School of Population Health


Predicting Cardiovascular Disease: the contribution of multiple risk factors

Professor Rod Jackson

Rod-Jackson

Rod Jackson is a professor of epidemiology in the Section of Epidemiology and Biostatistics. He is medically trained and has published over 230 peer-reviewed papers. His main research for many years has been the epidemiology of chronic diseases especially cardiovascular diseases. Key members of the VIEW programme team include Drs Sue Wells, Tania Riddell, Andrew Kerr, Daniel Exeter, Patricia Metcalf and Roger Marshall and Professor Jim Warren.

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From an individual’s perspective the causes of cardiovascular disease (CVD) are well known and have been for some time. We know that smoking is bad as is obesity, physical inactivity, type 2 diabetes, sugary drinks, salt and high blood pressure, to name a few. The renowned villainous roles of saturated fats and high cholesterol in causing CVD have been immortalised by University of Auckland medical students in their 2011 video “I’m sorry Rod Jackson.” on YouTube.. Recent newcomer to this hit list of bad foods is fructose (North & South, November 2012) with its ability to make us fat. From an individual’s perspective information on the causes of CVD is readily available in the public domain so why then is CVD still a leading cause of death in New Zealand? Professor Rod Jackson and his team of researchers investigate how to predict who will get CVD in New Zealand by shifting the focus from individual factors to absolute risk. Absolute risk is a product of the combined effect of a number of risks factors such as those listed above and including previous CVD history and medication use. Focusing on absolute risk led Rod Jackson to develop a colour chart that enabled clinicians estimate CVD risk of their patients.  The colour chart evolved into PREDICT, a web based decision support system developed by the research team and Enigma Publishing Limited. The PREDICT software is widely used by general practices throughout the North Island. In addition to the regular clinical use of this programme PREDICT also has a research component that has been supported by two HRC project grants. In the clinical setting PREDICT assists in risk assessment and recommending treatment/management options. In a research setting PREDICT data is anonymised and linked to an external database which in turn can be linked to laboratory results, prescriptions, hospitalisation and deaths. The resulting data sets are used to develop new risk prediction tools and have enabled the researchers to accurately describe the CVD risk profile, disease status and treatment status of a large number of New Zealanders from the PREDICT cohort.

Vascular Informatics using Epidemiology (VIEW): In June 2011 Rod Jackson and team were awarded a HRC programme worth ($4.93 million) for 5 years to continue their research on CVD risk. The specific aims of the VIEW programme are to accurately identify the 10 to15% of New Zealanders at high risk of a CVD event, to identify the socio demographic disparities in CVD risk management and disease burden and to determine the extent to which disparities in risk management account for disparities in CVD outcomes. Three linked cohort studies will be used to address these aims which will include the PREDICT general population primary care-based cohort, a hospital-based acute coronary syndrome cohort and a cohort from linked national and regional databases detailing hospitalisation, laboratory tests and medication. The 3 cohorts will support development of accurate risk prediction algorithms, development of a vascular atlas to map and quantify disparities in CVD risk and disease burden, estimate the impact of disparities in CVD risk and risk management and then use models to estimate the population-wide effects of the interventions that affect CVD outcomes. Ultimately outputs from this programme could lead to the establishment of an integrated national vascular cohort including the entire adult New Zealand population.

Developing more accurate CVD risk prediction and an up-to-date ‘view’ of the nation’s vascular health will in turn enable better targeting of treatment and a better outlook for equitable identification, management and even prevention of CVD events.

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