Cardiovascular Health - Q1 2022 by Mediaplanet UK&IE

Q1 2022 | A promotional supplement distributed on behalf of Mediaplanet, which takes sole responsibility for its content

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Working in partnership to improve the lives of cardiovascular disease patients Pharma companies are reimagining medicine by exploring collaborations with healthcare systems to deliver rapid and equitable access to treatments for cardiovascular diseases.

We want to do anything we can to reduce the capacity on the NHS, because if people make fewer visits to hospital then patient backlogs will reduce.

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espite advances in science that include innovative new monitoring technologies and ground-breaking therapies, cardiovascular disease (CVD) remains one of the leading causes of morbidity and mortality across the world. According to statistics from the British Heart Foundation, a quarter of all deaths in the UK can be attributed to heart and circulatory diseases — that’s more than 160,000 a year. No wonder the NHS Long Term Plan has set a target to prevent up to 150,000 heart attacks, strokes and dementia cases over the next 10 years.

Chinmay Bhatt, Managing Director UK, Ireland & Nordics, Novartis Pharmaceuticals UK Ltd, and Country President, Novartis UK, is optimistic that this milestone can be reached. But he is also under no illusion and knows that getting there will be hard. On the plus side, the global pandemic has focused minds on the importance of health and healthcare. “Health has become a central part of our societal debate,” he says. “More than ever, people understand that underlying health conditions are a cause for concern.” Addressing health inequality In theory, people can mitigate their CVD risk factors with a range of lifestyle changes, such as not smoking, modifying diet and losing weight. “Over the last few decades, public awareness of heart attacks and stroke and the importance of measuring blood pressure and cholesterol has improved,” agrees Bhatt. “But I think

much more can be done to treat underlying risk and conditions.” In practice, of course, it’s not quite that simple. “There’s a big problem of health inequality in our society,” notes Bhatt. “For example, we know that people in lower socioeconomic classes are four times more likely to die prematurely from cardiovascular disease than people who are more privileged. Our organisation wants to address the challenge of CVD with a broad portfolio and pipeline of therapies; but we also want to address this stubborn health inequality issue to give broad, rapid and equitable access to treatments.”

INTERVIEW WITH Chinmay Bhatt Managing Director UK, Ireland & Nordics, Novartis Pharmaceuticals UK Ltd, and Country President, Novartis UK WRITTEN BY Tony Greenway

Broader-based partnerships To do this successfully, Bhatt believes that pharma companies like Novartis should explore new approaches and partnerships. “Doing things the old way — where a pharma company would come up with an innovation, then work with the NHS to get it out into the market and hope that it sticks — is just not enough anymore,” he insists. “Our bold science should be accompanied by bold partnerships. That’s why we work closely with a number of different stakeholders such as NICE (the National Institute for Health and Care Excellence), the NHS, and the NHS Accelerated Access Collaborative to coordinate solutions in a focussed way. We help characterise the population that may benefit from a particular drug; then we work across geographies to ensure widespread education among healthcare professionals to improve patient pathways and ensure that patients can benefit more rapidly from innovation.” Utilising digital technology With hospitals so overburdened, Bhatt thinks it’s vital to reach as many CVD patients as possible through GP networks so that disease management can become a feature of primary, rather than secondary care. “We want to do anything we can to reduce the capacity on the NHS, because if people make fewer visits to hospital then patient backlogs will reduce,” he says. Digital technology can play a part here. “Digital tech has been one of the great enablers during the pandemic, facilitating the successful vaccination roll-out,” says Bhatt. “We need digital technologies that will identify at risk CVD patients, thereby speeding up their diagnosis and treatment.” Bhatt believes that stakeholder cooperation is here to stay and with it the potential for CVD treatments to be delivered to more people quickly. “There is a growing realisation that no one party can solve healthcare issues on their own” he says. “If anything, the spirit of collaboration and partnership across the healthcare ecosystem has grown stronger since the start of the pandemic.”

