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George Davey Smith

Other affiliations: Keele University, Western Infirmary, Health Science University  ...read more
Bio: George Davey Smith is an academic researcher from University of Bristol. The author has contributed to research in topics: Population & Mendelian randomization. The author has an hindex of 224, co-authored 2540 publications receiving 248373 citations. Previous affiliations of George Davey Smith include Keele University & Western Infirmary.


Papers
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Journal ArticleDOI
Daniel I. Swerdlow1, David Preiss2, Karoline Kuchenbaecker3, Michael V. Holmes1, Jorgen Engmann1, Tina Shah1, Reecha Sofat1, Stefan Stender4, Paul C. D. Johnson2, Robert A. Scott5, Maarten Leusink6, Niek Verweij, Stephen J. Sharp5, Yiran Guo7, Claudia Giambartolomei1, Christina Chung1, Anne Peasey1, Antoinette Amuzu8, KaWah Li7, Jutta Palmen1, Philip N. Howard1, Jackie A. Cooper1, Fotios Drenos1, Yun Li1, Gordon D.O. Lowe2, John Gallacher9, Marlene C. W. Stewart9, Ioanna Tzoulaki10, Sarah G. Buxbaum4, Daphne L. van der A4, Nita G. Forouhi5, N. Charlotte Onland-Moret4, Yvonne T. van der Schouw4, Renate B. Schnabel11, Jaroslav A. Hubacek12, Ruzena Kubinova13, Migle Baceviciene14, Abdonas Tamosiunas13, Andrzej Pajak15, Romanvan Topor-Madry15, Urszula Stepaniak15, Sofia Malyutina15, Damiano Baldassarre16, Bengt Sennblad17, Elena Tremoli16, Ulf de Faire18, Fabrizio Veglia19, Ian Ford2, J. Wouter Jukema20, Rudi G. J. Westendorp20, Gert J. de Borst4, Pim A. de Jong4, Ale Algra, Wilko Spiering, Anke H. Maitland-van der Zee6, Olaf H. Klungel6, Anthonius de Boer6, Pieter A. Doevendans, Charles B. Eaton21, Jennifer G. Robinson22, David Duggan23, John Kjekshus24, John R. Downs25, Antonio M. Gotto, Anthony C Keech, Roberto Marchioli, Gianni Tognoni26, Peter S. Sever, Neil R Poulter, David D. Waters, Terje R. Pedersen, Pierre Amarenco, Haruo Nakamura, John J.V. McMurray2, James Lewsey3, Daniel I. Chasman27, Paul M. Ridker27, Aldo P. Maggioni28, Luigi Tavazzi28, Kausik K. Ray29, Sreenivasa Rao Kondapally Seshasai29, JoAnn E. Manson27, Jackie F. Price9, Peter H. Whincup30, Richard W Morris1, Debbie A Lawlor31, George Davey Smith31, Yoav Ben-Shlomo31, Pamela J. Schreiner32, Myriam Fornage33, David S. Siscovick34, Mary Cushman35, Meena Kumari1, Nicholas J. Wareham5, W M Monique Verschuren4, Susan Redline36, Sanjay R. Patel36, John C. Whittaker32, Anders Hamsten17, Joseph A.C. Delaney37, Caroline Dale38, Tom R. Gaunt30, Andrew Wong1, Diana Kuh1, Rebecca Hardy1, Sekar Kathiresan, Berta Almoguera Castillo7, Pim van der Harst, Eric J. Brunner1, Anne Tybjærg-Hansen4, Michael Marmot1, Ronald M. Krauss39, Michael Y. Tsai26, Josef Coresh40, Ron C. Hoogeveen40, Bruce M. Psaty34, Leslie A. Lange40, Hakon Hakonarson7, Frank Dudbridge8, Steve E. Humphries1, Philippa J. Talmud1, Mika Kivimäki1, Nicholas J. Timpson31, Claudia Langenberg5, Folkert W. Asselbergs, Mikhail Voevoda15, Martin Bobak1, Hynek Pikhart1, James G. Wilson40, Alexander P. Reiner40, Brendan J. Keating7, Aroon D. Hingorani1, Naveed Sattar2 
TL;DR: The increased risk of type 2 diabetes noted with statins is at least partially explained by HMGCR inhibition.

