Not exercising worse for your health than smoking, diabetes and heart disease

 Health, News  Comments Off on Not exercising worse for your health than smoking, diabetes and heart disease
Nov 042018
 

Not exercising worse for your health than smoking, diabetes and heart disease, study reveals.

We’ve all heard exercise helps you live longer. But a new study goes one step further, finding that a sedentary lifestyle is worse for your health than smoking, diabetes and heart disease.

Dr. Wael Jaber, a cardiologist at the Cleveland Clinic and senior author of the study, called the results “extremely surprising.”

“Being unfit on a treadmill or in an exercise stress test has a worse prognosis, as far as death, than being hypertensive, being diabetic or being a current smoker,” Jaber told CNN. “We’ve never seen something as pronounced as this and as objective as this.”

Jaber said researchers must now convey the risks to the general population that “being unfit should be considered as strong of a risk factor as hypertension, diabetes and smoking — if not stronger than all of them.”

“It should be treated almost as a disease that has a prescription, which is called exercise,” he said.

Researchers retrospectively studied 122,007 patients who underwent exercise treadmill testing at Cleveland Clinic between January 1, 1991 and December 31, 2014 to measure all-cause mortality relating to the benefits of exercise and fitness. Those with the lowest exercise rate accounted for 12% of the participants.

“Cardiovascular disease and diabetes are the most expensive diseases in the United States. We spend more than $200 billion per year treating these diseases and their complications. Rather than pay huge sums for disease treatment, we should be encouraging our patients and communities to be active and exercise daily,” said Dr. Jordan Metzl, sports medicine physician at the Hospital for Special Surgery and author of the book “The Exercise Cure.”

Jaber said the other big revelation from the research is that fitness leads to longer life, with no limit to the benefit of aerobic exercise. Researchers have always been concerned that “ultra” exercisers might be at a higher risk of death, but the study found that not to be the case.

“There is no level of exercise or fitness that exposes you to risk,” he said. “We can see from the study that the ultra-fit still have lower mortality.”

“In this study, the most fit individuals did the best,” said Metzl, who was not involved in the study. “Once cleared by their physicians, patients shouldn’t be afraid of exercise intensity.”

The benefits of exercise were seen across all ages and in both men and women, “probably a little more pronounced in females,” Jaber said. “Whether you’re in your 40s or your 80s, you will benefit in the same way.”

The risks, he said, became more shocking when comparing those who don’t exercise much. “We all know that a sedentary lifestyle or being unfit has some risk. But I’m surprised they overwhelm even the risk factors as strong as smoking, diabetes or even end-stage disease.”

“People who do not perform very well on a treadmill test,” Jaber said, “have almost double the risk of people with kidney failure on dialysis.”

What made the study so unique, beyond the sheer number of people studied, he said was that researchers weren’t relying on patients self-reporting their exercise. “This is not the patients telling us what they do,” Jaber said. “This is us testing them and figuring out objectively the real measure of what they do.”

Comparing those with a sedentary lifestyle to the top exercise performers, he said, the risk associated with death is “500% higher.”

“If you compare the risk of sitting versus the highest performing on the exercise test, the risk is about three times higher than smoking,” Jaber explained.

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Comparing somebody who doesn’t exercise much to somebody who exercises regularly, he said, still showed a risk 390% higher. “There actually is no ceiling for the benefit of exercise,” he said. “”There’s no age limit that doesn’t benefit from being physically fit.”

Dr. Satjit Bhusri, a cardiologist at Lenox Hill Hospital, who was not involved in the study, said this reinforces what we know. “Sedentary, Western lifestyles have lead to a higher incidence in heart disease and this shows that it’s modifiable. It’s reversible,” he explained, adding that doctors are really good at treating patients who have had cardiovascular events but they can be prevented. “We’re meant to walk, run, exercise. It’s all about getting up and moving.”

For patients, especially those who live a sedentary lifestyle, Jaber said, “You should demand a prescription from your doctor for exercise.”

So get moving!


Published in CNN News 20/10/18

Cardiac rehab saves lives – so why do half of patients fail to show up?

 Health, Medical, News  Comments Off on Cardiac rehab saves lives – so why do half of patients fail to show up?
Aug 062018
 

The evidence shows cardiac rehabilitation reduces premature deaths and improves quality of life, yet half of patients invited still don’t attend. Siobhan Chan investigates why – and looks at what healthcare professionals can do about it.

