Comparison of risk factor associations in UK Biobank against representative, general population based studies with conventional response rates: prospective cohort study and individual participant meta-analysis

Batty, G. David; Gale, Catharine R.; Kivimäki, Mika; Deary, Ian J.; Bell, Steven

doi:10.1136/bmj.m131

Cited by 450 publications

(408 citation statements)

References 54 publications

(84 reference statements)

Supporting

Mentioning

372

Contrasting

Order By: Relevance

“…Second, the study was not designed to collect a representative sample of the UK population, which limits the generalizability of the findings to the UK as a whole. However, as a nationwide cohort, with a risk factor profile comparable to those in other representative studies in the UK [38], the results obtained from this study may reinforce the need for lowering the threshold for treating HTN in adults in the UK.…”

Section: Strengths and Limitationssupporting

confidence: 78%

Association between Stage 1 Hypertension Defined by the 2017 ACC/AHA Hypertension Guideline and Cardiovascular Risk: A Large Cohort Study from the UK

2020

Preprint

View full text Add to dashboard Cite

Importance The 2017 American College of Cardiology (ACC)/American Heart Association (AHA) hypertension (HTN) guideline lowered the threshold for HTN from 140/90 mmHg to 130/80 mmHg for systolic/diastolic blood pressure (SBP/DBP), resulting in a newly defined stage 1 HTN with an SBP/DBP reading of 130-139/80-89 mmHg. Few studies have assessed the impact of the redefined HTN on cardiovascular outcomes among the UK population. Objective To examine the effects of the revised ACC/AHA stage 1 HTN blood pressure parameters on the prevalence of HTN and related cardiovascular disease (CVD) risk in a large UK population. Design Adult men and women from a national cohort study in the UK. Setting The UK Biobank Study. Participants A total of 470,625 adults (mean age 56 years) with available data on blood pressure (BP) and without a history of CVDs at baseline. Main outcome measures Incident composite CVD outcome. Methods Prospective CVD events were analysed for survival in relation to BP measures using Cox proportional hazards regression models, adjusting for potential confounders. The associations are described by hazard ratios (HRs) and 95% confidence intervals (CIs). Results By adopting the 2017 ACC/AHA HTN guideline, an additional 24.7% of the participants were classified as having ACC/AHA stage 1 HTN, which resulted in a prevalence of HTN of 75.1% at baseline. During a mean follow-up period of 8.1 years, ACC/AHA stage 1 HTN (130-139/80-89 mmHg) was associated with a significantly increased risk of CVD (HR 1.20; 95% CI 1.10-1.30) compared to the risk associated with a normal BP (<120/80 mmHg). The excess risk of CVD associated with ACC/AHA stage 1 HTN was mainly driven by myocardial infarction (HR 1.19; 95% CI 1.05-1.36) and haemorrhagic stroke (HR 1.40; 95% CI 1.08-1.81), rather than ischaemic stroke (HR 1.02; 95% CI 0.87-1.19) and CVD death (HR 1.07; 95% CI 0.90-1.26). Conclusions The adoption of the 2017 ACC/AHA guideline would lead to a dramatic increase in the prevalence of HTN in the UK Biobank cohort study. Evidence from the present national cohort study may support lowering the threshold for HTN from 140/90 mmHg to 130/80 mmHg in the UK.

show abstract

Section: Strengths and Limitationssupporting

confidence: 78%

Association between Stage 1 Hypertension Defined by the 2017 ACC/AHA Hypertension Guideline and Cardiovascular Risk: A Large Cohort Study from the UK

2020

Preprint

View full text Add to dashboard Cite

show abstract

“…Although UK Biobank includes participants from multiple regions across the UK, including deprived areas, it is not a representative sample of the whole UK population 11 and this cohort may have suffered from selection bias, 42 although the direction of risk factor associations in the UK Biobank seem to be generalisable. 43 As in every observational study, there may be some residual confounding by unmeasured risk factors. Some of the results may be influenced by detection bias, as comorbidities may affect both biomarker concentrations and prostate specific antigen test attendance and/or results.…”