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Novartis has had full editorial control of this article March 2022 MLR ID 195390

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How self-help solutions can prevent the development of vascular diseases Simple steps and lifestyle changes can play an important role in reducing the risk of developing a vascular disease.

eripheral arterial disease (PAD) is a common condition where the main blood vessels that carry blood from the heart to other areas of the body get furred up and blocked. While there are surgical solutions, including non-invasive procedures to unblock or open up narrowed arteries and veins carrying blood around the body, surgeons say patients can take action to avoid the disease. Common condition Rachel Bell is a Consultant Vascular Surgeon at the Freeman Hospital in Newcastle upon Tyne and Chair of the Circulation Foundation. Miss Bell looks after patients with a wide range of vascular conditions that affect people’s veins and arteries. Often an early symptom of PAD in the legs is cramping pain in the calf muscle when walking, this usually happens because the main artery in the thigh is blocked and when you move, the calf muscle does not get enough blood. “This condition is called claudication and can be a forerunner to more serious arterial disease or circulation in the leg,” says Miss Bell. Risk factors Risk factors for PAD include smoking, high cholesterol, diabetes and high blood pressure. However, patients can reduce their risk by not smoking, having blood pressure and cholesterol checks, eating a balanced diet and getting diabetes under control with weight loss or medication. “Family history can also be a risk factor,” says Miss Bell. “If a parent has had a stroke, aortic aneurysm, or arterial disease, people need to be aware they are at a slightly higher risk because often these conditions have a genetic element.” Treatment options Treatments are continually evolving, along with technology to treat vascular disease, but exercise will help patients improve their condition. Miss Bell explains: “Exercise can develop smaller blood vessels around blockages and enables people to walk further and prevent their condition getting worse.” Patient support and information The Circulation Foundation aims to support patients with PAD by providing information and education about their disease. It also works to increase public awareness and fundraises to help research the condition. Find out more at circulationfoundation.org.uk INTERVIEW WITH

Rachel Bell Chair, The Circulation Foundation WRITTEN BY

Mark Nicholls

Paid for by The Circulation Foundation

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The power of science: turning science fiction into reality In recent decades some of the biggest advances have been made in treatment and care for people with heart and circulatory conditions, but more still needs to be done to keep making it a reality.

or over 60 years, the public’s generosity has helped the British Heart Foundation to turn ideas that once seemed like ‘science fiction’ into treatments and cures that save lives. Right now, our funding is supporting the development of new technologies that could transform lives by making surgeries safer and more successful. Virtual reality to repair hearts Every year in the UK thousands of heart operations and other procedures are performed for children and adults with congenital heart disease (heart conditions that develop before a baby is born) to repair their hearts. While the scans that allow doctors and surgeons to view the heart are more advanced than ever, they can usually only be viewed on a flat screen. We’re funding researchers from Evelina London Children’s Hospital and King’s College London to develop new virtual reality (VR) technology that combines different types of scans to create a threedimensional, beating replica of the heart. Surgeons using the technology are immersed into the heart. They can plan and practice procedures in VR before they get to the operating table. This technology could help to make congenital heart disease surgery even more successful. The researchers hope it will be in use planning procedures within two years. A new surgery risk calculator Over 30,000 adult patients are considered for heart surgery every year in the UK but, before deciding to operate, doctors and patients must weigh up the risks and benefits with patients. Heart surgery is advisable when the benefits outweigh the risks. But current approaches to

calculating risk may overestimate the actual risk that heart surgery poses. This means that some people may be deemed unsuitable for a particular heart operation when in actual fact it could save or improve their life. In partnership with The Alan Turing Institute, we’re funding researchers at the University of Bristol and the University of Oxford to apply machine learning algorithms to data routinely collected from all patients undergoing surgery in the UK. This could help doctors better calculate risk so that they can be better informed in medical decision-making. The platform will apply machine learning algorithms to data routinely collected from all patients undergoing surgery in the UK. This can identify people who are most likely to have a successful operation and will allow surgeons and patients to make better informed choices. Advances in science and technology like this can change lives. But millions of people are still waiting for the next breakthrough. Our new campaign, This is Science, is calling for the public’s support to power science that could lead to new treatments and cures for all heart and circulatory diseases.

