Title: Lifestyle and pharmacological interventions for the primary prevention of cardiovascular disease
Funder: Department of Health (England)

Abstract: 6. Details of proposed programme Background (1000 characters max):Cardiovascular disease (CVD) is still the number one cause of death and disability in the UK. The burden of disease will increase with an aging population and increasing levels of obesity and sedentary lifestyles. Prevention of CVD by targeting modifiable factors (smoking physical inactivity obesity high blood pressure raised cholesterol levels) remains a key public health priority. Successive guidance (e.g. The National Service Framework for Coronary Heart Disease (NSF CHD DH 2000)) has been important in reducing deaths from CVD but has indicated that a shift in emphasis is required towards primary prevention. This shift has been further highlighted by the report Destination 2020 (Cardio Vascular Coalition) which builds on the 10 year targets of the NSF CHD and which particularly welcomes the national roll out of the Vascular Risk Assessment Programme to assess manage and reduce risk in all those aged 40-74 (Putting Prevention First DH 2008). NICE guidance on prevention of CVD at a population level has recently been published (June 2010). These initiatives to prevent CVD at the individual and population level are currently ongoing and await evaluation.Theme and scope of proposed programme (1000 characters max):The programme theme is “Lifestyle and pharmacological interventions for the primary prevention of CVD”. The focus will be on modifiable risk factors in the general population and in those at increased risk of CVD. We plan a programme of work relevant to policy organisational public health clinical and individual levels which will provide a strong platform for wider more comprehensive prevention programmes including both population and high-risk strategies. Several recent publications commissioned by the Department of Health in the area of primary prevention (Statins for the prevention of CV events (NICE 2006) Lipid modification (NICE 2008) Putting prevention first (DH 2008) Prevention of CVD at a population level (NICE 2010)) have highlighted gaps in the evidence base and propose further research. These have been taken into consideration when developing the proposed programme of new reviews and those to be updated. Interventions related to smoking obesity and use of antihypertensive drugs are covered by other Cochrane groups (Tobacco Addiction Metabolic and Endocrine Disorders Hypertension) and will not form part of this bid.Proposed reviews to be undertaken and/or updated and how the choice is justified in terms of NHS priorities (2000 characters max):A programme of over 20 new reviews and 20 reviews currently registered with the CHG will be taken forward. The choice of new titles comes from gaps on the Cochrane library research needs highlighted in recent NHS/US guidance and after discussion with the CHG consumer group. Proposed reviews will assess effects of interventions on clinical outcomes (coronary heart disease peripheral arterial disease and stroke) risk factors (blood pressure lipid levels) adverse events and costs where possible.Planned new titles all take the form of intervention for the primary prevention of CVD as follows: Lifestyle interventions:Mediterranean diet Vegetarian diet Vitamin K Selenium Coenzyme Q10 Coenzyme Q10 in people taking statins Flavenoids Brisk walkingCycling Alternative exercise regimens (Tai Chi Qigong Yoga) Meditation Pharmacological interventions:Fibrates PolypillOver the counter statins Risk assessment and interventions directed at specific groups:Patient-led methods of risk assessmentFinancial incentives for primary care-led risk assessmentSystematic vs. opportunistic risk assessmentLifestyle interventions aimed at black and minority ethnic groupsMethods of risk assessment for identifying children with hypercholesterolemiaInterventions to reduce CVD risk in children with hypercholesterolemiaReviews currently registered with the CHG to be taken forward/updated: Lifestyle interventions:Dietary advice Omega 3 fatty acids Reduced or modified dietary fat Wholegrain cereals Homocysteine lowering interventions Supplemental plant sterols and stanols Vitamin D Multiple risk factor interventions Exercise for people with high CVD riskInterventions for promoting physical activity (3 reviews)Pharmacological interventions:Statins Aspirin Clopidogrel plus aspirin versus aspirin alone Hormone replacement therapy Risk assessment and interventions directed at specific groups:Risk scoring Interventions for preventing obesity in childrenInterventions for treating obesity in childrenInterventions for increasing fruit and vegetable consumption in preschool childrenWe are conscious of the importance of fiscal and legal interventions for population control of CVD risk factors and events and will register reviews jointly with the Cochrane Public Health Group where appropriate.Outline plan and timetable for undertaking reviews including how award would be used (eg. employment of new researchers) (2000 characters max):The award will be used to fund 2 new research fellows (at 75% FTE) to ensure correct and timely duplication processes and one day per week for the PI to manage the programme of work and train and oversee the work of the research fellows. A contribution will be made to the CHG for their support (see section 9 for details) and a smaller amount will be used for senior academic input for both methodological and subject expertise and a senior statistical advisor. Allowance has been made for advisory group meetings and regular meetings between the PI and CHG to ensure smooth running of the project. The advisory group will comprise public health professionals general practitioners and users and will be chaired by Paul Lincoln Chief Executive of the National Heart Forum. The advisory group will meet initially to discuss selection criteria (e.g. defining the interventions) and outcomes for each of the new reviews and will be involved in teleconferences every 3-6 months to discuss progress. There will be approximately 14 pieces of work to complete each year (new reviews and updates). Each research fellow will take the lead on half of the new reviews and will act as second reviewer on the others and vice versa. On average 7 new reviews will be undertaken each year allowing 6 weeks for each new review. Updates and assistance with reviews already registered with the CHG will be carried out concurrently. The PI will take the lead on facilitating updates along with the CHG. It is envisaged that this process is collaborative involving authors of the reviews and assistance will be provided where needed. As authors will be actively engaged in the process and retain overall control it is likely that only one research fellow will be required in each case. Regular contact and meetings between the PI and the CHG should also ensure that this process runs smoothly. Additional assistance with the duplication processes for both the new reviews and updates will be provided by junior doctors training in public health at Warwick Medical School and where possible by other staff employed in Warwick undertaking similar work. The PI has previous experience of training junior doctors in systematic review methodology and co-authorship on resulting publications. One of the co-applicants (SS) has managerial responsibility for the trainees which will facilitate this process.


Research activity codes: 3.1 PRIMARY PREVENTION INTERVENTIONS TO MODIFY BEHAVIOURS OR PROMOTE WELL-BEING;3.3 NUTRITION AND CHEMOPREVENTION
Health categories: CARDIOVASCULAR