Imagine you had a heart attack, or needed heart surgery. Imagine afterwards you were offered an intervention to reduce your risk of dying prematurely from a cardiovascular event by 26%, being readmitted to hospital unexpectedly by 18%, and experiencing another heart event. One would imagine you’d say yes.

That intervention is cardiac rehabilitation, a programme of exercise and information sessions to help heart event patients get back on their feet again. Yet, despite many clear benefits, half of all people offered it don’t turn up. More still don’t complete the course.

“Cardiac rehab saves lives,” says Professor Patrick Doherty, Director of the National Audit for Cardiac Rehabilitation (NACR). “People who complete cardiac rehab live longer and have a better quality of life.”

So why are patients not turning up?

Cardiac rehabilitation helps patients feel more confident returning to normal life after a heart event. More than a dozen Cochrane reviews, as well as clinical trials and observational studies, have shown evidence of benefit and NICE recommends that patients are referred to cardiac rehab schemes while in hospital (see: The benefits of cardiac rehabilitation).

Lack of interest is a key reason. In 2015-16, at least 39% of people did not attend cardiac rehab once they’d been discharged from hospital, according to the National Audit of Cardiac Rehabilitation Annual Statistical Report 2017. And a further 13% of patients who don’t take part in programmes signed up for cardiac rehab sessions but did not attend them.

People can think “what’s the point?”, says Cem Hilmi, 44, who had a heart attack in 2011 and now volunteers with his local cardiac rehabilitation service.

“There’s a lot going through your head and you’re not thinking positively. It’s so hard to absorb information [at that stage].

“People might be frightened and not happy with their body image, they’re not feeling positive about what they’re able to do. And for some people where health and exercise aren’t a priority, they were difficult to encourage before [their heart event], so they’ll be even harder to encourage afterwards.”

The benefits of cardiac rehabilitation

  • 26% reduced cardiovascular mortality
  • 18% reduced hospital admissions
  • 13% reduced all-cause mortality
  • Reduced risk of further events
  • Improved quality of life

Should the onus be on healthcare professionals and clinical leaders to raise patient interest to increase uptake rates?

Yes, according to Professor Doherty. “We can’t blame patients and [just concede that] they’re not interested,” he says.

“[Healthcare professionals] have to think about what we’re offering.”

What should cardiac rehab involve?

  • Health behaviour change and education
  • Lifestyle risk factor management
  • – Physical activity and exercise
  • – Diet
  • – Smoking cessation
  • Psychosocial health
  • Medical risk factor management
  • Cardioprotective therapies
  • Long term management
  • Audit and evaluation
  • Source: Dalal HM, Doherty P, Taylor RS (2015) Cardiac rehabilitation. BMJ; 351 :h5000. www.bmj.com/content/351/bmj.h5000

Adapting to local needs

One way cardiac rehab professionals have tried to encourage patients to attend is by taking into account the specific needs of local patients. NICE guidance recommends that services “reflect the diversity of the local population”.

Judith Colley is Lead Nurse for Cardiac Rehabilitation at Barts Health NHS Trust in North East London. Improving uptake can be more problematic for services based in areas with high ethnic diversity and deprivation, according to the NACR report 2017 and Judith’s personal experience.

Cardiac rehab programmes can be successful only when they’re tailored to meet local people’s needs, she says.

Judith’s team has made changes to the service as their knowledge of the local population increased. More than half of patients who start the programme are Bengali, so her team set up a Bengali language programme. They’ve also made allowances to encourage patients to come to sessions. “We’ve changed clinic times to accommodate prayer times; we’ve employed Bengali patient advocates to spread awareness of cardiac rehab; and we’ve paused some cardiac rehab programmes during Ramadan,” she says.

Simerjit Thapar, Cardiac Rehab Sister at Bradford Teaching Hospitals NHS Foundation Trust, experienced the same in her area, where many patients are from the South Asian community.

“I found the barriers to be cultural and religious beliefs, and a limited knowledge of cardiac rehabilitation,” she says, adding that many people see their health as being ‘in the hands of God’.

Judith says putting herself in her patients’ shoes and providing lots of options is the key to getting through to patients. “We have to think about how that group of people sees things,” she says. “We want people to come, so that means we have to be as flexible as possible.”

But in areas where the local population changes frequently, such as Tower Hamlets where they are based, their service has to be ready to adapt. “Lots of Italian and Spanish people are moving to the area, so we may need to change the service in future to reflect that,” she says.

