixed combination perindopril-indapamide or placebo, regardless of their BP at entry. During a mean follow-up of 4.3 yr, active treatment reduced the risk for renal events by 21% (P < 0.0001), which was driven by reduced risks for developing microalbuminuria and macroalbuminuria (both P < 0.003). Effects of active treatment were consistent across subgroups defined by baseline systolic or diastolic BP. Lower systolic BP levels during follow-up, even to <110 mmHg, was associated with progressively lower rates of renal events. In conclusion, BP-lowering treatment with perindopril-indapamide administered routinely to individuals with type 2 diabetes provides important renoprotection, even among those with initial BP <120/70 mmHg. We could not identify a BP threshold below which renal benefit is lost. %Z FOR Codes: 110312 %0 Journal Article %~ PubMed %A Joshi, Rohina %A Kengne, Andre Pascal %A Neal, Bruce %T Methodological trends in studies based on verbal autopsies before and after published guidelines. %B Bulletin of the World Health Organization %D 2009 %C Switzerland %I World Health Organization %V 87 %N 9 %P 678-682 %@ 1564-0604 %X OBJECTIVE: To report on the uptake of guidelines published in the early 1990s with specific recommendations about the design of future studies based on verbal autopsy conducted for mortality surveillance. METHODS: We conducted a systematic literature search of all verbal autopsy studies published before January 2006 and extracted from the studies a standard set of data. We then compared studies designed before and after the recommendations were issued in terms of seven key methodological indicators. FINDINGS: We found 102 studies conducted in 39 countries; 60 were designed before and 42 after the guidelines were issued. The methods used in these 102 studies varied considerably. While some encouraging trends were noted, there is no evidence that the design recommendations have been systematically implemented. Specifically, there was no clear increase in the proportion of studies with a combined questionnaire (63% before recommendations versus 74% after; P = 0.3), a trained interviewer (70% versus 70%; P = 1.0), a suitable respondent (98% versus 100%; P = 1.0), an optimal recall period (84% versus 97%; P = 0.2), predefined algorithms (28% versus 38%; P = 0.4), an option for assigning multiple causes of death (30% versus 38%; P = 0.3), or a follow-up validation study (83% versus 72%; P = 0.7). CONCLUSION: Expert recommendations for optimal design of verbal autopsy studies have been incompletely implemented to date. Better uptake of design recommendations through enhanced collaboration between research teams is likely to produce better mortality statistics from an increasing number of verbal autopsy studies. %Z FOR Codes: 111706 %0 Journal Article %~ PubMed %A Bell, Katy J L %A Hayen, Andrew %A Macaskill, Petra %A Craig, Jonathan C %A Neal, Bruce C %A Irwig, Les %T Mixed models showed no need for initial response monitoring after starting antihypertensive therapy. %B Journal of clinical epidemiology %D 2009 %C United States %I Elsevier %V 62 %N 0 %P 650-9 %@ 0895-4356 %X To demonstrate how mixed models may be used to estimate treatment effects, and inform decisions on the need for monitoring initial response. %Z FOR Codes: 111706 110201 %0 Journal Article %~ PubMed %A Chow, Clara K %A Joshi, Rohina %A Gottumukkala, Arun K %A Raju, Krishnam %A Raju, Rama %A Reddy, Srinath %A Macmahon, Stephen %A Neal, Bruce %T Rationale and design of the Rural Andhra Pradesh Cardiovascular Prevention Study (RAPCAPS): a factorial, cluster-randomized trial of 2 practical cardiovascular disease prevention strategies developed for rural Andhra Pradesh, India. %B American Heart Journal %D 2009 %C United States %I Mosby, Inc. %V 158 %N 3 %P 349-355 %@ 0002-8703 %X BACKGROUND: Developing countries are experiencing increasing levels of cardiovascular disease (CVD). Although there is a good understanding of how to deliver CVD prevention programs in developed countries, there are few data regarding strategies for CVD prevention in resource-poor settings. This study aimed to implement and evaluate a CVD prevention program in a rural area of India. METHODS: The 2 strategies of CVD prevention to be investigated are an algorithm-based care approach and a health-promotion campaign. A factorial, cluster-randomized trial design will be used to evaluate these, in which villages will be exposed to one, both, or neither of the interventions for a period of about 12 months. Surveys of households in every village will be used to assess outcomes in all high-risk individuals and a sample of the general adult population. RESULTS: The primary outcome of the algorithm-based component of this study will be the percentage of high-risk individuals that have been "identified"-defined as having received a cardiovascular-risk assessment in the last 12 months. The primary outcome for the health-promotion component will be the percentage of the adult population with correct knowledge about the effects of 6 behavioral determinants of cardiovascular risk (green-leafy vegetables, fruits, oily foods, salt, smoking, physical activity). Secondary outcomes include a range of measures defining uptake of different preventive strategies. CONCLUSIONS: This study will provide evidence about the effectiveness of a simple practical mechanism of CVD preventive care specifically designed for delivery in a resource-poor area in India. %Z FOR Codes: 110299 %0 Journal Article %~ PubMed %A Chow, C K %A Joshi, R %A Celermajer, D S %A Patel, A %A Neal, B C %T Recalibration of a Framingham risk equation for a rural population in India. %B Journal of Epidemiology & Community Health %D 2009 %C United Kingdom, Spai %I BMJ Group %V 63 %N 5 %P 379-385 %@ 0141-7681 %X BACKGROUND: Coronary heart disease (CHD) risk estimation tools are a simple means of identifying those at high risk in a community and hence a potentially cost-effective strategy for CHD prevention in resource-poor countries. Since India has few local data upon which to develop such a tool de novo, in this study a Framingham risk equation has been recalibrated to estimate CHD risks in a population from rural India and the sensitivity of the method to information resources examined. Recent surveys of this population have found high levels of cardiovascular risk factors, particularly metabolic risk factors and a high proportion of mortality due to cardiovascular diseases. METHODS: The proportion of a rural Indian population at high risk of CHD using