When causes of disease are assessed, their effects can be so extreme that links can easily be seen from relatively simple studies of lots of people. For example, the link between smoking and heart attacks.
Treatments, on the other hand, may only produce moderate improvements in outcome that are harder to notice, even if they save thousands of lives each year in a disease as common as heart disease. The best way to detect such effects is by getting evidence from large-scale randomised trials.
Professor Sir Rory Collins was knighted in the 2011 New Year Honours List for his services to medicine. His epidemiological studies unit aims to reliably assess the causes and treatment of heart and circulatory disease.
In 1989, we participated in the first big trial that looked at whether statins could help stop people with high cholesterol levels from developing heart disease. People like Ali can now make informed decisions about whether they should take statins to lower their cholesterol.
The Clinical Trial Service Unit (CTSU) has established the use of ‘meta-analyses’ which combine all of the trials that have addressed the same treatment question. Regular updates of these meta-analyses, as well as new collaborations ensure that the results become increasingly relevant to patient care. Professor Collins has been responsible for some of the most influential clinical trials in cardiovascular medicine and has shaped the way patients with heart disease are treated.
The CTSU also established the use of very large, simple, randomised ‘mega-trials’ to reliably assess the effects of widely usable treatments on survival. For example, it conducted the four International Studies of Infarct Survival (ISIS-1 to ISIS-4, randomising 140,000 patients) - the results of which substantially improved the emergency treatment of heart attacks.
In the Heart Protection Studies of 30,000 people at high risk of heart attacks, CTSU assessed several years of treatment with certain vitamins and with various doses of cholesterol-lowering drugs.
Other major CTSU treatment trials focus on aspirin for treating a blockage in the blood vessel that carries blood from the heart - a pulmonary embolism - and for the emergency treatment of stroke.
CTSU also conducts large scale studies of the causes of disease. In large part due to CTSU there is recognition of the scale of future worldwide epidemic of deaths due to tobacco. CTSU has helped to establish several large observational studies of smoking in various populations to monitor, and help control, this epidemic.
The establishment of a specialised laboratory in CTSU is allowing some large studies of blood-based risk factors for heart disease. For example, questionnaires and blood samples from tens of thousands of patients in the ISIS trials have already been used to quantify the effects of smoking on heart attack risks and are now being used to assess the contribution of various biochemical and genetic factors. A study involving hundreds of thousands of individuals in Mexico City will also help to investigate the causes of heart attacks, strokes and other chronic diseases.
Professor Collins is Chief Executive of UK Biobank, which is a research resource to improve health made up of information about half a million people across the UK. The project was originally funded by the Government through the MRC and the Wellcome Trust charity.
Since its beginnings in 2006 UK Biobank has received millions of pounds of funding from us to enhance the project and make it an even better resource for researchers studying heart disease and stroke.
In April 2016 UK Biobank received a major funding boost powered by your donations and support from the MRC and the Wellcome Trust so it could launch the world's biggest body scanning study.
BHF Professor Collins explains how this will help cardiovascular research.