Other areas in London, such as Newham, have such a broad range of ethnicities up to six interpreters will need to attend each cardiac rehabilitation session.

“It’s about knowing your population – I don’t think one size fits all,” Judith says. “The people that need to come the most are the hardest to reach.”

Reaching out to patients

Inviting patients onto programmes can also be an issue for busy healthcare professionals. In some areas cardiologists refer patients onto cardiac rehab services, but this isn’t the case everywhere.

In contrast, the cardiac rehab service at Bart’s Health isn’t based on referrals – attendance relies on cardiac rehab nurses speaking to patients directly.

Judith says: “When patients stayed in [hospital] for five days [in the past], we could arrange to see them, but nowadays people are only in for one or two days [after a heart attack], and cardiac rehab isn’t their priority at the time – recovery is.” She chairs the Pan London Cardiac Rehabilitation working group and says the picture is similar across the capital.

Healthcare professionals should recommend cardiac rehabilitation services to their patients, according to NICE, whose quality standard states that “people who are referred to rehabilitation programmes before they are discharged from hospital have better rates of uptake and adherence and improved clinical outcomes”.

Cem was not told about cardiac rehab when he was in hospital (see: “I wasn’t aware of cardiac rehab – I could have slipped through the net”), and has since spoken to other people who were similarly not informed about the programme.

“It needs to be more joined-up, so everyone hears about rehab,” he says. “I would recommend some kind of follow-up, either with a GP, another professional or another healthcare organisation like a charity,” he said. “In the first couple of weeks it all needs to sink in, so you’d probably get a bigger uptake if you gave them the information [about cardiac rehab] again at another stage.”

Additionally, if GPs and practice nurses endorsed cardiac rehab directly to their patients, it could have a big impact on the numbers attending.

People are up to nine times more likely to go to cardiac rehab if their referral comes from primary care rather than acute care, according to a recent small study. “This continuity of care may be driving greater referral and uptake,” says Professor Doherty, who is considering ways of reaching out to the GP community to encourage more referrals to cardiac rehab.


This is only part of the article from the British Heart Foundation. See the complete article here.

The five habits that can add more than a decade to your life

 Health  Comments Off on The five habits that can add more than a decade to your life
May 012018
 

People who stick to five healthy habits in adulthood can add more than a decade to their lives, according to a major study into the impact behaviour has on lifespan.

Researchers at Harvard University used lifestyle questionnaires and medical records from 123,000 volunteers to understand how much longer people lived if they followed a healthy diet, controlled their weight, took regular exercise, drank in moderation and did not smoke.

When the scientists calculated average life expectancy, they noticed a dramatic effect from the healthy habits. Compared with people who adopted none of them, men and women who adhered to all five saw their life expectancy at 50 rise from 26 to 38 years and 29 to 43 years respectively, or an extra 12 years for men and 14 for women.

“When we embarked on this study, I thought, of course, that people who adopted these habits would live longer. But the surprising thing was how huge the effect was,” said Meir Stampfer, a co-author on the study and professor of epidemiology and nutrition at the Harvard TH Chan School of Public Health.

The researchers performed the analysis in the hope of understanding why the US, which spends more on healthcare as a proportion of GDP than any other nation, ranks 31st in the world for life expectancy at birth. According to the World Health Organization, life expectancy at birth in 2015 was 76.9 and 81.6 years old for US men and women respectively. The equivalent figures for Britain are very similar at 79.4 and 83 years old.

The study, published in the journal Circulation, suggests poor lifestyle is a major factor that cuts American lives short. Only 8% of the general population followed all five healthy habits. The research focused on the US population, but Stampfer said the findings applied to the UK and much of the western world.

The five healthy habits were defined as not smoking; having a body mass index between 18.5 and 25; taking at least 30 minutes of moderate exercise a day, having no more than one 150ml glass of wine a day for women, or two for men; and having a diet rich in items such as fruit, vegetables and whole grains and low in red meat, saturated fats and sugar.

Men and women who had such healthy lives were 82% less likely to die of heart disease and 65% less likely to die of cancer compared with those with the least healthy lifestyles, over the roughly 30 years of the study.

Given that the habits of a healthy lifestyle are well known, the mystery is why we are so bad at adopting them, said Stampfer. Part of the problem is that many people struggle to give up smoking, and the continuous peddling of unhealthy food, as well as poor urban planning, which can make it hard for people to exercise, also feed in, he said.