Our new campaign, ‘This is Science’, is calling for the public’s support to power science that could lead to new treatments and cures for all heart and circulatory diseases. Find out more at bhf.org.uk/this-is-science

WRITTEN BY Dr Sonya Babu-Narayan Associate Medical Director and Consultant Cardiologist, British Heart Foundation

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How pulse checks could detect an irregular heartbeat

People with a personal or family history of heart conditions have been urged to check their pulse to help identify whether they may be suffering from atrial fibrillation.

INTERVIEW WITH Dr Belinda Sandler Associate Director and Medical Lead, BMS Cardiovascular UK & Ireland WRITTEN BY Mark Nicholls

Visit the Arrhythmia Alliance website for more guidance on pulse checking. knowyourpulse.org

trial fibrillation (AF) is the most common type of irregular heart rhythm disorder.1 While many people with AF experience symptoms, some people do not, meaning that many may not even be aware they have it.1 It is also known to increase the risk of stroke by five times2 and is associated with heart failure, but early detection is likely to control symptoms and help avoid more serious complications from developing.3,4

Irregular heartbeat Around 3% of the population have AF5 – a condition which can show minimal or no symptoms. However, people may experience symptoms such as heart palpitations, where the heart feels like it is fluttering or beating irregularly, as well as tiredness, shortness of breath, feeling faint or chest pain.6 Despite this, large sectors of the population have limited understanding of AF and its potential consequences if it remains undiagnosed and is not managed. A recent study of 2,100 participants, by the Bristol Myers Squibb (BMS)/

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Pfizer Alliance, identified that almost 20% of people with a personal, or familial risk of heart disease do not know how to check their pulse,7 which is regarded as the first step in detecting AF symptoms.8 Reducing risk Stroke is the fourth leading cause of death in the UK.9 However, of those who responded to the survey, just over half knew that an irregular heart rhythm could lead to a stroke.7 Dr Belinda Sandler, Associate Director and Medical Lead, BMS Cardiovascular UK & Ireland, says: “We urge people with a personal or family history of a heart condition to check their pulse or, if unsure how, to speak to their GP. “If more people actively check their pulse, which can take as little as 30 seconds, this can aid early diagnosis and management of the condition to help prevent stroke.” Heart health The BMS/Pfizer Alliance study surveyed more than 2,000 people aged 16-75 to assess the public awareness and understanding of irregular heart rhythm and gain insights on the

