In south Asia, the burden of cardiovascular and other chronic non-communicable diseases (NCD’s) have increased on an unprecedented scale and are expected to be much greater than any other geographical area worldwide. This calls for a better understanding of the NCD risk profile in the South Asian population, which in turn, can support the development of bespoke interventions which enable and empower people to live longer and healthier lives.  

Joint Principle Investigators 

Professor John Danesh, Professor Emanuele Di Angelantonio, and Dr Adam Butterworth  

Study Coordination 

Eleanor Farrow (Project Manager) and Valerie Rhenius (Study Coordinator)  

The BangladEsh Longitudinal Investigation of Emerging Vascular Events (BELIEVE) study 

 

In 2016, Cambridge University’s Cardiovascular Epidemiology partnered with three research centres operating across rural, urban and slum sites in Bangladesh to launch the BangladEsh Longitudinal Investigation of Emerging Vascular Events (BELIEVE) study: a large-scale prospective cohort investigation. The ongoing study, led by Cambridge University’s Professor John Danesh and Dr Emanuele Di Angelantonio, has a biological focus on:

(1) enabling genetic discovery using diverse phenotypes (particularly those related to nutrition such as iron deficiency anaemia, fat-metabolism, infection, or environment-related aspects such as air and toxic metal pollution), causal evaluation and functional genomics; 

(2) assessing reliably the roles of established and unique locally-relevant risk factors on incident NCDs such as cardiovascular, cancer, diabetes and kidney diseases (ascertained by clinical records and standardised validation); 

(3) helping study discrepant risk factor patterns unique to this population (e.g., unusually high tobacco usage, lowest average body mass index, highest physical inactivity rates) over time, in various age groups as a life-course approach; and their heritability; and 

(4) creating a well-characterised population base to set-up innovative and cost-effective behaviour modification and pharmaceutical interventions, suitable from a South-Asian context. 

Through ongoing research and collaboration, the BELIEVE study also aims to mobilise partnerships of Bangladesh and UK centres of excellence, create an NCDs research platform, and strengthen research capacity in Bangladesh. Achievements to date include the recruitment of 74,000 study participants from over 38,000 households and the collection of >56,000 blood samples; and the training of 80 Bangladeshis in cross-disciplinary population health research. 

Acknowledgement: 

The Cardiovascular Epidemiology Unit would like to acknowledge and thank The National Heart Foundation, Bangabandhu Sheikh Mujib Medical University, and the International Centre for Diarrhoeal Disease, Bangladesh, for their continued involvement and partnership in the BELIEVE Study. The Believe programme was initially supported by an £8M grant from the Research Councils-UK’s Global Challenges Research Fund programme. 

The Malaysian Acute Vascular Events RIsK (MAVERIK) study 

Coronary heart disease, with myocardial infarction (MI) as the main manifestation, is the single leading cause of death worldwide and is the leading cause of death in Malaysia. It is estimated that in Malaysia and other South-East Asian countries, nearly a quarter of MI events occur in people younger than 50, resulting in a significant loss of productive working years due to death and disability. To help understand the likely causes of accelerating rates of MI in young South-East Asians, Cambridge has taken a new initiative to establish a large-scale bioresource of early-onset MI in Malaysia. 

The Malaysian Acute Vascular Events RIsK (MAVERIK) study, in this regard, has been designed as a hospital-based case-control study of acute MI, and has recruited 5047 participants including 2500 first-onset MI patients and similar number of controls, aged <50 years from Malaysia. The study is being conducted in partnership with the Institute for Medical Research (IMR), National Heart Institute (IJN) and other leading clinical cardiology centres across Malaysia as well the Broad Institute in the US.  

The key objectives of MAVERIK are to enable: 

(i) assumption-free discovery science that leverages Malaysia’s unique history of multi-ethnicity and consanguinity through genomic studies of MI and cardiometabolic traits, with potential implications of results for downstream studies to elucidate the mechanistic basis of CHD and inform therapeutic target identification and prioritisation; 

(ii) detailed evaluation of candidate cardiovascular risk factors of specific relevance to the Malaysian population, such as indigenous forms of tobacco consumption and local dietary patterns, with potential implications of results for public health policy; 

(iii) enduring collaboration between Malaysian and UK scientists, who will jointly manage and harvest the dataset and bioresource of this distinctive and important research platform. 

The MAVERIK study was underpinned by a project grant from the UK Research Council/Newton Fund and the Malaysian Academy of Science. 

Publication  

Chowdhury R, Mohd Fairulnizal Md Noh, Rasheeqa Ismail S, et al.  Investigating Genetic and Other Determinants of First-Onset Myocardial Infarction in Malaysia: Protocol for the Malaysian Acute Vascular Events Risk Study. JMIR Res Protoc . 2022 Feb 10;11(2):e31885  doi:10.2196/31885 

The Strengthening Health systems by Improving Noncommunicable disease Epidemiology in Sri Lanka (SHINES) Study  

Non-communicable diseases (NCDs) are the leading causes of death and disability in Sri Lanka and elsewhere in South Asia. The Strengthening Health systems by Improving Noncommunicable disease Epidemiology in Sri Lanka (SHINES), in this regard, has been designed as a prospective study resource of ~10,000 community-based people from Sri Lanka. 

The SHINES study includes several inter-related components to study potential environmental, biochemical and hereditary risk factors of cardiometabolic and other NCDs in Sri Lanka and serves as a population platform for next-generation NCD prevention trials. The study is being conducted in partnership with the University of Sri Jayewardenepura.

The key objectives of the SHINES prospective cohort study are to: 

(1) assess reliably the burden of environmental and metabolic risk factors in Sri Lanka, by population subgroups (eg rural vs urban; by ethnicity) [“burden”]; 

(2) quantify any synergistic impact of these risk factors on incident NCDs [“aetiology”];  

(3) help monitor discrepant risk factor patterns unique to this population (high metabolic dysfunction; coconut oil consumption) [“monitoring trends”];  

(4) compare risk profiles between various population (eg, across other South Asians regionally; local vs. immigrant Sri Lankans through joint analyses with the existing cohorts) [“health transition”];  

(5) serve as a bioresource to determine the complex interplay between genes and environmental factors among South Asians and between different genes on disease risk [“interplay”]; 

(6) contribute in developing a “South Asian” risk score to predict future CVD risk and to compare with the established risk stratification approaches [“risk prediction”];  

(7) use this population platform to design and assess simple, scalable and cost-effective interventions that can improve NCD prevention in Sri Lanka (eg, those to reduce metabolic dysfunction in this population) [“trial platform”]; and 

(8) help enhance the general scientific and public health infrastructure and capacities in Sri Lanka [“capacity building”]. 

The initial phase of the ongoing study was funded by the Lyca-Health Initiative.