“I do think people need to step up and take some personal responsibility, but as a society we need to make it easier for people to do that,” he said. “People can get stuck in a rut and think it’s too late to change their ways, but what we find is that when people do change their ways, we see remarkable benefits.”

How exercise in old age prevents the immune system from declining

 Cycling Group, Health, News  Comments Off on How exercise in old age prevents the immune system from declining
Mar 312018
 

Professor Norman Lazarus, aged 82, has the immune system of a 20 year old

Doing lots of exercise in older age can prevent the immune system from declining and protect people against infections, scientists say.

They followed 125 long-distance cyclists, some now in their 80s, and found they had the immune systems of 20-year-olds.

Prof Norman Lazarus, 82, of King’s College London, who took part in and co-authored the research, said: “If exercise was a pill, everyone would be taking it.

“It has wide-ranging benefits for the body, the mind, for our muscles and our immune system.”

The research was published in the journal Aging Cell.

Prof Janet Lord, director of the Institute of Inflammation and Ageing, at the University of Birmingham, and co-author of the research, said: “The immune system declines by about 2-3% a year from our 20s, which is why older people are more susceptible to infections, conditions like rheumatoid arthritis and, potentially, cancer.

“Because the cyclists have the immune system of a 20-year-old rather than a 70- or 80-year-old, it means they have added protection against all these issues.”

The researchers looked at markers in the blood for T-cells, which help the immune system respond to new infections.

These are produced in the thymus, a gland in the chest, which normally shrinks in size in adulthood.

‘Out of puff’

They found that the endurance cyclists were producing the same level of T-cells as adults in their 20s, whereas a group of inactive older adults were producing very few.

The researchers believe that being physically active in old age will help people respond better to vaccines, and so be better protected against infections such as flu.

Steve Harridge, co-author and professor of physiology at King’s College London, said: “Being sedentary goes against evolution because humans are designed to be physically active.

“You don’t need to be a competitive athlete to reap the benefits – or be an endurance cyclist – anything which gets you moving and a little bit out of puff will help.”

Prof Harridge and Prof Lazarus believe that highly physically active older people represent the perfect group in which to analyse the true effects of biological ageing.

A separate paper in Aging Cell found that the cyclists did not lose muscle mass or strength, and did not see an increase in body fat – which are usually associated with ageing.

I met a dozen of the cyclists, on a morning ride in Surrey. Despite the bitter cold, they were universally cheerful, and clearly used to riding in all weathers.

They are members of Audax, a long-distance cycling organisation that organises events ranging from 100km to 300km.

The older members – in their 80s – say they do only the “short” 100km (62-mile) rides, but this is still highly impressive.

So why do they do it?

Pam Jones, 79, told me: “I do it for my health, because it’s sociable, and because I enjoy the freedom it gives you.”

Brian Matkins, 82, said: “One of the first results I got from the medical study was I was told my body fat was comparable to that of a 19-year-old.”

Aged just 64, Jim Woods, is a comparative youngster in the group. He averages 100 miles a week on his bike, with more during the summer.

He said: “I cycle for a sense of wellbeing and to enjoy our wonderful countryside.”

Cycling 60 miles or more may not be your idea of fun, but these riders have found something that gives them pleasure, which is a key reason why they continue.


From BBC http://www.bbc.co.uk/news/health-43308729

Even healthy fast food can make you fat

 Health  Comments Off on Even healthy fast food can make you fat
Mar 182018
 

Office workers should also switch off their phones and ignore emails while eating lunch, experts say

How you eat is as important as what you eat, with slower diners far less likely to be obese than those who wolf down their food, a study suggests.

Researchers analysing data on nearly 60,000 people found that slow eaters were 42 per cent less likely to be overweight or obese than fast eaters, while those who ate at a normal speed had a 29 per cent lower risk.

Experts said that people who ate quickly did not allow time for the brain to read cues from the gut that it was no longer empty. They have suggested chewing every bite at least ten times, with a goal of 20 times. Tam Fry, of the National Obesity Forum, said: “Eating more slowly means we tend to feel satiated for longer and gives more time for the hormones to signal ‘stop eating’. In particular, workers who snatch their lunch at the desk are doing their health no favours. They should stop what they’re doing, switch off their phones and emails and preferably take a half hour away from the office altogether.”

