1. health and fitness
2. disease

3
The International Centre
for Circulatory Health
introduction
The International Centre for Circulatory Health (ICCH) brings together internationally renowned scientists
from the National Heart and Lung Institute (NHLI) and other divisions of the Faculty of Medicine of
Imperial College, London and clinicians from St Mary’s Hospital NHS Trust, so creating a new and important
centre of excellence.The ICCH’s strategy is to deliver an integrated research programme in circulatory
medicine and to apply the results
of that research to advance standards of care in the prevention and treatment of cardiovascular diseases,
in a multi-ethnic society.
Cardiovascular disease including coronary heart disease and stroke is currently the leading cause of death worldwide.
The global burden of cardiovascular disease is expected to increase dramatically during the next two decades.
Such an increase in mortality and morbidity is not acceptable, given that the associated risk factors are largely identified
and preventable.
Collaborators in ICCH believe, that expertise is needed across the spectrum of science and clinical management, to work
together to pre-empt the anticipated global explosion of cardiovascular disease.The essential purpose of ICCH is therefore
to address this problem. ICCH’s experts cover the fields of vascular biology, pharmacology, diabetes, cardiology and clinical
investigation, through to epidemiology and the design and implementation of treatment strategies which optimise patient
management and improve outcomes.
A major focus of ICCH is to investigate the aetiology of cardiovascular disease and to design preventive strategies as
they relate to different ethnic groups, at various stages of the ecological transition.The international status of the centre
is evident from the nature of the research programme and the strong collaborative links with other leading centres
around the world.
The educational programmes devised by the Centre represent a further important contribution towards improving
patient care.
In 2004 the collaborators moved into new accommodation on the Paddington Health Campus. At the same time
the Foundation for Circulatory Health was formed. The Foundation is a charitable organisation with the primary aim
of supporting the activities of the ICCH and has already raised more than £1 million to facilitate its development.
The activities of ICCH are strongly dependent on the generous support of national and international bodies, charitable
trusts and industry to all of whom we are most grateful. We in ICCH look forward to new sponsors and supporters
to enable us to continue to expand what we believe can be a unique and powerful force both in diminishing the global
impact of cardiovascular disease and also in improving patient care.
Peter Sever
Neil Poulter
3
background
4
THE SIZE OF THE PROBLEM
By the year 2020, coronary heart disease and strokes will
rank as the first and fourth contributors to global disease
burden as they become more common in the developing
world. Similarly, the number of people with diabetes is
expected to double from the mid 1990s to the end of this
decade.These adverse trends are entirely preventable.
Cardiovascular disease event rates in the UK currently rank
amongst the highest in the world and has been identified
as a research priority area by the Department of Health.
Furthermore, within the UK there is dramatic geographical,
ethnic and social variation in the distribution of circulatory
diseases.This is compounded by inequalities in access to
preventive and treatment services.
The future direction of healthcare requires an acute
awareness of and adaptation to the needs of the community
in sickness and in health, communication between
professionals and patients, efficient delivery of care and
ongoing audit to refine performance.The National Health
Service looks to centres of excellence for leadership in
clinical medicine and innovation through research. ICCH
is such a centre.
THE NEED FOR CHANGE
For years the medical profession has gravitated towards
greater specialisation as we have learned more about the
causes and possible treatment of different diseases.The result
has been the ability to identify and treat specific conditions
with ever increasing effectiveness. Few organisations, however,
investigate the aetiology of specific diseases with a view to
changing the quality of the healthcare response, the modes
of service delivery and particularly the optimal relationship
and responsibilities between primary and secondary care.
To make progress in the area of cardiovascular disease,
several specialties need to join forces and work towards the
next milestones in combating the biggest killer worldwide.
Fusion of skills and understanding must link excellence
in research with its interpretation and implementation in
everyday patient management. Research should also be
focused on practical and realistic ways in which prevention
of circulatory diseases can be achieved.The knowledge
and experience within ICCH of cardiovascular disease
mechanisms and preventative measures is highly sophisticated.
Translation of this knowledge into clinical practice
throughout the world lags well behind. The situation is
further compounded by inequalities of health care at the
point of delivery. Access is currently hardest for the most
socially disadvantaged – the very groups who usually carry
the greatest burden of disease.
It is our determination that clinical excellence and first-rate
clinical research should always go hand in hand. Whilst
other institutions pursue either service or research
objectives, the ICCH brings together research and clinical
excellence, ensuring that hitherto disparate research
questions are addressed with common purpose.
In this regard the aims and objectives of ICCH are in full
accordance with the aims of the Secretary of State for
Health and the recommendations of the Research for
Patient Benefits Working Group.
ICCH MISSION
To create a centre of excellence with an integrated research strategy in the field of circulatory medicine and to apply the
results of scientific endeavour to advance standards of care in prevention and treatment of cardiovascular disease which
will reduce the expected increase in disease burden around the world.
ICCH VISION
•
Delivery of a strategic, multidisciplinary, research programme spanning aetiological and prognostic questions in healthy
subjects and patient populations.
•
Development and implementation of improved models of clinical care which change the principles and practices
of disease prevention in the developed and developing world.
•
Provision of a first class clinical service for cardiovascular disease prevention and treatment
which meets current standards, directs future scientific enquiry and helps to set
national policy.
•
Communication of the results of research and new treatment strategies
through publication and education of students, healthcare professionals
and the general public worldwide.
•
Creation of an environment that develops individual careers
in clinical and basic research related to circulatory disorders
and diabetes.
SPECIALTIES REPRESENTED IN ICCH
Trial Design and Management, Epidemiology, Health
Services Research, Endocrinology and Diabetes,
Clinical Investigation,Vascular Biology and Physiology,
Cardiology, Cardiac and Vascular Surgery,
Stroke Medicine, Pharmacology and Therapeutics.