three risk estimation equations was estimated. The first a published version of the Framingham risk equation, the second a recalibrated equation using local mortality surveillance data and local risk factor data, and the third a recalibrated equation using national mortality data and local risk factor data. RESULTS: The mean 10-year probability of CHD for adults >30 years was 10.4% (9.6% to 11.1%) for men and 5.3% (4.9% to 5.7%) for women using the Framingham equation; 10.7% (9.9% to 11.5%) for men and 4.2% (3.9% to 4.5%) for women using the local recalibration; and 18.9% (17.7% to 20.1%) for men and 8.2% (7.6% to 8.8%) for women using the national recalibration. CONCLUSION: These findings indicate that in India, equations recalibrated to summary national data are unlikely to be relevant to all regions of India and demonstrate the importance of local data collection to enable development of relevant CHD risk tools. %Z FOR Codes: 110201 1117 %0 Journal Article %~ PubMed %A Zoungas, Sophia %A de Galan, Bastiaan E %A Ninomiya, Toshiharu %A Grobbee, Diederick %A Hamet, Pavel %A Heller, Simon %A Macmahon, Stephen %A Marre, Michel %A Neal, Bruce %A Patel, Anushka %A Woodward, Mark %A Chalmers, John %A , on behalf of the ADVANCE Collaborative Group %T The combined effects of routine blood pressure lowering and intensive glucose control on macrovascular and microvascular outcomes in patients with type 2 diabetes; new results from ADVANCE. %B Diabetes care %D 2009 %C United States %I American Diabetes Association %V 32 %N 11 %P 2068-74 %@ 0149-5992 %X To assess the magnitude and independence of the effects of routine blood pressure lowering and intensive glucose control on clinical outcomes in patients with long-standing type 2 diabetes. %Z FOR Codes: 1102 %0 Journal Article %~ PubMed %A Webster, Jacqui %A Dunford, Elizabeth %A Huxley, Rachel %A Li, Nicole %A Nowson, Caryl A %A Neal, Bruce %T The development of a national salt reduction strategy for Australia. %B Asia Pacific journal of clinical nutrition %D 2009 %C Australia %I HEC Press %V 18 %N 3 %P 303-309 %@ 1440-6047 %X Excess dietary salt is a well established cause of high blood pressure and vascular disease. National and international bodies recommend a significant reduction in population salt intakes on the basis of strong evidence for health gains that population salt reduction strategies could achieve. The Australian Division of World Action on Salt and Health (AWASH) coordinates the Drop the Salt! campaign in Australia. This aims to reduce the average amount of salt consumed by Australians to six grams per day over five years through three main implementation strategies targeting the food industry, the media and government. This strategy has the potential to achieve a rapid and significant reduction in dietary salt consumption in Australia. With industry and government engagement, this promises to be a highly effective, low cost option for preventing chronic disease. %Z FOR Codes: 1102 %0 Journal Article %~ PubMed %A Li, Nicole %A Prescott, John %A Wu, Yangfeng %A Barzi, Federica %A Yu, Xuequn %A Zhao, Liancheng %A Neal, Bruce %A , for the China Salt Substitute Study Collaborative Group %T The effects of a reduced-sodium, high-potassium salt substitute on food taste and acceptability in rural northern China. %B The British journal of nutrition %D 2009 %C UK %I CABI Publishing %V 101 %N 0 %P 1088-93 %@ 0007-1145 %X A potassium chloride-containing salt substitute lowers blood pressure levels, but its overall acceptability has been of concern due to its potential adverse effects on food taste. In a large-scale, blinded randomised trial evaluating the comparative effects of a salt substitute (65 % sodium chloride, 25 % potassium chloride and 10 % magnesium sulphate) and a normal salt (100 % sodium chloride) on blood pressure, we collected data on the saltiness, flavour and overall acceptability of food. We performed this at baseline, 1, 6 and 12 months post-randomisation using 100 mm visual analogue scales for assessments of both home-cooked foods and a standard salty soup. The mean age of the 608 participants from rural northern China was 60 years and 56 % of them were females. In the primary analyses, the changes in the saltiness, flavour and overall acceptability of both home-cooked foods and a standard salty soup were not different between the randomised groups (all P>0.08). In the secondary analyses, weighting each of the data points according to the lengths of the respective follow-up intervals, the flavour of both home-cooked foods (mean difference = - 1.8 mm, P = 0.045) and a standard salty soup (mean difference = - 1.9 mm, P = 0.03) was slightly weaker in the salt substitute group. We conclude that salt substitution is both an effective and an acceptable means of blood pressure control. Possible small differences in flavour did not importantly deter the use of the salt substitute in this study group, although the acceptability of the salt substitute by a more general population group would need to be confirmed. %Z FOR Codes: 110201 111104 111706 %0 Journal Article %~ PubMed %A Joshi, Rohina %A Lopez, Alan D %A MacMahon, Stephen %A Reddy, Srinath %A Dandona, Rakhi %A Dandona, Lalit %A Neal, Bruce %T Verbal autopsy coding: are multiple coders better than one? %B Bulletin of the World Health Organization %D 2009 %C Switzerland %I World Health Organization %V 87 %N 1 %P 51-57 %@ 0042-9686 %X OBJECTIVE: To assess the impact on the reported cause-of-death patterns of a verbal autopsy coding strategy based on a review of every death by multiple coders versus a single coder. METHODS: Deaths in 45 villages (total population 180,162) in southern India were documented during 12 months in 2003-2004, and a standard verbal autopsy questionnaire was completed for each death. Two physician coders, each unaware of the other''s decisions, assigned an underlying cause of death in accordance with the causes listed in the chapter headings of the International classification of diseases and related health problems, 10th revision (ICD-10). For the three chapter headings that applied to more than 100 of the deaths, agreement for subsets of causes of death within the chapter was also analysed. In the event of discrepancies, a third coder was used to finalize a cause of death. Cohen''s kappa statistic (Kappa) was used to measure levels of agreement between the two physician coders. FINDINGS: In total, 1354 deaths were documented, and a verbal autopsy was completed for 1329 (98%) of them. At the chapter heading level