Healthier Lives is participating in two very significant studies to radically improve the early detection of cardiovascular disease (CVD), and to improve care following a coronary event (heart attack or angina):
- The Equitable Cardiovascular and Diabetes risk prediction project
- The Multi-Ethnic New Zealand Study of Acute Coronary Syndromes (MENZACS)¹.
Both studies use New Zealand’s rich health data to improve the assessment and delivery of care, particularly for our different ethnic populations.
Detecting CVD risk
Currently doctors throughout New Zealand use CVD risk scores that were developed in the early 2000s.
Principal Investigator Professor Cameron says, “These CVD risk scores don’t work very well for some groups, particularly Māori, Pacific, and Indian subcontinent peoples. These are the people who suffer the greatest inequities, and yet we’re not very good at identifying risk for them, so we’re unable to offer timely interventions that can prevent disease “.
Big data—a force for good
Records from half a million patients are helping reconfigure risk prediction by integrating data from 55,000 Māori, 55,000 Pacific people and 35,000 people of Indian descent. This is added to by Statistics NZ’s Integrated Data Infrastructure (IDI).
“For an individual you can see all kinds of information, such as cause and diagnosis, whether they’ve been hospitalised, mortality data, treatment drugs and how their body is functioning. Other data from the PHO enrolment database and census data about things like smoking, education, income level can be linked to this,” explains Professor Cameron.
Although the data is rich in information, it is protected so researchers don’t get any information that would identify an individual.
Co-principal Investigator Professor Rod Jackson and biostatistician Katrina Poppe and their team are able to link all the data to build a more representative picture of risk factors for ethnic groups.²
Better risk prediction
As a result, doctors will have more accurate tools to predict someone’s risk of cardiovascular disease or diabetes. When a doctor enters a patient’s information into the software, a much more informed and sensitive series of calculations is undertaken, so patients with higher risk may be able to be identified earlier, and treated more effectively.
Professor Cameron says “For a patient, it’s important to change major lifestyle factors, but these are often trickier to implement than changing treatments such as reducing blood pressure, reducing cholesterol, and getting diabetes well under control. These can significantly reduce someone’s risk even without major lifestyle changes. That’s why it’s so important that those risk factors get picked up and managed early, and appropriately for the level of risk”.
Existing coronary patients
The other side of improving risk prediction is for people who have already had a coronary event. How do we predict who is likely to have another one?
The MENZACS study will use Ministry of Health demographic and treatment data, and participants’ lifestyle, diet, physical activity and smoking data to endeavour to improve the prediction of secondary events. Researchers will also investigate more sensitive blood biomarkers and genetics to refine risk prediction.
The research, led by Professor Cameron, and Associate Professor Malcolm Legget, stands to benefit the people who tend to fare worse, health-wise, in New Zealand.
“It’s now been well accepted that in people who have coronary events, the management of their risk factors declines markedly over the 12 months after they’ve been in hospital”, says Professor Cameron.
“They tend to stop taking their medication, or the GPs relax about treating some of their risk factors. But if the risk factors are treated—if the patient is monitored closely and treated effectively—then it really reduces the risk of secondary events.”
Refining the focus of healthcare
“The goal is to limit the burden to GPs, and patients who have a low-ish risk of secondary events, and focus on the people who have the highest risk. We may find special factors which apply to particular ethnic groups and then we’ll be able to target treatments and monitor more effectively, the people who are most at risk.”
Read more about these studies:
¹ The MENZACS study is supported by research grants from the Heart Health Research Trust of the Heart Foundation, the Healthier Lives National Science Challenge and University of Auckland.
² This part of the work is co-funded by a programme grant from the Health Research Council of New Zealand.