Cardiovascular Health Sep 2019 by Mediaplanet UK&IE

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KAREN SLIWA CVD is the leading cause of death and disability in the world. » p2

SIMON GILLESPIE Working alongside the Government and NHS has enabled us to reduce unnecessary heartbreak. » p6

VICTORIA TAYLOR Eating well can help to lower your risk of having a heart attack or a stroke. » p6

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My heart, your heart: uniting for heart health on 29 September, World Heart Day Every year, 17.9 million people die from cardiovascular disease (CVD), including heart disease and stroke.

ardiovascular disease has many causes: from smoking, diabetes and high blood pressure – which are very common and affect a wide range of age groups and geographical regions – to less-common causes, such as Chagas and Kawasaki disease, and rare conditions, such as cardiac amyloidosis. These tend to affect mainly certain populations due to factors such as where they're from, their age and their genetic background. But, whatever the cause, we believe that every heartbeat matters and that means that every single person has

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the fundamental right to heart health. This year, on World Heart Day, our objective is to create a global com mu n it y of ‘Hear t Heroes’, inspiring people from all walks of life who are acting now to live longer, better, heart-healthy lives by making a promise… As individuals: a promise to our families to cook and eat a more healthy, balanced diet including plenty of fruit and vegetables… A promise to our children to do more exercise every day and help them to be more active; to say no to smoking and help our loved ones to stop.

At least 80% of premature deaths (between the ages of 30 and 70) from heart disease and stroke could be avoided.” As healthcare professionals: a promise to help our patients give up smoking or lower their cholesterol, and to understand their risks of CVD. As employers: to invest in hearthealthy workplaces, making time during the working day for exercise

WRITTEN BY: KAREN SLIWA President, World Heart Federation

and offering healthy meal options. CVD is the leading cause of death and disability in the world, causing a third of all deaths on the planet and half of all non-communicable-disease-related deaths. Around 85% of these deaths are due to heart disease and stroke. The good news is that at least 80% of premature deaths (between the ages of 30 and 70) from heart disease and stroke could be avoided. World Heart Day plays a crucial role in this with 1,000s of individuals and organisations around the world organising events and taking to social

media to help spread the word. It is a vital global platform that we can all use to raise awareness and encourage individuals, families, communities, and governments to take action now. Together, we have the power to reduce the burden of heart disease and stroke, helping people everywhere to live longer, better, heart-healthy lives. Because every heartbeat matters.

Read more at healthawareness.co.uk

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The simple check that can save your life

Alison Banayoti has a new lease of life after treatment for an unsuspected heart condition. Now, she’s urging everyone to get a simple stethoscope check for the disease.

n May, Alison Banayoti, 59, absei led dow n St Thoma s’ Hospital in London to raise awareness of heart valve disease. Six months earlier Alison had surgery there for the condition. She now says: “I feel fitter than ever. I’ve been given a second chance at life and nothing phases me.” She is not alone: heart valve diseases can mean the heart has to work harder. If the heart valve can be repaired or replaced, the heart functions more efficiently than normal. Alison considers herself lucky that her heart valve disease was diagnosed at an early stage. A ge d 4 5, she ex p er ienc e d a rubbery feeling down one arm and leg. A mini stroke was suspected, but a stethoscope check found a heart murmur, and she was diagnosed with bicuspid aortic heart valve disease. This can reduce or block the

INTERVIEW WITH:

ALISON BANAYOTI Ambassador, Heart Valve Voice

A quick check with a stethoscope takes so little time but it could save your life.” blood flow to the body, and can be present, undetected, from birth. Alison had an annual echocardiogram to check the valve and, after 15

years, a replacement valve operation was recommended. “I researched the replacement procedure, choice of valves and surgeons. I chose a new variety of valve that has been treated to extend its life to 25 years. If necessary, later on, a new valve can be inserted into it using transcatheter aortic valve implantation (TAVI), where the replacement valve is fed in through an artery.” She also chose a surgeon who specialised in the mini-sternotomy - a less invasive procedure than traditional open-heart surgery. It was only in the last two months before surgery in October 2018, that Alison got symptoms. “I got breathless more easily and was tired in the afternoons. At 58, many people would have put it down to ageing, she says.” After surgery and six weeks of cardiac rehabilitation, Alison now attends weekly cardiac exercise classes, goes to the gym twice a week, and walks her dog daily. “Now, I want to raise awareness of the disease and urge everyone to ask their doctor to listen to their heart. A quick stethoscope check takes so little time, but it could save your life.” WRITTEN BY: LINDA WHITNEY

