The death of diagnosis: Beyond hypertension, dyslipidaemia and diabetes

Professor Rod Jackson

Rod Jackson is a professor of epidemiology at the University of Auckland, New Zealand. He trained in medicine and completed his PhD in epidemiology at the University of Auckland and is a fellow of the New Zealand College of Public Health Medicine. He has over 35 years of research experience in cardiovascular disease epidemiology. For the past 15-20 years his research has been increasingly focused on CVD risk prediction and its application in clinical practice. He leads a ‘big-health data’ research programme that generates very large cohort studies from web-based clinical decision support systems in primary and secondary care. These cohorts are regularly linked to national health databases to generate new risk prediction equations and to monitor CVD risk management across New Zealand.

Fifty years ago, diagnoses of hypertension, dyslipidaemia and diabetes identified people at high risk of vascular disease because they were usually made in people with extreme levels of blood pressure or blood cholesterol, or in the case of diabetes, in people who already had signs or symptoms of vascular complications. However in the modern era of universal screening and changing definitions, none of these diagnoses necessarily identify people at high risk of vascular disease and so have limited clinical utility. Today, predicted risk of vascular disease is replacing these diagnoses. In New Zealand we have established large-scale cohort studies with regular linkage to multiple national health datasets to enable us to develop and regularly update a range of vascular risk prediction equations for different clinical populations. In this presentation Professor Jackson will describe the findings of these studies which challenge the relevance of binary diagnoses of hypertension, dyslipidaemia, diabetes and even coronary heart disease.