545 citations

Journal ArticleDOI
TL;DR: In this paper, the effects of lower LDL cholesterol levels that were mediated by variants in PCSK9, HMGCR, or both on the risk of cardiovascular events and risk of diabetes were compared.
Abstract: BackgroundPharmacologic inhibitors of proprotein convertase subtilisin–kexin type 9 (PCSK9) are being evaluated in clinical trials for the treatment of cardiovascular disease. The effect of lowering low-density lipoprotein (LDL) cholesterol levels by inhibiting PCSK9 on the risk of cardiovascular events or diabetes is unknown. MethodsWe used genetic scores consisting of independently inherited variants in the genes encoding PCSK9 and 3-hydroxy-3-methylglutaryl–coenzyme A reductase (HMGCR; the target of statins) as instruments to randomly assign 112,772 participants from 14 studies, with 14,120 cardiovascular events and 10,635 cases of diabetes, to groups according to the number of LDL cholesterol–lowering alleles that they had inherited. We compared the effects of lower LDL cholesterol levels that were mediated by variants in PCSK9, HMGCR, or both on the risk of cardiovascular events and the risk of diabetes. ResultsVariants in PCSK9 and HMGCR were associated with nearly identical protective effects on th...

537 citations

Journal ArticleDOI
Emmanouela Repapi1, Ian Sayers2, Louise V. Wain1, Paul Burton1, Toby Johnson3, Ma'en Obeidat2, Jing Hua Zhao4, Adaikalavan Ramasamy5, Guangju Zhai6, Veronique Vitart7, Jennifer E. Huffman7, Wilmar Igl8, E Albrecht, Panagiotis Deloukas9, John Henderson10, Raquel Granell10, Wendy L. McArdle10, Alicja R. Rudnicka11, Inês Barroso9, Loos Rjf.4, Nicholas J. Wareham4, Linda Mustelin12, Taina Rantanen13, Ida Surakka12, Ida Surakka14, Medea Imboden15, H E Wichmann16, Ivica Grković16, Stipan Janković16, Lina Zgaga17, Hartikainen A-L.12, Hartikainen A-L.14, Hartikainen A-L.9, Leena Peltonen12, Leena Peltonen14, Leena Peltonen9, Ulf Gyllensten8, Åsa Johansson8, Ghazal Zaboli8, Harry Campbell18, Sarah H. Wild18, James F. Wilson18, Sven Gläser19, Georg Homuth19, Henry Völzke19, Massimo Mangino6, Nicole Soranzo6, Nicole Soranzo9, Tim D. Spector6, Ozren Polasek17, Igor Rudan16, Igor Rudan18, Alan F. Wright7, Markku Heliövaara14, Samuli Ripatti14, Samuli Ripatti12, Anneli Pouta14, Åsa Torinsson Naluai20, Olin A-C.20, Kjell Torén20, Mark E. Cooper21, Alan James22, Lyle J. Palmer22, Lyle J. Palmer21, Aroon D. Hingorani23, S.G. Wannamethee11, Peter H. Whincup11, George Davey Smith10, Shah Ebrahim24, Tricia M. McKeever2, Ian D. Pavord25, Andrew K. MacLeod7, Andrew D. Morris26, David J. Porteous7, Cyrus Cooper27, Cyrus Cooper28, Elaine M. Dennison27, Seif O. Shaheen14, Stefan Karrasch, E Schnabel, Holger Schulz, H Grallert, Nabila Bouatia-Naji29, Jérôme Delplanque29, Philippe Froguel5, Philippe Froguel29, John D Blakey2, John Britton2, Richard W Morris23, John W. Holloway27, Debbie A Lawlor10, Jennie Hui30, Jennie Hui22, Fredrik Nyberg20, Fredrik Nyberg31, Jarvelin M-R.32, Catherine Jackson33, Mika Kähönen32, Jaakko Kaprio14, Jaakko Kaprio12, Nicole Probst-Hensch15, Nicole Probst-Hensch30, Beate Koch19, Caroline Hayward7, David M. Evans10, Paul Elliott5, Paul Elliott34, David P. Strachan11, Ian P. Hall2, Martin D. Tobin1 
TL;DR: Genome-wide association with forced expiratory volume in 1 s (FEV1) and the ratio of FEV1 to forced vital capacity (FVC) in the SpiroMeta consortium offers mechanistic insight into pulmonary function regulation and indicate potential targets for interventions to alleviate respiratory disease.
Abstract: Pulmonary function measures are heritable traits that predict morbidity and mortality and define chronic obstructive pulmonary disease (COPD). We tested genome-wide association with forced expiratory volume in 1 s (FEV(1)) and the ratio of FEV(1) to forced vital capacity (FVC) in the SpiroMeta consortium (n = 20,288 individuals of European ancestry). We conducted a meta-analysis of top signals with data from direct genotyping (n < or = 32,184 additional individuals) and in silico summary association data from the CHARGE Consortium (n = 21,209) and the Health 2000 survey (n < or = 883). We confirmed the reported locus at 4q31 and identified associations with FEV(1) or FEV(1)/FVC and common variants at five additional loci: 2q35 in TNS1 (P = 1.11 x 10(-12)), 4q24 in GSTCD (2.18 x 10(-23)), 5q33 in HTR4 (P = 4.29 x 10(-9)), 6p21 in AGER (P = 3.07 x 10(-15)) and 15q23 in THSD4 (P = 7.24 x 10(-15)). mRNA analyses showed expression of TNS1, GSTCD, AGER, HTR4 and THSD4 in human lung tissue. These associations offer mechanistic insight into pulmonary function regulation and indicate potential targets for interventions to alleviate respiratory disease.