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Innovations are transforming heart valve disease treatment

ear t va lve disease is a common condition that can turn into a killer. Half of UK over-65s have some level of disease related to heart structure. Over one in 10 - around 1.5 million people - have moderate or severe disease. By 2040, this is expected to reach 2.7 million. Statistics show that, of those with the most common heart valve disease, severe aortic stenosis, half will die within two years and only 3% survive five years. Part of the problem is detection. Chris Young, the heart surgeon and chair of the charity, Heart Valve Voice (HVV), says: "The main symptoms are breathlessness and feeling tired, but many people attribute this to age." Once suspected, hear t valve disease can be diagnosed by listening to the heart through a stethoscope but only 7% of UK GP consultations include this (compared to 79% in France). Treatment in less severe conditions usually starts with monitoring. "Monitoring means we can predict when valve repair is needed," says Young. Traditionally, this required open heart surgery, but new techniques are making this faster, easier and safer. Treatment innovations use tissue from cow or pig hearts I n nov at ive he a r t v a lve s h ave recently been tested in the UK TAVI Trial. The valves, made of tissue taken from cow or pig hearts, are used to repair the patient’s damaged aortic valve, using transcatheter aortic valve implantation (TAVI).

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INTERVIEW WITH:

MR CHRISTOPHER YOUNG Consultant Cardiovascular Surgeon, St Thomas’ Hospital Chair, Heart Valve Voice

Of those with the most common heart valve disease, severe aortic stenosis, half will die within two years and only 3% survive five years.” The valve is threaded into the body, usually via the femoral artery, until it reaches the patient’s own aortic valve, where it takes over the task of pumping blood. Catheterisation typically takes one to two hours and the typical hospital stay is three to five days. Procedure time, days in hospital and the risk of complications are lower than with traditional open heart surgery. Young says: "The TAVI trial will deliver more information about valve performance and patient outcomes. TAVI is underused in the NHS at present but I expect it to become mainstream in the next few years."

A new lease of life Heart valve repairs can deliver dramatic new energy and lengthen patients’ lives. "Typically, those who have successful surgery go on to live longer than their peers who have had no heart valve problems," says Young. The effort of pushing blood through an abnormal valve makes the heart stronger, so once the problem is corrected the heart is more efficient than average, he explains. "I’ve seen people who, before surgery, were only able to walk slowly, transformed into people who can achieve more than they ever could before." More and better treatment I ne qua l it ie s of d iag no si s a nd under-treatment of heart valve disease has spurred HVV to work with valve care specialists and patients to create Gold Standard of Care Guidelines. "These will help optimise patient care, improve access and influence policy makers on behalf of heart valve disease patients," says Young. HVV is now helping develop the 2019 NICE heart valve disease guidelines, and the issue will be debated in Parliament soon. Meanwhile, Young counsels: "Ask for a stethoscope check. Undetected heart valve disease can kill."