of the ICD-10, physician coders assigned the same cause to 1255 deaths (94%) (Kappa = 0.93; 95% confidence interval: 0.92-0.94). The patterns of death derived from the causes assigned by each physician were all very similar to the patterns obtained through the consensus process, with the rank order of the 10 leading causes of death being the same for all three coding methods. CONCLUSION: Duplicate coding of verbal autopsy results has little advantage over a single-coder system for mortality surveillance or for identifying population patterns of death. Resources could be better diverted to other parts of the mortality surveillance process, such as validation. %Z FOR Codes: 111799 %0 Journal Article %~ PubMed %A Tzourio, C %A Arima, H %A Harrap, S %A Anderson, C %A Godin, O %A Woodward, M %A Neal, B %A Bousser, M-G %A Chalmers, J %A Cambien, F %A MacMahon, S %T APOE genotype, ethnicity, and the risk of cerebral hemorrhage. %B Neurology %D 2008 %C US %I Lippincott Williams & Wilkins %V 70 %N 16 %P 1322-1328 %@ 0028-3878 %X OBJECTIVE: The apolipoprotein E (APOE) polymorphism is an established risk factor for intracerebral hemorrhage (ICH) that is related to cerebral amyloid angiopathy in the white population. Among Asian populations, although ICH represents up to one third of all strokes and has high rates of mortality and morbidity, the role of the APOE polymorphism has not been well studied. METHODS: The Perindopril Protection Against Recurrent Stroke Study (PROGRESS) was a randomized, double-blind, placebo-controlled trial of a blood pressure lowering regimen in subjects with prior cerebrovascular disease. APOE status was determined for 5,671 patients, including 2,148 Asians (38%). RESULTS: During the 3.9 years of follow-up, ICH occurred in 99 patients. Overall, carrying an epsilon 2 or epsilon 4 allele of the APOE polymorphism was associated with an adjusted hazard ratio (HR(a)) of 1.85 (95% CI = 1.24 to 2.76). In Asian patients the risk of ICH for epsilon 2 or epsilon 4 carriers was 2.11 (95% CI = 1.28 to 3.47) and 1.48 (95% CI = 0.76 to 2.87) in Europeans. Carriers of the epsilon 2 or epsilon 4 allele had an increased risk of both incident and recurrent ICH, and both cortical and deep ICH, and most risk estimates were higher in Asians than in Europeans. For both ethnic groups and for subtypes of ICH active treatment more than halved the risk of ICH and the treatment effects were not different in carriers of the epsilon 2 or epsilon 4 allele and in those with the epsilon 3 epsilon 3 genotype. CONCLUSIONS: There is a strong association between APOE genotype and the risk of intracerebral hemorrhage (ICH). In Asian patients the role of APOE polymorphisms in ICH is much broader than was previously supposed. %Z FOR Codes: 110904 %0 Journal Article %~ PubMed %A Welsh, Paul %A Lowe, Gordon D O %A Chalmers, John %A Campbell, Duncan J %A Rumley, Ann %A Neal, Bruce C %A Macmahon, Stephen W %A Woodward, Mark %T Associations of Proinflammatory Cytokines With the Risk of Recurrent Stroke. %B Stroke; a journal of cerebral circulation %D 2008 %C United States %I Lippincott Williams and Wilkins %V 39 %N %P 2226-30 %@ 0039-2499 %X There are few reports on proinflammatory cytokines and risk of primary or recurrent stroke. We studied the association of interleukin (IL)-6, IL-18, and tumor necrosis factor-alpha (TNF-alpha) with recurrent stroke in a nested case-control study derived from the Perindopril Protection Against Recurrent Stroke Study (PROGRESS). %Z FOR Codes: 110903 111706 %0 Journal Article %~ PubMed %A Turnbull, Fiona %A Woodward, Mark %A Neal, Bruce %A Barzi, Federica %A Ninomiya, Toshiharu %A Chalmers, John %A Perkovic, Vlado %A Li, Nicole %A Macmahon, S %A , the Blood Pressure Lowering Treatment Trialists' Collaboration %T Do men and women respond differently to blood pressure-lowering treatment? Results of prospectively designed overviews of randomized trials. %B European heart journal %D 2008 %C United Kingdom %I Oxford University Press %V 29 %N 21 %P 2669-80 %@ 1522-9645 %X Large-scale observational studies show that lower blood pressure is associated with lower cardiovascular risk in both men and women although some studies have suggested that different outcomes between the sexes may reflect different responses to blood pressure-lowering treatment. The aims of these overview analyses were to quantify the effects of blood pressure-lowering treatment in each sex and to determine if there are important differences in the proportional benefits of treatment between men and women. %Z FOR Codes: 110201 111716 1115 %0 Journal Article %~ PubMed %A Granger, Christopher B %A Vogel, Victor %A Cummings, Steve R %A Held, Peter %A Fiedorek, Fred %A Lawrence, Mitzi %A Neal, Bruce %A Reidies, Hiedi %A Santarelli, Leanne %A Schroyer, Rosemary %A Stockbridge, Norman L %A Feng Zhao, Z %T Do we need to adjudicate major clinical events? %B Clinical trials %D 2008 %C United Kingdom %I Sage Science Press %V 5 %N 1 %P 56-60 %@ 1740-7745 %X PURPOSE: The use of centralized systems to adjudicate clinical events is common in large clinical trials, in spite of relatively little published literature concerning the rationale and justification. The purpose of this manuscript is to review the reasons for central adjudication and to discuss whether trials could be simplified by limiting or streamlining the adjudication process. METHODS: We reviewed the literature concerning central adjudication and documented the experience of adjudication in several clinical trials. Since definitions for nonfatal events are generally heterogeneous and subjective, one reason for a central process of adjudication is to assist in assuring systematic application of the definition used in the trial. In open-label trials, assuring that the adjudication is done blinded to treatment assignment may provide protection against differential misclassification. Regulatory authorities, including the FDA, derive confidence in the validity of results when central adjudication is performed. The clinical community has become accustomed to a certain amount of adjudication and may criticize trials that lack adjudication. LIMITATIONS: It is difficult to document the value of adjudication in trials that have reported adjudicated and nonadjudicated event rates and related treatment effects. Making rationale decisions about when and how to adjudicate is hampered by the lack of published study of when and how central adjudication is helpful to improve the quality and validity of trials and at what cost. CONCLUSIONS: Adjudication