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family history

The last couple of weeks have taught me a lot about how clinical research gets published and disseminated. On 1st February, our article, titled, “Familial History of Stroke Is Associated with Acute Coronary Syndromes in Women”, was published online by Circulation Cardiovascular Genetics prior to print. This is one of the subspeciality journals of “Circulation”, a publication aimed at scientists generally interested in cardiovascular medicine and research. Over the last few years, several of the major journals have increasingly multiplied into “sub-speciality journals”. For example, “Lancet” has spawned “Lancet Neurology”, “Lancet Infectious Diseases” and “Lancet Oncology”. Not only are the journals able to publish more specialised research that might have been rejected by the parent, general journal; they can also charge more for subscriptions, reprints and so on.

Interestingly, even as an author, I did not receive a copy of my manuscript and do not have access to the journal article, unless I pay for access or buy a reprint. So I will tell you what the gist of the research is. Basically, within the Oxford Vascular Study, a much studied cohort of 90 000 patients from the Oxfordshire general practice population, we looked at about 1000 patients with stroke and about 1000 patients with heart attacks.

Previous analyses from the same study have shown that women with stroke are twice as likely to have female relatives with stroke as male relatives with stroke. In addition, young women with heart attacks are twice as likely as young men with heart attacks to have mothers with heart attacks. Therefore, mother-to-daughter transmission seems to be important. For this reason we looked at family history of stroke in detail among patients with acute coronary syndromes (heart attacks and “unstable angina”).

Firstly, we found that family history of stroke is as common in heart attack patients as stroke patients. Secondly, women with heart attacks were twice as likely to have history of stroke in their mother as in their father. Thirdly, when we looked at the coronary arteries (which supply the heart) directly using coronary angiography, family history did not predict the location of the coronary artery disease or how severe it was. We concluded that family history of stroke needs to be studied in more detail and may well be important in better identifying women most at risk of heart attack, since women are less likely to be picked up by current risk prediction tools used by doctors. Also family history probably has its effect via influences on clotting rather than on arteries directly, given our lack of correlation with disease on angiography.

I spoke with only 1 freelance American journalist and helped write 2 press releases in the week before the article went online. On 1st February, I received an e-mail from the University that the article had been picked up by news brokering websites from Reuters to Yahoo, newspapers and TV from Canada and the Phillippines to India, South Africa and the UK tabloids. I don’t mind telling you I was surprised by all the interest! Even BBC Radio 4 contacted me to go on Woman’s Hour.

I have taken three lessons from this experience. First, a journal article will probably be read by almost nobody, primarily because it is published in a journal, and secondly because access to that journal requires money. Second, although research is published in journals, the immense speed and penetration of the global media/internet machine (based in this case on 3 interviews or press releases!) have led to the devolution of the dissemination of research findings away from journals, even though journals may be the trusted source of the original research. Third, as scientists, if we want our research to be understood by the broader public, then we need to do more than publish articles in journals, we must engage with the media and with the public. Both doctors and patients are more likely to use internet search engines than journals so we have to make sure that Google is well-informed, otherwise a great opportunity for health communication will be missed.

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