Approved research

Developing a risk score for prediction of cardiovascular disease in patients with chronic neurological diseases based on traditional and novel risk factors

Lay summary

Cardiovascular disease, such as heart attacks and strokes are the most common cause of early death in the UK, and are caused by a complex interaction between different risk factors such as age, sex, cholesterol, diabetes and smoking. There are excellent scoring systems available to general practitioners to measure an individual's risk and then treat identified risk factors to prolong patients' cardiovascular-disease free years. These scores cannot be directly applied to patients with neurological conditions because other factors such as difficulty walking and the treatment they are on might also influence their individual risk of having a heart attack or stroke. One of the treatments we are specifically interested in investigating is intravenous immunoglobulin (IVIg), a blood product given regularly to patients with inflammatory, neurological conditions to dampen down inflammation attacking nerves and muscles. This treatment is given regularly over many years and it protects the nerves and muscles from damage, prevents disability and maintains independence. Our research so far has shown that patients treated with IVIg have a higher incidence of cardiovascular disease compared to other neurology patients, when other risk factors are taken in to account. As our patients on this treatment become older, their risk for cardiovascular disease naturally increases, and so it is important to fully understand whether this treatment also contributes to this increasing risk. Therefore, our aim is to investigate, on a larger scale, the association between the known cardiovascular risk factors, and our exposure of interest, IVIg, in contributing to the development of cardiovascular disease. After identifying the significant risk factors, we will create a risk prediction model or a scoring system that will quantify this risk, and identify patients who would benefit from screening or surveillance of modifiable risk factors. IVIg is an expensive but effective treatment administered to around 3000 neurology patients a year, many of whom require long-term treatment. Developing a specific risk assessment score for this population has the potential of significantly impacting our overall use of IVIg and the long-term, holistic management of these patients. It has the potential to lead to service-level changes as currently some of the classic cardiovascular risk factors are not measured or collected in routine neurology practice. This project will form one of the key projects of applicant Mahima Kapoor's PhD thesis. We aim to complete the project by no later than November 2019, and published by no later than September 2020.