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Cardiovascular disease

The Million Women Study is one of the world's largest studies of cardiovascular disease in women

The Cancer Epidemiology Unit also has a strong programme of cardiovascular research

CEU researchers use large-scale data from cohorts with record linkage to hospital records and to death registries to identify diagnoses of cardiovascular diseases.  EPIC-Oxford, which includes large numbers of vegetarians and vegans, offers a unique opportunity to investigate the relationship between diet and cardiovascular disease, and is also part of EPIC-Europe, a long-term cohort study of 500,000 people. With over 100,000 cases of heart disease and 20,000 strokes identified through linked databases, the Million Women Study has become one of the world’s largest studies of cardiovascular diseases in women. 

Our researchers study the effects of known cardiovascular risk factors, as well as less-studied exposures including reproductive history, vegetarian and vegan diets, and early life and social factors. Increasingly, we are incorporating blood-based studies into this work, including genetics of heart diseases, stroke and venous thrombosis. Funding for this research has mainly been provided by the Medical Research Council as well as UK Research and Innovation.  

Heart disease

We have published a meta-analysis of the worldwide evidence on the association between unprocessed red meat intake and processed meat intake on the risk of ischaemic heart disease (Papier et al, 2021a). We also conducted an analysis in UK Biobank on meat consumption and the risk of 25 common conditions, showing that higher consumption of unprocessed red meat and processed meat was associated with higher risks of ischaemic heart disease (Papier et al, 2021b)

Using data from the Million Women Study, CEU researchers have published on cardiovascular risks in women, including known risk factors such as obesity (Canoy et al 2013, 2013), smoking (Pirie et al 2013), and physical activity (Armstrong et al 2015), as well as less well-studied reproductive factors (Canoy et al 2015, Canoy et al 2016), social factors (Floud et al 2014, 2016, 2016; Smith et al 2021) and psychological factors (Parkin et al, 2021). 

 

Using data from the EPIC-Oxford study, our work has shown that vegetarians have lower rates of heart disease than omnivores (Crowe 2013, Tong 2019). We have also conducted work on a wide range of other dietary factors in relation to heart disease using data from EPIC-Europe (Crowe 2012, Key et al 2019, Perez-Cornago et al 2021) as part of the EPIC-CVD Consortium.  We have also evaluated the EAT-Lancet Commission’s universal reference diet to promote human and environmental health within EPIC-Oxford. We showed that high adherence to the EAT-Lancet score was associated with lower risks of ischaemic heart disease and diabetes (Knuppel et al, 2019).

Stroke

Stroke can lead to conditions such as dementia, and has a large impact on a person’s quality of life.  In the Million Women Study, we have shown that there are differences in the risk factors for three types of stroke (Price et al, 2018). In EPIC-Oxford, we have shown that while fish eaters and vegetarians had lower rates of ischaemic heart disease, vegetarians had higher rates of haemorrhagic stroke (Tong et al, 2019).Other work in EPIC-Europe also showed that different dietary factors, including food groups (Tong et al, 2020) or nutrients (Tong et al, 2024), were associated with risks of different subtypes of stroke. 

Venous thrombosis

Venous thrombosis, including deep vein thrombosis (DVT) and pulmonary embolism, is a common and often serious vascular disease.  Research in the Million Women Study has shown that the risk of venous thrombosis is associated with use of hormone replacement therapy (Sweetland et al, 2012) and the use of anti-depressants (Parkin et al, 2017). Importantly, we have demonstrated that the greatly increased risks of VTE following many types of surgery lasted longer than previously thought (Sweetland et al, 2009, Parkin et al, 2012, Sweetland et al, 2013).  We continue to investigate how venous thrombosis may be related to other diseases, such as cancer.

Other RESEARCH

We investigate a range of vascular diseases in the Million Women Study, EPIC-Oxford, and other cohorts.  We have shown that having multiple cardiovascular diseases, what is known as cardiovascular multimorbidity, is common in women, with the majority of women with any specific cardiovascular subtype eventually developing at least one other (Suh et al 2023). 

CEU researchers use large-scale data from cohorts with record linkage to hospital records and to death registries to identify diagnoses of cardiovascular diseases.  EPIC-Oxford, which includes large numbers of vegetarians and vegans, offers a unique opportunity to investigate the relationship between diet and cardiovascular disease, and is also part of EPIC-Europe, a long-term cohort study of 500,000 people. With over 100,000 cases of heart disease and 20,000 strokes identified through linked databases, the Million Women Study has become one of the world’s largest studies of cardiovascular diseases in women.

Our researchers study the effects of known cardiovascular risk factors, as well as less-studied exposures including reproductive history, vegetarian and vegan diets, and early life and social factors. Increasingly, we are incorporating blood-based studies into this work, including genetics of heart diseases, stroke and venous thrombosis. Funding for this research has mainly been provided by the Medical Research Council as well as UK Research and Innovation.  

 

Our team

Selected publications

Related research themes

The Cancer Epidemiology Unit actively works to develop methodology for large-scale studies like the Million Women Study and the European Prospective Investigation into Cancer and Nutrition (EPIC). We focus in particular on epidemiological and statistical methods for three key areas: long-term epidemiological studies; data linkage and the use of e-health data for research; and the development of online questionnaires.
RESEARCH THEMES