NZ leads the world in cardiovascular risk prediction

New Zealand leads the world in cardiovascular risk prediction

Media Release - University of Auckland - 27 June 2016

A unique risk prediction tool developed at the University of Auckland will soon be able to accurately predict the risk of having a heart attack or stroke for New Zealand adults.

A team of the University’s epidemiology and clinical experts at the School of Population Health, led by Professor Rod Jackson, has just received a substantial grant for continuation of this work from the Health Research Council (HRC).

The five year programme grant of just under $5 million backs HRC’s earlier investments in this cardiovascular risk research (in 2002, 2006 and 2011). Other key supporters of the research are the Heart Foundation, the Ministry of Health, Primary Health Organisations, and District Health Boards.

Professor Jackson started his research programme in 2000 with his colleagues Associate Professor Sue Wells, who has a backgound in general practice, and Associate Professor Andrew Kerr, a senior cardiologist at Middlemore Hospital.

Professor Jackson had previously led the development of the world’s first national guidelines based on predicted cardiovascular risk.

“New Zealand was the first country to recommend that GPs use a risk prediction tool to take account of a patient’s combined risk factor status before making treatment decisions,” says Professor Jackson. “Your predicted risk is a better way of determining how well treatment will work for you than just focussing on a single risk factor like blood pressure or blood cholesterol,” he says.

“When we started this back in the 1990s, we used an American cardiovascular risk prediction score. However we wanted to determine its relevance to NZ in the 21st century since it was based on a study from the USA conducted in the 1970s,” says Professor Jackson.

“We used an American score because that’s all there was at the time,” he says. “The score came from the Framingham Heart Study which started collecting data about cardiovascular risk factors on most of the adults in the town of Framingham in Massachusetts in 1950.”

“But we always wanted to develop New Zealand risk predictors for New Zealand people,” he says. “Cardiovascular disease peaked in New Zealand in the late 1960s and it’s been plummeting ever since, so we were concerned that charts would become outdated.”

The Framingham Heart study showed that if an individual with high blood cholesterol, also had high blood pressure, then their risk of a cardiovascular event was much higher than if their only risk factor was a high blood cholesterol. If they were also a smoker or had diabetes, the risk was even higher.

“A group of patients could all have the same blood cholesterol level, but their risks of having cardiovascular disease would be very different depending on what other risk factors they had”, says Professor Jackson.

“That’s important because if you treat that high blood cholesterol, you can halve the risk,” he says. “All of these patients could have an identical blood cholesterol level, but the same cholesterol lowering treatment will provide a large benefit for one, but a small benefit for another patient. Halving a large risk is much more effective and cost-effective than halving a small risk. That’s the rationale behind what we do in New Zealand.”

“Framingham is no longer accurate in 2016, because we have done an amazing job of reducing cardio-vascular disease in most developed western countries,” he says. “Yet most countries are still using risk prediction tools that were developed last century.”

“Our new risk prediction equations will be relevant to the rest of the developed world.”

“In 2000, our vision was for more accurate vascular risk prediction leading to better vascular risk management with the goal of reducing inequities,” says Professor Jackson. “This five year grant allows us to bring this vision to fruition.”

Since the team started collecting data in 2002, it has accumulated information on more than half a million New Zealanders, including representative cohorts of Māori, Pacific Island, South Asian and Chinese people.

“Over the last 15 years we have collected data to do robust risk prediction and robust research about how peoples’ treatment is being managed,” says Dr Jackson. “Our data sets are so large and so representative, that we can now generate risk prediction tools for vascular events and describe management in a way that has never been possible before.

“We have such large cohorts, that we can make confident statements and inferences about vascular risk for New Zealanders,” he says. This vascular risk prediction research is globally unique as no other country have access to such comprehensive, high quality data.

“Our national health index number – the NHI - is key to this because it allows us to link data from multiple sources,” says Professor Jackson. “We have high quality data and we are a small country where we trust each other, so we are able to do this. Our team also has an established track record going back over 30 years and we are trusted professionals.”

“Ours is the most contemporary, large-scale cohort in the world and to do this work well you need contemporary cohorts,” he says.

“We have strong links with researchers in other countries, but most are jealous of our access to high quality national health data. We also have enlightened ethics committees and enlightened government leaders who understand that giving us access to these data can bring significant benefits to the health of New Zealanders.”

“Everything we do uses a military strength encryption process, as we are absolutely stringent about anonymity,” he says. “We have no access to anyone’s name or actual NHI number – it’s all anonymised and we are extremely careful about this.”

Our database of more than 500,000 New Zealanders now includes more than 57,000 Maori, more than 55,000 Pacific people, more than 35,000 South Asians, and about 25,000 Chinese, so we will be able to develop risk prediction equations specifically for these groups.

“There are zero degrees of separation between our research and clinical practice,” says Professor Jackson. “We use data that comes directly from everyday clinical practice to develop risk prediction tools and we will give these new tools back to the same clinicians who provided us with the data, for them to use in everyday practice.”

ENDS

© Scoop Media