5
a summary of activities
and future plans for ICCH
PATIENT BASED RESEARCH AND CLINICAL TRIALS
ICCH co-ordinates several large-scale national and
international studies designed to identify optimal treatment
strategies to prevent cardiovascular disease and the
complications of diabetes.
In one study, the Anglo Scandinavian Cardiac Outcomes
Trial (ASCOT) the impact of cholesterol and blood
pressure lowering treatments in almost 20,000 patients
are being evaluated.The results of this trial have already
influenced national and international guidelines regarding
the use of lipid lowering agents in patients with hypertension
and other risk factors. ASCOT also incorporates over twenty
sub-studies and addresses six of the eight areas identified
in World Health Organisation/International Society for
Hypertension Guidelines for hypertension management.
6
ICCH also coordinates the northern European arm of the
major 11,000 patient trial (ADVANCE), which is evaluating
the potential benefits of better blood pressure and blood
sugar control in diabetic patients.
In a further study (DIRECT), the ICCH team is playing
a major role in evaluating the prevention of diabetic eye
disease with new treatment strategies.
In addition to its national and international trial
coordinating activities, ICCH also operates a substantial
local trial centre recruiting patients largely from general
practices throughout northwest London. Presently, over
1,500 patients are being closely monitored.
The ICCH team is currently identifying other relevant
areas for therapeutic intervention to prevent cardiovascular
disease. Other major studies designed to answer
important questions on cardiovascular medicine are
in various stages of development.These studies include
the identification of optimal targets for blood pressure
lowering and the potential benefits of blood pressure
and lipid lowering on the prevention of dementia and
worsening cognitive function.
ETHNICITY AND CARDIOVASCULAR DISEASE
A most important yet under researched area is the
relationship between ethnicity and cardiovascular disease.
Studies in the United Kingdom have brought to light
highly significant differences in the prevalence of certain
cardiovascular diseases amongst ethnic groups.The
consequences of hypertension and lipid abnormalities
also differ and there are inequalities in health care
directed at the prevention and treatment of cardiovascular
disease amongst ethnic minorities. Detailed studies
are underway to establish the basis for some of these
differences, including the use of new methods in cardiac
and vascular imaging and studies in the community to
shed further light on causative mechanisms, prevalence
and management of risk.
pill and the risk from
cardiovascular disease has brought
to light interesting ethnic variations in the risks of deep
vein thrombosis and its consequences, which occur rarely
in populations from the far east.These findings have given
rise to further research investigating the potential
mechanisms of protection against venous thrombosis.
A study funded by the British Heart Foundation is
examining reasons why, despite their high risk of strokes
and coronary heart disease, south Asian people are at less
risk of developing peripheral arterial disease.The findings
of this study will provide new insights into specific
determinants of patterns of cardiovascular disease in
different ethnic groups.
A major World Health Organisation funded programme
investigating the association between the oral contraceptive
7
THE DEVELOPING WORLD
The developing world provides a unique opportunity
to study the natural history of cardiovascular disease
and, in particular, the emergence of so called “westernised”
diseases as more isolated populations come under
the influence of dietary and other consequences of
“westernisation”. Migration studies in Kenya carried out
by ICCH researchers made important observations on
the cause of the blood pressure elevation observed with
the process of migration. Other collaborative studies
in Jamaica and South Africa, related to blood pressure
and its management, are proposed.
In Pakistan, a large randomised trial is under way to
evaluate simple preventive and treatment measures for
hypertension and to explore ethnic subgroup differences
in hypertension risk in this country.
Studies on diabetes related complications, including
amputation rates, which differ amongst different ethnic
groups in different environments, are in progress in
Barbados and will identify key risk factors with the hope
of determining the most appropriate interventions.
PATIENT SERVICES
•
The Peart-Rose Clinic was developed to provide optimal
clinical management of hypertension, heart failure,
and related cardiovascular risk factors.The organised
structure of the clinic provides a strong platform
for intervention studies, small-scale trials with detailed
investigation and collaboration in major multi-centre
trials.The focus of intervention studies has been the
assessment of hypertension treatment effects on aspects
of cardiac and vascular structure.
•
•
The Waller Cardiac Unit has been at the forefront
of providing urgent coronary interventions for acute
coronary syndromes. It is a regional electrophysiology
centre and national centre for treatment of ventricular
tachycardia. In addition, the unit is a leading centre
for “off-pump” cardiac surgery and is the regional
vascular unit for highest risk case referral in the
South-East of England
These services will link directly with the computer systems
of referring GPs. Integrated care pathways for cardiac
admissions and procedures have been developed to ensure
that high quality management is standardised.
A “same-day” chest pain assessment unit, a specialist
heart failure clinic and community service, and a stroke
unit are also in place.The stroke unit has a very low
mortality rate and the clinical outcomes for the cardiac
and vascular services are among the best in the United
Kingdom. Clinical databases in all of these areas are
under development, with the initial databases of chest
pain, heart failure and hypertension due to go live early
in 2005.
MECHANISMS OF CARDIOVASCULAR DISEASE
8
ICCH undertakes a wide range of mechanistic studies that explore the origins and consequences of cardiovascular disease.
The scope of these studies is wide, ranging from laboratory studies of the cells that make up the blood vessel wall to
clinical studies in patients – a truly ‘bench to bedside’ approach.