The study by Kyushu University in Japan is based on health insurance data for 59,717 Japanese men and women who had type 2 diabetes diagnosed and had regular health check-ups between 2008 and 2013. The authors said that their findings would support “interventions aimed at reducing eating speed” to prevent obesity and lower the associated health risks.

In the UK, 63 per cent of adults are overweight and 27 per cent of those are obese. The research, published in the BMJ Open online journal, relied on patients’ own assessments of eating speed. Slow eaters tended to be healthier and have a healthier lifestyle than fast eaters. They also had slightly smaller waists.

HOW TO SLOW DOWN

Drink water

A 2013 study compared consumption of a group volunteers over two meals – one of which they were told to eat imagining they were in a rush, and the other of which they were told to imagine they had no time constraints. When they ate slowly, people drank around 12oz (350ml) of water, compared to 9oz when eating fast.

Chew your food more

Studies have shown this cuts the number of calories consumed. According to Dr Joanna Dolgoff, author of Red Light, Green Light, Eat Right!, “One of the major reasons for eating too fast is not chewing long enough. To slow down your eating, chew every bite a minimum of 10 times — but shoot for 20.”

Aim for your meal to last at least 20 minutes

It is thought the body takes around 20 minutes to register that it is full – so taking less time over your meal does not give the brain chance to read hunger cues properly.

Pick foods that take some effort to eat

A 2011 study found that people offered pistachios with shells on as a snack consumed 41 per cent fewer calories than those offered the nuts already shelled – but there was no significant difference in how they rated fullness or satisfaction.


Published in The Times

Symptoms of Heart Attack

 Health, Medical  Comments Off on Symptoms of Heart Attack
Nov 092017
 

If you suspect the symptoms of a heart attack, dial 999 immediately and ask for an ambulance.

Don’t worry if you have doubts. Paramedics would rather be called out to find an honest mistake has been made than be too late to save a person’s life.

Symptoms of a heart attack can include:

  • chest pain – a sensation of pressure, tightness or squeezing in the centre of your chest
  • pain in other parts of the body – it can feel as if the pain is travelling from your chest to your arms (usually the left arm is affected, but it can affect both arms), jaw, neck, back and abdomen
  • feeling lightheaded or dizzy
  • sweating
  • shortness of breath
  • feeling sick (nausea) or being sick (vomiting)
  • an overwhelming sense of anxiety (similar to having a panic attack)
  • coughing or wheezing

Although the chest pain is often severe, some people may only experience minor pain, similar to indigestion. In some cases, there may not be any chest pain at all, especially in women, the elderly and people with diabetes.

It’s the overall pattern of symptoms that helps to determine whether you are having a heart attack.

Waiting for the ambulance

If you suspect the symptoms of a heart attack, dial 999 immediately and ask for an ambulance.

If someone has had a heart attack, it’s important to rest while they wait for an ambulance, to avoid unnecessary strain on the heart.

If aspirin is easily available and the person who has had a heart attack isn’t allergic to it, slowly chew and then swallow an adult-sized tablet (300mg) while waiting for the ambulance.

The aspirin helps to thin the blood and restore the heart’s blood supply.

Cardiac arrest

In some cases a complication called ventricular arrhythmia can cause the heart to stop beating. This is known as sudden cardiac arrest.

Signs and symptoms suggesting a person has gone into cardiac arrest include:

  • they appear not to be breathing
  • they’re not moving
  • they don’t respond to any stimulation, such as being touched or spoken to

If you think somebody has gone into cardiac arrest and you don’t have access to an automated external defibrillator (AED), you should perform chest compressions, as this can help restart the heart.

Chest compression

To carry out a chest compression on an adult:

  1. Place the heel of your hand on the breastbone at the centre of the person’s chest. Place your other hand on top of your first hand and interlock your fingers.
  2. Using your body weight (not just your arms), press straight down by 5-6cm on their chest.
  3. Repeat this until an ambulance arrives.

Aim to do the chest compressions at a rate of 100-120 compressions a minute. You can watch a video on CPR for more information about how to perform “hands-only” CPR.

Read information about how to resuscitate a child.

Automated external defibrillator (AED)

If you have access to a device called an AED, you should use it. An AED is a safe, portable electrical device that most large organisations keep as part of their first aid equipment.

It helps to establish a regular heartbeat during a cardiac arrest by monitoring the person’s heartbeat and giving them an electric shock if necessary.

You can read more information about CPR and AEDs on the Arrhythmia Alliance website.

