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

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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.

Sign up here to get The Results Are In with Dr. Sanjay Gupta every Tuesday from the CNN Health team.

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

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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.”

Glad to be grey: older people are happiest

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Apr 272018
 

Those ages 65 and over represent 18 per cent of the population in Britain

Britain’s pensioners are happier, have a greater sense of self-worth and are less anxious than all other age groups.

The annual wellbeing survey from the Office for National Statistics (ONS) confirmed the cliché about contentment rising with age but also found that pensioners were the least satisfied of all age groups with their health.

The ONS started measuring wellbeing and quality of life eight years ago to answer the question: “How are we doing?” The survey-based approach went beyond traditional economic measures to gauge “a fuller picture of UK progress”, Rhian Jones, an ONS statistician, said.

The ONS estimates that there are 11.8 million UK residents aged over 65, representing 18 per cent of the population. Twenty-five years ago, this age group accounted for 15.6 per cent of the population: in 25 years’ time, it is projected to rise to a quarter.

“Contrary to a commonly held belief that ageing involves loss and increasing burden, those aged 65 and over are currently faring better on many measures of social and financial well-being than their younger counterparts,” the ONS said.

Life appears to be becoming more challenging for the young, even without factoring in the high cost of rent and housing. One in five people aged between 16 and 34 exhibits signs of depression, anxiety or other signs of mental ill health, compared with 12.5 per cent of those aged 65 to 74 and 15 per cent of those aged over 75.

“[The young] are less likely to feel they have someone to rely on or a sense of belonging and also have higher rates of unemployment and more frequently report loneliness,” the ONS said. “This matters both at an individual level and for society in terms of how well we will be able to sustain high levels of national well-being into the future.”

Those aged over 75 who are still working report the greatest level of job satisfaction, at 87 per cent. By comparison, for those in the three age groupings between 16 and 44, job satisfaction is consistent at just below 55 per cent.

Youth has its advantages, however. As might be expected, the younger cohorts surveyed are happier about their health. Post-millennials, or Generation Z, also enjoy their leisure time more than those aged 25 to 54, who were “less likely to report that they were satisfied with the amount of their leisure time than any other age group, probably due to work and family commitments”, the ONS said.

Those in the youngest cohort are also relatively happy with their income levels, possibly because many are still living at home.

“Those aged 16 to 24 were significantly more likely to say that they were mostly or completely satisfied with their household income than those aged 25 to 54,” the survey found. Pensioners were happiest of all in this regard.

The survey found that 19.1 per cent of the working-age public have given up their time to volunteer, which “can contribute both to the well-being of others as well as ourselves”, the ONS said.


Published in The Times

 Posted by at 6:57 pm

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

Local volunteers with IT know-how are transforming people’s lives

 News  Comments Off on Local volunteers with IT know-how are transforming people’s lives
Mar 292018
 

The Dorset branch of a national volunteering programme that helps disabled and older people with their computer problems is supporting people in the local area with their IT needs.

AbilityNet helps disabled and older people use computers and the internet, whatever their disability. Access to the internet can be hugely empowering, especially if they have limited mobility or lack the resources to get out and about as much as they would like.

AbilityNet offers a free helpline and its website offers lots of free advice and information. One of its free services is ITCanHelp, a national network of Disclosure-checked volunteers who can visit disabled and older people in their homes and diagnose and fix most computer related problems. This may include installing and setting up hardware, software, internet and email, as well as changing settings to make equipment more user-friendly.

The Dorset ITCanHelp County Co-ordinator for the Region says that many people want to use computers and the internet but don’t know where to start. “10.5 million adults don’t have basic digital skills and a large proportion of disabled and older people have never have been online and are therefore excluded from many activities we all take for granted.”

For the past two decades, ITCanHelp’s 250 volunteers have been providing disabled and older people nationwide with the vital IT support they need. During 2017 the service made over 1500 free visits to disabled and older people across the country.