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impact and understanding of heart health in the UK. While early detection is likely to improve patient outcomes,3 some people with AF may experience minimal or no symptoms at all and the British Heart Foundation suggests that as many as 300,000 people are living with undiagnosed AF in the UK.10 During the early stages of the COVID-19 pandemic in 2020, there was a significant drop in attendance at hospitals and GPs, raising fears that even more people with heart conditions such as AF were remaining undiagnosed.11 Remote monitoring Dr Sandler adds: “Most commonly, atrial fibrillation is diagnosed at routine doctors’ appointments. However, during March 2020 of the COVID-19 pandemic, a 30% drop in attendance was observed in England.11 “If we can counter the number of potentially missed diagnoses during the pandemic by equipping the general public with the correct knowledge to monitor their heart health, we can help prevent serious cardiovascular complications from arising.” While attendance at health facilities fell during the pandemic, it did lead to greater use of telemedicine, which enables video and phone appointments between patients and their healthcare practitioner, and remote patient monitoring devices for a range of chronic conditions.12 Recognising the signs and symptoms of AF is critical in preventing heartrelated complications. It is important that those with an increased risk are taking the time to pulse check as, only through diagnosis, can the condition be managed and monitored efficiently. References 1. NHS. Overview. Atrial Fibrillation. Available at: https://www.nhs. uk/conditions/atrial-fibrillation/ [last accessed February 2022] 2. Wolf PA, et al. Atrial fibrillation as an independent risk factor for stroke: the Framingham Study. Stroke. 1991;22:983-8 3. Sekelj S, et al. Detecting undiagnosed atrial fibrillation in UK primary care: Validation of a machine learning prediction algorithm in a retrospective cohort study. Eur J Prev Cardiol. 2020;28(6):1-9 4. Benito L, et al. EARLY: a pilot study on early diagnosis of atrial fibrillation in a primary healthcare centre. EP Europace. 2015;17(11):1688-1693 5. Adderley NJ, et al. Prevalence and treatment of atrial fibrillation in UK general practice from 2000 to 2016. Heart. 2019;105(1):1-22 6. NHS. Symptoms. Atrial fibrillation. Available at: https://www. nhs.uk/conditions/atrial-fibrillation/symptoms/ [last accessed February 2022] 7. BMS. Data on File 2021: CVD Awareness Research in the UK 8. NHS. Diagnosis. Atrial Fibrillation. Available at: https://www. nhs.uk/conditions/atrial-fibrillation/diagnosis/ [last accessed February 2022] 9. Brain Research UK. Neurological conditions / Stroke. Available at: https://www.brainresearchuk.org.uk/neurological-conditions/ stroke [last accessed February 2022] 10. British Heart Foundation. Atrial Fibrillation: finding the missing 300,000. Available at: https://www.bhf.org.uk/forprofessionals/healthcare-professionals/news-and-analysis/ analysis/atrial-fibrillation-finding-the-missing-300000 [last accessed February 2022] 11. NHS Digital. Appointments in General Practice - March 2020. Available at: https://files.digital.nhs.uk/F5/98B3B6/GP_APPT_ Publication_March_2020.xlsx [last accessed February 2022] 12. Nuffield Trust. The impact of Covid-19 on the use of digital technology in the NHS – Briefing August 2020. Available at: https://www.nuffieldtrust.org.uk/files/2020-08/the-impact-ofcovid-19-on-the-use-of-digital-technology-in-the-nhs-web-2.pdf [last accessed February 2022] BMS job code: CV-GB-2200040 Pfizer job code: PP-INT-GBR-0546 February 2022

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Why remote monitoring is an integral part of arrhythmia patient care

A century of driving improvements in heart disease care

The pandemic has caused disruption and delays to healthcare services, but remote monitoring has enabled arrhythmia patients to continue with their care with confidence.

A lot has changed in the last 100 years for cardiovascular care as we look back on progress made and towards the future of advancements to come.

hen 16 senior doctors met on 22 April 1922 to form the Cardiac Club, the first cardiac society in the world, they could not have predicted that their small association would grow and become an international model for the development of standards in education and clinical practice. One hundred years later, its success in spreading innovation has been echoed by the growth in cardiac societies around the world. The BCS will be celebrating international collaboration with a ‘Cardiology Around the World Day’ at our annual conference in June, where we will be joined by fellow societies across four continents. Immense development of cardiology The major developments over the last century, many of them first introduced to colleagues at our meetings and conferences, have revolutionised the diagnosis and treatment of heart disease. A century ago we couldn’t see inside the beating heart – now we can pinpoint minute changes in heart structure and function and use sophisticated imaging techniques to spot emerging heart problems. Pivotal time of change The 1950s was a key time for the development of cardiology – the first heart bypass operation took place in the US in 1953 and the first pacemaker was planted into Swedish patient, Arne Larsson, in 1958. Progress has accelerated, particularly since the mid-80s. The discovery of clot-busting drugs and other treatments like coronary angioplasty – inserting a tiny stent (tube-shaped metallic scaffold device) to open a narrowed artery

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and improve anginal symptoms, were followed by devices to repair and replace worn out heart valves. The tremendous improvements in survival following a heart attack and the developments in treatment for heart disease are now joined by home monitoring equipment, enabling doctors to observe the patient’s progress remotely, reducing admissions to hospital. With the NHS now more focused on improving the patient pathway from GP to hospital and to social care, the ambition is for more joined-up and better care for patients.