535 citations

Journal ArticleDOI
TL;DR: There was some evidence that reducing saturated fats reduced the risk of myocardial infarction, but effects on all-cause mortality and cardiovascular morbidity were less clear, and there were suggestions of greater protection with greater saturated fat reduction or greater increase in polyunsaturated and monounsaturated fats.
Abstract: Background Reducing saturated fat reduces serum cholesterol, but effects on other intermediate outcomes may be less clear. Additionally, it is unclear whether the energy from saturated fats eliminated from the diet are more helpfully replaced by polyunsaturated fats, monounsaturated fats, carbohydrate or protein. Objectives To assess the effect of reducing saturated fat intake and replacing it with carbohydrate (CHO), polyunsaturated (PUFA), monounsaturated fat (MUFA) and/or protein on mortality and cardiovascular morbidity, using all available randomised clinical trials. Search methods We updated our searches of the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (Ovid) and Embase (Ovid) on 15 October 2019, and searched Clinicaltrials.gov and WHO International Clinical Trials Registry Platform (ICTRP) on 17 October 2019. Selection criteria Included trials fulfilled the following criteria: 1) randomised; 2) intention to reduce saturated fat intake OR intention to alter dietary fats and achieving a reduction in saturated fat; 3) compared with higher saturated fat intake or usual diet; 4) not multifactorial; 5) in adult humans with or without cardiovascular disease (but not acutely ill, pregnant or breastfeeding); 6) intervention duration at least 24 months; 7) mortality or cardiovascular morbidity data available. Data collection and analysis Two review authors independently assessed inclusion, extracted study data and assessed risk of bias. We performed random-effects meta-analyses, meta-regression, subgrouping, sensitivity analyses, funnel plots and GRADE assessment. Main results We included 15 randomised controlled trials (RCTs) (16 comparisons, ~59,000 participants), that used a variety of interventions from providing all food to advice on reducing saturated fat. The included long-term trials suggested that reducing dietary saturated fat reduced the risk of combined cardiovascular events by 21% (risk ratio (RR) 0.79; 95% confidence interval (CI) 0.66 to 0.93, 11 trials, 53,300 participants of whom 8% had a cardiovascular event, I² = 65%, GRADE moderate-quality evidence). Meta-regression suggested that greater reductions in saturated fat (reflected in greater reductions in serum cholesterol) resulted in greater reductions in risk of CVD events, explaining most heterogeneity between trials. The number needed to treat for an additional beneficial outcome (NNTB) was 56 in primary prevention trials, so 56 people need to reduce their saturated fat intake for ~four years for one person to avoid experiencing a CVD event. In secondary prevention trials, the NNTB was 32. Subgrouping did not suggest significant differences between replacement of saturated fat calories with polyunsaturated fat or carbohydrate, and data on replacement with monounsaturated fat and protein was very limited. We found little or no effect of reducing saturated fat on all-cause mortality (RR 0.96; 95% CI 0.90 to 1.03; 11 trials, 55,858 participants) or cardiovascular mortality (RR 0.95; 95% CI 0.80 to 1.12, 10 trials, 53,421 participants), both with GRADE moderate-quality evidence. There was little or no effect of reducing saturated fats on non-fatal myocardial infarction (RR 0.97, 95% CI 0.87 to 1.07) or CHD mortality (RR 0.97, 95% CI 0.82 to 1.16, both low-quality evidence), but effects on total (fatal or non-fatal) myocardial infarction, stroke and CHD events (fatal or non-fatal) were all unclear as the evidence was of very low quality. There was little or no effect on cancer mortality, cancer diagnoses, diabetes diagnosis, HDL cholesterol, serum triglycerides or blood pressure, and small reductions in weight, serum total cholesterol, LDL cholesterol and BMI. There was no evidence of harmful effects of reducing saturated fat intakes. Authors' conclusions The findings of this updated review suggest that reducing saturated fat intake for at least two years causes a potentially important reduction in combined cardiovascular events. Replacing the energy from saturated fat with polyunsaturated fat or carbohydrate appear to be useful strategies, while effects of replacement with monounsaturated fat are unclear. The reduction in combined cardiovascular events resulting from reducing saturated fat did not alter by study duration, sex or baseline level of cardiovascular risk, but greater reduction in saturated fat caused greater reductions in cardiovascular events.