• The Heart and Large Arteries
ICCH has a major interest in the assessment of heart and
arterial function in the context of hypertension, diabetes
and heart failure. In addition to conventional means of
assessment such as echocardiography, arterial ultrasound
or measurement of heart rate variability, members of ICCH
have played a leading role in the application of novel
methods of assessment of the cardiovascular system in
man. For example, together with colleagues in Chemical
Engineering, Physiological Flow Studies unit, Imaging
Sciences, Imperial College London and the Cardiovascular
Magnetic Resonance Unit at the Brompton, we have used
sophisticated computational methods to assess blood flow
patterns in arteries in man.These studies provide much
more information than conventional assessments using
ultrasound or magnetic resonance imaging.This approach
has major potential for identifying haemodynamic
determinants of atherosclerosis and exploring the impact
of both risk factors and therapies.These techniques are
now being used to visualize blood flow patterns in the
coronary arteries that supply the heart.
• The microvasculature
Abnormalities of the microvasculature (the smallest blood
vessels) are increasingly recognised as playing a key role in
cardiovascular disease and target organ damage. A number
of methods of assessing microvascular function are used in
ICCH.These include measurement of skin blood flow using
laser Doppler, pharmacological examination of small arteries
removed from skin biopsies, and examination of the blood
vessels at the back of the eye (the retina).The study of
retinal arteries is particularly interesting in view of its
potential for use on a population scale.The blood vessels
of the retina are relatively easy to photograph and provide
an insight into the blood supply of the eye and the brain.
ICCH has developed novel approaches to automate the
process of retinal image analysis in collaboration with
colleagues in the Bioengineering group at Imperial College
London that provide quantitative information regarding
abnormalities of the retinal blood vessels.These studies
have identified important relationships between
abnormalities of retinal blood vessels and cardiovascular
risk factors and are currently being used in several large
international studies. In the long term we believe this
approach promises a simple means of early identification
of individuals at high level of cardiovascular risk.
Achieving the mission
NATIONAL AND INTERNATIONAL GUIDELINES
Members of ICCH are co-authors of the British
Hypertension Society Guidelines 1993, 1998 and 2004, Joint
British Guidelines 1998 and 2005, the European Society
of Hypertension Guidelines 2003 and WHO-ISH Statement
of Management of Hypertension 2003.
Members of ICCH also provide input into national
guidelines (NICE) for the management of various
cardiovascular risk factors and contribute to briefing
papers for government ministers.
SELECTED PUBLICATIONS
Further information on studies published by members of ICCH is contained on pages under inside back cover.
9
grant and contract support
During the last decade, ICCH collaborators have successfully won over £30 million of research funding, much of this
in open competition. Current sponsors of research activity within ICCH include:-
10
future prospects
The formation of ICCH has already resulted in discussions
with major funding bodies including the World Health
Organisation, who have invited ICCH to collaborate with
the design and implementation of intervention strategies
to prevent and treat cardiovascular disease in the developing
world. ICCH is much stronger and better placed to compete
nationally and internationally for necessary research funding
to support timely delivery of its overall vision.
Academic and clinical interaction, with the pooling of
intellectual resource, is a major advantage of bringing
together groups working in related fields on one site.
The activities of the centre will cover the whole spectrum
of research, from basic scientific investigations to health
services research.This unique feature of ICCH will allow,
for example, a hypothesis generated by epidemiological
work to be methodically traced back to possible
mechanistic origins or vice versa. Although ICCH has
outstanding potential for a wide range of investigations,
in the short term it will remain focused on the areas
of research activities previously outlined.
These and other new initiatives, with financial support from
industry, charitable organisations and Research Councils
will be an inevitable consequence of a highly visible,
internationally recognised, multidisciplinary centre.
collaborative group
The collaborative group, led by Professor Peter Sever and Professor Neil Poulter, is responsible for the day to day
running of the International Centre for Circulatory Health, and meets regularly to discuss progress towards the
shared objectives and to review strategy.The members of this group are:Peter Sever
Professor of Clinical Pharmacology, NHLI Division,
Imperial College London
Honorary Consultant Physician, St Mary’s Hospital, London.
Current research interests include the pathophysiology of
vascular disease, the evaluation of antihypertensive drug
therapy and multiple risk factor intervention in hypertensive
populations.
Professor Sever is Joint Editor in Chief of the Journal of the
Renin-Angiotensin-Aldosterone System. He is a
past-president of the British Hypertension Society, past
president of the European Council for Blood Pressure and
Cardiovascular Research and a Fellow of the European
Society of Cardiology. He is the current chairman of the
Fellowships committee of the British Heart Foundation.
11
Neil Poulter
Professor of Preventive Cardiovascular Medicine, NHLI Division,
Imperial College London
Honorary Consultant Physician and Epidemiologist,
St Mary’s Hospital, London.
Current research interests include the optimal investigation
and management of essential hypertension and dyslipidaemia
and cardiovascular disease in the third world.
Professor Poulter is President of the British Hypertension
Society, and was co-author of the 2003 European Society of
Hypertension–European Society of Cardiology guidelines for
the management of arterial hypertension and the 2004
British Hypertension Society guidelines for management of
hypertension.
Neil Chapman
Consultant Physician, St Mary’s Hospital, London
Honorary Senior Lecturer, Imperial College London
Current research interests include the epidemiology of
cardiovascular disease, primary and secondary prevention of
cardiovascular disease and the investigation and management
of secondary hypertension.
Dr Chapman was co-author of an International Society of
Hypertension statement on blood pressure and stroke
prevention and has worked on meta-analyses of the effects
of blood pressure lowering on cardiovascular disease
outcomes for the Blood Pressure Lowering Treatment
Trialists’ Collaboration.
Jeremy Chataway
Consultant Neurologist, St Mary’s Hospital, London
Current research interests include the clinical supervision of
thesis work in carotid flow geometry and also multi-centre
trials such as FOOD,VITATOPS and ICSS.