WRITTEN BY Trudie Lobban MBE Founder and CEO, Arrhythmia Alliance

How implanted devices are monitored Implanted devices such as pacemakers or implantable cardioverter defibrillators (ICDs) are fitted with a device that kicks into action when required and can save a patient’s life. Remote monitoring devices can alleviate concerns and provide reassurance for people. The term remote monitoring means exactly what it implies: monitoring your heart with an implanted device while you are at home (or on holiday – in fact, anywhere!) and ‘remote’ from a care team at the hospital. The implant has an integrated aerial that automatically sends medical and technical information to a cardiac team remotely via the monitoring device or from a mobile application. This allows heart rhythm specialists to monitor a patient’s condition based on accurate, up-to-date clinical information daily – not just at the hospital. Remote monitoring should be the gold standard of care for anyone with a CIED. If deemed suitable for a patient, it should be offered as part of the treatment package, not as an added extra. A positive from the pandemic is that more patients are now being offered this package – saving time, hospital visits and most importantly, improving care.

Continued education and training This fast-moving specialty has to be matched with parallel and continuous education and training programmes, committing valuable time to teach the next generation of doctors. Starting as a meeting of a few specialists with an interest in the heart, the British Cardiovascular Society has grown into a large, diverse, vibrant organisation whose members now span medicine, nursing, physiology, clinical science and other disciplines. However, we retain the commitment to education and sharing innovation handed down by our founders to improve cardiovascular care for patients.

WRITTEN BY John Greenwood President, British Cardiovascular Society

he impact of COVID-19 has resulted in an increase in the use of remote monitoring and has highlighted the value and importance of remote monitoring cardiac implantable electronic devices (CIEDs).

Remote monitoring patient feedback In 2020, we surveyed more than 300 patients about their remote monitoring experience. Of the responses, 43% said the most important benefit of remote monitoring is that they felt reassured and almost 80% said that they didn’t have concerns about their follow up appointment. More than 50% said that by having a remote monitor, they feel better about their heart condition. Remote monitoring relieves fear and anxiety for patients, knowing that their heart rhythm is routinely monitored by their healthcare team who would be in touch should any concerns arise. To find out more information or to download our patient booklets about specific devices and remote monitoring, please go to our website heartrhythm alliance.org.

Educating and raising awareness about arrhythmia Arrhythmia Alliance is a patient-focused charity that works to improve the diagnosis, treatment and quality of life for all those affected by arrhythmias. This is why we launched the “Living with Series”, a virtual education series which is free for patients to register for. This series includes webinars from medical experts about remote monitoring and devices, including pacemakers, ICMs and ICDs.

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How new devices are helping cardiologists with difficult cases Devices to treat patients with serious blockages in the blood vessels of their heart are constantly advancing.

M INTERVIEW WITH Sofia De Dionigi Europe & India Sales Manager, Acrostak International Distribution Sarl WRITTEN BY Mark Nicholls

Paid for by Acrostak UK Ltd

ost cases are dealt with by interventional cardiologists through keyhole surgery conducted in hospital cardiac catheterisation labs while the patient is awake. This is via PCI (percutaneous coronary intervention) or PTCA (percutaneous transluminal coronary angioplasty), where a balloon catheter is threaded through arteries with guidewires to the heart to clear the blockage. However, in cases of CTO (chronic total occlusion), where the vessels within the heart have become totally blocked, the treatment options become more limited. Tackling difficult cases Biomedical engineer, Dr Sofia De Dionigi, outlines how patients with this level of blockage have a low quality of life and may need open-heart surgery, when the key hole options fail. In these difficult cases, cardiologists require high levels of experience to achieve success. An additional issue is a lack of high-quality devices that have the technical features to cope with a heavily calcified vessel. Swiss firm Acrostak have developed advanced technology, the M-CATH and M-CATH Flexy, which are specialist microcatheters with features, such as ultra-resistant tips, for use in challenging cardiac lesions such as CTO. Dr De Dionigi points out: “The benefit for patients is that they would not need to undergo surgery but instead be treated with a simple, faster and safer percutaneous coronary intervention procedure.”

