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Cardiovascular Prevention and Outcomes Research

The identification, prevention and management of chronic disease risk factors and understanding impact on clinical outcomes is fundamental to improving health and well-being.

Professor Christopher Reid has developed a number of clinical tools for prediction of cardiovascular risk and outcomes from cardiac surgical interventions that have been widely adopted in the clinical setting in Australia.

Early mechanistic trials were amongst the first to show the additive effects of exercise and weight loss on blood pressure control. Major research outcomes also included a better understanding of the utility of various blood pressure measurements (ambulatory blood pressure, pule wave velocity and ankle brachial index) in the community and how well they inform risk estimation. The ongoing research interest in blood pressure control and management led to developing and planning large scale clinical outcome studies of the treatment of hypertension in the elderly.

Chris has led the establishment of a world class capability in the conduct of large scale community based clinical trials in Australia, primarily through the establishment of a nation-wide general practice research network and a clinical informatics and data management centre based at the School of Public Health and Preventive Medicine at Monash University. The general practice network was initially used for the successful conduct of the 2nd Australian National Blood Pressure Study (ANBP2) which involved over 2000 GPs across Australia. He was the Study Director for ANBP2 which randomised over 6000 patients and reported on the potential benefits of newer agents for controlling blood pressure in comparison to older agents in the treatment of hypertension in the elderly. The impact of large scale trial research such as ANBP2 has had direct influence on clinical practice and policy for the management of hypertension globally. ANBP2, published in the New England Journal of Medicine has influenced subsequent hypertension guidelines around the world.

Following on from the successful ANBP2 study, Chris has led the establishment of a state of the art Clinical Informatics and Data Management Unit at Monash University which is one of the few centres in the country with ISO27001/2 accreditation of the secure management of clinical trial and personal health information. This has provided research capacity for the group to undertake large scale cost-effective web based clinical trial management, independent of commercial providers. Furthermore, the capability for general practice based research and high quality data management and analysis in Australia has been instrumental in an ability to attract over USD$50 million in research funding for the Aspirin in Reducing Events in the Elderly (ASPREE) Study. ASPREE has utilised the methodology established through ANBP2 to recruit 19,000 participants to the trial (16,500 recruited as of May 2014). Other key clinical trial research impact includes a better understanding of the potential of poly-pill based strategies for the prevention of cardiovascular disease in the community and identification of an accelerated discharge pathway for patients attending emergency departments with chest-pain. The Combination therapy for cardiovascular risk factor management and CVD prevention is now a standard part of clinical practice. The accelerated discharge protocol has been adopted by all State hospital emergency departments in Queensland and is being trialled for similar implementation in Victoria.

Professor Christopher Reid, School of Public Health – Health Policy Management Directorate, Faculty of Health Sciences.