has not been shown to improve the ability to determine treatment effects. Thus, adjudication may be overly complex and overused in many large simple trials. The appropriate role of central adjudication - which trials, which outcomes, what methods - deserves scrutiny and further study. %Z FOR Codes: 110399 %0 Journal Article %~ PubMed %A , Blood Pressure Lowering Treatment Trialists' Collaboration %A Turnbull, F %A Neal, B %A Ninomiya, T %A Algert, C %A Arima, H %A Barzi, F %A Bulpitt, C %A Chalmers, J %A Fagard, R %A Gleason, A %A Heritier, S %A Li, N %A Perkovic, V %A Woodward, M %A MacMahon, S %T Effects of different regimens to lower blood pressure on major cardiovascular events in older and younger adults: meta-analysis of randomised trials. %B BMJ (Clinical research ed.) %D 2008 %C United Kingdom %I BMJ Publishing Group %V 336 %N 7653 %P 1121-1123 %@ 1468-5833 %X OBJECTIVE: To quantify the relative risk reductions achieved with different regimens to lower blood pressure in younger and older adults. DESIGN: Meta-analyses and meta-regression analyses used to compare the effects on the primary outcome between two age groups (<65 v > or =65 years). Evidence for an interaction between age and the effects of treatment sought by fitting age as a continuous variable and estimating overall effects across trials. MAIN OUTCOME MEASURES: Primary outcome: total major cardiovascular events. RESULTS: 31 trials, with 190 606 participants, were included. The meta-analyses showed no clear difference between age groups in the effects of lowering blood pressure or any difference between the effects of the drug classes on major cardiovascular events (all P> or =0.24). Neither was there any significant interaction between age and treatment when age was fitted as a continuous variable (all P>0.09). The meta-regressions also showed no difference in effects between the two age groups for the outcome of major cardiovascular events (<65 v > or =65; P=0.38). CONCLUSIONS: Reduction of blood pressure produces benefits in younger (<65 years) and older (> or =65 years) adults, with no strong evidence that protection against major vascular events afforded by different drug classes varies substantially with age. %Z FOR Codes: 110502 110201 %0 Journal Article %~ PubMed %A , ADVANCE Collaborative Group %A Patel, Anushka %A MacMahon, Stephen %A Chalmers, John %A Neal, Bruce %A Billot, Laurent %A Woodward, Mark %A Marre, Michel %A Cooper, Mark %A Glasziou, Paul %A Grobbee, Diederick %A Hamet, Pavel %A Harrap, Stephen %A Heller, Simon %A Liu, Lisheng %A Mancia, Giuseppe %A Mogensen, Carl Erik %A Pan, Changyu %A Poulter, Neil %A Rodgers, Anthony %A Williams, Bryan %A Bompoint, Severine %A de Galan, Bastiaan E %A Joshi, Rohina %A Travert, Florence %T Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. %B The New England Journal of Medicine %D 2008 %C USA %I Massachusetts Medical Society %V 358 %N 24 %P 2560-2572 %@ 1533-4406 %X BACKGROUND: In patients with type 2 diabetes, the effects of intensive glucose control on vascular outcomes remain uncertain. METHODS: We randomly assigned 11,140 patients with type 2 diabetes to undergo either standard glucose control or intensive glucose control, defined as the use of gliclazide (modified release) plus other drugs as required to achieve a glycated hemoglobin value of 6.5% or less. Primary end points were composites of major macrovascular events (death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke) and major microvascular events (new or worsening nephropathy or retinopathy), assessed both jointly and separately. RESULTS: After a median of 5 years of follow-up, the mean glycated hemoglobin level was lower in the intensive-control group (6.5%) than in the standard-control group (7.3%). Intensive control reduced the incidence of combined major macrovascular and microvascular events (18.1%, vs. 20.0% with standard control; hazard ratio, 0.90; 95% confidence interval [CI], 0.82 to 0.98; P=0.01), as well as that of major microvascular events (9.4% vs. 10.9%; hazard ratio, 0.86; 95% CI, 0.77 to 0.97; P=0.01), primarily because of a reduction in the incidence of nephropathy (4.1% vs. 5.2%; hazard ratio, 0.79; 95% CI, 0.66 to 0.93; P=0.006), with no significant effect on retinopathy (P=0.50). There were no significant effects of the type of glucose control on major macrovascular events (hazard ratio with intensive control, 0.94; 95% CI, 0.84 to 1.06; P=0.32), death from cardiovascular causes (hazard ratio with intensive control, 0.88; 95% CI, 0.74 to 1.04; P=0.12), or death from any cause (hazard ratio with intensive control, 0.93; 95% CI, 0.83 to 1.06; P=0.28). Severe hypoglycemia, although uncommon, was more common in the intensive-control group (2.7%, vs. 1.5% in the standard-control group; hazard ratio, 1.86; 95% CI, 1.42 to 2.40; P<0.001). CONCLUSIONS: A strategy of intensive glucose control, involving gliclazide (modified release) and other drugs as required, that lowered the glycated hemoglobin value to 6.5% yielded a 10% relative reduction in the combined outcome of major macrovascular and microvascular events, primarily as a consequence of a 21% relative reduction in nephropathy. (ClinicalTrials.gov number, NCT00145925.) %Z FOR Codes: 110306 %0 Journal Article %~ PubMed %A Anderson, Craig S %A Huang, Yining %A Wang, Ji Guang %A Arima, Hisatomi %A Neal, Bruce %A Peng, Bin %A Heeley, Emma %A Skulina, Christian %A Parsons, Mark W %A Kim, Jong Sung %A Tao, Qing Ling %A Li, Yue Chun %A Jiang, Jian Dong %A Tai, Li Wen %A Zhang, Jin Li %A Xu, En %A Cheng, Yan %A Heritier, Stephane %A Morgenstern, Lewis B %A Chalmers, John %A , for the INTERACT Investigators %T Intensive blood pressure reduction in acute cerebral haemorrhage trial (INTERACT): a randomised pilot trial. %B Lancet Neurology %D 2008 %C United Kingdom %I Lancet Publishing Group %V 7 %N 5 %P 391-399 %@ 1474-4422 %X BACKGROUND: There is much uncertainty about the effects of early lowering of elevated blood pressure (BP) after acute intracerebral haemorrhage (ICH). Our aim was to assess the safety and efficiency of this treatment, as a run-in phase to a larger trial. METHODS: Patients who had acute spontaneous ICH diagnosed by CT within 6 h of onset, elevated systolic BP (150-220 mm Hg), and no definite indication or contraindication to treatment were randomly assigned to early intensive lowering of BP (target systolic BP 140 mm Hg; n=203) or standard guideline-based management of BP (target systolic BP 180 mm Hg; n=201). The primary efficacy endpoint was proportional change in