Takeheart Health Check      

503 Readable summary of the evidence for the use of statins. http://www.eguidelines.co.uk

504 Scoring system similar to Takeheart. 11 factors considered, those in TH plus creatinine, left ventricular hypertrophy and a history of stroke. www.riskscore.org.uk

505 A population study of 28,000 women confirming that C-reactive protein is an important independent cardiovascular risk factor - more than HDL.

506 20,000 Danes. Stopping smoking reduces COPD by 40%. Merely cutting down has little effect. COPD? chronic obstructive pulmonary disease, one of the horrible end results of smoking.

507 Although a policy of informed choice may reduce the likelihood of the public health objectives of screening being achieved, it may also increase the effectiveness of interventions among people who choose tp participate and may prove at least as cost effective as current efforts.

508 Unevaluated screening inhibits consent.

509 A not altogether tongue in cheek debunking of recommended lifestyle changes in the Christmas edition of the BMJ.

512 Framingham risk estimates of CHD underestimate the risks of cerebrovascular disease in South Asians and Africans and implies a need for different thresholds for intervention. They also have an increased overall risk if hypertension is undertreated.

513 Good & short summary of the place of homocysteine and folic acid in cardiovascular disease prevention.

514 The polypill. A statin, a thiazide, a beta blocker, an ACE inhibitor, folic acid and aspirin. The polypill strategy could largely prevent heart attacks and stroke if taken by everyone aged 55 and older and everyone with existing cardiovascular disease. It would be acceptably safe and with widespread use would have a greater impact on the prevention of disease in the Western world than any other single intervention. The editor suggests that this is one of the most important papers published by the BMJ for 50 years, it may well become a collector's item.

515 Most patients forget four fifths of what they were advised as soon as they leave the clinic. This is not the case if the advice is in writing (which is what we do in Takeheart, GC).

516 This is the original paper by Doll & Bradford Hill in 1954 of the British Doctors Study into cigarette smoking. Reprinted in 2004 together with Richard Doll's paper on the same study 50 years later (RD over 90yrs old). This was the first prospective study (previous retrospective studies had ppinted to the dangers of cigarettes) and involoved questioning 40,000 British doctors about their smoking habits. These preliminary results showed a significant and steadily rising mortality from deaths due to cancer of the lung as the amount of tobacco smoked increases. They also showed a rise in deaths attributed to coronary thrombosis as the amount smoked increases.

517 50 years on from the beginning of the British Doctors Study. A substantial progressive decrease in the mortality rates among non-smokers over the past half century (due to prevention and improved treatment of disease) has been wholly outweighed, among cigarette smokers, by a progressive increase in the smoker versus non-smoker death rate ratio due to earlier and more intensive use of cigarettes. Among the men born around 1920, prolonged cigarette smoking from early adult life tripled age specific mortality rates, but cessation at age 50 halved the hazard, and cessation at age 30 avoided almost all of it.

518 A short readable account of obesity
Ten dieatary

tips:-

1. Eat a minimum of 5 portions of fruit and vegetables daily, as snacks or as part of meals
2. Boil, bake, steam or grill food - avoid any kind of frying in oil
3. Choose lean meats and trim all fat from meat before cooking
4. Change to semi- or fully skimmed milk for tea, coffee, on cereal and for making sauces
5. Avoid foods with hidden fats such as pastries and pies, and meat products such as burgers and sausages
6. Fill up in starchy foods such as potatoes, pasta, rice and bread
7. Choose tomato-based sauces for pasta instead of chesse-based or creamy ones
8. Have fruit available at all times - at home and at your place of work
9. Cut your portion sizes - use a smaller plate
10. Don't skip meals, especially breakfast. If you feel hungry, choose low-fat snacks such as fresh or dried fruit, a fruit yoghurt, or a small scone or bagel with jam

519 Obesity related diseases include diabetes, coronary heart disease and some cancers. Also breathlessness, stress incontinence, joint and back pain, infertility and depression 520 A modest loss of 10kg body weight can improve and even normalise blood glucose levels in people with type 2 diabetes.

521 Atkins diet and very-low-carbohydrate diets. The initial short term loss represents water loss. Long term weight loss no greater than that achieved by a nutritionally balanced low energy diet. No long term trials to assess the impact of ketogenic diets on, for example, kidney function.

523 The Polypill not such a good idea after all. Professor of the Epidemilolgy of Ageing at Bristol University, Shah Ebrahim.

• Only theoretical evidence for the additive effect of the components and unlikely to transcribe into clinical practice.
• Risk of serious adverse effects.
• Cost effectiveness poor.

525 Almost half of all CHD deaths (46%) can be linked to raised cholesterol, and about two thirds of adults in the UK have blood cholesterol levels higher than 5 mmol/l.

526 Data from Framingham. Dropping a stone in middle age reduces the risk of hypertension by over 30%.

528 The NHS is being broken up and dismantled. Important services are no longer provided by the NHS, what is left is being subjected to part or full privatisation. Control and ownership of health care is moving from public bodies to private companies whose profits are made at the expense of staff & patients.
Read Allyson Pollock's book about it. A jolly good read.

529 Between 1981 and 2000, primary prevention of coronary heart disease (CHD) may have saved about four times more lives than did secondary prevention in England and Wales. Using the IMPACT CHD mortality model, Unal and colleagues found reductions in three major risk factors smoking, high blood cholesterol concentration, and high blood pressure saved about 45,370 lives, with 81% in people without CHD and 19% in patients with CHD. The authors argue that the government should shift the focus of its policy from secondary prevention to primary prevention.

530 "If early clopidogrel (Plavix) therapy were to be given in hospital to 1million of the 10 million patients who have a heart attack every year, then it would, on present evidence, prevent about 5,000 deaths and 5,000 non-fatal reinfarctions and strokes. Moreover, continued treatment with clopidogrel after hospital discharge could lead to further net gains, although the benefits and hazards of more long-term therapy are still under investigation."

535 "Unless further evidence emerges that the metabolic syndrome confers a risk beyond the sum of the risk factors used in its definition, its use as a clinical predictor may be premature."

544 Passive smoking no link with myocardial infarction! Abstract

545 Are cardiovascular risk scores reliable. Two systematic reviews of primary health prevention based on the Framingham equation. Conclusion:- Not particularly reliable. Apt to underestimate or overestimate true risk depending on the population under study.

546 Many GPs and their patients suffer from anxiety and could benefit from cognitive behavioural therapy (CBT). FearFighter, the only NICE approved internet therapy for anxiety and phobia, is based on the CBT work of Professor Isaac Marks, Professor Emeritus at the Institute of Psychology, King's College, London, a world leader in the treatment of panic, anxiety and phobias.

547Legislation to cut levels of salt in processed food is necessary and justified. In a climate of scarce healthcare resources, one of the most cost effective ways to reduce the burden of cardiovascular disease is being overlooked. And yet the evidence gets stronger.

548 Age Related Macular Degeneration - Smokers with a record of 40 pack years treble their risk of developing ARMD. (Pack years = number of cigarettes per day times number of years smoked divided by 20).

549 Bladder cancer appears to be inversely related to the age at which a person starts smoking.

550 Within the last 25 years the proportion of adults with obesity in the UK has grown fourfold.