Cardiovascular diseases are disorders of the heart and blood vessels and include coronary heart disease (i.e., heart attacks and angina), cerebrovascular disease (i.e. strokes) and other conditions. Heart attack and stroke are of particular importance, because they are responsible for 4 out of every 5 CVD deaths. Electronic Health Records are an extremely suitable data source for studying cardiovascular disease. This is because some of the most important risk factors for cardiovascular disease such as high blood pressure, smoking and obesity are recorded in electronic health records, along with information on medication usage and other comorbidities. This means we can study the effects of lifestyle factors, medication factors and other diseases on health outcomes such as heart attacks and strokes.
Our cardiovascular work is widespread. We have highlighted some of the main areas below.
Medicines associated with cardiovascular events
We have also been investigating causes of acute cardiovascular events, often using self-controlled methods to better deal with between-person confounding. Some of our work has looked at drugs used in Chronic Obstructive Pulmonary Disease, depression, psychosis and weight loss and assessed whether they are associated with heart attack and stroke. In addition to this we have examined the use of drugs used in osteoporosis on atrial fibrillation. Another example of our work looked at a very commonly used antibiotic and sought to establish whether this drug was associated with long term cardiovascular events.
Medicines used in cardiovascular disease associated with other health outcomes
We have also investigated the intended and unintended effects of a wide range of medicines used to treat cardiovascular disease. For example, statins are a group of medicines that are used to treat high cholesterol. We have examined their effects on diabetes, on the risk of mortality after pneumonia and a range of other health outcomes inclusive of fractures, infections and stomach bleeds. We have also studied the association between blood pressure medications and the risk of developing dementia and cancer. Other work has focused on the interaction between medicines commonly used in cardiovascular disease.
Risk factors for cardiovascular disease
We have also been investigating other causes of acute cardiovascular events, outside of the medication related causes referred to above. For example, we have led and collaborated on studies to examine whether there is a short term increased risk of heart attack or stroke after systemic infections, after specific infections such as influenza or chickenpox, and whether the increased risk seen after shingles, is modified by having a vaccination for shingles.
High blood pressure (hypertension) is a an extremely important risk factor for cardiovascular disease. It affects 1 in 4 people and is responsible for 9.4 million deaths annually, usually from heart attack or stroke. As part of our cardiovascular research theme, we have a blood pressure special interest group which meets once monthly to discuss recent published work in the area of hypertension. The group also serves as an advisory group for planning and working on studies relating to hypertension within the EHR group. On going projects include work on resistant hypertension and examining adherence to laboratory monitoring guidelines when starting anti-hypertensive medicines.
There is also a major programme of work underway investigating cardiovascular disease risks in survivors of cancer.