haematoma volume at 24 h; secondary efficacy outcomes included other measurements of haematoma volume. Safety and clinical outcomes were assessed for up to 90 days. Analysis was by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT00226096. FINDINGS: Baseline characteristics of patients were similar between groups, but mean haematoma volumes were smaller in the guideline group (12.7 mL, SD 11.6) than in the intensive group (14.2 mL, SD 14.5). From randomisation to 1 h, mean systolic BP was 153 mm Hg in the intensive group and 167 mm Hg in the guideline group (difference 13.3 mm Hg, 95% CI 8.9-17.6 mm Hg; p<0.0001); from 1 h to 24 h, BP was 146 mm Hg in the intensive group and 157 mm Hg in the guideline group (10.8 mm Hg, 95% CI 7.7-13.9 mm Hg; p<0.0001). Mean proportional haematoma growth was 36.3% in the guideline group and 13.7% in the intensive group (difference 22.6%, 95% CI 0.6-44.5%; p=0.04) at 24 h. After adjustment for initial haematoma volume and time from onset to CT, median haematoma growth differed between the groups with p=0.06; the absolute difference in volume between groups was 1.7 mL (95% CI -0.5 to 3.9, p=0.13). Relative risk of haematoma growth >/=33% or >/=12.5 mL was 36% lower (95% CI 0-59%, p=0.05) in the intensive group than in the guideline group. The absolute risk reduction was 8% (95% CI -1.0 to 17%, p=0.05). Intensive BP-lowering treatment did not alter the risks of adverse events or secondary clinical outcomes at 90 days. INTERPRETATION: Early intensive BP-lowering treatment is clinically feasible, well tolerated, and seems to reduce haematoma growth in ICH. A large randomised trial is needed to define the effects on clinical outcomes across a broad range of patients with ICH. FUNDING: National Health and Medical Research Council of Australia. %Z FOR Codes: 110903 111706 110399 %0 Journal Article %~ PubMed %A Ninomiya, T %A Perkovic, V %A Gallagher, M %A Jardine, M %A Cass, A %A Arima, H %A Anderson, C %A Neal, B %A Woodward, M %A Omae, T %A Macmahon, S %A Chalmers, J %A , for the PROGRESS Collaborative Group %T Lower blood pressure and risk of recurrent stroke in patients with chronic kidney disease: PROGRESS trial. %B Kidney international %D 2008 %C United States %I Blackwell Publishing, Inc. %V 73 %N 8 %P 963-70 %@ 1523-1755 %X Recent epidemiological studies have shown a J-shaped association between the risk of stroke and systolic blood pressure (SBP) levels in people with chronic kidney disease (CKD). The Perindopril Protection Against Recurrent Stroke Study (PROGRESS) was a randomized, placebo-controlled trial demonstrating that perindopril-based blood pressure (BP) lowering reduced the risk of stroke in 6105 participants with prior cerebrovascular disease. We estimated the effects of therapy on the risk of recurrent stroke in 1757 of these participants with stage 3 or greater CKD according to baseline BP and the relationship between achieved follow-up BP and the risk of stroke. Active therapy produced comparable and significant reductions in the risk of stroke across all baseline SBP levels. The age- and gender-adjusted incidence of stroke increased significantly in a log-linear relationship for achieved SBP levels and strokes per 1000 person-years. This association persisted after adjusting for potential confounding factors. We found that perindopril-based BP lowering effectively prevented recurrent stroke in people with CKD, across a wide range of BP levels, without evidence of an increased risk of stroke in people with low BP levels. %Z FOR Codes: 110312 %0 Journal Article %~ PubMed %A Neal, Bruce %T Quantifying the importance of interleukin-6 for coronary heart disease. %B PLoS medicine %D 2008 %C United States %I Public Library of Science %V 5 %N 4 %P e84 %@ 1549-1676 %X %Z FOR Codes: 110201 111706 %0 Journal Article %A Patel, A %A MacMahon, S %A Neal, B %A Billot, L %A Chalmers, John %T The ADVANCE Trial - the author's reply %B The Lancet %D 2008 %C United Kingdom %I Lancet Ltd. %V 371 %N 9606 %P 25-26 %@ 1474-547X %X %Z FOR Codes: 110399 %0 Journal Article %~ PubMed %A Cardona, M %A Joshi, R %A Ivers, R Q %A Iyengar, S %A Chow, C K %A Colman, S %A Ramakrishna, G %A Dandona, R %A Stevenson, M R %A Neal, B C %T The burden of fatal and non-fatal injury in rural India. %B Injury prevention : journal of the International Society for Child and Adolescent Injury Prevention %D 2008 %C UK %I BMJ Publishing Group %V 14 %N 4 %P 232-237 %@ 1353-8047 %X BACKGROUND: Little is known about the burden or causes of injury in rural villages in India. OBJECTIVE: To examine injury-related mortality and morbidity in villages in the state of Andhra Pradesh, India. METHODS: A verbal-autopsy-based mortality surveillance study was used to collect mortality data on all ages from residents in 45 villages in 2003-2004. In early 2005, a morbidity survey in adults was carried out using stratified random sampling in 20 villages. Participants were asked about injuries sustained in the preceding 12 months. Both fatal and non-fatal injuries were coded using classification methods derived from ICD-10. RESULTS: Response rates for the mortality surveillance and morbidity survey were 98% and 81%, respectively. Injury was the second leading cause of death for all ages, responsible for 13% (95% CI 11% to 15%) of all deaths. The leading causes of fatal injury were self-harm (36%), falls (20%), and road traffic crashes (13%). Non-fatal injury was reported by 6.7% of survey participants, with the leading causes of injury being falls (38%), road traffic crashes (25%), and mechanical forces (16.1%). Falls were more common in women, with most (72.3%) attributable to slipping and tripping. Road traffic injuries were sustained mainly by men and were primarily the result of motorcycle crashes (48.8%). DISCUSSION: Injury is an important contributor to disease burden in rural India. The leading causes of injury-falls, road traffic crashes, and suicides-are all preventable. It is important that effective interventions are developed and implemented to minimize the impact of injury in this region. %Z FOR Codes: 111706 110699 %0 Journal Article %~ PubMed %A , Blood Pressure Lowering Treatment Trialists' Collaboration %A Turnbull, F %A Neal, B %A Pfeffer, M %A Kostis, J %A Algert, C %A Woodward, M %A Chalmers, J %A Zanchetti, A %A MacMahon, S %T Blood pressure-dependent and independent effects of agents that inhibit the renin-angiotensin system. %B Journal of Hypertension %D 2007 %C United Kingdom %I Lippincott Williams & Wilkins %V 25 %N 5 %P 951-958 %@ 0263-6352 %X OBJECTIVES: To evaluate the blood pressure-dependent and independent effects of angiotensin-converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB) on major cardiovascular events. METHODS: Using data from 26 large-scale trials comparing an ACEI or an ARB with placebo or another drug class, meta-regression analyses were conducted in which treatment-specific relative risks for major cause-specific outcomes [stroke, major coronary heart disease (CHD) events and heart failure] were regressed against follow-up blood pressure differences. RESULTS: From a total of 146 838 individuals with high blood pressure or an elevated risk of cardiovascular disease, 22 666 major cardiovascular events were documented during follow-up. The analyses showed comparable blood pressure-dependent reductions in risk with ACEI and ARB (P >or= 0.3 for all three outcomes). The analyses also showed that ACEI produced a blood pressure-independent reduction in the relative risk of CHD of approximately 9% (95% confidence interval 3-14%). No similar effect was detected for ARB, and there was some evidence of a difference between ACEI and ARB in this regard (P = 0.002). For both stroke and heart failure there was no evidence of any blood pressure-independent effects of either ACEI or ARB. CONCLUSION: There are similar blood pressure-dependent effects of ACEI and ARB for the risks of stroke, CHD and heart failure. For ACEI, but not ARB, there is evidence of blood pressure-independent effects on the risk of major coronary disease events. %Z FOR Codes: 111706 110201 %0 Conference Proceedings %A Campbell, D J %A Woodward, Mark %A Chalmers, John %A Colman, S A %A Jenkins, A J %A Kemp, B E %A Neal, Bruce %A Patel, Anushka %A MacMahon, Stephen %T Can NT-proBNP Monitoring Help Prevent Cardiovascular Disease? %B 13th World Congress on Heart Disease %D 2007 %C July 28-31,07, Vancouver, B.C., Canada %I Medimon %V %N %P %@ %E Kimchi, Asher %X %Z FOR Codes: 110201 %0 Journal Article %~ PubMed %A Chow, Clara %A Cardona, Magnolia %A Raju, P Krishnam %A Iyengar, Srinivas %A Sukumar, Akamshetty %A Raju, Ravi %A Colman, Sam %A Madhav, P %A Raju, Rama %A Srinath Reddy, K %A Celermajer, David %A Neal, Bruce %T Cardiovascular disease and risk factors among 345 adults in rural India-the Andhra Pradesh Rural Health Initiative. %B International journal of cardiology %D 2007 %C Ireland %I Elsevier Ireland Ltd %V 116 %N 2 %P 180-5 %@ 0167-5273 %X Heart attack and stroke are problems already faced by some urban populations of India, but less is known about cardiovascular disease and risk factors in rural areas. The aim of the study was to investigate the levels and management of major cardiovascular risk factors and the prevalence of cardiovascular disease in two villages in rural Andhra Pradesh, India. %Z FOR Codes: 110201 %0 Journal Article %~ PubMed %A Perkovic, Vlado %A Ninomiya, Toshiharu %A Arima, Hisatomi %A Gallagher, Martin %A Jardine, Meg %A Cass, Alan %A Neal, Bruce %A Macmahon, Stephen %A Chalmers, John %T Chronic Kidney Disease, Cardiovascular Events, and the Effects of Perindopril-Based Blood Pressure Lowering: Data from the PROGRESS Study. %B Journal of the American Society of Nephrology : JASN %D 2007 %C United States %I Lippincott Williams & Wilkins %V 18 %N 10 %P 2766-72 %@ 1046-6673 %X Chronic kidney disease (CKD) is associated with a high risk of cardiovascular disease, but evidence regarding the effectiveness of interventions to reduce that risk is lacking. The Perindopril Protection against Recurrent Stroke Study (PROGRESS) study enrolled 6105 participants with cerebrovascular disease and randomly allocated them to perindopril-based blood pressure-lowering therapy or placebo. Individuals with CKD were at approximately 1.5-fold greater risk of major vascular events, stroke, and coronary heart disease, and were more than twice as likely to die (all P< or =0.002). Perindopril-based treatment reduced the risk of major vascular events by 30% and stroke by 35% among subjects with CKD, and the absolute effects of treatment were 1.7-fold greater for those with CKD than for those without. Considering patients with CKD and a history of cerebrovascular disease, perindopril prevented one stroke or other cardiovascular event among every 11 patients treated over five years. In conclusion, kidney function should be considered when determining the need for blood pressure lowering therapy in patients with cerebrovascular disease. %Z FOR Codes: 110312 111706 %0 Journal Article %~ PubMed %A Patel, Anushka %A , ADVANCE Collaborative Group %A MacMahon, S %A Chalmers, J %A Neal, B %A Woodward, M %A Billot, L %A Harrap, S %A Poulter, N %A Marre, M %A Cooper, M %A Glasziou, P %A Grobbee, D E %A Hamet, P %A Heller, S %A Liu, L S %A Mancia, G %A Mogensen, C E %A Pan, C Y %A Rodgers, A %A Williams, B %T Effects of a fixed combination of perindopril and indapamide on macrovascular and microvascular outcomes in patients with type 2 diabetes mellitus (the ADVANCE trial): a randomised controlled trial. %B Lancet %D 2007 %C US %I The Lancet Publishing group %V 370 %N 9590 %P 829-840 %@ 1474-547X %X BACKGROUND: Blood pressure is an important determinant of the risks of macrovascular and microvascular complications of type 2 diabetes, and guidelines recommend intensive lowering of blood pressure for diabetic patients with hypertension. We assessed the effects of the routine administration of an angiotensin converting enzyme (ACE) inhibitor-diuretic combination on serious vascular events in patients with diabetes, irrespective of initial blood pressure levels or the use of other blood pressure lowering drugs. METHODS: The trial was done by 215 collaborating centres in 20 countries. After a 6-week active run-in period, 11 140 patients with type 2 diabetes were randomised to treatment with a fixed combination of perindopril and indapamide or matching placebo, in addition to current therapy. The primary endpoints were composites of major macrovascular and microvascular events, defined as death from cardiovascular disease, non-fatal stroke or non-fatal myocardial infarction, and new or worsening renal or diabetic eye disease, and analysis was by intention-to-treat. The macrovascular and microvascular composites were analysed jointly and separately. This trial is registered with ClinicalTrials.gov, number NCT00145925. FINDINGS: After a mean of 4.3 years of follow-up, 73% of those assigned active treatment and 74% of those assigned control remained on randomised treatment. Compared with patients assigned placebo, those assigned