====Cardiovascular Health==== Around one in two men and one in three women suffer a cardiovascular (CV) event (such as a heart attack or stroke) sometime during life, making cardiovascular disease (CVD) a major cause of mortality and morbidity. With improvements in primary prevention and treatment of acute clinical events, other manifestations of CVD such as atrial fibrillation (abnormal heart rhythm) and heart failure are assuming increasing importance.
Questions relating to CVD were asked in [[questionnaires:1982|1982]], [[questionnaires:1989|1989]], [[questionnaires:1999|1999]], [[questionnaires:2009|2006-10]], and [[questionnaires:2015|2014-16]].
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Blood pressure

In adult life, blood pressure was measured at 36((At age 36 and 43 years, blood pressure was measured twice using a Hawksley random zero sphygmomanometer with regular (12x23 cm) upper arm cuff. A correction was made for arm circumference.
The following formulae were used to correct for arm circumference (RUAC):
SBP+(32-(1.05//(RUAC/10))), DBP+(22-(0.72//(RUAC/10))) )), 43, 53(( Blood pressure measurements at 53 and 60-64 years were conducted using the validated automated Omron HEM-705 (Omron Corp., Tokyo, Japan) digital oscillometric sphygmomanometer)), 60-64 and 69((Blood pressure measurement at 69 years was conducted using the validated automated Omron 907-HEM digital oscillometric sphygmomanometer)) years. Blood pressure at 53 and 60-64 years was measured twice, while the survey member was seated and after five minutes of rest. At age 69 it was measured three times under the same conditions.\\ \\ At each age, the final blood pressure reading was used for analysis unless it was unavailable, when a previous measure was used. This was done for both SBP and DBP.
At each interview survey members were also asked whether they had taken any prescribed medicines or tablets for high blood pressure in the last year.
Variable names for the main blood pressure measurements can be seen below.

Variable	1982	1989	1999	2009	2015
Systolic blood pressure, 1st	SBP182	SBP189	SBP991	sbp109	sbp115x
Systolic blood pressure, 2nd	SBP282	SBP289	SBP992	sbp209	sbp215x
Systolic blood pressure, 3rd					sbp315x
Systolic blood pressure, final	SBP82	SBP89	SBP99	sbp09	sbp15x
Diastolic blood pressure, 1st	DBP182	DBP189	DBP991	dbp109	dbp115x
Diastolic blood pressure, 2nd	DBP282	DBP289	DBP992	dbp209	dbp215x
Diastolic blood pressure, 3rd					dbp315x
Diastolic blood pressure, final	DBP82	DBP89	DBP99	dbp09	dbp15x

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Heart trouble

As a child, the school doctor examination recorded whether there was any irregularities in the study member's heart beat or murmurs at each of the four examinations conducted (in [[questionnaires:1952|1952]], [[questionnaires:1953|1953]], [[questionnaires:1957|1957]] and [[questionnaires:1961|1961]]). A record was also made if the study member had received any treatment for heart trouble in these examinations. In [[questionnaires:1957|1957]] and [[questionnaires:1961|1961]] the doctors were specifically asked if the study member showed any signs of rheumatic heart disease.
In [[questionnaires:1982|1982]] and [[questionnaires:1989|1989]], study members were asked if they or their mother or father had ever had heart trouble.
In [[questionnaires:1999|1999]], [[questionnaires:2009|2006-10]] and [[questionnaires:2015|2014-16]], the questions separated heart attacks from other heart trouble (such as coronary thrombosis, myocardial infarction, valvular disease, aortic stenosis, ischaemic heart disease, tachycardia, palpitations or heart murmur).
In [[questionnaires:1982|1982]], study members were asked if they or their mother or father had ever had a stroke.
In [[questionnaires:1989|1989]] more detailed questions about strokes were asked including the age of their first and their most recent stroke, whether they had consulted a doctor and whether they were taking any medication. In [[questionnaires:1999|1999]] this information was updated to cover the period 1989 to 1999.
Longitudinal variables have been derived to show if the study member had a 'diagnosed stroke', an undiagnosed stroke or never had a stroke.
In [[questionnaires:1999|1999]], [[questionnaires:2009|2006-10]], and [[questionnaires:2015|2014-16]], study members were asked if they had ever had a heart attack and if so how many, who had diagnosed it, as well as the age of the first and most recent heart attack. \\ \\ **Longitudinal variables** covering all years up to 2016 have been derived to show doctor diagnosis of the most common CV conditions over the life course to date. The conditions covered are: * Angina * High blood pressure * Diabetes (see [[diabetes|standalone topic guide]]) * Heart failure * Heart attack (MI) * Stroke \\ === Angina === The Rose Angina battery of questions was asked in [[questionnaires:1989|1989]] and [[questionnaires:1999|1999]]. There are three scales derived: stage 1, stage 2 and a combined variable.