531 citations

Journal ArticleDOI
TL;DR: It is suggested that lay epidemiology readily accommodates official messages concerning behavioural risks within the important cultural fields of luck, fate and destiny.
Abstract: This paper is concerned with the appropriateness of current attempts to prevent chronic disease through behavioural change. Based on extensive ethnographic research in South Wales, the paper suggests that, within contemporary British health culture, there exists a well developed lay epidemiology which has a significant bearing on the public plausibility of modern health promotion messages. The paper describes the notion of the coronary candidate (the ‘kind of person who gets heart trouble’) and discusses the operation of the idea in everyday life. The manner by which lay epidemiology and the population approach to health promotion construct the ‘prevention paradox’ within the social world is outlined. In conclusion it is suggested that lay epidemiology readily accommodates official messages concerning behavioural risks within the important cultural fields of luck, fate and destiny. This simultaneously constitutes a rational way of incorporating potentially troublesome information, and a potential barrier to the aims of health education.

531 citations


Cited by
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04 Sep 2003-BMJ
TL;DR: A new quantity is developed, I 2, which the authors believe gives a better measure of the consistency between trials in a meta-analysis, which is susceptible to the number of trials included in the meta- analysis.
Abstract: Cochrane Reviews have recently started including the quantity I 2 to help readers assess the consistency of the results of studies in meta-analyses. What does this new quantity mean, and why is assessment of heterogeneity so important to clinical practice? Systematic reviews and meta-analyses can provide convincing and reliable evidence relevant to many aspects of medicine and health care.1 Their value is especially clear when the results of the studies they include show clinically important effects of similar magnitude. However, the conclusions are less clear when the included studies have differing results. In an attempt to establish whether studies are consistent, reports of meta-analyses commonly present a statistical test of heterogeneity. The test seeks to determine whether there are genuine differences underlying the results of the studies (heterogeneity), or whether the variation in findings is compatible with chance alone (homogeneity). However, the test is susceptible to the number of trials included in the meta-analysis. We have developed a new quantity, I 2, which we believe gives a better measure of the consistency between trials in a meta-analysis. Assessment of the consistency of effects across studies is an essential part of meta-analysis. Unless we know how consistent the results of studies are, we cannot determine the generalisability of the findings of the meta-analysis. Indeed, several hierarchical systems for grading evidence state that the results of studies must be consistent or homogeneous to obtain the highest grading.2–4 Tests for heterogeneity are commonly used to decide on methods for combining studies and for concluding consistency or inconsistency of findings.5 6 But what does the test achieve in practice, and how should the resulting P values be interpreted? A test for heterogeneity examines the null hypothesis that all studies are evaluating the same effect. The usual test statistic …