Angina and heart attacks

Angina is a syndrome (a collection of symptoms caused by an underlying health condition) caused when the supply of oxygen-rich blood to the heart becomes restricted.

People with angina can experience similar symptoms to a heart attack, but they usually happen during exercise and pass within a few minutes.

However, occasionally, people with angina can have a heart attack. It’s important to recognise the difference between the symptoms of angina and those of a heart attack.

The best way to do this is to remember that the symptoms of angina can be controlled with medication, unlike the symptoms of a heart attack.

If you have angina, you may have been prescribed medication that improves your symptoms within five minutes. If the first dose doesn’t work, a second dose can be taken after five minutes, and a third dose after a further five minutes.

If the pain persists, despite taking three doses of glyceryl trinitrate over 15 minutes, call 999 and ask for an ambulance.


Article published on NHS Choices

NHS England takes new measures to prevent heart disease

 Health, News  Comments Off on NHS England takes new measures to prevent heart disease
Aug 222017
 

Millions of people will be offered checks for high blood pressure, high cholesterol and atrial fibrillation at GPs surgeries and local pharmacies, as part of an NHS England drive to cut heart disease deaths.

Woman taking blood pressure and heart rate with monitor

Our Associate Medical Director has welcomed the move, saying that improved detection of these conditions will prevent countless heart attacks and strokes, and help reduce the pressure on the NHS.

Risk factors for heart disease

Cardiovascular disease (CVD) causes more than a quarter (26 per cent) of all deaths in the UK. However, some of the major risk factors for CVD are significantly underdiagnosed, including high blood pressure, high cholesterol and atrial fibrillation (AF) – a type of abnormal heart rhythm.

Nearly 30 per cent of adults in the UK have high blood pressure and it is estimated 7 million adults remain undiagnosed. Similarly, around one third of people with AF are not yet diagnosed, increasing their risk of a potentially fatal stroke. This equates to around 500,000 people across the UK.

A donut chart showing that there are 9.5 million people in the UK who have been diagnosed with high blood pressure and up to 7 million who are undiagnosed

Simple checks

The scheme, called the NHS Right-Care Cardiovascular Disease Prevention Pathway, aims to identify people with heart disease risk factors by doing simple checks at GP surgeries and pharmacies. It will also take steps to ensure that people who have previously been diagnosed with high blood pressure or high cholesterol are on the appropriate medication.

So far, the scheme has been rolled out at 84 of the 209 clinical commissioning groups (CCGs) in England, with plans to introduce it at the remaining CCGs within the next two years.

Reducing variations in care

Dr Mike Knapton, Associate Medical Director at the BHF, said: “Early detection of high blood pressure, atrial fibrillation or high cholesterol will ensure more people get the right treatments to prevent heart attacks and stroke.

“The NHS is good at doing this in some areas of the country but not all. If we can get the NHS to detect and treat atrial fibrillation, high blood pressure and high cholesterol better, we will reduce the burden of disease on individuals, their families and the NHS.

“The Right Care programme is providing the NHS with the support and resources it needs to reduce the unacceptable variations in care across the country, ultimately to improve outcomes for patients.”

Continually improving care

Our work with the NHS has been central to identifying best case practice for improving the diagnosis and treatment of cardiovascular conditions, including high blood pressure, atrial fibrillation and genetically high cholesterol.

We are now working with the NHS to run pilot schemes aimed at finding more effective ways of diagnosing high blood pressure in the community, which could help inform future guidelines issued through initiatives like NHS Rightcare to CCGs.


Published by the BHF on 14/08/17

 Posted by at 11:12 pm

There’s no such thing as ‘fat but fit’, doctors told

 There’s no such thing as ‘fat but fit’, doctors told  Health, News  Comments Off on There’s no such thing as ‘fat but fit’, doctors told
Aug 162017
 

The mantra “fat but fit” is a myth that doctors should no longer perpetuate, scientists have said.

Research involving more than 500,000 people across Europe suggests that carrying too much weight is a cardiovascular problem in its own right and doctors should recognise it as such.

Nearly two thirds of adults in Britain are overweight or obese. About a third of them show no obvious sign of ill health, such as high blood pressure or insulin resistance, leading some experts to call them “metabolically healthy”.

Adele, the singer, has previously said that she would only lose weight if it affected her health or her sex life

Advocates of the theory include the singer Adele, who said that she “would lose weight only if it affected my health or sex life, which it doesn’t”, to the UK medical regulator, which tells GPs there is no need to instruct people to diet or exercise more unless they exhibit serious warning signs.