WRITTEN BY: LINDA WHITNEY Read more at healthawareness.co.uk

Diagnosis does not mean the end to an active and fulfilling life WRITTEN BY: STEVE MCCABE MP Ambassador, Heart Valve Voice

Almost seven years ago, MP, Steve McCabe had open heart surgery to repair his mitral valve. The surgery was intense; hours in the operating theatre, vast volumes of anaesthetic and time spent on a ventilator. “When I eventually came round, I wasn’t actually sure if I’d survived,” he says.

fter the major surgery, he was in intensive care for three days and on a recovery ward for another two weeks. “It was a long and arduous process and, despite being quite a determined character, I have to confess there were periods when I began to doubt that I’d ever be OK again.” Even though Steve lives a full and active life now, he says: “After my treatment, I had a long recovery time, which meant I had to be off work for six months. I wish I had been more aware of the treatment options available and chosen a less invasive procedure.” Early diagnosis and patient education is key Steve stresses the importance of early diagnosis of heart valve disease, which can be achieved simply by listening to the heart with a stethoscope. Untreated, heart valve disease can progress to heart failure and ultimately death but, identified early enough, it is treatable, and a less-invasive treatment procedures may be appropriate. “As someone who has experienced heart valve disease, I know firsthand the importance of receiving timely treatment and how this can return people to a good quality of life, so it is important that this can be provided across the whole country.” But do people know enough about the need for diagnosis or the options available to them? Steve feels more must be done. “I believe we must continue to work together to ensure that people living with these conditions have access to the care and support they need,” says Steve. “It is vital that people are better educated on the condition, are aware of the symptoms and know what treatments options are available to ensure more lives are saved.” Innovations in treatment: “I am living proof that, with early diagnosis and proper treatment, these conditions needn’t be debilitating. My advice to patients would be to speak to your clinician about the treatment options available so that you can make an informed choice.” Read more at healthawareness.co.uk HEALTHAWARENESS.CO.UK

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Striving for a world without heart and circulatory diseases WRITTEN BY: SIMON GILLESPIE Chief Executive, British Heart Foundation (BHF)

Heart and circulatory diseases cause pain on every street. Life-saving research has helped halve the number of UK deaths from these conditions, but more must be done if we want to beat heartbreak forever.

ncredible advances have helped reduce the number of people dying from heart and circulatory diseases in the UK. However, new data paints a worrying picture. For the first time in decades, progress in reducing early deaths from heart and circulatory diseases is stalling. Over seven million people live with these conditions in the UK, and millions more are at risk due to undiagnosed high blood pressure, diabetes or abnormal heart rhythms, which can lead to a fatal heart attack or stroke. Accepting this slowdown is not an option. We must do more to prevent the development of these conditions, speed-up diagnosis, and treat people more effectively so they can have better, longer lives. Research into heart and circulatory diseases is crucial Cutting-edge research provides endless potential for improving the prognosis for those living with heart and circulatory diseases in the UK. Harnessing genetic information as well as advancements in AI could enable earlier diagnoses and personalised care. Meanwhile, research into regenerative medicine could lead to new treatments for incurable heart failure. These are just some examples of the research programmes that could reaccelerate progress and improve lives. However, research must go hand-in-hand with stronger commitments to improve care at the bedside and to prevent people from developing these diseases in the first place. Pushing for change across Government and the NHS Working alongside the Government and NHS has enabled us to reduce unnecessary heartbreak. We’ve helped put first aid, including CPR, on the school curriculum in England and for schools across Scotland to teach CPR. In England, Scotland and Wales we’ve successfully campaigned for the introduction of an opt-out organ donation system. The NHS in England’s Long Term Plan prioritses tackling heart and circulatory diseases, but we need renewed commitments across Northern Ireland, Scotland and Wales. We also need action across the UK to tackle air pollution, the leading environmental threat to heart and circulatory health. The challenge ahead of us is considerable, but with the public’s support, we can do more to beat the world’s biggest killers.