45,105 citations

Journal ArticleDOI
13 Sep 1997-BMJ
TL;DR: Funnel plots, plots of the trials' effect estimates against sample size, are skewed and asymmetrical in the presence of publication bias and other biases Funnel plot asymmetry, measured by regression analysis, predicts discordance of results when meta-analyses are compared with single large trials.
Abstract: Objective: Funnel plots (plots of effect estimates against sample size) may be useful to detect bias in meta-analyses that were later contradicted by large trials. We examined whether a simple test of asymmetry of funnel plots predicts discordance of results when meta-analyses are compared to large trials, and we assessed the prevalence of bias in published meta-analyses. Design: Medline search to identify pairs consisting of a meta-analysis and a single large trial (concordance of results was assumed if effects were in the same direction and the meta-analytic estimate was within 30% of the trial); analysis of funnel plots from 37 meta-analyses identified from a hand search of four leading general medicine journals 1993-6 and 38 meta-analyses from the second 1996 issue of the Cochrane Database of Systematic Reviews . Main outcome measure: Degree of funnel plot asymmetry as measured by the intercept from regression of standard normal deviates against precision. Results: In the eight pairs of meta-analysis and large trial that were identified (five from cardiovascular medicine, one from diabetic medicine, one from geriatric medicine, one from perinatal medicine) there were four concordant and four discordant pairs. In all cases discordance was due to meta-analyses showing larger effects. Funnel plot asymmetry was present in three out of four discordant pairs but in none of concordant pairs. In 14 (38%) journal meta-analyses and 5 (13%) Cochrane reviews, funnel plot asymmetry indicated that there was bias. Conclusions: A simple analysis of funnel plots provides a useful test for the likely presence of bias in meta-analyses, but as the capacity to detect bias will be limited when meta-analyses are based on a limited number of small trials the results from such analyses should be treated with considerable caution. Key messages Systematic reviews of randomised trials are the best strategy for appraising evidence; however, the findings of some meta-analyses were later contradicted by large trials Funnel plots, plots of the trials9 effect estimates against sample size, are skewed and asymmetrical in the presence of publication bias and other biases Funnel plot asymmetry, measured by regression analysis, predicts discordance of results when meta-analyses are compared with single large trials Funnel plot asymmetry was found in 38% of meta-analyses published in leading general medicine journals and in 13% of reviews from the Cochrane Database of Systematic Reviews Critical examination of systematic reviews for publication and related biases should be considered a routine procedure

37,989 citations

Journal ArticleDOI
TL;DR: In this review the usual methods applied in systematic reviews and meta-analyses are outlined, and the most common procedures for combining studies with binary outcomes are described, illustrating how they can be done using Stata commands.

31,656 citations

Journal ArticleDOI
TL;DR: An Explanation and Elaboration of the PRISMA Statement is presented and updated guidelines for the reporting of systematic reviews and meta-analyses are presented.
Abstract: Systematic reviews and meta-analyses are essential to summarize evidence relating to efficacy and safety of health care interventions accurately and reliably. The clarity and transparency of these reports, however, is not optimal. Poor reporting of systematic reviews diminishes their value to clinicians, policy makers, and other users. Since the development of the QUOROM (QUality Of Reporting Of Meta-analysis) Statement—a reporting guideline published in 1999—there have been several conceptual, methodological, and practical advances regarding the conduct and reporting of systematic reviews and meta-analyses. Also, reviews of published systematic reviews have found that key information about these studies is often poorly reported. Realizing these issues, an international group that included experienced authors and methodologists developed PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) as an evolution of the original QUOROM guideline for systematic reviews and meta-analyses of evaluations of health care interventions. The PRISMA Statement consists of a 27-item checklist and a four-phase flow diagram. The checklist includes items deemed essential for transparent reporting of a systematic review. In this Explanation and Elaboration document, we explain the meaning and rationale for each checklist item. For each item, we include an example of good reporting and, where possible, references to relevant empirical studies and methodological literature. The PRISMA Statement, this document, and the associated Web site (http://www.prisma-statement.org/) should be helpful resources to improve reporting of systematic reviews and meta-analyses.

25,711 citations

Journal ArticleDOI
18 Oct 2011-BMJ
TL;DR: The Cochrane Collaboration’s tool for assessing risk of bias aims to make the process clearer and more accurate.
Abstract: Flaws in the design, conduct, analysis, and reporting of randomised trials can cause the effect of an intervention to be underestimated or overestimated. The Cochrane Collaboration’s tool for assessing risk of bias aims to make the process clearer and more accurate

22,227 citations