ITCanHelp are always looking for new volunteers to join the team, if you have good IT skills and would like to spend a few hours a month helping people with their IT issues, or bringing them into the digital age, this is a fantastic and very rewarding way to do it. In return you gain access to the latest IT training and info as well as the opportunity to network with other IT professionals and all your travel expenses are paid for.

If you could benefit from the service or are interested in joining the volunteering team please call 0800 269 545 email enquiries@abilitynet.org.uk or visit www.abilitynet.org.uk.

Notes – about ITCanHelp

AbilityNet is a registered charity. AbilityNet has over 20 years’ experience enabling people with disabilities to access technology and the internet at home, at work and in education. AbilityNet has worked with clients in the private, public and voluntary sector including all major Departments of State and many FTSE top 100 indexed companies.

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

PHSG has new banners

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Feb 282018
 

PHSG were pleased to receive two new banners that we will use to publicise our work, especially when we talk to new patients at Poole Hospital. Quadrant2Design were terrific and produced and designed them free of charge under their policy of supporting local charities.

The Quadrant2Design website is at https://www.prestige-system.com/

PHSG Chairman Keith Matthews and Committee Member Dave Evans receive the new banners from Quadrant2Design

 Posted by at 2:07 pm

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

Blood-thinning drugs may reduce dementia risk in people with irregular heartbeats

 Medical, News  Comments Off on Blood-thinning drugs may reduce dementia risk in people with irregular heartbeats
Oct 302017
 

“Common blood thinning drugs halve the risk of dementia for patients who have an irregular heartbeat,” reports the Mail Online.

Researchers in Sweden used the country’s health registry data to assess whether people with a condition called atrial fibrillation were less likely to get dementia if they took drugs like warfarin.

Atrial fibrillation (AF) is a heart condition that causes an irregular and often abnormally fast heartbeat. This can make the blood more likely to clot, which can lead to a stroke.

Most people with AF are prescribed anticoagulant drugs, which reduce the blood’s ability to clot.

Anticoagulants are often referred to as “blood-thinning drugs”, but this is technically incorrect as they don’t affect the density of blood.

People with AF are also at more risk of dementia, probably because of a build-up of tiny clots in the small blood vessels of the brain.

This study showed people with AF who were prescribed anticoagulants within a month of diagnosis had a 29% lower risk of getting dementia, compared with those not given the prescription.

But because of the type of study, the researchers can’t prove that anticoagulants are the reason for the reduced risk.

Still, as the researchers point out, the possible reduction in dementia risk is another reason to keep taking anticoagulant drugs if you’re prescribed them.

You shouldn’t take anticoagulants if you’re not at risk of blood clots as they can increase your risk of bleeding.

Where did the story come from?

The study was carried out by researchers at Danderyds University Hospital in Stockholm, Sweden.

It was published in the peer-reviewed European Heart Journal on an open access basis, making it free to read online.

Among the UK media, only the Sun pointed out that the study can’t prove cause and effect. The Sun’s headline described anticoagulant treatment as a “2p Alzheimer’s buster”, which is unfortunate – the type of dementia likely to be most affected by blood clots is not Alzheimer’s disease, but vascular dementia.

All the media used the more impressive 48% risk reduction figure from the study, which came from looking at people who took the drugs for most of the time, compared with people who never took them.

The more usual scientific standard is to use an intention to treat analysis of the figures, which gives a risk reduction of 29%.

Finally, The Guardian’s headline could have made it clearer that any reported dementia risk reduction only applied to people diagnosed with atrial fibrillation and not the population at large.

What kind of research was this?

This retrospective cohort study used data from Swedish health registries.

This type of study can help researchers spot patterns and links between factors (in this case anticoagulant drugs and dementia) but can’t prove that one thing (the drugs) causes another (the lower dementia risk).

That’s because researchers can’t rule out the effect of confounding factors that may influence the results.

What did the research involve?

Researchers looked at the records of all patients diagnosed with AF in Sweden from 2006 to 2014, excluding those who already had dementia.