Dr Chataway is responsible for a ‘one-stop’ TIA (mini-stroke)
service through the Rapid Assessment Unit, and is chair the
carotid-stent group, with multi-disciplinary team discussions
involving vascular, cardiology and interventional radiology
specialities.
Nishi Chaturvedi
Professor of Clinical Epidemiology, NHLI Division,
Imperial College London
Current research interests include physiological and
metabolic studies of ethnic differences in vascular disease
and diabetes, risks of disease and approaches to treatment in
the developing world, and a clinical trial of prevention of
diabetic retonothepy (DIRECT).
Professor Chaturvedi is currently on a number of grant
giving committees and is associate editor of the International
Journal of Epidemiology and Diabetic Medicine. She was
awarded the RD Lawrence lectureship by Diabetes UK in
2001.
Rodney Foale
Consultant Cardiologist and Director of the Surgical
and Cardiovascular Services Directorate,
St Mary’s Hospital, London
Current research interests include the management of
clinical syndromes pertaining to coronary disease, such
as angina pectoris, and specifically in the management of
acute myocardial infarction.
Dr Foale has particular expertise in acquired heart
disease. Specific interests lie in the field of coronary
intervention and his specialist skills are related to
diagnostic cardiac catheterisation and percutaneous
angioplasty/stent techniques.
Alun Hughes
Professor of Clinical Pharmacology, NHLI Division,
Imperial College London
Current research interests include regulation of
intracellular calcium and excitation-contraction coupling
in vascular smooth muscle, imaging and computational
analysis of cardiovascular structure, function,
haemodynamics and atherosclerosis.
Professor Hughes is currently the secretary of the
British Hypertension Society and of the European
Council for Cardiovascular Research and co-convener
of the Special Interest Group (SIG) for Cardiovascular
& Pulmonary Pharmacology for the British
Pharmacological Society.
Desmond Johnston
Professor of Clinical Endocrinology, Division of Medicine,
Imperial College London
Honorary Consultant Physician, St Mary’s Hospital, London
Current research interests include the pathogenesis of
Type 2 diabetes and the metabolic changes which are
observed in people predisposed to develop Type 2
diabetes, before the onset of the disorder.
Professor Johnston is Head of the Section of
Endocrinology and Metabolism and Clinical Dean of
Imperial College London.
Jamil Mayet
Consultant Cardiologist St Mary’s Hospital, London
Honorary Senior Lecturer, Imperial College London
Current research interests include the causes and
consequences of cardiovascular hypertrophy,
ventricular-arterial interaction and the selection of
patients for, and optimisation of, cardiac
resynchronisation therapy.
Dr Mayet’s major area of clinical expertise is complex
echocardiography. He is on the Royal College of
Physicians Committee on Cardiology and the Council
of the British Society of Echocardiography.
Simon Thom
Reader in Clinical Pharmacology, NHLI Division,
Imperial College London
Honorary Consultant Physician, St Mary’s Hospital, London
Current research interests include vascular
pharmacology and physiology, structure and mechanics
of the circulation and haemodynamics in relation to
vascular disease.
Dr Thom is a recent member of the Executive
Committee of the British Hypertension Society and his
clinical interests include general medicine, hypertension,
cardiovascular disease prevention and hypertensive
complications in pregnancy.
selected publications
In the last 5 years ICCH staff have made over 400 contributions to peer reviewed medical literature. A selection of relevant papers may be
provided on request and is available on the ICCH website – www.icch.org.uk
Wimalasundera R, Regan L,Thom SA,
Hughes AD. Effects of vasoactive agents
on intracellular calcium and force in
myometrial and subcutaneous resistance
arteries isolated from pre-eclamptic,
pregnant and non-pregnant women.
Am J Obs & Gynecol (in press).
Reeves BC, Angelini GD, Bryan AJ,
Taylor FC, Cripps T, Spyt TJ, Samani NJ,
Roberts JA, Jacklin P, Seehra HK,
Culliford LA, Keenan DJM, Rowlands DJ,
Clarke B, Stanbridge R, Foale R.
A multi-centre randomised controlled
trial of minimally invasive direct coronary
bypass grafting versus percutaneous
transluminal coronary angioplasty with
stenting for proximal stenosis of the left
anterior descending coronary artery.
Health Tech Assess 2004; 8(16): 1-43.
de Luca N, Mallion JM, O'Rourke MF,
O'Brien E, Rahn KH,Trimarco B,
Romero R, De Leeuw PW,
Hitzenberger G, Battegay E, Duprez D,
Sever P, Safar ME. Regression of left
ventricular mass in hypertensive
patients treated with perindopril/
indapamide as a first-line combination:
the REASON echocardiography study.
Am J Hypertens 2004; 8: 660-67.
Primatesa P, Falaschetti E, Poulter N.
Birthweight and BP in children: results
from the Health Survey for England.
Hypertens 2004 (in press).
Primatesta P, Poulter NR. Hypertension
management and control among English
adults aged 65 years and older in 2000
and 2001. J Hypertens 2004; 22: 1093-98.
Bryan Williams, Neil R Poulter,
Morris J Brown, Mark Davis,
Gordon T McInnes, John F Potter,
Peter S Sever, Simon McG Thom.
British Hypertension Society guidelines
for hypertension management 2004
(BHS-IV): summary BMJ 2004;
328: 634-40.
Wolf-Maier K, Cooper RS, Kramer H,
Banegas JR, Giampaoli S, Joffres MR,
Poulter N, Primatesta P, Stegmayr B,
Thamm M. Hypertension treatment and
control in five European countries,
Canada, and the United States.
