The University of Southampton
University of Southampton Institutional Repository

Cardiovascular risk factors associated with venous thromboembolism

Cardiovascular risk factors associated with venous thromboembolism
Cardiovascular risk factors associated with venous thromboembolism

Importance: It is uncertain to what extent established cardiovascular risk factors are associated with venous thromboembolism (VTE). Objective: To estimate the associations of major cardiovascular risk factors with VTE, ie, deep vein thrombosis and pulmonary embolism. Design, Setting, and Participants: This study included individual participant data mostly from essentially population-based cohort studies from the Emerging Risk Factors Collaboration (ERFC; 731728 participants; 75 cohorts; years of baseline surveys, February 1960 to June 2008; latest date of follow-up, December 2015) and the UK Biobank (421537 participants; years of baseline surveys, March 2006 to September 2010; latest date of follow-up, February 2016). Participants without cardiovascular disease at baseline were included. Data were analyzed from June 2017 to September 2018. Exposures: A panel of several established cardiovascular risk factors. Main Outcomes and Measures: Hazard ratios (HRs) per 1-SD higher usual risk factor levels (or presence/absence). Incident fatal outcomes in ERFC (VTE, 1041; coronary heart disease [CHD], 25131) and incident fatal/nonfatal outcomes in UK Biobank (VTE, 2321; CHD, 3385). Hazard ratios were adjusted for age, sex, smoking status, diabetes, and body mass index (BMI). Results: Of the 731728 participants from the ERFC, 403396 (55.1%) were female, and the mean (SD) age at the time of the survey was 51.9 (9.0) years; of the 421537 participants from the UK Biobank, 233699 (55.4%) were female, and the mean (SD) age at the time of the survey was 56.4 (8.1) years. Risk factors for VTE included older age (ERFC: HR per decade, 2.67; 95% CI, 2.45-2.91; UK Biobank: HR, 1.81; 95% CI, 1.71-1.92), current smoking (ERFC: HR, 1.38; 95% CI, 1.20-1.58; UK Biobank: HR, 1.23; 95% CI, 1.08-1.40), and BMI (ERFC: HR per 1-SD higher BMI, 1.43; 95% CI, 1.35-1.50; UK Biobank: HR, 1.37; 95% CI, 1.32-1.41). For these factors, there were similar HRs for pulmonary embolism and deep vein thrombosis in UK Biobank (except adiposity was more strongly associated with pulmonary embolism) and similar HRs for unprovoked vs provoked VTE. Apart from adiposity, these risk factors were less strongly associated with VTE than CHD. There were inconsistent associations of VTEs with diabetes and blood pressure across ERFC and UK Biobank, and there was limited ability to study lipid and inflammation markers. Conclusions and Relevance: Older age, smoking, and adiposity were consistently associated with higher VTE risk..

