“This review of studies is extremely comprehensive and there is no reason to believe that its conclusions do not apply to the situation in the UK” said Professor Nick Finer, honorary professor at the Department of Medicine, University College London. “It confirms what we see with our patients on a daily basis – the link between excess weight, a poor diet containing excessive sugary drinks, and cardiovascular disease. Of course the links between diet, obesity and disease are complex but especially for children, consumption of sugar-sweetened beverages is un-neccessary and exposes them to health risks.”

Professor Avijit Lahiri says: “We only ignore this warning at serious risk to the community. There are 196 million diabetics in the world, in 2020 there will be 400 million! 70-80% will die a premature ‘cardiac’ death. The commonest cause of death in the World will be due coronary heart disease fuelled by Metabolic Syndrome, diabetes and obesity combination. Obesity and hyperlipaedimia is also increasing in children and this will lead to development of early T2 diabetes.

Governments all over the world should focus on low sugar containing, low fat healthier food. Many of these ‘developing’ countries saw increased mortality from child birth, infections, starvation and war; this will change to mortality from coronary heart disease driven by diabetes and metabolic syndrome in the next decade. I therefore support the data presented, and I am of the opinion that these high risk individuals should be screened early for silent coronary atherosclerosis and vascular disease.“

ASDA shoppers are worst and spending the most on unhealthy food at £18.23. The ‘healthiest’ shoppers were from Tesco, spending £16.65 on junk items. Research into shopper attitudes shows consumers often don’t realise what they are buying. Whilst many shoppers aim to stick to shopping lists and best intentions, temptation can prove to be too much.

The survey also revealed that:
- Over a third (37%) of those questioned said that every time they go to the supermarket they overspend their set budget because they are too tempted by what they see as treats (Fat fact: It
takes just 3,500 calories to put on a pound)
- 39% confessed that they expect to overspend on ‘naughty treats’ even if they didn’t plan to buy them (Fat fact: Average yearly spend on junk food equals GBP895 per person )
- A staggering 81% of people also admitted to buying additional snacks outside of the supermarket shop. (Fat fact: Just one latte a day can add up to 1 stone in weight gain and GBP600 a year)

In 2008, almost a quarter of adults (24% of men and 25% of women aged 16 or over) in England were classified as obese. In the same year, the number of prescription items dispensed for the treatment of obesity was 1.28million; this is ten times the number in 1999 (127,000).

Professor Iain Broom, Medical Director of LighterLife and a leading expert on obesity, says: “The cost of obesity, both to an individual’s health and to the NHS, is significant and growing. As a nation, this issue needs to be addressed as a matter of urgency. Too many of us abuse our bodies by choosing the wrong foods, in the wrong quantities, and in extreme situations this can lead to a dramatic reduction in life expectancy.”

Anyone concerned that their diet might be causing heart disease should read this article by Cardiologist Avijit Lahiri.

News emerged yesterday of the start of the PIONEER trial the: “first coronary stent on drug eluting balloon has been implanted”, and that this innovation improves patient’s comfort and reduces procedure cost significantly.

The trial enables for the first time the delivery of a coronary stent that is mounted on a Drug Eluting Balloon. On placement of the stent a predetermined load of the plaque-busting drug Paclitaxel is delivered to the vessel wall to support the vessel in adapting to the stent and reducing adverse effects in the first days after implantation.

The Drug Eluting Balloon product in the PIONEER trial delivers drugs  during stent placement only, instead of continuous drug delivery by drug eluting stents. This reduces the period that follow-up medication is needed, which means total procedure costs are reduced significantly. The new procedure improves patient’s comfort, as the period for which daily antiplatelet medication is reduced from up to two years to one month.

A coronary balloon angioplasty is a minimally invasive procedure performed to improve blood flow to the heart muscle. In an angioplasty procedure a balloon is inflated to open the coronary artery. In addition a small wire mesh tube called a stent may be permanently placed to help the artery to remain open. Drug eluting stents, that release drug from the stent surface after implantation, are commonly used to prevent re-closure of the vessel. A downside is that patients are required to take antiplatelet medication daily for a long period with significant discomfort and risks associated.

Providing an expert comment on this news, UK Cardiologist, Professor Avijit Lahiri says: “This is a good idea. Avoiding intensive antiplatelet treatment (aspirin and clopidegrol) will definitely reduce some of the bleeding side effects. However, more data is required about these new stents. It will be important to know whether the prognostic data are similar or better than the current treatment options with drug eluting stents, that there are fewer complications, and also cost is always an important issue. In the UK private sector it is still less costly to have open heart coronary bypass surgery compared to having 2-3 stents.”

This is an interesting step forward to improve the outcome and performance of cardiac stents, and we await with interest the results from the PIONEER trial.

The report said that men must exercise to get rid of ‘brinkles’ as they could be a sign of future heart problems. Brinkles – the term used to describe wrinkles of fat which appear on the necks of bald men – have been highlighted in a US heart study as a possible factor in developing heart problems.