Hypertens 2004; 43: 10-17.
Godsland IF, Jeffs JAR, Johnston DG.
Loss of beta cell function as fasting
glucose increases in the non-diabetic
range. Diabetologia (2004) 47:1157-66.
Jolly M, Bertie J, Gray R, Bannister P,
Venkatesan S, Johnston D, Robinson S.
Increased leucine turnover in women
during the third trimester of
uncomplicated pregnancy. Metabolism
2004; 53: 545-49.
Robinson ACJ, Jeffs JAR, Gray RG,
Bannister PA, Mather H, Gallagher JJ,
Robinson S, Nattrass M,Venkatesan S,
Halliday D, Johnston DG. Metabolic
effects of Troglitazone in patients with
diet-controlled Type 2 diabetes.
Eur J Clin Invest 2004; 34: 29-36.
Albrecht C, Simon-Vermot I, Elliott JI,
Higgins CF, Johnston DG,Valabhji J.
Leukocyte ABCA1 gene expression
is associated with fasting glucose
concentration in normoglycaemic men.
Metabolism 2004; 53: 17-21.
Rodgers A, Chapman N,Woodward M,
Liu L-S, Colman S, Lee A, Chalmers J
and MacMahon S; PROGRESS
Collaborative Group. Perindopril-based
blood pressure lowering in individuals
with cerebrovascular disease:
consistency of benefits by age, sex and
region. J Hypertens 2004; 22: 653-59.
Chapman N, Huxley R, Anderson C,
Bousser MG, Chalmers J, Colman S,
Davis S, Donnan G, MacMahon S,
Neal B,Warlow C,Woodward M.
Effects of a perindopril-based blood
pressure-lowering regimen on the risk
of recurrent stroke according to
stroke subtype and medical history.
The PROGRESS Trial. Stroke 2004;
35: 116-21.
Bath P, Algert C, Chapman N, Neal B;
PROGRESS Collaborative Group.
Association of mean platelet volume with
risk of stroke among 3134 individuals
with history of cerebrovascular disease.
Stroke 2004; 35: 622-26.
Giorgino F, Laviola L, Cavallo Perin P,
Solnica B, Fuller J, Chaturvedi N.
Factors associated with progression to
macroalbuminuria in microalbuminuric
Type 1 diabetic patients:The
EURODIAB Prospective Complications
Study. Diabetologia 2004; 47; 1020-28.
Jafar TH, Levey AS, Jafary FH,White F,
Gul A, Rahbar MH, Khan AQ,
Hattersley A, Schmid CH, Chaturvedi N.
Ethnic differences and determinants of
diabetes and central obesity among
South Asians of Pakistan. Diabetic Med
2004; 21; 716-23.
Chaturvedi N, Bulpitt CJ, Leggetter SY,
Schiff R, Nihoyannopoulos P, Strain WD,
Shore AC, Rajkumar C. Ethnic
differences in vascular stiffness and
relations to hypertensive target organ
damage J Hypertens 2004; 22: 1731-37.
Soedamah-Muthu SS, Chaturvedi N,
Toeller M, Ferriss B, Reboldi P, Michel G,
Manes C, Fuller JH, and the EURODIAB
Prospective Complications Study group.
Risk factors for Coronary Heart
Disease in Type 1 Diabetic patients in
Europe.The EURODIAB Prospective
Complications Study (PCS). Diabetes
Care 2004; 27; 530-37
Wong T, Mayet J, Casula RP. Minimal
invasive direct revascularisation of the
left anterior descending artery using a
novel magnetic vascular anastomotic
device. Heart 2004; 90: 632.
Dimopoulos K, Salukhe TV, Coats AJ,
Mayet J, Piepoli M, Francis DP.
Meta-analyses of mortality and morbidity
effects of an angiotensin receptor
blocker in patients with chronic heart
failure already receiving an ACE
inhibitor (alone or with a beta-blocker).
Int J Cardiol 2004; 93: 05-11.
Sharp A, Mayet J.The utility of BNP in
clinical practice. J Renin Angiotensin
Aldosterone Syst 2004; 5: 53-8.
Glor FP, Ariff B, Hughes AD,
Verdonck PR, Barratt DC, Augst AD,
Thom SA, Xu XY. Influence of head
position on carotid hemodynamics
in young adults. Am J Physiol 2004;
287: H1670-81.
Barratt DC, Ariff BB, Humphries KN,
Thom SA, Hughes AD. Reconstruction
and quantification of the carotid artery
bifurcation from 3-D ultrasound images.
IEEE Trans Med Imaging 2004; 23: 567-83.
Dalby M, Davies J, Rakhit R, Mayet J,
Foale RA, Davies DW. Feasibility
and safety of day case transfemoral
coronary stenting. Catheter Cardiovasc
Interv 2003; 60(1): 18-24.
R Foale. Using statins to best advantage.
Coronary Care in the UK. 2003: 56-8.
Casula RP, Athanasiou T, Cherian A,
Bacon R, Foale R, Darzi A. Totally
endoscopic enhanced coronary
artery bypass on the beating heart.
J Royal Soc of Med 2003; 96(8): 400-1.
Haude M, Konorza TFM, Kalnins U,
Erglis A, et al, for the COAST Trial
Investigators. Heparin-coated stent
placement for the treatment of
stenoses in small coronary arteries
of symptomatic patients. Circ 2003:
107(9); 1265-70.
World Health Organization,
International Society of Hypertension
Writing Group. 2003 World Health
Organization (WHO) / International
Society of Hypertension (ISH)
statement on management of
hypertension. J Hypertens 2003;
21: 1983-92.
