Cardiovascular disease (CVD) includes all the diseases of the heart and circulation including coronary heart disease, angina, heart attack, congenital heart disease and stroke. Despite improvements in the prevention and treatment of CVD in recent decades, it remains the leading cause of death worldwide, particularly in developed countries.
CTSU conducts a wide range of studies designed to understand the causes of cardiovascular disease and to help prevent them. These studies are characterised by their large size, which helps to ensure that they provide a better understanding of disease mechanisms and the appropriate use of treatments.
Examples of CTSU’s large population studies investigating cardiovascular disease (as well as other diseases), all of which are conducted collaboratively with researchers in the countries concerned, include the China Kadoorie Biobank in 500,000 Chinese people, the Mexico Prospective Study in 150,000 people, and large studies in Russia, Cuba, and India (in total, such studies involve around 1.7 million participants). CTSU’s studies, and meta-analyses of prospective studies, are exploring the relevance both of established risk factors (such as cigarette smoking, blood cholesterol, adiposity and blood pressure) and of novel or ‘emerging’ risk factors (such as certain aspects of diet, lipid fractions such as lipoprotein (a), and renal disease).
CTSU has pioneered large randomized trials, generally involving many tens of thousands of patients, for the treatment and prevention of cardiovascular disease, and meta-analyses of randomized trials that have helped to determine the benefits and risks of treatments. In the field of blood cholesterol, for example, trials have included the 20,000 patient Heart Protection Study (HPS), the Study of the Effectiveness of Additional Reductions in Cholesterol and Homocysteine (SEARCH), the Study of Heart and Renal Protection (SHARP), and CTSU is currently conducting the 30,000 patient REVEAL trial of anacetrapib, a treatment to increase blood HDL cholesterol. In parallel, we coordinate the Cholesterol Treatment Trialists’ (CTT) Collaboration meta-analysis of large trials of lipid modification, which has helped to guide the use of statins.