They looked at who was prescribed anticoagulants within 30 days of diagnosis and who was diagnosed with dementia during an average of around 3 years of follow-up.

After adjusting for confounding factors, they calculated the risk of stroke for people with or without anticoagulant prescriptions.

The researchers used a statistical technique called propensity scoring to try to even out confounding factors of why some people did and others didn’t take anticoagulants despite all having a diagnosis of AF.

This is a suitable step to take, as compliance problems (not taking medication as instructed) are a known issue in some AF patients. They say this allowed them to make matched comparisons between the groups.

They also tested anticoagulant use with unconnected outcomes like falls, flu, diabetes and chronic obstructive pulmonary disorders (COPD).

They said that if anticoagulants were linked to any of them, this would indicate there may be an underlying confounding factor they hadn’t accounted for.

This would mean they wouldn’t be confident making any association between anticoagulants and dementia risk.

What were the basic results?

The researchers found:

  • 26,210 of the 444,106 people in the study group got dementia – a rate of 1.73 dementia cases per 100 people each year
  • people who’d started anticoagulants shortly after AF diagnosis were 29% less likely to get dementia (hazard ratio [HR] 0.71, 95% confidence interval [CI] 0.69 to 0.74)
  • there was no difference between rates of dementia when directly comparing older anticoagulants like warfarin with newer types, such as clopidogrel
  • people who had anticoagulant prescriptions 80% of the time were 48% less likely to get dementia than people who never had anticoagulant prescriptions (HR 0.52, 95% CI 0.5 to 0.55)
  • there was no association between anticoagulants and falls or flu

Anticoagulant use slightly increased the risk of diabetes and COPD, but as this association was in the opposite direction from that for dementia, the researchers remained confident in their results.

They also found that people prescribed anticoagulants were likely to be younger and healthier.

Apart from not taking anticoagulants, the factors most closely linked to chances of getting dementia were older age, Parkinson’s disease and alcohol abuse.

How did the researchers interpret the results?

The researchers said their results “strongly suggest that oral anticoagulation treatment protects against dementia in atrial fibrillation” and that “early initiation of anticoagulant treatment in patients with AF could be of value” to prevent dementia.

Conclusion

If you’ve been diagnosed with AF and prescribed anticoagulant treatments such as warfarin or clopidogrel, we already know they protect you against having a stroke. This study suggests they may also help protect you against dementia.

Cutting the risk of dementia for people who have a raised risk from AF would be an exciting step forward.

Unfortunately, we can’t tell from this study whether the protection against dementia was down to the anticoagulants because of the possible effect of unmeasured confounding factors.

Usually, we’d want to see a randomised controlled trial (RCT) to follow this study to find out if anticoagulant drugs really do have that effect.

But because people with AF are usually prescribed anticoagulants to reduce their risk of stroke, it wouldn’t be ethical to do an RCT, as it would leave people unprotected against stroke when a known preventative treatment is available.

Because of the difficulties of carrying out a proper trial, we’ll need to see more studies of the kind done here, in different populations, to see whether the results hold true.

It would be useful if future studies have clearer information about which confounding factors are being taken into account.

There are a few things we don’t know from this study.

  • The researchers were unable to differentiate between types of AF. Some people have just 1 episode of AF that doesn’t return or goes away with treatment, while others have persistent AF that happens all the time. The type of AF may affect both dementia risk and whether you’re prescribed anticoagulants.
  • We also don’t know which types of dementia people were diagnosed with. AF may be more strongly linked to vascular dementia than Alzheimer’s disease. But we don’t know for sure which type of dementia might be helped by taking anticoagulants.

You can reduce your risk of vascular dementia by avoiding conditions such as type 2 diabetes and high blood pressure, which can be triggered by smoking and obesity.

When it comes to dementia prevention, it’s often the case that what’s good for the heart is also good for the brain.


Published by the NHS on 25/10/17

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