Guidelines Committee. 2003 European
Society of Hypertension – European
Society of Cardiology guidelines for the
management of arterial hypertension.
J Hypertens 2003; 21: 1011-53.
Robless P, Bicknell C, Chataway SJS,
Cheshire N,Wolfe J. Stenosis and
carotid endarterectomy. Lancet 2003;
361: 1655.
The FOOD Trial Collaboration. Poor
nutritional status on admission predicts
poor outcomes after stroke. Stroke
2003; 34: 1450-56.
Jolly MC, Hovorka R, Godsland I,
Amin R, Lawrence N, Anyaoku V,
Johnston D, Robinson S. Relation
between insulin kinetics and insulin
sensitivity in pregnancy. Eur J Clin Invest
2003; 33: 698-703.
Kousta E, Larwence NJ, Godsland IF,
Penny A, Anyaoku V, Millauer BA,
Cela E, Johnston DG, Robinson S,
McCarthy MI. Insulin resistance and
b-cell function in normoglycaemic
European women with a history of
gestational diabetes. Clin Endocrinol
2003; 59: 289-97.
Wimalasundera R, Fexby S, Regan L,
Thom SA, Hughes AD. Effect of tumour
necrosis factor-alpha and interleukin
1beta on endothelium-dependent
relaxation in rat mesenteric resistance
arteries in vitro. Br J Pharmacol 2003;
138: 1285-94.
Sever PS, Dahlof B, Poulter NR,
Wedel H, Beevers G, Caulfield M,
Collins R, Kjeldsen SE, Kristinsson A,
McInnes GT, Mehlsen J, Nieminen M,
O'Brien E, Ostergren J; ASCOT
investigators. Prevention of coronary
and stroke events with atorvastatin
in hypertensive patients who have
average or lower-than-average
cholesterol concentrations, in the
Anglo-Scandinavian Cardiac Outcomes
Trial-Lipid Lowering Arm (ASCOT-LLA):
a multicentre randomised controlled
trial. Lancet 2003; 361: 1149-58.
Brown MJ, Cruikshank JK,
Dominiczak A, MacGregor GA,
Poulter NR, Russell GI,Thom S,
Williams B. Better blood pressure
control: how to combine drugs.
J Human Hypertension 2003; 17: 81-86.
Glor FP, Ariff B, Crowe L, Hughes AD,
Cheong P,Thom SA,Verdonck P,
Firmin D, Barratt DC, Xu XY. Carotid
geometry reconstruction: a comparison
between MRI & ultrasound. Med Phys
2003; 30: 3251-61.
Bicknell CD, Cowling MG, Clark MW,
Delis KT, Jenkins MP, Hughes AD,
Thom SA,Wolfe JH, Cheshire NJ.
Carotid angioplasty in a pulsatile
flow model: factors affecting embolic
potential. Eur J Vasc Endovasc Surg 2003;
26: 22-31.
Augst AD, Barratt DC, Hughes AD,
Thom SAMcG, Xu XY.Various issues
relating to computational fluid dynamics
simulations of carotid bifurcation
flow based on models reconstructed
from three-dimensional ultrasound
images. Proc Inst Mech Eng [H] 2003;
217: 393-403.
Schram MT, Chaturvedi N, Fuller JH,
Stehouwer CDA, and the EURODIAB
Prospective Complications Study
Group. Pulse Pressure is Associated
with Age and Cardiovascular Disease in
Type 1 Diabetes – The Eurodiab
Prospective Complications Study.
J Hypertens 2003; 21: 2035-44.
Jafar TH, Levey AS, Jafary FH,White F,
Gul A, Rahbar MH, Khan AQ,
Hattersley A, Schmid CH, Chaturvedi N.
Ethnic subgroup differences in
hypertension in Pakistan. J Hypertens
2003; 21: 905-12.
Chalmers J,Todd A, Chapman N, Beilin L,
Davis S, Donnan G, Frommer M,
Huxley R, Lenfant C, MacMahon S,
Mancia G, Mendis S,Whitworth J,
Zanchetti A; International Society of
Hypertension Writing Group. 2003
International Society of Hypertension
(ISH) Statement on blood pressure
lowering and stroke prevention.
J Hypertens 2003; 21: 651-63.
Wimalasundera R, Fexby S, Regan L,
Thom SA, Hughes AD. Effect of tumour
necrosis factor-alpha and interleukin
1beta on endothelium-dependent
relaxation in rat mesenteric resistance
arteries in vitro. Br J Pharmacol 2003;
138: 1285-94.
Lymn JS, Gallagher KL, Clunn GF,
Fexby SE, Patel MK, Hughes AD.
PDGF stimulates DNA synthesis in
human vascular smooth muscle cells
via a novel wortmannin-insensitive
phosphatidylinositol 3-kinase. FEBS Let
2003; 555: 591-96.
Bicknell CD, Cowling MG, Clark MW,
Delis KT, Jenkins MP, Hughes AD,
Thom SA,Wolfe JH, Cheshire NJ.
Carotid angioplasty in a pulsatile
flow model: factors affecting embolic
potential. Eur J Vasc Endovasc Surg 2003;
26: 22-31.
Sritara P, Cheepudomwit S, Chapman N,
Woodward M, Kositchaiwat C,
Tunlayadechanont S, Sura T,
Hengprasith B,Tanphaichitr V, Lochaya S,
Neal B,Tanomsup S,Yipintsoi T.
Twelve-year changes in vascular risk
factors and their associations with
mortality in a cohort of 3499 Thais:
the Electricity Generating Authority of
Thailand Study. Int J Epidemiol 2003;
32: 461-68.
