A new risk calculator will better predict people at high risk of stroke or heart attack years before they strike and is ready for use across the UK and Europe, it has been announced.
The risk calculator, SCORE2, will be adopted by the upcoming European Guidelines on Cardiovascular Disease Prevention in Clinical Practice, and enables doctors across Europe in the next ten years with greater accuracy than ever before.
The research team behind the breakthrough say this new prediction tool will help save many more people across Europe from having a potentially deadly heart attack or stroke, ultimately saving lives.
People who are flagged as having an increased risk can be put on personalised preventative treatment, such a statins, or will receive lifestyle advice to lower their risk.
“This risk tool is much more powerful and superior than what doctors have used for decades. It will fit seamlessly into current prevention programmes with substantial real-world impact by improving the prevention of cardiovascular diseases across Europe before they strike,” says Professor Emanuele Di Angelantonio at the University of Cambridge British Heart Foundation (BHF) Centre of Research Excellence.
Around 200 investigators from across Europe were involved in the development of SCORE2, with data analysed from nearly 700,000 participants – mostly middle-aged – from 45 different studies. The tool has also been tailored for use in different European countries.
Participants had no prior history of heart and circulatory disease when they were recruited to the studies, and in the ten years they were followed up, 30,000 had a ‘cardiovascular event’ – including fatal or non-fatal heart attack or stroke.
The risk tool was then statistically ‘recalibrated’, by using regional-specific cardiovascular and risk factor data from 10.8 million people, to more accurately estimate cardiovascular risk for populations split into four European risk regions.
The tool uses known risk factors for heart and circulatory diseases such as age, sex, cholesterol levels, blood pressure and smoking.
This is a much-needed upgrade from the previous prediction tool that was developed using data before 1986 and underestimated the cardiovascular risk in some countries. The new SCORE2 risk calculator now accounts for current trends in heart and circulatory diseases, can predict both fatal and non-fatal conditions and is adaptable to countries with different levels of risk.
The researchers say that this upgrade will better estimate the cardiovascular risk amongst younger people, and will improve how treatment is tailored for older people and those in high-risk regions across Europe.
Dr Lisa Pennells, from Cambridge’s BHF Centre of Research Excellence, says: “This project was a highly collaborative effort that has brought together key experts and extensive data sources to develop improved risk prediction tools for cardiovascular disease for use across the UK and Europe.
“A key feature is that our calculators are relevant to current day rates of cardiovascular disease in different regions of Europe. Importantly, our methods allow them to be easily updated using routinely collected data in the future to ensure they stay relevant as trends in heart and circulatory diseases change.”
This study was carried out by the SCORE2 Working Group and the European Society of Cardiology Cardiovascular Risk Collaboration. It was supported by organisations including the British Heart Foundation, the Medical Research Council, National Institute for Health Research Cambridge Biomedical Research Centre and Health Data Research UK.
Robot with ‘potential to redefine neurorehab’ unveiled by Fourier
The ArmMotus™ EMU is the world’s first 3D back-drivable upper limb rehabilitation robot, setting a new benchmark for intelligent rehabilitation devices.
The robot, the latest world-leading addition to Fourier Intelligence’s portfolio, is said to have the potential to redefine human-machine interaction.
It is the first of its kind that applies the end-effector based concept into the 3D movement, bringing a new experience of robotics rehabilitation therapy.
The product – revealed during RehabWeek 2021 – revolves around a cable-driven mechanism, that combines with a four-linkage structure, which reduces the friction and inertia during the movement of the system. This design also enables the control system to respond and execute more efficiently.
Zen Koh, co-founder and Global Hub CEO of Fourier Intelligence, hailed the robot as helping to redefine the future.
“Current neurorehabilitation models primarily rely on extended hospital stays or regular therapy sessions which require close physical interactions between rehab professionals and patients,” he said.
“The ongoing COVID-19 pandemic situation has challenged this model and as a result, many neurological patients are not receiving sufficient therapy. There is an urgent need to rethink conventional neurorehabilitation therapy.
“The new ArmMotus™ EMU provides that solution. The EMU, equipped with clinical intelligence, provides personalised therapy, technology-based solutions, coaching capabilities and remote monitoring.