2380-6583
Gregson, John
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Kaptoge, Stephen
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Bolton, Thomas
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Pennells, Lisa
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Willeit, Peter
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Burgess, Stephen
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Bell, Steven
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Sweeting, Michael
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Rimm, Eric B.
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Després, Jean Pierre
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Simons, Leon
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Björkelund, Cecilia
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Notdurfter, Marlene
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Kromhout, Daan
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Price, Jackie
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Dankner, Rachel
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Cooper, Cyrus
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Giampaoli, Simona
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Deen, Jason F.
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Gómez De La Cámara, Agustín
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Kuller, Lewis H.
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Rosengren, Annika
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Svensson, Peter J.
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Nagel, Dorothea
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Crespo, Carlos J.
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Brenner, Hermann
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Albertorio-Diaz, Juan R.
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Atkins, Robert
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Brunner, Eric J.
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Shipley, Martin
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Njølstad, Inger
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Lawlor, Deborah A.
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Van Der Schouw, Yvonne T.
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Selmer, Randi Marie
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Trevisan, Maurizio
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Verschuren, W. M.Monique
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Greenland, Philip
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Wassertheil-Smoller, Sylvia
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Lowe, Gordon D.O.
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Wood, Angela M.
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Butterworth, Adam S.
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Thompson, Simon G.
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Danesh, John
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Di Angelantonio, Emanuele
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Meade, Tom
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Gregson, John
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Kaptoge, Stephen
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Bolton, Thomas
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Pennells, Lisa
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Willeit, Peter
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Burgess, Stephen
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Bell, Steven
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Sweeting, Michael
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Rimm, Eric B.
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Kabrhel, Christopher
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Zöller, Bengt
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Assmann, Gerd
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Gudnason, Vilmundur
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Folsom, Aaron R.
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Arndt, Volker
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Fletcher, Astrid
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Norman, Paul E.
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Nordestgaard, Børge G.
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Kitamura, Akihiko
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Mahmoodi, Bakhtawar K.
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Whincup, Peter H.
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Knuiman, Matthew
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Salomaa, Veikko
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Meisinger, Christa
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Koenig, Wolfgang
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Kavousi, Maryam
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Völzke, Henry
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Cooper, Jackie A.
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Ninomiya, Toshiharu
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Casiglia, Edoardo
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Rodriguez, Beatriz
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Ben-Shlomo, Yoav
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Després, Jean Pierre
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Simons, Leon
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Barrett-Connor, Elizabeth
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Björkelund, Cecilia
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Notdurfter, Marlene
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Kromhout, Daan
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Price, Jackie
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Sutherland, Susan E.
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Sundström, Johan
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Kauhanen, Jussi
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Gallacher, John
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Beulens, Joline W.J.
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Dankner, Rachel
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Cooper, Cyrus
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Giampaoli, Simona
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Deen, Jason F.
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Gómez De La Cámara, Agustín
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Kuller, Lewis H.
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Rosengren, Annika
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Svensson, Peter J.
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Nagel, Dorothea
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Crespo, Carlos J.
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Brenner, Hermann
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Albertorio-Diaz, Juan R.
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Atkins, Robert
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Brunner, Eric J.
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Shipley, Martin
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Njølstad, Inger
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Lawlor, Deborah A.
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Van Der Schouw, Yvonne T.
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Selmer, Randi Marie
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Trevisan, Maurizio
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Verschuren, W. M.Monique
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Greenland, Philip
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Wood, Angela M.
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Butterworth, Adam S.
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Thompson, Simon G.
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Danesh, John
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Di Angelantonio, Emanuele
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Meade, Tom
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Gregson, John, Kaptoge, Stephen, Bolton, Thomas, Pennells, Lisa, Willeit, Peter, Burgess, Stephen, Bell, Steven, Sweeting, Michael, Rimm, Eric B., Kabrhel, Christopher, Zöller, Bengt, Assmann, Gerd, Gudnason, Vilmundur, Folsom, Aaron R., Arndt, Volker, Fletcher, Astrid, Norman, Paul E., Nordestgaard, Børge G., Kitamura, Akihiko, Mahmoodi, Bakhtawar K., Whincup, Peter H., Knuiman, Matthew, Salomaa, Veikko, Meisinger, Christa, Koenig, Wolfgang, Kavousi, Maryam, Völzke, Henry, Cooper, Jackie A., Ninomiya, Toshiharu, Casiglia, Edoardo, Rodriguez, Beatriz, Ben-Shlomo, Yoav, Després, Jean Pierre, Simons, Leon, Barrett-Connor, Elizabeth, Björkelund, Cecilia, Notdurfter, Marlene, Kromhout, Daan, Price, Jackie, Sutherland, Susan E., Sundström, Johan, Kauhanen, Jussi, Gallacher, John, Beulens, Joline W.J., Dankner, Rachel, Cooper, Cyrus, Giampaoli, Simona, Deen, Jason F., Gómez De La Cámara, Agustín, Kuller, Lewis H., Rosengren, Annika, Svensson, Peter J., Nagel, Dorothea, Crespo, Carlos J., Brenner, Hermann, Albertorio-Diaz, Juan R., Atkins, Robert, Brunner, Eric J., Shipley, Martin, Njølstad, Inger, Lawlor, Deborah A., Van Der Schouw, Yvonne T., Selmer, Randi Marie, Trevisan, Maurizio, Verschuren, W. M.Monique, Greenland, Philip, Wassertheil-Smoller, Sylvia, Lowe, Gordon D.O., Wood, Angela M., Butterworth, Adam S., Thompson, Simon G., Danesh, John, Di Angelantonio, Emanuele and Meade, Tom (2019) Cardiovascular risk factors associated with venous thromboembolism. JAMA Cardiology. (doi:10.1001/jamacardio.2018.4537).