Fransen M, Anderson C, Chalmers J,
Chapman N, Davis S, MacMahon S,
Neal B, Sega R,Terent A,Tzourio C,
Woodward M; PROGRESS. Effects
of a perindopril-based blood
pressure-lowering regimen on disability
and dependency in 6105 patients with
cerebrovascular disease: a randomized
controlled trial. Stroke 2003;
34: 2333-38.
Cheepudomwit S, Chapman N,
MacMahon S,Woodward M, Neal B,
Suriyawongpaisal P; the InterASIA
Collaborative Group. Cardiovascular
risk factor levels in urban and rural
Thailand – The International
Collaborative Study of Cardiovascular
Disease in Asia (InterASIA). Eur J
Cardiovasc Prev Rehabil 2003; 10: 249-57.
Harrap S,Tzourio C, Cambien F,
Poirier O, Raoux S, Chalmers J,
Chapman N, Colman S, Leguennec S,
MacMahon S, Neal B, Ohkubo T,
Woodward M; PROGRESS
Collaborative Group. The ACE gene
I/D polymorphism is not associated
with the blood pressure and
cardiovascular benefits of ACE
inhibition. Hypertens 2003; 42: 297-303.
Blood Pressure Lowering Treatment
Trialists’ Collaboration. Effects of
different blood-pressure-lowering
regimens on major cardiovascular
events: results of prospectively-designed
overviews of randomised trials.
Lancet 2003; 362: 1527-35.
Dalby M, Davies J, Rakhit R, Mayet J,
Foale RA, Davies DW. Feasibility and
safety of day case transfemoral
coronary stenting. Catheter Cardiovasc
Interv 2003; 60: 18-24.
Senior R, Galasko G, McMurray JV,
Mayet J. Screening for left ventricular
dysfunction in the community: role of
hand-held echocardiography and brain
natriuretic peptides. Heart 2003;
89 Suppl 3:24-28.
Mayet J, Hughes AD. Cardiac and
vascular pathophysiology in
hypertension. Heart 2003; 89: 1104-9.
Lane R, Mayet J, Peters NS. Biventricular
Pacing for Heart Failure. BMJ 2003;
326: 944-45.
Lawrence NJ, Kousta E, Penny A,
Millauer B, Robinson S, Johnston DG,
McCarthy MI. Elevation of soluble
E-selectin levels following gestational
diabetes is restricted to women with
persistent abnormalities of glucose
regulation. Clin Endocrinol 2002;
56(3): 335-40.
Johnston DG, Robinson S, Forbes S.
What should we measure in the
diabetic patient and how does
this respond to therapy?
Br J Clin Pharmacol 2002; 54(1): 81-86.
Kousta E, Parker KH, Lawrence NJ,
Penny A, Millauer BA, Anyaoku V,
Mulnier H, Forster, DC MacDonald IA,
Robinson S, McCarthy MI, Johnston DG.
Delayed metabolic and thermogenic
response to a mixed meal in
normoglycemic European women with
previous gestational diabetes. J Clin
Endocrinol Metab 2002; 87(7): 3407-12.
Donaghy M, Chang CL, Poulter N.
Duration, frequency, recency and type
of migraine and the risk of ischaemic
stroke in women of childbearing age.
J Neurol, Neurosurg Psychiatry 2002;
73: 747-50.
Sharp A, Mayet J. Regression of left
ventricular hypertrophy: hoping for a
longer life. J Renin Angiotensin
Aldosterone Syst 2002; 3: 41-44.
Garcha RS, Sever PS, Hughes AD.
Mechanism of action of angiotensin II in
human isolated subcutaneous resistance
arteries. Br J Pharmacol 2001; 1:188-96.
Wijetunge S, Dolphin AC, Hughes AD.
Tyrosine kinases act directly on the
alpha1 subunit to modulate Ca(v)2.2
calcium channels. Biochem Biophys Res
Commun 2002; 290: 1246-49.
Sever PS, Dahlof B, Poulter NR,
Wedel H, Beevers G, Caulfield M,
Collins R, Kjeldsen SE, McInnes GT,
Mehlsen J, Nieminen M, O'Brien E,
Ostergren J; ASCOT Steering
Committee, Anglo-Scandinavian Cardiac
Outcomes Trial. Anglo-Scandinavian
Cardiac Outcomes Trial: a brief history,
rationale and outline protocol.
J Hum Hypertens 2001; Suppl 1: S11-2.
Starmans-Kool MJ, Stanton AV, Zhao S,
Xu XY, Thom SA, Hughes AD.
Measurement of hemodynamics in
human carotid artery using ultrasound
and computational fluid dynamics.
J Appl Physiol 2002; 92: 957-61.
Patel MK, Mulloy B, Gallagher KL,
O’Brien L, Hughes AD. The
antimitogenic action of the sulphated
polysaccharide fucoidan differs from
heparin in human vascular smooth
muscle cells. Thromb Haemost 2002;
87: 149-54.
Martinez-Perez ME, Hughes AD,
Stanton AV,Thom SA, Chapman N,
Bharath AA, Parker KH. Retinal vascular
tree morphology: a semi-automatic
quantification. IEEE Trans Biomed Eng
2002; 49: 912-17.
Lymn JS, Patel MK, Clunn GF, Rao SJ,
Gallagher KL, Hughes AD.
Thrombospondin-1 differentially induces
chemotaxis and DNA synthesis of
human venous smooth muscle cells at
the receptor-binding level.
J Cell Sci 2002; 115: 4353-60.
Chang CL, Shipley M, Marmot MG,
Poulter NR. Can cardiovascular risk
factors explain the association between
education and cardiovascular disease
in young women? J Clin Epid 2002;
55: 749-55.
Chaturvedi N, Abbott CA,Whalley A,
Widdows P, Leggetter SY, Boulton AJM.