Designed for elective procedures Acrostak is focused on niche technology products to solve challenging cases faced by interventional cardiologists and radiologists. The products are designed for elective procedures, rather than emergency operations, to help remedy a patient’s blocked arteries before the situation becomes more serious. Dr De Dionigi, who is Europe and India Sales Manager for Acrostak International Distribution, explains the new device has been developed using specific materials and design, with the production process checked in fully automated clean room environments. Enabling a faster procedure The M-CATH, which is already in clinical use, is a unique hybrid design microcatheter, with a low entry profile, an ultra-resistant tip and hydrophilic coating. Dr De Dionigi explains: “Because of the material and the design, the procedure is faster, which means the dose of radiation for the patient is lower and the success rate increases.” Acrostak has also developed the balloon technology used within cardiology, into innovative specialist balloons that can now be used below the knee (BTK).This device offers interventional radiologists an approach for treating blocked arteries where there are no dedicated devices such as, below the knee, or to open an occluded vessel in the foot where good outcomes have been achieved in the treatment of diabetic foot syndrome.

How AI-powered heart monitor tech ‘can improve diagnosis’ Ambulatory cardiac monitoring powered by AI technology is more comfortable for arrhythmia patients. It also provides clinicians with better data for a definitive diagnosis.

I INTERVIEW WITH Professor Charles Knight Consultant Cardiologist and Chief Executive of St Bartholomew’s Hospital WRITTEN BY Tony Greenway

f you have suspected cardiac arrhythmia — an abnormal heart rhythm which is either too fast, too slow or irregular — you may be given an ambulatory electrocardiogram (ECG) to wear for around 24 - 48 hours. These traditional ECG monitors, holters, record the electrical activity in your heart so your clinician can diagnose if you have an arrhythmia. Wearable tech provides clearer data Yet this technology can pose a challenge to clinicians, notes Professor Charles Knight, Consultant Cardiologist and Chief Executive of London’s St Bartholomew’s Hospital. Continuous and reliable data is needed for a definitive diagnosis; but because this type of monitoring is

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only carried out for a relatively short period, it may not provide enough information. “There are also issues of patient comfort and discretion with conventional, rather cumbersome (ECG) recording devices,” he says. However, more modern cardiac monitoring powered by AI technology may prove to be a better option. This includes wearable patches, like Zio by iRhythm, which can be continuously worn for up to 14 days, even in the shower or while exercising. Professor Knight argues that this type of innovation is “more acceptable to patients, more comfortable and, because they are able to be used for a longer period, they can provide a definitive diagnosis of palpitations in greater numbers of patients.”

Clear and definitive diagnosis It may also reduce the burden on the NHS by providing a more definitive and rapid diagnosis to improve backlogs and reduce waiting times. “Although most palpitations are mild and not a threat to the patient’s health they generate much anxiety,” explains Professor Knight. “Some patients may have multiple visits to GPs, specialists and emergency departments for what are non-life threatening symptoms. A clear and definitive diagnosis provided promptly is better for the patient and saves the NHS money. For patients in whom atrial fibrillation is detected, treatment with prompt anticoagulation saves lives, avoids strokes and vastly reduces the call on NHS resources.” Unfortunately, adoption of new technology within the NHS isn’t always easy. “The NHS is a large and complex organisation which can be difficult for new technologies to infiltrate,” says Professor Knight. “Historically the NHS has focused more on upfront costs than the much greater longer term health and financial benefits of some new technologies. A national accreditation system for new technologies would be a big help so that they can be adopted faster and more widely.”

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WRITTEN BY Jules Payne Chief Executive, Heart UK

Know, understand, take appropriate action – it’s that easy!

It is important for people to know and understand their cholesterol and blood fat numbers. They must then be able to take the appropriate actions to control it.

e all need some cholesterol in our bodies, but too much is when problems arise. When there is too much cholesterol circulating in the body, it builds up in the arteries and can eventually cause a heart attack or stroke. As an organisation, our vision is to prevent premature disease and deaths from cholesterol and other blood fats.