Record type: Article

Abstract

Importance: It is uncertain to what extent established cardiovascular risk factors are associated with venous thromboembolism (VTE). Objective: To estimate the associations of major cardiovascular risk factors with VTE, ie, deep vein thrombosis and pulmonary embolism. Design, Setting, and Participants: This study included individual participant data mostly from essentially population-based cohort studies from the Emerging Risk Factors Collaboration (ERFC; 731728 participants; 75 cohorts; years of baseline surveys, February 1960 to June 2008; latest date of follow-up, December 2015) and the UK Biobank (421537 participants; years of baseline surveys, March 2006 to September 2010; latest date of follow-up, February 2016). Participants without cardiovascular disease at baseline were included. Data were analyzed from June 2017 to September 2018. Exposures: A panel of several established cardiovascular risk factors. Main Outcomes and Measures: Hazard ratios (HRs) per 1-SD higher usual risk factor levels (or presence/absence). Incident fatal outcomes in ERFC (VTE, 1041; coronary heart disease [CHD], 25131) and incident fatal/nonfatal outcomes in UK Biobank (VTE, 2321; CHD, 3385). Hazard ratios were adjusted for age, sex, smoking status, diabetes, and body mass index (BMI). Results: Of the 731728 participants from the ERFC, 403396 (55.1%) were female, and the mean (SD) age at the time of the survey was 51.9 (9.0) years; of the 421537 participants from the UK Biobank, 233699 (55.4%) were female, and the mean (SD) age at the time of the survey was 56.4 (8.1) years. Risk factors for VTE included older age (ERFC: HR per decade, 2.67; 95% CI, 2.45-2.91; UK Biobank: HR, 1.81; 95% CI, 1.71-1.92), current smoking (ERFC: HR, 1.38; 95% CI, 1.20-1.58; UK Biobank: HR, 1.23; 95% CI, 1.08-1.40), and BMI (ERFC: HR per 1-SD higher BMI, 1.43; 95% CI, 1.35-1.50; UK Biobank: HR, 1.37; 95% CI, 1.32-1.41). For these factors, there were similar HRs for pulmonary embolism and deep vein thrombosis in UK Biobank (except adiposity was more strongly associated with pulmonary embolism) and similar HRs for unprovoked vs provoked VTE. Apart from adiposity, these risk factors were less strongly associated with VTE than CHD. There were inconsistent associations of VTEs with diabetes and blood pressure across ERFC and UK Biobank, and there was limited ability to study lipid and inflammation markers. Conclusions and Relevance: Older age, smoking, and adiposity were consistently associated with higher VTE risk..

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Accepted/In Press date: 15 November 2018
e-pub ahead of print date: 16 January 2019

Identifiers

Local EPrints ID: 427917
URI: http://eprints.soton.ac.uk/id/eprint/427917
ISSN: 2380-6583
PURE UUID: 4c150ea8-0d53-4ccf-9c91-795a1b8ee89a
ORCID for Cyrus Cooper: ORCID iD orcid.org/0000-0003-3510-0709

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Date deposited: 04 Feb 2019 17:30
Last modified: 18 Feb 2021 16:48

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Contributors

Author: John Gregson
Author: Stephen Kaptoge
Author: Thomas Bolton
Author: Lisa Pennells
Author: Peter Willeit
Author: Stephen Burgess
Author: Steven Bell
Author: Michael Sweeting
Author: Eric B. Rimm
Author: Christopher Kabrhel
Author: Bengt Zöller
Author: Gerd Assmann
Author: Vilmundur Gudnason
Author: Aaron R. Folsom
Author: Volker Arndt
Author: Astrid Fletcher
Author: Paul E. Norman
Author: Børge G. Nordestgaard
Author: Akihiko Kitamura
Author: Bakhtawar K. Mahmoodi
Author: Peter H. Whincup
Author: Matthew Knuiman
Author: Veikko Salomaa
Author: Christa Meisinger
Author: Wolfgang Koenig
Author: Maryam Kavousi
Author: Henry Völzke
Author: Jackie A. Cooper
Author: Toshiharu Ninomiya
Author: Edoardo Casiglia
Author: Beatriz Rodriguez
Author: Yoav Ben-Shlomo
Author: Jean Pierre Després
Author: Leon Simons
Author: Elizabeth Barrett-Connor
Author: Cecilia Björkelund
Author: Marlene Notdurfter
Author: Daan Kromhout
Author: Jackie Price
Author: Susan E. Sutherland
Author: Johan Sundström
Author: Jussi Kauhanen
Author: John Gallacher
Author: Joline W.J. Beulens
Author: Rachel Dankner
Author: Cyrus Cooper ORCID iD
Author: Simona Giampaoli
Author: Jason F. Deen
Author: Agustín Gómez De La Cámara
Author: Lewis H. Kuller
Author: Annika Rosengren
Author: Peter J. Svensson
Author: Dorothea Nagel
Author: Carlos J. Crespo
Author: Hermann Brenner
Author: Juan R. Albertorio-Diaz
Author: Robert Atkins
Author: Eric J. Brunner
Author: Martin Shipley
Author: Inger Njølstad
Author: Deborah A. Lawlor
Author: Yvonne T. Van Der Schouw
Author: Randi Marie Selmer
Author: Maurizio Trevisan
Author: W. M.Monique Verschuren
Author: Philip Greenland
Author: Sylvia Wassertheil-Smoller
Author: Gordon D.O. Lowe
Author: Angela M. Wood
Author: Adam S. Butterworth
Author: Simon G. Thompson
Author: John Danesh
Author: Emanuele Di Angelantonio
Author: Tom Meade

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