Takeheart Health Check      

402 Provisional figures for Great Britain in 1996/7 indicate that 21 people died and a further 90 suffered ill-health as a result of carbon monoxide poisoning.

403 A leaflet which encourages people to maintain gas appliances in a safe condition and to have their safety checked annually. Translated into five languages.

404 Some 6,750 deaths from coronary heart disease were postponed or prevented in Scotland in 1994 by medical treatments and risk factor changes, compared with 1975. Half of these could be explained by reduced risk factors, emphasizing the importance of prevention strategies.

405* Core standards

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406 The authors estimate that after allowing for dietary confounding the excess risk of ischaemic heart disease in a non-smoker who lives with a smoker is 23%. (full text)

407* "On balance, the evidence suggests that people with light to moderate alcohol consumption have a 30% lower coronary heart disease incidence than non-drinkers. However, one should be wary of a blanket recommendation to drink in order to prevent heart disease.
First, there is no evidence that drinking when young confers protection later in life. Hence, in the young, the balance of risks and benefits is adverse.
Second, much of the benefit of alcohol on coronary heart disease is seen in people at otherwise high risk. If people have a good reason for being non-drinkers, an appropriate strategy would be to reduce the level of other risk factors.
Third, if the overall level of alcohol consumption in the population rose, so too would the burden of problems associated with alcohol."

408* "Lack of exercise is an important risk factor in cardiovascular disease." Doubts though cast on methods of published results and meta-analyses on the effects of exercise. "Not proven" seems to be the conclusion. (full text)

409 87 men monitored for 6 - 10yrs post myocardial infarction. Type "D" people (anxiety and negative feelings) 52% recurrence of myocardial infarction, 12% non type "D" individuals. Type "A" a 'hotchpotch of signs & symptoms' less reliable.

410Adrian and Paula Roberts note that large trials of primary care based health promotion to modify coronary heart disease risks have shown only modest benefits. In order to assess the cost-effectiveness of an intensive programme of coronary heart disease risk factor modification in a rural general practice in which doctors had a major input, they carried out a longitudinal study in changes of risk factors in a group of adult patients identified as having one or more major coronary heart disease risk factor. The results suggest that more intensive eforts in lifestyle modification and health promotion could produce significant additional benefit.

411 Cigarette smoking accelerates the progression of atherosclerosis. Exposure to other people's cigarette smoke also has a significant effect.

412 Those who ate fish at least once a week had a 52% reduced risk of sudden cardiac death compared to those who ate fish rarely or never. There was no effect on other types of cardiac incident.

415 Up to 1,000 deaths a year from lung cancer across Europe may be ultimately caused by cigarette smoking by the person's spouse.

416 A 'hostile' personality may prove to be a coronary heart disease risk factor. (full text)

417 Treating 'well' middle-aged men who have cholesterol levels greater or equal to 7.0 mmol/l with statins may save thousands of years of life but will cost millions of pounds.

418 The review found that a health check conducted by a practice nurse, take-home materials and a follow up check, led to a 2 to 3 percent reduction in blood cholesterol in large populations.

419 "Significant coronary artery disease remains unusual in pre-menopausal women, and following the menopause women lag approximately ten years behind their male counterparts in their prevalence of symptomatic myocardial ischaemia, except among patients with diabetes mellitus where any female advantage is eliminated."

420 Women appear to be at a 50 per cent greater risk from myocardial infarction from smoking tobacco than men.

421* "Although the questionnaire appraising coronary risk increased the percentage of people at high risk who obtained cholesterol testing, the effect was small. Most patients at risk who received the questionnaire did not respond by having a test." (full text)

422* "To provide a brief guide to consumer health information on the Internet this article highlights some authoritative consumer sites that can be used to answer a range of frequently asked questions."

423 "We now think that secondary prevention clinics should be given money under the health promotion scheme because we know that they work".
A primary care study that finds that GPs could be doing better at secondary prevention of heart disease. (full text)

424* "Decisions to screen must take account of the social and psychological costs." (full text)

425 It might be more effective to manage multiple risk factors for coronary heart disease in early life rather than a single risk factor such as hypercholesterolaemia in later life. Life style interventions should perhaps begin in the young.

426 Smokers are twice as likely as non-smokers to develop Alzheimer's disease, according to the results of a Dutch population based study.

428 Discussion of report by Professor Trevor Sheldon (430). Cholesterol screening on its own is not worthwhile. Must look into the whole range of risk factors. Cholesterol undoubtedly one of the most important risk factors. (full text)

429 Review of public smoking in Britain, US, China, Australia, Italy, France, Poland, Canada, India, Germany and Hungary.