active therapy had a mean reduction in systolic blood pressure of 5.6 mm Hg and diastolic blood pressure of 2.2 mm Hg. The relative risk of a major macrovascular or microvascular event was reduced by 9% (861 [15.5%] active vs 938 [16.8%] placebo; hazard ratio 0.91, 95% CI 0.83-1.00, p=0.04). The separate reductions in macrovascular and microvascular events were similar but were not independently significant (macrovascular 0.92; 0.81-1.04, p=0.16; microvascular 0.91; 0.80-1.04, p=0.16). The relative risk of death from cardiovascular disease was reduced by 18% (211 [3.8%] active vs 257 [4.6%] placebo; 0.82, 0.68-0.98, p=0.03) and death from any cause was reduced by 14% (408 [7.3%] active vs 471 [8.5%] placebo; 0.86, 0.75-0.98, p=0.03). There was no evidence that the effects of the study treatment differed by initial blood pressure level or concomitant use of other treatments at baseline. INTERPRETATION: Routine administration of a fixed combination of perindopril and indapamide to patients with type 2 diabetes was well tolerated and reduced the risks of major vascular events, including death. Although the confidence limits were wide, the results suggest that over 5 years, one death due to any cause would be averted among every 79 patients assigned active therapy. %Z FOR Codes: 110201 111706 %0 Journal Article %~ PubMed %A Chow, Clara Kayei %A McQuillan, Brendan %A Raju, P Krishnam %A Iyengar, Srinivas %A Raju, Rama %A Harmer, Jason A %A Neal, Bruce C %A Celermajer, David S %T Greater adverse effects of cholesterol and diabetes on carotid intima-media thickness in South Asian Indians: Comparison of risk factor-IMT associations in two population-based surveys. %B Atherosclerosis %D 2007 %C Ireland %I Elsevier Ireland Ltd %V 199 %N 0 %P 116-22 %@ 0021-9150 %X Asian Indians appear particularly susceptible to coronary heart disease compared with other ethnic groups. We compared the effects of vascular risk factors on carotid intima-media thickness (IMT) in a population of South Asians from Andhra Pradesh, India with a population of Caucasians from Perth, Australia. Cardiovascular risk factors and ultrasound-assessed carotid IMT were measured in randomly selected adults from two villages in rural India (n=303) and compared to those for randomly sampled adults from Australia (n=1111). Regression models with interaction terms were used to compare the strengths of associations between risk factors and carotid IMT, in these two populations. There were stronger associations of cholesterol (p for interaction=0.009) and diabetes (p=0.04) with carotid IMT in the Indian compared to the Australian population. Also, while increasing HDL-cholesterol was associated with decreasing carotid IMT in the Australian population the reverse was true for the Indian population (p<0.001). The associations with IMT of blood pressure, triglycerides, age, HDL to total cholesterol ratio, glucose, BMI, waist, waist to hip ratio and smoking were not different between the populations. Greater adverse effects of total cholesterol and diabetes on atherosclerosis and no protective effect of HDL-cholesterol amongst Asian Indians provide a novel possible explanation for observed excess rates of cardiovascular disease amongst these populations. %Z FOR Codes: 110201 111706 %0 Journal Article %~ PubMed %A Perkovic, V %A Cass, A %A Patel, A A %A Suriyawongpaisal, P %A Barzi, F %A Chadban, S %A Macmahon, S %A Neal, B %T High prevalence of chronic kidney disease in Thailand. %B Kidney International %D 2007 %C United States %I Blackwell Publishing, Inc. %V 73 %N 4 %P 473-479 %@ 1523-1755 %X We describe the prevalence of stage III and IV chronic kidney disease in Thailand from a representative sample of individuals aged 35 years and above using a stratified, multistage, cluster-sampling method. Population estimates were calculated by applying sampling weights from the 2000 Thai census. Glomerular filtration rates were estimated from serum creatinine using the Cockroft-Gault and the simplified Modification of Diet in Renal Disease (MDRD) formulae. The prevalence of stage III disease among individuals aged 35 years and above was estimated to be about 20% using the Cockroft-Gault formula and about 13% from the MDRD formula. Stage IV disease was present in about 0.9 and 0.6% of this population using the respective formulae. The highest prevalence rates were observed in less well-developed rural areas and the lowest in developed urban areas. The prevalence of chronic kidney disease was significantly higher than that reported in individuals over 40 years old from the United States for both stage III and IV disease and higher than the reported incidence in Taiwan and Australia. This high prevalence of chronic kidney disease in Thailand has obvious implications for the health of its citizens and for the allocation of health-care resources. %Z FOR Codes: 111706 %0 Journal Article %~ PubMed %A Campbell, Duncan J %A Neal, Bruce C %A Chalmers, John P %A Colman, Samuel A %A Jenkins, Alicia J %A Kemp, Bruce E %A Patel, Anushka %A Macmahon, Stephen W %A Woodward, Mark %T Low-density lipoprotein particles and risk of intracerebral haemorrhage in subjects with cerebrovascular disease. %B European journal of cardiovascular prevention and rehabilitation : official journal of the European Society of Cardiology, Working Groups on Epidemiology & Prevention and Cardiac Rehabilitation and Exercise Physiology %D 2007 %C United States %I Lippincott Williams & Wilkins %V 14 %N 3 %P 413-418 %@ 1741-8267 %X BACKGROUND: Only limited data are available for risk factors for intracerebral haemorrhage (ICH) in subjects with established cerebrovascular disease. DESIGN: We performed a nested case-control study of participants of the Perindopril Protection Against Recurrent Stroke Study (PROGRESS). This was a randomized, placebo-controlled trial that established the beneficial effects of blood pressure lowering in 6105 patients with cerebrovascular disease. METHODS: Each of 41 subjects who experienced ICH during a mean follow-up of 3.9 years was matched to 1-3 control subjects. Lipoprotein particles and other plasma markers were measured in baseline blood samples from PROGRESS participants. RESULTS: In comparison with control subjects, ICH cases had increased mean low-density lipoprotein (LDL) diameter (P=0.04) and increased large LDL particle concentration (P=0.03). The odds ratio (adjusted for regression dilution bias) for ICH risk with 10 mmHg increase in systolic blood pressure (SBP) was 1.45 (95% confidence interval: 1.01-2.09, P=0.05), with