Emeritus Professor Hugh Tunstall-Pedoe

Cardiovascular Epidemiology

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Emeritus Professor Hugh Tunstall-Pedoe was training in cardiology and general medicine at the London Hospital (now Royal London) in 1969 when he joined the MRC Social Medicine Unit to organize a register of coronary heart attacks in the surrounding London Borough of Tower Hamlets. He found that most coronary deaths occurred suddenly outside hospital, often unwitnessed, and beyond medical help; and also, first showed that South Asian people were particularly vulnerable to heart disease. So, began 35-years with World Health Organization collaborations, writing protocols, scientific papers, reports as conference Rapporteur, and books. He next moved to the United Kingdom Heart Disease Prevention Project at St Mary’s Hospital Medical School.  In 1981 he became foundation Professor and Director of the Cardiovascular Epidemiology Unit, University of Dundee, studying the then Scottish excess of heart disease, and the country’s east-west gradient. Between 1984 and 1995 he recruited 18 000 men and women to the Scottish Heart Health Study (SHHS)/ Extended Cohort (SHHEC), recording their lifestyle and risk factors, and reporting on their medical outcomes ever since. Before leaving London he drafted the protocol for a WHO multicentre study of ten-year trends in coronary heart attacks, strokes and risk factors, later  involving 38 populations in 21 countries, including Glasgow, and Belfast – the WHO MONICA Project (MONItoring trends and determinants in CArdiovascular disease). The Unit was designated WHO Collaborating Centre in Cardiovascular Epidemiology and Quality Control Centre for Event Registration.

Comparison of results of the Scottish surveys with elsewhere showed that levels of risk factors were too high, precipitating coronary prevention campaigns in Scotland in the 1990s. He produced the Dundee Coronary Risk-Disk in 1991, adopted into general practice, winning a national prize for invention.  Glasgow MONICA showed that men and women died equally frequently in their heart attacks, but men died more rapidly outside hospital, while more women died after arrival, later confirmed elsewhere. He led the authorship of key papers from the WHO MONICA Project in Circulation, and Lancet, and designed, edited and half-wrote – with 67 co-authors – a 250-page illustrated monograph, published by WHO in 2003.

In 2006, with colleague Mark Woodward and the Scottish Intercollegiate Guidelines Network (SIGN), he produced a cardiovascular risk score, ASSIGN, based on the SHHEC study. This incorporated social deprivation and family history with traditional risk factors. It has been the Scottish national score ever since.  Now semi-retired, he has recently worked on international trends in blood pressure, vitamin D, fatty acids, and the differing risk factors for coronary heart disease and peripheral arterial disease.

Other interests over the decades have been a national survey of cardiopulmonary resuscitation, writing short humorous articles for medical journals, golf, beekeeping, and, recently, fostering Dundee red squirrels versus invasive greys.

He is a Fellow of the London, and the Edinburgh, Royal Colleges of Physicians, and the Faculty of Public Health, and a Foundation Fellow of the European Society of Cardiology. Research funding from Scottish Chief Scientist Organization, British Heart Foundation, Medical Research Council, European Commission, FP Fleming Trust, and TICR.

A few of Professor Hugh Tunstall-Pedoe’s Publications

  1. Tunstall-Pedoe H, Woodward M, Hughes M, Anderson A, Kennedy G, Belch J, Kuulasmaa K, for MORGAM investigators. Prime mover or fellow traveller: 25-hydroxy vitamin D’s seasonal variation, cardiovascular disease and death in the Scottish Heart Health Extended Cohort (SHHEC). Int J Epidemiol 2015 Oct; 44(5): 1602-12. doi: 10.1093/ije/dyv092. Epub 2015 Jun21.
    • Seasonal changes in vitamin D are out of phase with the seasonal changes in deaths they are said to cause.  Low vitamin D does not appear to be a significant risk factor for cardiovascular disease in individuals, once other factors have been allowed for, debunking many popular claims about vitamin D: only 15 citations.
  2. Woodward M, Brindle P, Tunstall-Pedoe H, for the SIGN group on risk estimation.  Adding social deprivation and family history to cardiovascular risk assessment: the ASSIGN score from the Scottish Heart Health Extended Cohort (SHHEC).  Heart 2007 Feb; 93(2): 172-6. Epub 2006 Nov 7.
    • Without the addition of social deprivation, risk assessment tends to overestimate risk in the socially privileged, and underestimate it in the deprived, resulting in relative neglect of the latter.  The new score predicts well and achieves equity for this reason, and has been adopted nationally in Scotland and emulated elsewhere. 513 citations.
  3. Tunstall-Pedoe H, Connaghan J, Woodward M, Tolonen H, Kuulasmaa K,  for the WHO MONICA Project.  Pattern of declining blood pressure across replicate population surveys of the WHO MONICA project, mid-1980s to mid-1990s, and the role of medication. BMJ 2006 Mar 18; 332(7542): 629-35. Epub 2006 Mar 10.
    • On average blood pressure was falling slightly but significantly across the 38 populations in the decade of the WHO MONICA Project.  It was widely assumed that this was because of better treatment of raised blood pressure. Analysis in Dundee showed that the pressure fall was equal across high, middle and low readings, so unlikely to result from treatment.  An unpopular paper with the other journals’ choice of referees, and therefore difficult to publish, it was rescued by the editor of the BMJ who better understood the epidemiological concept. 117 citations.
  4. Tunstall-Pedoe H (ed), for the WHO MONICA Project. MONICA Monograph and Multimedia Sourcebook: World’ largest study of heart disease, stroke, risk factors, and population trends 1979-2002.  Geneva, World Health Organization, 2003. (http://apps.who.int/iris/bitstream/10665/42597/1/9241562234.pdf)
    • Thousands of copies of this monograph were distributed world-wide describing the project, the participants, the investigators, their cities and all the results. Richly illustrated in colour by photographs, and with multiple graphics, it included two CD-ROMs and doubled-up as a textbook of cardiovascular epidemiology. 269 citations.
  5. Tunstall-Pedoe H, Kuulasmaa K, Amouyel P, Arveiler D, Rajakangas AM, Pajak A, for the WHO MONICA Project. Myocardial infarction and coronary deaths in the World Health Organization MONICA Project. Registration procedures, event rates and case fatality-rates in 38 population from 21 countries in four continents.  Circulation 1994 Jul; 90 (1): 583-612.
    • A blockbuster result from fifteen years of collaboration involving multiple centres. This report confirmed huge differences in coronary disease event rates between different populations, showed that coronary deaths and non-fatal heart attacks ran in parallel, and, despite this international variation, men were more susceptible than women within each population – even though female rates in Glasgow were greater than those in men in many other populations.  That epidemiologists had standardized an international definition of myocardial infarction, and used it for many years, persuaded clinicians to do the same, although theirs has been revised several times since 2000.  2489 citations.