Risk of diabetes-related amputation
in South Asians versus Europeans in
the UK. Diabetic Med 2002: 19; 99-104.
Stanton AV, Mayet J, Chapman N,
Foale RA, Hughes AD,Thom SA.
Ethnic differences in carotid and left
ventricular hypertrophy. J Hypertens
2002; 20: 539-43.
Chaturvedi N. Differing aspects of
insulin resistance in diabetes
complications: the shape of things to
come. RD Lawrence lecture 2002.
Diabetic Med 2002: 19; 973-77.
Zambanini A, Khir AW, Byrd SM,
Parker KH,Thom SAMcG, Hughes AD.
Wave intensity analysis: a novel
non-invasive method for determining
arterial wave transmission. Computers in
Cardiol 2002; 29: 717-20.
Kuh D, Hardy R, Chaturvedi N,
Wadsworth M. Birth weight, childhood
growth and abdominal obesity in adult
life. Int J Obes 2002; 26: 40-7.
Zambanini A,Thom SAMcG, Hughes AD,
Parker KH. Central aortic pressure
influences pulse wave velocity.
Hypertens 2002; 40: e10-e11.
Mayet J, Ariff B,Wasan B, Chapman N,
Shahi M, Senior R, Foale RA,Thom SA.
Midwall myocardial shortening in
athletic left ventricular hypertrophy.
Int J Cardiol 2002; 86: 233-38.
Chapman N, Dell’omo G, Sartini MS,
Witt N, Hughes A,Thom S, Pedrinelli R.
Peripheral vascular disease is associated
with abnormal arteriolar diameter
relationships at bifurcations in the
human retina. Clin Sci (Lond) 2002;
103: 111-16.
Neal B, Chapman N, Patel A. Managing
the global burden of cardiovascular
disease. Eur Heart J 2002;
4 (Suppl F): F2-F6.
Cunningham SL, Mayet J. Modern
management of heart failure: education
as well as medication. Eur Heart J 2002;
23: 101-2.
Mayet J, Stanton AV, Chapman N,
Foale RA, Hughes AD,Thom SA.
Is carotid artery intima-media
thickening a reliable marker of early
atherosclerosis? J Cardiovasc Risk 2002;
9: 77-81.
Brooks MJ, Mayet J, Glenville B, Foale R,
Wolfe JH. Cardiac investigation and
intervention prior to thoracoabdominal aneurysm repair: coronary
angiography in 35 patients. Eur J Vasc
Endovasc Surg 2001; 21: 437-44.
Hughes AD,Thom SA. Wearing your
heart on your sleeve? European Heart J
2001; 22: 1071-10073.
Sever PS, Dahlof B, Poulter NR,
Wedel H, Beevers G, Caulfield M,
Collins R, Kjeldsen SE, McInnes GT,
Mehlsen J, Nieminen M, O’Brien E,
Ostergren J. Rationale, design, methods
and baseline demography of participants
of the Anglo-Scandinavian Cardiac
Outcomes Trial. ASCOT investigators.
J Hypertens 2001; 6: 1139-47.
Stanton A, Fitzgerald D, Hughes A,
Mayet J, O'Brien E, Poulter NR,
Sever PS, Shields D,Thom S;
Anglo-Scandinavian Cardiac Outcomes
Trial. An intensive phenotyping study to
enable the future examination of
genetic influences on hypertensionassociated cardiovascular disease.
J Hum Hypertens 2001; Suppl 1: S13-8.
Sever PS, Chang CL. Discordant
responses to two classes of drugs acting
on the renin-angiotensin system.
JRAAS 2001; 1: 25-30.
Primatesta P, Falaschetti E, Gupta S,
Marmot MG, Poulter NR. Association
between smoking and blood pressure.
Evidence from the Health Survey for
England. Hypertension 2001; 37: 187-93.
The ADVANCE Collaborative Group.
Rationale and design of the ADVANCE
study: a randomised trial of blood
pressure lowering and intensive glucose
control in high-risk individuals with type
2 diabetes mellitus. J Hypertens 2001;
19: S21-S28.
Godsland IF, Rosankiewicz JR,
Proudler AJ, Johnston DG. Plasma total
homocysteine concentrations are
unrelated to insulin sensitivity and
components of the Metabolic Syndrome
in healthy men. J Clin EndocMet 2001;
86: 719-23.
Kempler P, Tesfaye S, Chaturvedi N,
Stevens LK,Webb DJ, Eaton S,
Kerenyi Z,Tamas G,Ward JD, Fuller JH.
Blood pressure response to standing in
the diagnosis of autonomic neuropathy.
The EURODIAB IDDM Complications
Study. Arch Physiol Biochem 2001;
109: 215-22.
Ibrahim J, Hughes AD, Sever PS. Action
of angiotensin II on DNA synthesis by
human saphenous vein in organ culture.
Hypertens 2000; 5: 917-21.
Sever PS, Poulter NR. Hypertension
drug trials: past, present, and future.
J Hum Hypertens 2000; 10-11: 729-38.
Neal B, MacMahon S, Chapman N;
Blood Pressure Lowering Treatment
Trialists’ Collaboration. Effects of ACE
inhibitors, calcium antagonists, and
other blood pressure lowering drugs:
results of prospectively designed
overviews of randomised trials.
Lancet 2000; 356: 1955-64.
Sever P. ACE inhibitors in hypertension:
still a shortage of evidence. J Renin
Angiotensin Aldosterone Syst 2000;
2: 117-18.
2
59 North Wharf Road, London W2 1LA
Tel: +44 (0)20 7594 1100
Email: [email protected]
www.icch.org.uk