a 1 nm increase in mean LDL diameter it was 2.15 (95% confidence interval: 0.97-4.77, P=0.06), and with 100 nmol/l increase in large LDL particle concentration it was 1.18 (95% confidence interval: 0.98-1.43, P=0.08). Plasma levels of C-reactive protein (CRP), soluble vascular cell adhesion molecule 1 (sVCAM-1), homocysteine, amino-terminal-pro-B-type natriuretic peptide (NT-proBNP), and renin were not associated with ICH risk. CONCLUSION: SBP predicted ICH risk in subjects with cerebrovascular disease, whereas CRP, sVCAM-1, homocysteine, NT-proBNP, and renin did not predict ICH risk. The trends for prediction of ICH risk by mean LDL particle diameter and large LDL particle concentration are hypothesis generating and require confirmation in larger studies. %Z FOR Codes: %0 Book Section %A Turnbull, Fiona %A Neal, Bruce %T Meta-analyses of Hypertension Trials %B Hypertension: A Companion to Braunwald's Heart Disease %D 2007 %C United Kingdom %I Elsevier %V %N %P 316-324 %@ 9781416030539 %E Black, H %E Elliott, W %X %Z FOR Codes: 110201 %0 Journal Article %~ PubMed %A Campbell, Duncan J %A Woodward, Mark %A Chalmers, John P %A Colman, Samuel A %A Jenkins, Alicia J %A Kemp, Bruce E %A Neal, Bruce C %A Patel, Anushka %A MacMahon, Stephen W %T Perindopril-based blood pressure-lowering therapy reduces amino-terminal-pro-B-type natriuretic peptide in individuals with cerebrovascular disease. %B Journal of hypertension %D 2007 %C United Kingdom %I Lippincott Williams & Wilkins %V 25 %N 3 %P 699-705 %@ 0263-6352 %X OBJECTIVE: The plasma amino-terminal-pro-B-type natriuretic peptide (NT-proBNP) level predicted congestive heart failure, myocardial infarction, and ischaemic stroke in participants of the Perindopril Protection Against Recurrent Stroke Study (PROGRESS), a placebo-controlled study of the effects of blood pressure lowering on cardiovascular events among individuals with cerebrovascular disease. Active treatment comprised a flexible regimen based on perindopril, with the addition of indapamide at the discretion of treating physicians. Active treatment reduced cardiovascular events, and we therefore investigated whether active treatment modified NT-proBNP and other cardiovascular risk factors. METHODS: We measured NT-proBNP and other cardiovascular risk factors at randomization and after 13 months of therapy in a subset of 357 PROGRESS participants. RESULTS: Baseline systolic and pulse pressures were higher in individuals with elevated baseline NT-proBNP levels. In comparison with placebo, active treatment reduced the blood pressure and NT-proBNP levels, and increased renin levels. Reduction of NT-proBNP levels by active treatment was most evident in individuals with baseline NT-proBNP levels in the highest quarter (> 26 pmol/l), with a median reduction of 16 pmol/l (interquartile range 0-51 pmol/l, P = 0.004), corresponding to a median decrease of 39% (interquartile range 0-69%). Active treatment reduced blood pressure similarly for individuals in each of the four quarters of baseline NT-proBNP. Active therapy had no effect on plasma lipid, C-reactive protein, homocysteine, or soluble vascular cell adhesion molecule 1 levels. CONCLUSION: We conclude that plasma NT-proBNP level, in addition to predicting cardiovascular risk, may provide a measure of risk reduction by blood pressure-lowering therapy. %Z FOR Codes: %0 Journal Article %~ PubMed %A Li, Nicole Y %A Li, Keji %A Qi, Zhi %A Demonty, Isabelle %A Gordon, Michelle %A Francis, Lesley %A Molhuizen, Henri O F %A Neal, Bruce C %T Plant sterol-enriched milk tea decreases blood cholesterol concentrations in Chinese adults: a randomised controlled trial. %B The British Journal of Nutrition %D 2007 %C UK %I CABI Publishing %V 98 %N %P 978-983 %@ 0007-1145 %X The cholesterol-lowering effects of plant sterols in a format suitable for use in China have not previously been investigated. We conducted the study to quantify in adult Chinese the effects on blood lipid concentrations of a plant sterol-enriched milk tea powder. The study was a double-blind, randomised trial in which 309 participants were randomised to receive daily 2.3 or 1.5 g plant sterol supplementation or placebo for 5 weeks. The milk tea was consumed with the two fattiest meals of the day with half the assigned daily dose taken on each occasion. Fasting venous blood samples were collected before commencement and upon completion of randomised treatment. The mean age of study participants was 44 years, 62% were female and 62% had a history of hypercholesterolaemia. Baseline mean total cholesterol was 5.5 mmol/l and LDL-cholesterol was 3.2 mmol/l. Compared with placebo, the 2.3 g/d plant sterol dose reduced total cholesterol by 0.25 (95% CI 0.07, 0.43) mmol/l (P = 0.01) and the 1.5 g/d dose by 0.23 (95% CI 0.06, 0.41) mmol/l (P = 0.01). For LDL-cholesterol the corresponding reductions were 0.17 (95% CI 0.00, 0.35) mmol/l (P = 0.06) and 0.15 (95% CI -0.02, 0.32) mmol/l (P = 0.08). For neither outcome was there evidence of differences between the effects of the two doses (both P values >0.4). In conclusion, the consumption of plant sterol-enriched milk tea decreased cholesterol concentrations although to a lesser extent than was anticipated. The reason for reduced efficacy is unclear but may be attributable to the novel food format used or the Chinese population studied. %Z FOR Codes: 110201 111501 %0 Journal Article %~ Isi %A Yu, XQ %A Rodgers, A %A Barzi, F %A Wu, YF %A Neal, B %A Li, N %A Huxley, R %A Zhao, LC %T Salt substitution: a low-cost strategy for blood pressure control among rural Chinese. A randomized, controlled trial %B Journal of Hypertension %D 2007 %C United Kingdom %I Lippincott Williams & Wilkins %V 25 %N 10-12 %P 2011-2018 %@ 0263-6352 %X %Z FOR Codes: 111706 110201 %0 Journal Article %~ PubMed %A Chow, Clara Kayei %A Naidu, Shanthi %A Raju, Krishnam %A Raju, Rama %A Joshi, Rohina %A Sullivan, David %A Celermajer, David S %A Neal, Bruce C %T Significant lipid, adiposity and metabolic abnormalities amongst 4535 Indians from a developing region of rural Andhra Pradesh. %B Atherosclerosis %D 2007 %C Ireland %I Elsevier Ireland Ltd %V 196 %N 0 %P 943-52 %@ 0021-9150 %X Both migrant and local urban populations of Asian Indians have high rates of cardiovascular disease. Metabolic risk factors appear key to this phenomenon but data from rural India are few. We sought to determine the prevalence and distribution of lipids, obesity and metabolic syndrome in a rural region of Andhra Pradesh. %Z FOR Codes: 111706 110104 110107