“The implementation of fun functional games with embedded artificial intelligence also provides clinically motivating therapy to patients as well as giving caregivers and healthcare practitioners confidence.”
The ArmMotus™ EMU, jointly built by Fourier Intelligence and the University of Melbourne Robotics Laboratory, has taken two years to bring to fruition and was led by Professor Denny Oetomo.
“The robot offers large workspace with very minimal resistance and reflected inertia of the robot on the patient. This would allow the patient to move freely”, said Prof Oetomo.
“Combined with the appropriate gravity compensation of the weight of the arm, patients with weak or little arm function, is able to carry out therapy without exertion.”
Another key person to the success of the ArmMotus™ EMU, Dr Marlena Klaic, the translational research lead at Royal Melbourne Hospital, gave further insight into why robotic rehabilitation is important.
“There’s a large and growing body of evidence suggesting that robotic devices can improve a patient’s outcome, including function, strength and ADL,” said Dr Klaic.
“This evidence is growing even more rapidly in these pandemic times as more people are exploring digital and remote prevision therapies.
“We conducted a user-based design study where we build and modify the robot based on the feedback from clinicians. Based on our results, we found that clinicians believe that robotic devices can be helpful in their practice. Patients and junior therapists are more frequently asking for robotic devices as part of their therapy session.”
Aside from exoskeleton and other one-dimension upper limb rehabilitation robots, EMU is based on terminal control and high technical content which is difficult to develop. It is China’s first breakthrough in this field.
EMU uses the industry-leading force feedback technology platform, which was independently developed by Fourier Intelligence, to simulate the force exerted by a therapist. It also provides a large 3D trajectory training space which allows rehabilitation movements to be more realistic and guides users to complete various complex rehabilitation training.
Product director of Fourier Intelligence, Daris Yang, also explained the importance of having interactive rehabilitation programmes.
“By equipping EMU with games such as table tennis, cooking, and fishing, this would simulate activities of daily living even more,” said Yang.
“The boring and repetitive training actions in traditional rehabilitation makes it boring for patients to train for a long time. Our EMU game settings have completely rewritten the rehabilitation scene.”
Brain Bank spearheads quest for CTE cure by 2040
Sportspeople are urged to play their role in making sport a safer place, as well as to follow the lead of Steve Thompson MBE in donating their brains to research
Professional sportspeople were today urged to play their role in making sport safer as a pioneering project was announced with the aim of preventing new cases of Chronic Traumatic Encephalopathy (CTE) within five years and of finding a cure by 2040.
The internationally-renowned Concussion Legacy Foundation has now come to the UK, following 14 years of research and advocacy that has led to change in sport, and support of players, around the world. Its founder, Dr Chris Nowinski, was instrumental in forcing NFL to change its protocols around head injury through his 2006 book ‘Head Games: Football’s Concussion Crisis’.
And through the creation of the Concussion Legacy Project, a new brain bank in partnership with the Jeff Astle Foundation, it hopes to gather more vital research in this area to protect future generations of sportspeople.
England Rugby World Cup winner Steve Thompson MBE announced he had become the first donor to the Project.
And Dr Nowinski called on sportspeople to take the lead in making sport a safer place for themselves, their teammates and future generations, as he bids to eradicate CTE.
Research has shown CTE develops through repeated hits to the head over a period of time, which can begin in childhood in many instances.
“This is the time for professional sports men and women to step up and join the fight to change the game, reduce the risk of CTE, change your destiny,” he told a press conference.
“Make no mistake – some of you already have CTE and every header or tackle will be making it worse. You will have teammates who will have, or will develop, CTE.
“Step forward and make a positive difference. Take advantage of this opportunity before it’s too late. It is too late for heroes like Jeff Astle and Rod Taylor, but it’s not too late for our children.”
Dr Nowinski, who is an advocate of non-contact sport until at least the age of 14, reiterated his fears for children if action is not taken now.
“We should not be giving children a preventable brain disease before they are old enough to drive, vote, or take many decisions for themselves,” he said.
“We need to stop hitting children in the head, we are giving them a life-long brain disease. The only way we know to prevent CTE is to limit the exposure to head impact and we have to do that.”
Dr Adam White was announced as executive director of the newly-created Concussion Legacy Foundation UK.
