Emeritus Professor Hugh Tunstall-Pedoe

Cardiovascular Epidemiology

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Emeritus Professor Hugh Tunstall-Pedoe (an identical twin) was training in cardiology and general medicine at the London Hospital (now the Royal London) in 1969 when he was recruited to undertake a population study of heart attacks in the London Borough of Tower Hamlets. There he showed that most coronary deaths occurred outside hospital, often unwitnessed and so suddenly as to be beyond medical help.  He also first showed that the local South Asian population had an abnormally high attack rate. This began a 25-year involvement with World Health Organization collaborative research projects on heart disease, writing reports, protocols, papers and books. His next move was to participate in the United Kingdom Heart Disease Prevention Project research at St Mary’s Hospital Medical School.  In 1981 he was appointed Professor and Director of the new Cardiovascular Epidemiology Unit at Ninewells Hospital, University of Dundee, to study the excess of heart disease, and the regional variation in Scotland. 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 continues to follow and publish on their medical outcomes. Before leaving London he started to write the protocol for a huge WHO multicentre study of ten-year trends in coronary heart attacks, strokes and risk factors, which eventually involved 38 populations in 21 countries, including north Glasgow in Scotland, and Belfast in Northern Ireland – the WHO MONICA Project (MONItoring trends and determinants in CArdiovascular disease). After he moved, the Cardiovascular Epidemiology  Unit in Dundee was designated as a WHO Collaborating Centre in Cardiovascular Epidemiology and the Quality Control Centre for Event Registration for the project.

Results of the Scottish surveys, and comparison with results from elsewhere, showed that levels of known risk factors were too high, precipitating the launch of national coronary prevention campaigns in Scotland in the 1990s. He produced the Dundee Coronary Risk-Disk in 1991 adopted widely in general practice and winning a national prize for invention.  He found in Glasgow that men and women died equally frequently if they had a heart attack, but the men died more rapidly outside hospital, and more women died after arrival. He led the authorship of key papers from the WHO MONICA Project in Circulation and the Lancet and designed, edited and half-wrote a 250-page illustrated monograph on the study, published in Geneva in 2003.

In 2006, with his colleague Mark Woodward and the Scottish Intercollegiate Guidelines Network (SIGN), he produced a cardiovascular risk score, called ASSIGN, based on the SHHEC study which incorporated social deprivation and family history as risk factors along with the traditional ones.  It has been the Scottish national standard score for assessing cardiovascular risk for the ten years since then. He is now semi-retired but recent work has been on international trends in blood pressure, vitamin D, and the different risk factors for coronary heart disease and peripheral arterial disease.

Other interests over the decades have been a national survey of cardiopulmonary resuscitation and writing short humorous articles for medical journals.

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 has come among others from the Scottish Chief Scientist Organization, the British Heart Foundation, the Medical Research Council (London) and the European Commission.

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.  Vitamin D does not appear to be a significant risk factor in individuals once other factors have been allowed for, debunking many popular claims about vitamin D, but only 10 citations so far.
  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. 340 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. 95 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. 221 citations.
  5. Tunstall-Pedoe H, Vanuzzo D, Hobbs M, Mähönen M, Cepaitis Z, Kuulasmaa  K, Keil U, for the WHO MONICA Project. Estimation of contribution of changes in coronary care to improving survival, event rates, and coronary heart disease mortality across the WHO MONICA Project populations.  Lancet 2000 Feb 26; 355(9205):688-700.
    • Populations that adopted all the new evidence-based treatments for before, during, and after heart attacks, experienced big improvements in death rates, and even event rates, compared with others. These findings were almost too good to be true, but not as definitive in terms of causation as randomized controlled trials. It was an ‘ecological analysis’ of whole populations–not randomized individuals. 573 citations.