The Framingham Heart Study*also found the thickness of a person’s neck provided as many clues about future health issues as measuring the waist. Professor Jimmy Bell, of the MRC Clinical Sciences Centre, said health was not dependent on how fat a person was but where fat was deposited. The Framingham Heart Study found the average neck circumference of men was 40.5cm.

So we asked Professor Lahiri if the claim that brinkles is an accurate marker of heart disease, and here is his reply:

All these factors such as ‘ear lobe crease’, and brinkles are unlikely to stand the test of time. There are much ‘stronger’ risk factors, as seen in the Framingham or UKPDS scores for predicting coronary artery disease (CAD). The comment from the MRC is correct, abdominal fat, leading to an altered waist-hip ratio is a strong risk factor. However, the overlap between the presence and absence of coronary artery disease, even when using a group of risk factors have poor specificity for detecting CAD.

The best screening method available today is the addition of Coronary Artery Calcium Imaging to other risk factors, this has been proven in multiple trials.

WHY IS THAT IMPORTANT? High levels of salt raise blood pressure and cause cardiovascular disease.

The new research from CASH surveyed 784 products in the largest survey of its kind in the UK, across supermarket shelves, independent shops and takeaway restaurants. The survey reveals very high levels of salt hidden in bought Indian & South Asian cuisine including; takeaways, ready meals, cooking sauces, chutneys, pickles and side dishes.
Curry dishes frequently top the poll as the UK’s favourite meals, but these findings highlight that the nation is blindly consuming dangerous levels of salt.  As well as main curry dishes being high in salt; you can more than DOUBLE your salt intake with extras such as chutney and Naan bread.  The lack of clear labelling on the packaging, combined with the spicy ingredients masking the salty flavour, makes it very hard for people to know how much salt they are eating.

Takeaway Your Life

Takeaways are thought of as a convenient option, however CASH found large variations in the salt content of the same curries from different restaurants in London’s famous curry street Brick Lane.  CASH found the lowest takeaway to be a Vegetable Korma (1.37g per portion) and the highest a Chicken Tikka Masala (6.81g per portion), so a simple swap could cut your salt intake by up to 4 times in the main meal alone.

“A regular ’Curry Night’ is becoming a British institution, making these high salt levels extremely worrying” says CASH Campaign Manager & Nutritionist Katharine Jenner. “This survey shows salt can be hidden behind all the spices and chilli in your curry, even in side dishes and sauces.  Add to this the lack of clear labelling on packaging and in takeaway restaurants, and it makes it very hard for consumers to choose a healthy option.”

See www.actiononsalt.org.uk for more information and tables detailing the products and their associated salt levels. Patients concerned about the affects of eating too much salty curry and / or with a curry worry about subsequent pain should see the article by Professor Avijit Lahiri – Chest Pain – Cardiac or not?

Until now, the significance of cortisol levels in patients with acute coronary syndrome (ACS) has been unknown.  Cortisol is a hormone produced by the adrenal gland.  Amongst other actions, it modifies our reactions to stress and anxiety, regulates blood pressure and helps to keep blood sugar levels within normal ranges.  Now a group of researchers headed by Dr Andreas Tomaschitz at the Medical University of Graz-Austria  have used the information from a German heart study to show the link between serum cortisol levels and increased mortality in patients with ACS.

The LURIC (Ludwigshafen Risk and Cardiovascular Health; headed by the principal investigator Prof. Winfried März, Synlab Center of Laboratory Diagnostics, Germany) study is an ongoing trial designed to investigate the effects of genetic and other biological traits on the cardiovascular system.  The study has enrolled over 3000 participants for coronary angiography at the Herzzentrum, Ludwigshafen, Germany.

For this work, 1036 patients with acute coronary syndrome were studied for an average period of 7.7 years.  There were no significant differences in the serum cortisol levels between patients with and without acute coronary syndrome.  However, the patients with ACS and high cortisol levels had a significantly elevated number of deaths when compared to the patients with ACS and the lowest cortisol levels. 758 total deaths were reported during the follow-up period.  The ACS patients with the highest cortisol levels (i.e. the highest 25% serum cortisol) were significantly more likely to die from fatal cardiovascular events than those with the lowest cortisol levels (the lowest 25% serum cortisol).

Lead researcher, Dr Andreas Tomaschitz, said: “In the future we will need to understand the complex way in which cells react to cortisol, and how this causes cardiovascular damage to people with acute coronary syndrome.”

Definitions

Acute coronary syndrome (ACS) is a term that doctors use to describe a range of problems that can be caused by a sudden reduction in blood flow to the heart muscle caused by a narrowing or blockage of the blood vessels.  This group of problems ranges from a threatened heart attack (unstable angina) to an actual heart attack (myocardial infarction).

Coronary angiography is a procedure that uses a special dye (contrast material) and x-rays to see how blood flows through your heart.

See ‘Chest Pain – Cardiac or not’ by Professor Lahiri for plain English guidance on latest recommended cardiac assessment.

The new guidelines warn that the old fashioned test could lead doctors to wrongly assume that the patient’s symptoms were not heart related if exercising did not trigger the problems. Prof Adam Timmis, Chairman of NICE’s clinical guideline group, said some patients who went through NHS chest clinics had their pain wrongly dismissed as not heart related and then died or suffered a heart attack as a result. He suggested that this may be because clinicians were using the exercise test, which has been around for 50 years. Chest pain accounts for 25% of emergency admissions to hospital and 1% of visits to GPs, according to NICE – which issues guidance for England and Wales.