431

• There is considerable evidence to suggest that the identification and treatment of dyslipidaemia will reduce the risk of premature coronary heart disease, ie. before the age of 65.
• Diagnosis of the cause of raised plasma lipid levels will enable appropriate decisions to be taken with regard to management.
• The bedrock of treatment is nutritional counselling and attention to the other major risk factors for coronary heart diseas, particularly smoking and hypertension.
• For a small percentage of patients with severe hyperlipidaemia drug therapy is indicated.
• Appropriate drug choices need to be made based upon the particular lipid abnormality to be treated.
• In general those patients with clinical vascular disease are treated more aggressively than those where the main aim is primary prevention.
• Aggressive therapy with drugs should be reserved for those at high risk where the benefit is likely to be greatest.

433 Professor John-Arne Skolbekken shows that subjects taking a statin can "reduce risk of having a first time heart attack by 31% and risk of death by 22%" seems less dramatic considered in terms of absolute risk reduction. The statement now reads: "reduce their (absolute) risk of first time heart attack by 1.9% and (absolute) risk of death by 0.9%". Or patients with IHD can improve probability of avoiding coronary death from 91.5% to 95% with treatment and those with IHD from 98.3% to 98.8%. (full text)

435* "There is a strong case for promoting physical activity in men and women at all ages including the elderly.
There is good evidence that regular and frequent aerobic physical activity at a moderate intensity is protective against heart attacks. It would be desirable if everyone could aim for an average of 30 minutes moderate activity on at least five days of the week, with reference to their doctor if any medical condition is present.
The presence of ischaemic heart disease is not a contra-indication."

436* "The message is clear: patients with coronary disease and high or normal serum cholesterol concentrations benefit from cholesterol lowering treatment, by a 20-40% reduction in coronary events." (full text)

437 Even small improvements in physical fitness in later life confer significant medical and psychological benefits, including a reduced risk of death. Norwegian study. 2,000 healthy men aged 40-60.

438 Revised European Guidelines on the prevention of coronary heart disease in clinical practice. Key recommendations:- optimal target BP 140/90; Total cholesterol less than or equal to 5.0mmol/l; LDL less than or equal to 3.0mmols/l.
Joint British guidelines from the British Hypertension Society, British Hyperlipdaemia Association and the British Cardiac Society. Key recommendations:- patients with raised BP, raised total cholesterol, diabetes or family history of CHD, or a combination should be considered at same risk as those with CHD or other atherosclerotic disease.
Revise British Hypertension Society guidelines. Key recommendation: target optimal BP 140/85

439 "The increasing use of statins raises important issues for general practice - the spectacular success of treatment, initially in high-risk patients (secondary prevention), then in higher risk primary prevention (WOSCOPS) and more recently in a relatively low-risk population (AFCAPS/TexCAPS), demonstrates that GPs will increasingly be treating patients with lower levels of cholesterol. This will have an enormous impact on individual practices, both in terms of clinical activity and the practice prescribing budget".

440 Lovastatin treatment reduced the risk of first acute major coronary events in patients with average total and LDL cholesterol levels and below average HDL levels. The beneficial effects of treatment were seen in men and women.

441 Brief advice from a general practitioner to give up smoking has an effect on smoking rates.

442 Facts to enhance motivation:

• Mortality is halved in retired men who walk more than two miles every day.
• Regular exercise can halve the risk of heart disease, particularly in men who walk briskly.
• Someone who is inactive has as great a risk of having heart disease as someone who smokes, has high blood pressure or has high cholesterol.
• Exercise significantly reduces the chances of type-II diabetes.
• The risk of having a stroke is three times higher in those who do little or no exercise.
• With regular exercise, blood pressure in those with hypertension is reduced by as much as 20mms Hg.
• Walking two miles a day three times a week can help reduce weight by one pound every three weeks. Regular uphill walking can reduce weight by 14 lbs in only three to four months.
• Lifelong exercise has been shown to lessen the chances of developing Alzheimer's disease.
• Regular exercise is associated with a 40% reduction in bowel cancer.

444 A long term prospective study involving more than 4,000 middle-aged and older men. Taking up and maintaining exercise reduced mortality.

445 People whose health habits are better not only live longer, but also have less disability at the end of life.

446, 447 About 750,000 Chinese people, mostly men, die from smoking each year. By the time that the young smokers of today reach middle or old age the number will have increased to 3,000,000. If current smoking patterns persist tobacco will kill 100,000,000 of the 300,000,000 males now age 0-29. China consumes a third of the world's cigarettes.

448 Waist circumference and the waist to hip ratio are independent risk factors for heart disease in women. 44,702 women aged 40-65, followed up for eight years. Those with a ratio of more than 0.76 had more than a twofold risk of CHD relative to women with lower ratios. Waist circumference of more than 30 inches was associated with a twofold increase in the risk.

449* "This simple computer program to estimate individuals' cardiovascular disease risk and display the benefits of intervention should help clinicians and patients decide on the most effective packages of risk reduction and identify those most likely to benefit from modulation of risk factors." Employers can reduce stress for their employees by redsigning the way jobs are structured.