Are plant-based diets good for your heart? WRITTEN BY: VICTORIA TAYLOR Senior Dietician and Nutrition Lead, British Heart Foundation (BHF)

Eating a plant-based diet has never been so trendy, and it’s not just a passing craze. Meatfree options now line supermarket shelves - but how good are they for your heart?

stimates vary, but as many as one in three UK adults eats a plant-based diet some or all of the time.1 Growing concern for animal welfare and the environment is partly behind this boom, but it’s also due to the lifestyle’s links to numerous health benefits, including a lower risk of heart and circulatory diseases. Many people assume you must become vegan to adopt a plant-based lifestyle, but this isn’t the case. In fact, there are several other plantbased diets that can help keep our hearts healthy. Growing evidence suggests that the health benefits of these diets come from a focus on eating plenty of whole foods, such as fruits and vegetables, whole grains, legumes, nuts and seeds, 2 w it h sma l ler portions of lean meat, fish and dairy. Not all plant-based diets are healthy However, it’s a myth that all plantbased diets are healthy. Like any diet, the quality of what you eat is important, and won’t make up for any other harmful lifestyle factors, such as smoking, not exercising enough or drinking too much alcohol. Eating well can help to lower your risk of having a heart attack

or a stroke. Meanwhile, an unbalanced, plant-based diet full of sugary drinks, chips, cake and biscuits is unlikely to keep your heart healthy.3 We could all benefit from eating more fruit and vegetables and less meat but, as these examples show, a plant-based diet doesn’t need to be restrictive. A Mediterranean diet only includes small amounts of meat The Mediterranean diet is made up of fruit and vegetables, legumes, fish and whole grains with only small amounts of meat. Fats are mainly unsaturated and come from foods like olive oil, oily fish and nuts. The Mediterranean diet as a whole can reduce your risk of a heart attack or stroke, so focus on a well-balanced variety instead of specific foods or nutrients.4 Limiting red meat, sugar and salt with the DASH diet The DASH diet encourages you to eat plenty of fruit, vegetables, whole grains, and nuts, with some dairy, fish and poultry. Meanwhile, red meat, sweets and sweetened drinks are limited, and salt is restricted to under 6g a day – the UK’s maximum recommended intake.

Research has shown that this diet can help to lower your blood pressure, which decreases your risk of heart disease.5 Eatwell Guide limits fat, sugar and salt The Government’s Eatwell Guide sets out the UK’s dietary guidelines on healthy eating.6 It tells us what amounts of each food groups we should be eating, and the type of foods that can make up a balanced diet. The guide recommends similar foods to the above two diets. Dairy, meat, and fish can also be included, or swapped for plant-based alternatives, while foods that are high in fat, salt and sugar are limited. Vegan diet eliminates all animal produce Many meat-eaters could benefit from eating vegan meals now and then, as it could help you cut down on high-fat dairy products, red meat, and processed foods. A well-balanced vegan diet is healthy, but also a serious undertaking due to the range of foods that are excluded. If you adopt this diet, you will need to plan carefully to avoid missing out on essential nutrients. Do your research first.

1: Waitrose&Partners Food and Drink Report 2: Parker T, Taylor V et al. Cardioprotective whole diet advice in cardiac rehabilitation. British Journal of Cardiac Nursing. 2018. 3: Satija A, Bhupathiraju SN, SpiegelmanD et al. Healthful and unhealthful plant-based diets and the risk of coronary heart disease in U.S. Adults. J Am Coll Cardiol. 2017. 4: Sofi F, Abbate R, Gensini GF, Casini A. Accruing evidence on benefits of adherence to the Mediterranean diet on health: An updated systematic review and meta-analysis. Am J Clin Nutr. 2010. 5: Sacks FM, Svetkey LP, Vollmer WM, Appel LJ et al. DASH-Sodium Collaborative Research Group. Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet. N Engl J Med. 2001. 6: Public Health England. 2017.

WHAT YOU SHOULD KNOW IF YOU ARE ON STATINS! Statins are most commonly prescribed in the UK to lower the level of cholesterol in your blood but did you know they could be depleting key nutrients your body needs like CoQ10?* Bioglan Stat-Guard™ contains an expertly blended formula to help replenish these nutrients including CoQ10, Zinc, Vitamin E, Vitamin B1 & Magnesium. These key nutrients help support heart health, muscle function & energy metabolism. Try Bioglan Stat-Guard™ today and discover the Bioglan difference. Available at:

Bioglan.co.uk

DISCOVER THE BIOGLAN DIFFERENCE *https://www.ncbi.nlm.nih.gov/pubmed/8463436 (Accessed: 22nd Aug 2019)

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One in four people will develop AFib

AFib affects an estimated 16m people worldwide

Every 15 seconds Antisomeone coagulants suffers an can reduce the AFib-related risk of stroke to stroke 1 in 100 people per year 3 in 5 who suffer an AF stroke could lead to disability

1 in 5 who suffer an AF stroke could lead to death

AFib can be detected easily with simple manual pulse checks

We offer free pulse checks globally at varying locations.

