Cardiovascular Projects
Incidence and natural history of cardiovascular disease
Cardiovascular diseases (CVDs) are often studied in isolation despite being interlinked. Prevention and treatment strategies that impact on the incidence or natural history of one condition can change others. A more holistic approach to understanding the complex interrelationships could be more accurate in informing interventions.
This project aims to study the interrelationships between different CVDs, and how these have changed over time. Firstly, using hospital and death data, this study will examine to what extent one type of CVD leads to another. This study will also examine whether this relationship differs by population sub-group (e.g. sex, deprivation, urban/rural residence) and time. Relevantly, this study will also examine the prescription pattern, how are these related to prior diagnoses, and whether this changes over time. Lastly, this study will examine how prescription patterns might lead to health outcomes, such as mortality.
Carbon footprint in CVD treatment
Current strategies to reduce carbon emissions in the NHS include recycling, reducing transport, and supply chain optimization, all of which are expected to produce a tangible reduction in carbon emissions. However, the carbon footprint of clinical care is currently not available, and this is crucial to adapt care pathways to allow NHS to attain Net Zero.
There is evidence for a bi-directional relationship between hypertension and cardiovascular disease (CVD) and climate change. Hypertension and CVD strikes adults in their middle age requiring lifelong follow-up and treatment. This indirectly drives carbon emissions through the large number of affected individuals, 25-30% of adults, requiring medications and follow-up.
This study aims to estimate the carbon footprint of CVD treatment in NHSGGC. Record-linked data will allow us to calculate the distance between patients’ homes and clinic postcodes, as well as the number of hospital visits and radiological and pathological investigations, all of which will be used for carbon footprint calculations based on emission conversions. This will be the first large-scale calculation of the carbon footprint of clinical activities related to CVD and this model will be applicable to other chronic diseases stimulating further research and policy activities.
Lead Investigator: Professor Sandosh Padmanabhan
Utility of age-adjusted D-dimer in diagnostic assessment of pulmonary embolism & DVT
D-dimer is a protein fragment that's made when a blood clot dissolves in your body and D-dimer testing is an important, non-invasive tool that can be used to diagnose major clots such as a pulmonary embolism (PE) or deep vein thrombosis (DVT). However, its utility is limited in older patients as D-dimer levels increase with age.
This study aims to investigate the utility of an age-adjusted D-dimer (AADD) score compared to the gold standard medical imaging techniques of CT pulmonary angiogram (CTPA) and lower limb doppler ultrasound scans (USS) in diagnosing PE and DVT in patients aged over 50. Different assays have different cut-offs and this age-related testing has not been validated in the NHSGGC system.
The results will indicate whether AADD can help reduce the requirement for CTPA and USS, thus improving patient outcomes through benefits such as reduced hospital length stays and reduced side effects associated with such imaging techniques alongside reduced pressure on hospital services such as radiology department inpatient bed stays and duration of attendance in assessment units.
Lead investigator: Dr Colin Church
The prognosis and outcomes of patients with incident Post Myocardial Infarction Left Ventricular Systolic Dysfunction (Post-MI LVSD) between 2013 and 2022 in the West of Scotland
Post myocardial infarction left ventricular systolic dysfunction (post-MI LVSD) is where the heart muscle is weakened after a heart attack and cannot pump blood around the body as efficiently as before. Post MI LVSD is one of the main causes of heart failure. Appropriate use of cardiology medication is crucial in improving outcomes for patients with post MI LVSD. In NHS Greater Glasgow and Clyde the pharmacy heart service has provided care, including the initial optimisation of cardiology medication, in over 5000 patients with post MI LVSD between 2013 and 2022.
The aim of the study is to measure the rate of major cardiac events, like heart attacks, strokes and cardiac death, in these patients and describe what factors make these outcomes more likely. We will also describe what happens to the long-term prescribing of cardiology medication.
Lead Investigator: Lynsey Moir
Does long term testosterone therapy increase the risk of cardiovascular disease?
Hypogonadism, decreased functional activity of the gonads, affects over 10% of men over the age of 50 and is associated with increased mortality. However, only 10% of hypogonadal men are prescribed testosterone as its cardiovascular safety remains controversial, particularly in older, multi-morbid men. Studies have shown that short-term testosterone therapy may not increase cardiovascular risk, but data relating to longer-term administration, and the influence of aging and multi-morbidity, is lacking. This study aims to investigate the influence of age, multi-morbidity, and adverse health behaviours (e.g. smoking) upon the development of cardiovascular disease in older men using testosterone.
Lead Investigator: Dr Paul Connelly
Associations between white blood cell count and morbidity / mortality in people older than 50 years
Inflammation plays a crucial role in the progression of cardiovascular disease (CVD). Routine tests for white blood cell (WBC) count is a useful inflammatory test that can be used as an indicator of systemic inflammation. In particular, the neutrophil-lymphocyte ratio (NLR) is emerging as an independent predictor of CVD.
This study aims to investigate associations of WBC count, with a focus on NLR, with morbidity and mortality in people older than 50 years, studying patients with and without cardiovascular risk factors or overt CVD. It will expand on ongoing work with the inclusion of a large number of patients with CV risk factors and diseases, and the possibility to assess risk of CV and non-CV outcomes.
This proposal will strengthen the interdisciplinary collaboration between the Institute of Infection, Immunology and Inflammation with the heart failure community in Glasgow, and act as a catalyst for international collaborations and engagement with pharmaceutical industries.
Lead Investigator: Dr Pierpaolo Pellicori
Association between allergic diseases and cardiovascular events
Increasing evidence suggests that allergic diseases are associated with cardiovascular events. In a focused clinical study, we demonstrated that young individuals with seasonal allergic rhinitis, known as hayfever, present development of endothelial dysfunction, a type of coronary artery disease, during the peak of allergic season and the degree of vascular dysfunction is correlated to exposure of dominant allergic pollens.
This study aims to investigate whether allergic rhinitis and/or allergic asthma are associated with long-term cardiovascular risk. Outcomes will include diagnosis of cardiovascular disease and cardiovascular events.