An international team of researchers has found, however, that overweight people face a greater chance of developing coronary heart disease (CHD), which kills 73,000 people a year in Britain, more than any other condition.

The researchers tracked 366,000 women and 153,000 men between the ages of 35 and 70 in ten European countries, including the UK, for an average of just over 12 years.

During that period there were 7,637 cases of CHD. After stripping out other risk factors such as smoking, diet and exercise, the overweight but ostensibly healthy people were still 26 per cent more likely to have developed the disease than those of normal weight.

Camille Lassale, who led the study while at Imperial College London but who is now based at University College London, called on the National Institute for Health and Care Excellence (Nice) to overhaul its guidance. She said: “Regardless of the measurements of blood pressure, blood glucose or cholesterol and so on, if you have a patient who is overweight or obese it is always wise to tell them to lose weight. It’s particularly relevant here because the UK has a greater prevalence of overweight [people] and obesity than other European countries.”

The study, which is published in the European Heart Journal, also shows that even though the “fat but fit” did not necessarily meet the clinical criteria for health problems such as high cholesterol or triglycerides, they still had higher concentrations of these chemicals than people of normal weight. This led Dr Lassale and her colleagues to believe that the effects of being overweight catch up with most people eventually. “We think what happens is when you classify these people as metabolically healthy obese they are on their way to developing metabolic abnormalities,” she said.

Metin Avkiran, professor of molecular cardiology at King’s College London and associate medical director at the British Heart Foundation, which funded part of the research, said: “This study conclusively shows that being obese increases a person’s risk of developing heart disease, even if they are otherwise healthy.”

A spokesman for Nice said it regularly reviewed its guidance in the light of the latest scientific evidence.

•Only one in five GPs is familiar with the national guidelines on how much exercise people should do, according to a study in the British Journal of General Practice. The poll of 1,000 family doctors also found that only two fifths had made use of the 2011 recommendations for physical activity, which state that adults need at least 150 minutes of moderate intensity exercise a week.


Published in The Times on 15/08/17

 Posted by at 10:38 pm

Protection from stroke: How the internet can help 1.3 million UK Atrial Fibrillation patients

 Health  Comments Off on Protection from stroke: How the internet can help 1.3 million UK Atrial Fibrillation patients
Feb 032017
 

Atrial Fibrillation (also ‘AF’ or ‘AFib’) is a serious health condition that, if untreated, can have severe consequences. In the UK alone, 1.3 million are diagnosed with AF. Every 18 minutes a UK citizen suffers an AF-related stroke. Battling AF and its life-changing consequences is not only a task for medical professionals: patient behaviour greatly influences the risks associated with AF. Our infographic on Atrial Fibrillation in the UK summarises what patients need to know, what apps they can use, and what sites they should turn to for more information.

Click for full-size image

Choosing the right treatment for an AF patient is up to the cardiologist or GP. However, patients themselves can do a lot to manage their risk. This of course assumes informed patients with access to the right set of tools. To give an overview of AF as well as helpful tools and sites, we sat down together with Anticoagulation Europe and designed an infographic on Atrial Fibrillation in the UK: What is AF? How wide-spread is AF in the UK? What can you do as a patient to mitigate the risk of stroke? And what are apps for Atrial Fibrillation patients and sites building a sound understanding of the disease?

What is atrial fibrillation and why is it dangerous?

Atrial Fibrillation describes episodes of irregular heartbeat. As a consequence, the heart may not empty completely and dangerous blood clots can form. If a clot breaks loose it can travel from the heart to the brain, where it can cause a stroke. People with Atrial Fibrillation have a 5 times higher risk of having a stroke. In the UK alone each year 30,000 patients suffer from an AF-related stroke.

The causes of atrial fibrillation are not fully understood. UK data shows that men are more often affected by AF than women and that the risk increases with age. There are also a couple of conditions that often go along with or precede AF, such as Hypertension, Angina Pectoris or Diabetes. Atrial Fibrillation should be taken seriously. The good news: When discovered early, the right treatment can control your heart rate and lower your risk of stroke significantly.

I have Atrial Fibrillation. What can I do?

