Professor Sir
Rory Collins
BHF Chair of Medicine and
Epidemiology
University of
Oxford, Clinical Trial Service Unit &
Epidemiological Studies Unit
BHF Centre of Research Excellence
When important causes of disease are to be assessed,
their effects are sometimes so extreme that links can be easily
found from simple observational studies of lots of people. For
example, the link between smoking and heart attacks.
Treatments may, however, produce only moderate improvements in
outcome - though they may still 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 Collins was knighted in the 2011 New Year Honours List
for his services to medicine. His epidemiological studies unit aims
to assess the causes and treatment of heart and circulatory disease
reliably.
Meta-analyses
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.
Mega-trials
CTSU also established the use of very large, simple randomised
‘mega-trials’ to assess reliably the effects on survival of widely
practicable treatments. For example, it conducted the four
International Studies of Infarct Survival (ISIS-1 to ISIS-4,
randomising 140,000 patients) whose results substantially improved
the emergency treatment of heart attacks.
In the current Heart Protection
Studies of 30,000 people at high risk of heart attacks, CTSU is
assessing several years of treatment with certain vitamins and with
various doses of cholesterol-lowering drugs.
Other major CTSU treatment trials focus on aspirin for pulmonary
embolism and for the emergency treatment of stroke.
Observational epidemiology
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.
Blood-based epidemiology
The establishment in CTSU of a specialised laboratory is
allowing some uniquely 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.
Further information
Read more about Rory
Collins' recent research that has discovered how variations in
a gene can make some people more susceptible to a rare side-effect
of statins.