Section: Discussionmentioning

confidence: 99%

Examination of potential novel biochemical factors in relation to prostate cancer incidence and mortality in UK Biobank

et al. 2020

View full text Add to dashboard Cite

Background Although prostate cancer is a leading cause of cancer death, its aetiology is not well understood. We aimed to identify novel biochemical factors for prostate cancer incidence and mortality in UK Biobank. Methods A range of cardiovascular, bone, joint, diabetes, renal and liver-related biomarkers were measured in baseline blood samples collected from up to 211,754 men at recruitment and in a subsample 5 years later. Participants were followed-up via linkage to health administrative datasets to identify prostate cancer cases. Hazard ratios (HRs) and 95% confidence intervals were calculated using multivariable-adjusted Cox regression corrected for regression dilution bias. Multiple testing was accounted for by using a false discovery rate controlling procedure. Results After an average follow-up of 6.9 years, 5763 prostate cancer cases and 331 prostate cancer deaths were ascertained. Prostate cancer incidence was positively associated with circulating vitamin D, urea and phosphate concentrations and inversely associated with glucose, total protein and aspartate aminotransferase. Phosphate and cystatin-C were the only biomarkers positively and inversely, respectively, associated with risk in analyses excluding the first 4 years of follow-up. There was little evidence of associations with prostate cancer death. Conclusion We found novel associations of several biomarkers with prostate cancer incidence. Future research will examine associations by tumour characteristics.

show abstract

“…Despite low response rates potentially leading to more favorable risk factor profiles, exposure-outcome associations in the UKB seem to be generalisable. 48 The comprehensive phenotyping of individuals in the cohort allowed us to correct for multiple potential confounding factors. In contrast to previous work utilizing cohorts with manifest PD, the availability of baseline blood tests and longitudinal assessment of PD diagnosis enabled us to examine the association between leukocyte subsets and risk of incident PD.…”

Section: Discussionmentioning

confidence: 99%

Low lymphocyte count is a risk factor for Parkinson’s disease

Jensen

Jacobs

Dobson

et al. 2020

Preprint

View full text Add to dashboard Cite

Importance: Biomarkers for the early detection of Parkinsons disease (PD) are needed; emerging evidence implicates immune dysregulation. Altered leukocyte differentials and C-reactive protein (CRP), common markers of immune function, occur in patients with PD. Whether these changes drive pathogenesis remains unclear. Objectives: We sought to identify whether peripheral immune dysregulation can be seen as a pre-diagnostic feature of PD, and whether it appears to play a causal role. Design: We examined the relationship between differential leukocyte count and other markers of acute inflammation at enrolment, and incident cases of PD, in UK Biobank, a longitudinal cohort study. We used Mendelian randomization to establish whether differences in leukocyte subsets have a causal influence on risk of PD. Setting: The UK Biobank; a population-based cohort with over 500,000 participants aged 40-69 recruited in the UK between 2006 and 2010. Participants: PD cases were defined as individuals with an ICD-10 coded diagnosis of PD. Cases were defined as incident if their age at diagnosis was greater than their age at recruitment to UKB. Controls were defined as all other individuals in the dataset after applying the above exclusions. After applying exclusion criteria for pre-existing health conditions that can influence blood counts, 507 incident PD cases and 328,280 controls were included in the analysis. Exposure: Blood cell markers (absolute and relative counts) and other markers of inflammation (CRP and albumin) were obtained from blood tests of participants taken at the initial assessment visit. Results: Lower lymphocyte count was associated with increased risk of incident PD. There was weaker evidence of association between lower eosinophil and monocyte counts, lower CRP, and higher neutrophil counts on risk of incident PD. The association between lymphopenia and incident PD remained robust to sensitivity analyses. Mendelian randomization did not reveal a clear causal effect of low lymphocyte count on PD risk, but a weak trend in that direction was seen. Conclusions and relevance: In this large, prospective setting, lower lymphocyte count was associated with higher risk of subsequent PD diagnosis. The absence of a clear causal effect indicates that lymphopenia might be a consequence of prodromal PD.

show abstract

Comparison of risk factor associations in UK Biobank against representative, general population based studies with conventional response rates: prospective cohort study and individual participant meta-analysis

Cited by 450 publications

References 54 publications

Association between Stage 1 Hypertension Defined by the 2017 ACC/AHA Hypertension Guideline and Cardiovascular Risk: A Large Cohort Study from the UK

Association between Stage 1 Hypertension Defined by the 2017 ACC/AHA Hypertension Guideline and Cardiovascular Risk: A Large Cohort Study from the UK

Examination of potential novel biochemical factors in relation to prostate cancer incidence and mortality in UK Biobank

Low lymphocyte count is a risk factor for Parkinson’s disease

Contact Info

Product

Resources

About