AF is a serious health condition and your doctor will guide you through diagnosis and treatment decisions. Regular doctor visits are important to monitor your treatment and your symptoms, such as shortness of breath, tiredness and dizzyness. However, also when you are on your own, there is a lot you can do to ensure treatment success and safeguard yourself:

Never miss a dose

With AF, you typically receive different kinds of medication: Heart rate control drugs manage your irregular heartbeat. Anticoagulants such as Warfarin, Xarelto, Eliquis or Pradaxa prevent clots from forming. So while you might feel an immediate benefit from taking your heart rate control drugs, regular intake of your anticoagulant is key for preventing stroke. The MyTherapy app (available for iOS and Android) has been clinically tested for supporting you in safely taking medications, be it Warfarin or one of the newer NOACs (‘Novel Oral Anticoagulant, e.g. Xarelto (Rivaroxaban), Eliquis (Apixaban) or Pradaxa (Dabigatran)). MyTherapy reminds you to take your meds on time. It also supports you in monitoring your measurements, such as your heart rate and weight. The built-in health report summarises your medications, measurements and symptoms so you and your doctor can oversee your health progress.

Stay fit

Exercising is a great way to improve your quality of life. Even with Atrial Fibrillation you can do moderate physical activities to keep a healthy weight and to reduce your heart rate. Apps like the ‘7 Minute Workout’ can help you finding the right exercise and staying motivated. Before you start, please consult your doctor what you can and what you cannot do. Also, make sure to slowly ramp up your level of exercise and to always watch your pulse and symptoms.

Minimise risk factors

High blood pressure, poor diet or smoking are proven risk factors for stroke. Take action and protect yourself from a stroke. Apps like ‘Lifesum’ and ‘Smoke Free’ can help you set up and reach your individual health goals.

Buildling a sound understanding of your disease is a pre-requisite for taking informed decisions regarding (un-)healthy behaviour. If you are based in the UK and need additional information about atrial fibrillation and stroke, also check out:

  • NHS Choices
  • Anticoagulation Europe
  • British Heart Foundation
  • Stroke Association
  • Thrombosis UK
  • AF Association

Article from MyTherapy on 17th January 2017

 

£5 blood test can predict risk of heart attack

 Health  Comments Off on £5 blood test can predict risk of heart attack
Jan 232017
 

A simple blood test could be used to predict which patients are at risk of heart attack up to 15 years later and determine those who would benefit from statins, according to research.

About seven million people take statins to reduce the risk of cardiovascular disease, yet there is continuing scientific debate about their effectiveness.

The £5 test, which is currently used to diagnose heart attacks in patients arriving at A&E, has been found to predict accurately the chance of someone suffering an attack in the future.

Researchers at the University of Edinburgh and University of Glasgow claim that the highly sensitive test, which picks up on damage to the heart muscle, is a more effective way of assessing future heart disease risk than blood pressure or cholesterol.

The study of 3,000 men with high cholesterol but no history of heart disease found that changes in troponin blood levels could predict whether a person was at risk of heart attack or dying of coronary heart disease up to 15 years later.
The test measures the levels of proteins in the blood known as troponin T or troponin I, which are released when the heart muscle has been damaged, as occurs in a heart attack.

Coronary heart disease, which causes heart attacks, accounts for nearly 70,000 deaths in the UK each year. About seven million people take statins regularly to lower cholesterol and reduce the risk of cardiovascular disease, yet there is continuing scientific debate about their effectiveness.

The study, published in the Journal of the American College of Cardiology, suggested that measuring levels of troponin in the blood could determine which patients were responding to the statins used to treat them.

Researchers found that patients whose troponin levels decreased after taking statins had lower risk of heart attack later on compared with those whose troponin levels were unchanged or increased, according to the paper.

However, because the study group consisted of middle-aged men with high blood cholesterol, the researchers said that further work was needed to see if the results were the same for women or men with lower cholesterol.

Professor Nicholas Mills, senior clinical research fellow at the University of Edinburgh, who led the research, said: “Whilst blood cholesterol levels and blood pressure are important and associated with the risk of developing heart disease, troponin is a direct measure of injury to the heart. Troponin testing will help doctors to identify apparently healthy individuals who have silent heart disease so we can target preventative treatments to those who are likely to benefit most.”

Professor Sir Nilesh Samani, medical director at the British Heart Foundation, said: “Before the findings from this research can be clinically applied, the usefulness of measuring troponin findings needs to be demonstrated in a wider group of patients. If this confirms its value, the test could easily be administered by GPs during standard check-ups and could ultimately save lives.”


From The Times 20th December 2016

 Posted by at 7:30 am
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