Epidemiologists study causation and prevention of disease. The Cardiovascular Epidemiology Unit in Ninewells Hospital, University of Dundee, was created in 1981 to answer why Scotland then had the highest death rates in the world from coronary heart disease in both sexes, and how and why these rates varied across Scotland. Was there a mysterious Scottish factor? Thousands of Scottish men and women volunteered for the Scottish Heart Health Study, attended survey clinics, agreeing to confidential tracking of their health records. Standardized measurement showed, by international standards, that Scots had high levels of known coronary risk factors, including poor diet–information confounding the doubters, enabling delayed prevention programmes to take place. (No Scottish mystery after all!) Recruitment took place over twelve years. Follow-up of the 18 000 participants has continued ever since, as the Scottish Heart Health Extended Cohort (SHHEC).
Overlapping with the above was the ten-year World Health Organization MONICA Project in which the Dundee Unit had a leading role, studying heart disease and risk factors over ten years in 38 populations in 21 countries. North Glasgow was a nominated Scottish population, with the highest coronary disease rates, particularly in women. Analysis of what happened in heart attacks showed that proportionately more men died before reaching hospital and more women after arrival, but attacks were better recognised and treated in Glasgow, where they were common, than they were in many other countries. MONICA monitored improvements in coronary disease rates, treatment, and risk factors over ten years. Major reports on WHO MONICA were authored and edited from Dundee; those on Scottish MONICA involving Glasgow collaborators.
Over the decades SHHEC has produced increasing information on the contribution of classic, and newer, risk factors to cardiovascular diseases, and now, potentially, to non-cardiovascular diseases. Follow-up to 2005 led to the ASSIGN cardiovascular risk score, for more than ten years the default method for assessing risk in Scots. Archived serum has now been analysed for new candidate risk factors. Follow-up to 2009 has produced studies of the role of vitamin D in heart disease, and recently a comparison of causation of coronary disease and arterial disease in the legs (claudication). With TICR funding, a further follow-up is planned to the end of 2016, facilitating more detailed studies, including cancers.
SHHEC is a major national and international resource in the study of disease, based in Dundee University, and supported by TICR.