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The Mediterranean Diet

Jan 10, 2017

We have all heard that the Mediterranean diet (that is a diet high in fruit and vegetables, fish and unrefined foods), is linked to a lower incidence of heart disease and strokes in populations. A new study published in the European Heart Journal now looks at patients with proven heart disease and assesses the impact of diet on vascular risk. In 15,000 patients form 39 different countries, the benefit of a Mediterranean-type diet was clear - for every 100 patients eating the highest proportion of healthy food, there were 3 fewer heart attacks and strokes compared to the 100 patients eating the least amount of healthy food. So even if you’ve been unlucky enough to have had an event there are still major benefits to looking after yourself.

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No need to fast before a cholesterol test

Jan 10, 2017

A recent study of more than 300,000 patients has shown that there are only very small differences in lipid levels in those that have fasted compared to those that have not. The study published in the European Heart Journal will hopefully improve compliance with testing so that those who may benefit from treatment can be identified more easily and hence reduce the number of heart attacks and strokes, still the major killer in the western world.

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Screening young athletes for cardiac disease

Jan 10, 2017

It is always shocking to hear of the sudden death a child or young adult on the sports field and one’s immediate reaction is to think that screening these participants would immediately reduce the risk. The ‘literature’ as it stands does not however support this view and that is why the US and UK bodies do not advocate national screening programmes for all those partaking in sport. The reasons for this are complex but essentially boil down to fact that the risk is very small in asymptomatic people, no screening programme could identify all the conditions that may predispose to sudden death and a lot of people would be prevented from playing sport who may never run into problems. I think a sensible approach would be for there to be better training of the public in resuscitation techniques and for there to be a greater availability of defibrillators in public places.

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Betablockers and Heart Failure

Jan 10, 2017

We have known for 20 years that beta-blockers are a good thing in heart failure - they prolong life, improve symptoms and reduce admissions to hospital. What was not known was whether they were equally effective in older patients and in women. A recent meta-analysis in this weeks BMJ (23rd April 2016) shows that they are and that the beneficial effects are very similar in these groups of patients.

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Vitamin D and Heart Disease

Jan 10, 2017

The recent ‘hype’ regarding the link between Vit D3 supplementation and heart failure was probably little more than ‘hype’ - the media have a habit of over-egging results and focusing on the positives. This was a relatively small study conducted in men with ‘heart failure’ and published in the Journal of the American College of Cardiology. The study found that supplementation with Vit D3 improved the pump function of the heart as measured with echocardiography but did not improve symptoms or the distance walked. These findings are intriguing but do not make the case for a change in routine care - I do think that we will all be measuring vitamin D levels a little more frequently though. There is also an association between Vit D levels and cardiovascular disease ie that those with low levels of the vitamin tend to have higher rates of hypertension, heart attacks and strokes. For example, those lucky enough to have one holiday a year in the sunshine over 3 decades have a lower risk of developing the above complications. We have no evidence that supplementing Vit D levels actually reduces the vascular events so the we cannot prove for certain that the link is causal. Rather than taking pills, the sensible advice seems to be that giving yourself moderate exposure to sunlight is a good thing and should be encouraged for a number of reasons!

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End of Life Planning - Advance Care Directives

Jan 10, 2017

Modern medicine has gone a long way in helping to prolong life but death, at some point, remains inevitable and this is unlikely to change for the foreseeable future. This prolongation of existence on the planet has had many many societal and personal benefits but has also resulted in an unwillingness to accept that dying is part of life and, hence, many deaths are not ‘planned’ or managed. The mantra ‘we can always do something’ has become paramount without giving thought to the fact that the ‘something’ may cause more harm and detriment to the patient. It is not easy to predict death as the terminal phase of one’s life can be a slow decline over many years but there are a number of tell-tale signs such as falls, admissions to hospital and a decline in cognitive function. It is at this point that I think discussions about end-of-life wishes should start. This is clearly important for the patient and those who will provide medical care but it is absolutely crucial for the family and loved-ones. These are difficult discussions and need to take place over time so that all involved understand each others wishes and concerns. Advance care directives provide an avenue for patients to discuss their wishes about life-sustaining treatments and are a good way to start the process and are relatively simple to enact. There is ample evidence that those that have had the ‘conversation’ have a much better end-of-life experience - a so-called ‘good death’. The positive effects this has on both patients and their families should not be underestimated. Atul Gawunde in his book ‘Being Mortal’ explores these issues in detail. It is an easy read despite the subject matter and I would highly recommend it to all those who still consider death as part of life.

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Palliative Care and Heart Failure

Jan 10, 2017

Those of you who care for loved ones or patients with chronic health needs will realise how, over time, those needs change with a huge impact on all those involved. As the ability to live independently declines and reliance on others for help with day-to-day needs increases, the negative effects on both physical and emotional well-being can be immense. Palliative care, which has until recently been largely in the preserve of cancer management, has a role to play in many of these chronic health conditions and has been very valuable for my heart failure patients. Not only does this specialist input help with symptom management, but their experience on end-of-life discussions and their access to community support can make all the difference to both patient and care-giver. As doctors we can always do something but that intervention is not always in the best interest of the patient - combining conventional treatment options and palliative care techniques seems like the best approach in this very difficult area.

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Food Labelling

Jan 10, 2017

With more than two-thirds of adults in the UK either overweight or obese, any measure to change population behaviour is welcome. The Royal Society for Public Health has called for the introduction of ‘activity equivalent’ calorie labelling. They advocate a series of symbols showing how many minutes of physical activity are required to expend the number of calories in a particular product. This has the benefit of not only making the link that one’s weight is a balance of calories in vs calories out but also may encourage more exercise which has numerous other health benefits than pure calorie expenditure. How good would that be? Apparently, food packaging is governed by EU legislation so bear this in mind when voting in June!

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Wine and Wellbeing

Jan 10, 2017

As we know, the apparent benefit of moderate wine consumption has been appreciated for millennia. A recent study from an unlikely source, the journal Alcohol and Alcoholism, found that in a random sample of Finns ‘consumption of wine with meals was associated high subjective well-being’. The authors did admit that there may be potential confounders but this finding seems again to confirm the positive benefits of wine with meals. (BMJ 2016;353:i1985)

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Hypertension

Jan 10, 2017

The recently published SPRINT trial on the treatment of patients with hypertension or high blood pressure (BP) received widespread media coverage. It made the BBC news programmes and, of course, the Daily Mail. This study took patients over the age of 50 with one other risk factor for cardiac disease and split them into two groups. The first group received ‘standard’ treatment aiming for systolic BP below 140mmHg and the other received ‘intensive therapy’ aiming for a systolic BP below 120mmHg. The headline results were that those who received intensive BP lowering had fewer event rates in terms of death, stroke and heart attacks. In order to achieve this benefit though, patients had to take three BP drugs instead of two and had more side effects from the medications. Whilst attention to BP levels is undoubtedly important and in general the lower the better, the relative risks and benefits of the available treatments are very individual. At privateheartspecialists.com we have all the expertise and access to diagnostics to help tailor your individual hypertension management.

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Antibiotics and dental treatment

May 30, 2017
For many years, cardiologists believed that giving patients antibiotics prior to dental surgery was a good thing if they were at high risk o…

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