STATISTICS FROM ARRYTHMIA ALLIANCE’S DETECT, CORRECT, PROTECT, PERFECT CAMPAIGN

We have conducted over half a million pulse checks. For the AF Association Global AF Aware Week, we make the detection of AFib a priority.

A simple pulse check could save your life

A pulse check is an effective way of detecting atrial fibrillation, the most common heart rhythm disorder and the leading cause of stroke. It’s time more of us learned how to do it.

any of us are aware of our heart rate, says Trudie Lobban MBE, Founder & CEO of Arrythmia Alliance, a coalition of charities, patient groups, patients, carers, healthcare professionals, medical groups and allied professionals working to promote timely and effective diagnosis and treatment of arrhythmias. But to make sure we are not at risk of atrial fibrillation (AF) — the most common arrhythmia (or heart rhythm disorder) and the leading cause of stroke — it's also crucial we are aware of our heart rhythm. No expensive equipment or complicated technology is needed to do this (although medically approved apps are available). In fact, it can be done with a simple pulse check.

Know your pulse to know your heart rhythm.”

Get to know the rhythm of your pulse “Many people don't connect their pulse with their heart,” says Lobban. “Yet, by taking our pulse we can check our heart rhythm, which can detect AF. That's why our message is: 'Know your pulse to know your heart rhythm'.” Lobban advises feeling your pulse when you're sitting down and relaxed (“not after drinking a cup of coffee or running a marathon”) and getting to know its normal rhythm (not to be confused with the beat). If you feel that it's jumping around, going too slow, too fast or is irregular, then see your doctor. This is important because, when the heart rhythm is irregular, clots can form in the blood, which may break off and

cause heart failure, or travel to the brain and cause an AF-related stroke.

INTERVIEW WITH:

TRUDIE LOBBAN MBE Founder and CEO, Arrythmia Alliance

Recognise the symptoms of atrial ﬁbrillation “If you have AF, you are five times more likely to have an AF-related stroke, which can often prove to be fatal — or they can be more disabling and debilitating than any other type of stroke,” says Lobban. AF is a more prevalent condition than prev iously suspected. Worryingly, a quarter of people over the age of 40 will develop AF at some time in their lives; and at least one-third of those with AF are yet to be diagnosed. Obesity, alcohol, smoking and stress all increase risk of atrial fibrillation, the symptoms of which

may include breathlessness and/or palpitations. “Some people say A F feels as though they have a bag of worms in their chest — or drums beating in their chest,” says Lobban. “But it is possible to have AF and experience no symptoms at all.” Detect, protect, correct and perfect If your GP diagnoses AF, you will be given anti-coagulation therapy. “There are several types available, which will help reduce the risk of a clot forming,” explains Lobban. “This type of therapy does not treat AF, however, so you should also discuss treatment options with your doctor. “ There are lots of treatments available to reduce symptoms of AF, and potentially cure it.” These include drug therapy or ablation therapy (where a catheter is placed into the heart to detect and ablate the area causing the abnormal rhythm). Lobban also asks those at risk of AF to remember a simple slogan: ‘Detect, protect, correct and perfect’. “Detect AF with a simple pulse check; protect against AF-related stroke with anti-coagulation therapy; correct an irregular heart rhythm with access to appropriate treatment,” she says. “Finally, perfect the patient care pathway, restoring the patient back to a person leading as active a life as possible.” WRITTEN BY: LINDA WHITNEY Read more at healthawareness.co.uk