**Stage 1 Rose Angina**

If Study member has ever had any pain or discomfort in their chest then all of the following conditions must be met:
The pain must be in the Sternum (upper and middle) or Sternum (lower), left anterior chest or the left arm;
They must get the pain when walking uphill or in a hurry but not when walking at an ordinary pace on the level;
That pain is relieved in 10 minutes or less when they stand still.

**Stage 2 Angina**

If Study member has ever had any pain or discomfort in their chest then all of the following conditions must be met:
The pain must be in the Sternum (upper and middle) or Sternum (lower), left anterior chest or the left arm;
They must get the pain when walking at an ordinary pace on the level;
That pain is relieved in 10 minutes or less when they stand still.

**Overall Rose Angina**

This is the sum of stage 1 and 2.

\\ === Diagnosed Angina ===

In [[questionnaires:1999|1999]], [[questionnaires:2009|2006-10]], and [[questionnaires:2015|2014-16]] study members were asked directly if they had been told by a doctor that they had angina. For [[questionnaires:1999|1999]] and [[questionnaires:2015|2014-16]], they were subsequently asked at what age they were diagnosed, what medication they took and how often they consulted a doctor.

Intermittent Claudication

Diagnostic Intermittent claudication questions were asked in [[questionnaires:1999|1999]], and the relevant variables derived.

Intermittent claudication is defined by

getting pain in either leg on walking combined with the leg pain not beginning when standing still or sitting
the pain being felt in the calf
the pain being present when walking uphill or in a hurry or pain being felt when walking at an ordinary pace on the level
and the pain not disappearing whilst walking
the study member stops or slows down when pain felt whilst walking,
and the pain is relieved when standing still in less than 10 minutes \\ \\ === Cardiological scans at age 60-64 === As part of the [[questionnaires:2009|2006-10]] data collection, a number of cardiological scans and other measurements were performed, including ECG, Heart Rate Variability (HRV), Pulse Wave Velocity / Analysis (PWV/PWA), ECHO and IMT. A great deal of data resulted from these investigations, so please [[skylark:search|search Skylark]] and then [[mrclha.swiftinfo@ucl.ac.uk|contact us]] if you wish to use these specialist datasets. \\

CVD Risk Factors

At 53 and 69 years, a non-fasting venous blood sample was taken and at 60-64 a fasting venous blood sample was taken, according to standardised protocols. Total cholesterol was measured by enzymatic CHOD – PAP.
Precipitation for measurement of high density lipoprotein (HDL) cholesterol was carried out using phosphotungstic Mg2+, triglycerides were measured using a glycerol/kinase POD linked reaction of glycerol liberated enzymatically from triglycerides. All of these measurements were made with a Bayer DAX-72.
Samples were analyzed for HbA1c with the Tosoh A1C 2.2 Plus Analyzer (Tosoh, Tokyo, Japan) using high performance liquid chromatography.
There are variables for Total cholesterol (mmol/l), high density lipoprotein (HDL) cholesterol (mmol/l), low density lipoprotein (LDL) cholesterol (mmol/l), triglycerides (mmol/l) and glycated haemoglobin (%).
Low density lipoprotein (LDL) cholesterol was calculated using the Friedwald formula:
LDL cholesterol (mmol/l) = total cholesterol - HDL cholesterol - 0.45 x triglycerides.
More information on the bloods can be found in [[biologicalsamplesanddna| the biological samples topic section]].

Research programme

Further information on the cardiometabolic Health research programme is available on the public LHA website.

=== Obtaining the adult cardiovascular health standard variables === * You can obtain a list of the standard topic variables to use in an NSHD data sharing request by selecting the link below.\\ \\ **Please Note** that the adult cardiovascular health standard basket only contains a few longitudinal summary variables on the most common CV conditions, as well as blood pressure readings. Adult cardiovascular health is an extremely broad subject, with data on many different conditions and symptoms, tests and scans undertaken, so you are strongly advised to investigate this subject in more detail on [[skylark:skylark|Skylark]]. \\ \\ [[http://skylark.ucl.ac.uk/Sparrow/search/html/keyword/mrepo:topics:cardiovasculardisease | HTML version of the standard variables to view]] \\ \\