In the United Kingdom, over 40% of the population suffer from diseases that affect their blood vessels (vascular disease). Two of the most costly and life-threatening vascular diseases are aortic aneurysms and aortic dissections. An aortic aneurysm refers to the abnormal widening of the aorta which is the main artery that branches from the heart, and aortic dissection refers to a tear in the aorta. If these conditions are mismanaged they carry a significant risk of disability and death, but understanding of the best approach to treatment and long-term outcomes is limited.
Currently the principal approach to treating aortic diseases uses a range of medicines (treatments) to improve blood pressure, lower cholesterol and slow disease progression in order to improve patients' quality of life and survival (outcomes). There is, however, a lack of robust evidence at a population level to determine the influence of these medications and treatment goals on long-term outcomes in patients with aortic disease. This study therefore aims be the first population-based evaluation of health data from both the community and hospitals in England to assess the relationship between treatment and long-term outcomes in aortic disease.
Symptomatic aortic aneurysms and aortic dissections represent the two most commonly occurring aortic emergencies in England. They can result in significant morbidity and mortality, however, in the absence of acute aortic morphology changes or complications, a clinically stable phase may be achieved with judicious blood pressure control and statin therapy. In addition, there is emerging evidence for the potential protective effect of metformin and other medications
Current guidelines advocate the use of beta-blockers as first line anti-hypertensive therapy despite a paucity of evidence to support this. Moreover, there have been no large-scale population studies examining the relationship between blood pressure control and long-term outcomes. Statin therapy and metformin have also been positioned as having protective effects on the aorta, but once again there is a lack of longitudinal data for their impact.
This study aims to interrogate linked primary and secondary care data to examine the relationship between blood pressure control and medication choice, statin therapy and metformin with long-term health outcomes in patients with aortic disease. In order to answer these research questions previously employed cox-regression models will be used with g-computation formulas to adjust for confounding and study the effect of dynamic treatment options on patient outcomes.
Aortic/cardiovascular events
- Aortic/cardiovascular mortality
- All-cause mortality
- Hospital admissions (elective and emergency)
- Aortic/cardiovascular interventions
Colin Bicknell - Chief Investigator - Imperial College London
Colin Bicknell - Corresponding Applicant - Imperial College London
Alberto Vidal-Diez - Collaborator - Imperial College London
Guy Martin - Collaborator - Imperial College London
Jaet Powell - Collaborator - Imperial College London
Joshua Symons - Collaborator - NHS Digital ( HSCIC )
Neil Poulter - Collaborator - Imperial College London
Viknesh Sounderajah - Collaborator - Imperial College London
HES Admitted Patient Care;HES Outpatient;ONS Death Registration Data;Patient Level Index of Multiple Deprivation