Job code: NOUK1900935-01 Date of prep: September 2019

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Fainting could be a sign of a fatal condition Fainting or palpitations may be signs of an underlying heart rhythm disorder that could potentially prove fatal. Here’s how to check whether you are at risk.

ainting or palpitations may be nothing to worry about, but they can also be early warnings of a potentially fatal condition. Both commonly occur in people with cardiac arrhythmias - the medical term for an irregular heart rhythm. Heart rhythm disorders are Britain’s biggest killer. There are four main types of arrhythmias. They are common, potentially serious, and often unsuspected. Fainting (syncope) resulting from an insufficient blood supply to the brain, can be a symptom of the most common arrhythmia - atrial fibrillation (AF), an irregular and/or too-rapid heart rhythm. This is means blood does not flow through the body properly, which may result in blood clots. If a clot forms in the heart and travels to the brain it can cause a potentially fatal AF-related stroke. “AF causes 12,000 debilitating and fatal AF-related strokes in the UK each year. These are more debilitating and more likely to be fatal than most other strokes. Many could be avoided if AF is diagnosed and appropriate anticoagulation therapy prescribed,” says Trudie C A Lobban MBE FRCP Edin, Founder and Chief Executive of the charities STARS, Arrhythmia

Alliance and AF Association. “AF affects one in four of us over the age of 40, and the symptoms are often palpitations or a faint, which are all too often overlooked,” she adds. “Anyone of any age experiencing a faint could have an underlying arrhythmia, which could result in an AF-related stroke.” Aspirin proven ineffective in preventing AF-related strokes Anticoagulants, which help prevent c lo t s for m i n g a nd t he r e for e, reducing the risk of an AF-related stroke, have long been used to treat AF, but many people have AF unknowingly, and so suffer strokes that may have been avoided. Lobban points out that aspirin, commonly taken as a stroke-preventative, has been proven ineffective in preventing AF-related strokes. The good news is that a simple pulse check will indicate the possibility of AF before it results in a potentially fatal AF-related stroke. However, the UK currently has no national screening programme of pulse checks or heart rhythm screening, so you need to know how to do it yourself. Lobban says: “Checking your pulse will indicate your heart rhythm as

INTERVIEW WITH:

TRUDIE LOBBAN MBE Founder and CEO, Arrythmia Alliance

Checking your pulse will indicate your heart rhythm as well as your heart rate - how often the heart beats - but also the regularity of the rhythm, which is important in diagnosing AF.” well as your heart rate - how often the heart beats - but also the regularity of the rhythm, which is important in diagnosing AF.” How to take your own pulse To get your baseline pulse and normal heart rhythm, take your resting

pulse when you wake in the morning and before bed, for seven days. To assess your resting pulse rate in your wrist, sit down for five minutes beforehand. Remember that any stimulants (such as caffeine or nicotine) taken before the reading will affect the rate. You will need a watch or clock with a second hand. Hold your left or right hand out with your palm facing up and your elbow slightly bent. With your other hand, place your index and middle fingers on your wrist, at the base of your thumb. Your fingers should sit between the bone on the edge of your wrist and the stringy tendon attached to your thumb. You may need to move your fingers around to find the pulse. Keep firm pressure on your wrist with your fingers in order to feel your pulse. Count for 30 seconds, and multiply by two to get your heart rate in beats per minute. If your heart rhythm is irregular, count for one minute and do not multiply. Record the results. A heart rate of 60 to 100 beats a minute is normal, but also pay attention to the rhythm. If it is irregular anything other than a steady boom, boom, boom - consult your doctor.

Everyone is different, so regular pulse checks will help you understand what is normal for you, and detect changes warranting investigation. WRITTEN BY: LINDA WHITNEY

Arrhythmia Alliance Resources Arrhythmia Alliance offers resources and information for both patients and healthcare professionals. Both the STARS Blackout Checklist and AF checklist help patients and HCPs alike with diagnosis. For more details, see: knowyourpulse.org