Dr R Wilkie, Dr D Yu
No more applications being accepted
Funded PhD Project (European/UK Students Only)
About the Project
Purpose: To improve the quality of care and quality of life for adults with osteoarthritis who are at risk of cardiovascular disease by contributing evidence for policymakers, practitioners, and the public.
METHODS
The student will follow a structured series of studies linked to the objectives and use data from the Clinical Practice Research Datalink (CPRD) in all analyses. CPRD is a longitudinal database containing anonymised electronic health record data (e.g. demographics, symptoms, behavioural factors, tests, etc.) for 11.3 million patients in the UK. CPRD has been used in over 1500 observational research studies covering a variety of diseases such as osteoarthritis, cardiovascular disease and studied therapeutic interventions.
Additional analyses will use data from the PRELIM initiative and the ClinicAl research using Linked Bespoke studies and Electronic Records (CALIBER) e-health database (CALIBER). The PRELIM initiative is funded by Arthritis Research UK and will collect survey data from consulters aged 25 years and over registered with 10 general practices in North Staffordshire. The survey data on cardiovascular risk factors, musculoskeletal health and core behavioural and psychosocial factors will be linked to electronic health records for those that give consent to do so (n=7392). CALIBER is a research platform of linked electronic health records and administrative health data from primary care, secondary care and disease registries in over 10 million patients collected during 1997-2010, with a specific focus on cardiovascular disease.
Study 1: Comparative CVD risk profile in patients with osteoarthritis (objective 1)
The prevalence of cardiovascular risk factors (e.g. diabetes, hypertension, hyperlipidaemia, BMI and family history of premature cardiovascular disease), at baseline in patients with osteoarthritis and the general population, stratified by age, will be estimated to examine for differences in the cardiovascular risk factor profile between the two cohorts Additional analysis will be performed with data from the PRELIM initiative to account for additional covariates and confounders (e.g. physical activity). JBS3 will be used to calculate 10-year and lifetime cardiovascular risk in both groups; the distribution of cardiovascular risk across both cohorts will be defined and the proportion of patients with high risk (10-year risk >10%) of a CV event will be calculated. In a matched cohort study, the development of cardiovascular risk over time in patients with osteoarthritis and in the general population will be modelled to determine whether the evolving trajectory of cardiovascular risk differs between the two populations.
Study 2: Comparison of first presentation of cardiovascular events between those with and without osteoarthritis (objectives 2 & 3)
There are currently no data on patterns of first lifetime presentation of cardiovascular disease in patients with osteoarthritis and whether it differs from the general population. The incidence rates of cardiovascular diseases (e.g. myocardial infarction (MI), heart failure) in patients with and without osteoarthritis will be compared to identify differences in patterns of presentation between the two groups. A secondary analysis will separate MI into ST-segment–elevation MI and non–ST-segment–elevation MI. Regression models will be used to determine whether the rates of myocardial and stroke are in-line with those predicted from the calculated cardiovascular risk at the population level, and determine whether differences in incident cardiovascular disease in patients with osteoarthritis can be explained by differences in baseline cardiovascular risk factor profile or whether patients with OA are at increased risk of future events after adjusting for baseline cardiovascular risk. Sensitivity analysis will be undertaken with data from CALIBER which provides more detailed data around cardiovascular outcomes.
Study 3: Are adults with osteoarthritis and at high risk of cardiovascular disease managed in line with NICE guidelines? (objectives 4 & 5)
Current NICE guidelines recommend initiation of a statin in patients with a cardiovascular risk calculated at >10 % over 10 years in patients without prevalent cardiovascular disease. To test the hypothesis that osteoarthritis is associated with less intensive primary prevention of cardiovascular disease than the underlying population for a given cardiovascular risk, the prescription rates for statins and anti-hypertensive therapies will be compared in those with and without osteoarthritis using data from CPRD. Further modelling procedures will be used to estimate the number of cardiovascular events that could be prevented in patients with osteoarthritis with greater adherence to current guidelines using CPRD data.
Funding Notes
All fees paid at current UK/EU rates, for three years only
Stipend paid at current Research Council rate, for three years full time or six years part time.
Fees provided at EU rates only, Non-EU students would be required to pay the additional overseas fees themselves. Fees will only be paid for three years full time or six years part time.
Good (2:1 or above) First degree in epidemiology, statistics, math, social sciences or health-related discipline. A Master’s degree in a relevant discipline is highly desirable. Work experience in a health-related discipline would be useful.
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