The tests are vital to diagnose the cause of pain so appropriate treatment can begin which may avoid the patient having a heart attack. Patients with new chest pain who were suspected of suffering from certain types of heart attack or angina should be given an electrocardiogram as soon as possible, which could be in the GP’s surgery or in an ambulance on the way to hospital, the guidance added.

1.4 million people have angina, 300,000 have a heart attack and around 110,000 die annually as a result of heart problems. Chest pain affects up to 40 per cent of the population at some point in their lives and accounts for 700,000 visits to A&E departments and a quarter of hospital admissions.

Unfortunately, there is only one centre in the UK providing the current recognised state-of-the-art scan, Dual-Source CT Definition and this is the CIRC at The Wellington Hospital under the leadership of Professor Lahiri.

The current tests used to identify people at risk of a major heart attack, because their blood vessels are dangerously narrowed, are inadequate, costly and even risky, Prof Avijit Lahiri, of the Wellington Hospital in London said. Patients with chest pain are referred for initial tests and then sent for an angiogram which involves injecting dye into the veins and then taking a series of x-rays to find narrowing.
However around 40 per cent of the angiograms show nothing meaning the patient was put through the £1,000 procedure for nothing. On top of this, an estimated one in 10 of those with chest pain perform well on the initial tests and are discharged but are in fact suffering from arteries which are up to 90 per cent blocked.
He is now carrying out a trial of 1,000 patients who will be randomly assigned to receive either the normal NHS care or be sent to the Wellington to receive CT scans.
He said: “The use of imaging is abysmal in this country in comparison to the rest of the world.

“It is not uncommon for the NHS to turn patients away and them drop dead of a heart attack. It is the whole system. We are dinosaurs. I believe using CT scans can reduce the number of unnecessary angiograms, which are too invasive. We have got the radiation dose down to the minimum possible with our CT and at £400 a go, it is also cheaper than an angiogram.”
A spokesman for the Department of Health said: “New research into the place of these newer imaging techniques is always welcome and helps to inform future recommendations made by Department of Health and other organisations, such as NICE.

See latest plain English article on heart scans – Chest Pain – Cardiac or not?

Diagnose your pain.

It’s vital to obtain an accurate and rapid diagnosis of coronary artery disease at the outset. Chest pains are often the first telltale signs of CVD, however, in many instances the differential diagnosis of chest pain is elusive, leading to a large number of ‘false’ diagnosis, which creates a very significant impact on the NHS.

Stress Electrocardiography (ECG).
In the 1980’s Rapid Access Chest Pain Clinics (RACPCs) were set up in order to systematically evaluate patients and have now become a de facto standard of care within the NHS. The first test which is usually performed on patients presenting with chest pain is a stress electrocardiography (ECG).

Leads are attached to your chest whilst you perform light exercise, usually on a bike or treadmill, to ascertain how your heart functions under stress.  The problem is that the results of Large Clinical trials suggest that incorrect diagnoses from ECG may run as high as 25%. Some patients are unable to perform enough exercise to allow an accurate diagnosis, others give false positive or false negative results.

Doctors are well aware of the shortcomings of stress ECGs. They frequently order subsequent tests such as coronary angiography (CA) even when the stress ECG is normal. This has led to an increase in the number of coronary angiography procedures. Unfortunately, coronary angiography is an invasive and expensive procedure with a small but significant risk of major complications such as; death, heart attack (myocardial infarction – MI) and stroke. This is clearly an unsatisfactory state of affairs, from both a clinical and economic perspective.

Click the link to read more about screening for cardiovascular disease.

The Medical Editor of the Telegraph in June 2009 reported: “Hundreds of cases of serious heart disease are being missed every year by the NHS, which is putting thousands more through needless tests which waste around £40 million a year.” The article went on to say, “The current tests used to identify people at risk of a major heart attack – because their blood vessels are dangerously narrowed – are inadequate, costly and even risky.”

The report was based on information from Prof Lahiri of the Wellington Hospital who said: “Patients with chest pain are referred for initial tests and then sent for an angiogram which involves injecting dye into the veins and then taking a series of x-rays to find narrowing.”

So what exactly is the problem with the usual heart screen?

40% of the angiograms show nothing, meaning the waste of a £1,000 procedure.
1 in 10 patients with chest pain perform well on other tests due to false negatives and are therefore discharged.

The bottom line according to Prof Lahiri is, “It is not uncommon for the NHS to turn patients away and them drop dead of a heart attack.”

So what’s the solution?

Dual Source Definition CT – this imaging configuration, according to Prof Lahiri provides the greatest information on the state of the coronary arteries, unlike an angiogram it is non-invasive and at £400 a screen is considerably more cost-effective as well as accurate.

The article, Latest Cardiac Diagnostics and Treatment Methods has been written in plain English for anyone who is concerned about chest pain and would like to rule out the possibility of cardiovascular disease.