“We’ve long known about the relationship between sport and CTE, but we urgently need to better understand how CTE affects athletes and veterans, as well as their families, at every stage of their life,” said Dr White.
“We have reason for hope. CTE usually begins in a person’s teens or twenties, which means we have a lifetime to treat patients, educate people and support their families.
“We want to stop all new cases of CTE in the next five years and have a cure by 2040.”
Appeals were also made for sportspeople to donate their brains to the Concussion Legacy Project, following the brave lead of Steve Thompson.
The project builds on the lead of the VA-BU-CLF Brain Bank in Boston, which has created the world’s leading CTE research program. To date, more than 1,000 brains have been donated and 600 cases of CTE diagnosed, which comprises about 80 per cent of the world’s confirmed cases.
“I’m pledging my brain so the children of the people I love don’t have to go through what I have gone through,” said the former British Lion who was diagnosed with dementia at the age of 42.
“It’s up to my generation to pledge our brains so researchers can develop better treatments and ways to make the game safer.”
“Brain donation is the most valuable gift of all for future generations of footballers,” said Dawn Astle, daughter of Jeff Astle.
“It may be many years before this jigsaw is complete, but by adding each piece, one at a time, it is the only way we shall understand the true picture and so be able to make a better future for others.
“The Jeff Astle Foundation encourages families of athletes and veterans to donate the brain of their loved one to the Concussion Legacy Project.”
The Concussion Legacy Project will be led by Dr Gabriele DeLuca, associate professor in the Nuffield Department of Clinical Neurosciences, University of Oxford, and director of clinical neurosciences undergraduate education at Oxford Medical School.
“Brain donation will allow us to better understand the complexities of CTE so that we can develop tailored interventions and treatments to prevent its devastating consequences,” said Dr DeLuca.
In the next phase of the collaboration, Dr. DeLuca will lead clinical research efforts aimed at learning how best to treat common CTE-related symptoms, including problems with thinking and memory, mood, and sleep.
Athletes and veterans can pledge to donate their brains to CTE research at PledgeMyBrain.org.
The Concussion Legacy Foundation UK has created a 24-hour brain donation hotline for families to call and coordinate brain donations. Family members of athletes and military service members who wish to donate their loved one’s brain can contact the Concussion Legacy Project at 07534 029 223 and UK@concussionfoundation.org.
Sexual trauma ‘could lead to neurological conditions’
Traumatic experiences, including sexual violence, could be linked to dementia, stroke and other brain disorders in women, new research has indicated.
Links between such trauma and poor mental and cardiovascular health are already established – but a new study suggests they could also be linked to indicators of cerebrovascular risk that may be a precursor to neurological conditions.
To date, little research has been done to examine the relationship between traumatic experiences, including sexual assault, and indicators of small vessel disease in the brain.
But a new study from the University of Pittsburgh specifically investigated whether traumatic experiences were associated with white matter hyperintensities (WMHs), which are markers of brain small vessel disease.
WMHs can be detected decades before the onset of dementia, stroke, and other neurological risk and can serve as early markers.
Of the nearly 150 mid-life women involved in the study, 68 per cent reported having at least one trauma, with the most common trauma being sexual assault (23 per cent of the women).
After evaluating the data, researchers concluded that women with trauma exposure had greater WMH volume than women without trauma. The particular trauma significantly associated with WMH was sexual assault.
Associations between sexual assault and WMHs persisted even after adjusting for depressive or post-traumatic stress symptoms, suggesting that sexual assault may put women at greater risk for poor brain health.
“The results of this study are noteworthy in that sexual assault is an unfortunate, yet all-too-common, experience for women; national data indicates that, on average, up to a third of women have had this experience,” says Dr Rebecca Thurston from the University of Pittsburgh and lead author of the study.
“This distressing experience is not only important for women’s mental health, but also their brain health. This work is a major step toward identifying a novel risk factor for stroke and dementia among women.
“Not only do these results underscore the need for greater prevention of sexual assault, but also provide healthcare professionals with another indicator of who may be at most risk for stroke and dementia later in life.”
“Identifying early warning signs of stroke and dementia are critical to providing effective intervention,” says Dr. Stephanie Faubion, North American Menopause Society (NAMS) medical director.
“Studies like this one provide important information about the long-term effects of traumatic experiences on a woman’s overall well-being and mental health.”
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