During the pandemic, 1.2 million NHS Health Checks were missed and there were 80 million fewer in person GP appointments than in 2019. Importance of cholesterol numbers Around half of adults in the UK are living with raised cholesterol (above 5 mmol/l), which is a significant cardiovascular disease (CVD) risk factor. Cholesterol is a silent killer and often the first sign of a problem is a heart attack or stroke. The first step to knowing whether you have a problem is to have a cholesterol test.

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Cholesterol is a silent killer and often the first sign of a problem is a heart attack or stroke. ~Jules Payne, Chief Executive, Heart UK

Sadly, cholesterol testing on the NHS took a back seat during the height of the pandemic. NHS Health Checks are offered to people in England between the ages of 40 and 74, cholesterol testing is part of this check. Attending your cholesterol check During the pandemic, 1.2 million NHS Health Checks were missed and there were 80 million fewer in person GP appointments than in 2019. Things are not back on track yet. It is anticipated that there is likely to be an additional 12,000 heart attacks or strokes in the next five years if action isn’t taken. We will continue to raise public awareness of CVD risk factors and ensure that people are aware of the dangers of cholesterol as well as the importance of knowing and understanding their numbers. Once you know you have an issue, it can be managed through diet and lifestyle and medication when appropriate. HEART UK – The cholesterol charity is a national organisation providing support, education and influencing services for people with raised cholesterol and other blood fat conditions and healthcare professionals treating those people. For more information visit: heartuk.org.uk

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The impact of diet and lifestyle on cholesterol levels Plant sterols are a critical ingredient that can help people lower cholesterol using their daily diet.

E INTERVIEW WITH Rob Hobson Registered Nutritionist, Flora ProActiv

WRITTEN BY Mark Nicholls

ating a healthy and balanced diet is crucial in helping people reduce their cholesterol levels. High levels of “bad” cholesterol can have serious health implications, potentially leading to increased risk of heart attacks, strokes, peripheral arterial disease and vascular dementia. But as registered nutritionist Rob Hobson explains, there are a few ways people can reduce their levels of cholesterol through diet and lifestyle changes. Understanding cholesterol Cholesterol is produced naturally in the liver. It makes hormones, vitamin D, digestive fluids and helps organs function properly. There are two types of cholesterol: low-density lipoprotein (bad cholesterol), or LDL; and high-density lipoprotein (good cholesterol) also known as HDL. “Your diet has a major impact on your bad cholesterol, especially saturated fats which increase the LDL levels that can cause health issues. They are found in foods such as fatty meats, full-fat dairy products like cream, butter and cheese and in processed foods”, says Hobson. “The bad cholesterol, the unhealthy kind, builds up in arteries and forms deposits called plaques.” Risks of high cholesterol “A 2018 Health Survey for England found 47% of adults have raised cholesterol, but a lot of them do not realise it,” he says. “One of the dangers is from the fatty deposits that occur in blood vessels. Eventually, these deposits will grow and arteries start to narrow because of plaques building up, making it difficult for blood to flow. “If a piece of plaque falls off and forms a clot, depending on where that goes, it can cause heart attack or stroke.” Because high cholesterol often has no symptoms, Hobson advises anyone over the age of 40 to have a blood test to check their cholesterol levels and triglycerides, which show how fat is being stored in the body.

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Plant sterols in diet Raised cholesterol can be tackled by taking statins - a group of medicines that lower LDL cholesterol and are prescribed in tablet form by GPs. But in some cases, medication can be prevented by following a low cholesterol diet and exercising. As part of a healthy lifestyle, eating a balanced diet with plenty of fruit and vegetables can help naturally lower cholesterol, especially foods, such as Flora ProActiv, which contain plant sterols.

“We know from research that 1.5-2.4 grams a day of plant sterols can lower cholesterol by 7-10% in 2-3 weeks,” he says. “Plant sterols are compounds from plants that have the ability to remove cholesterol from the body.” Some 50 clinical trials have shown the efficacy of plant sterols, which are natural substances found in small quantities in fruits and vegetables, oils, nuts, seeds and grain and lower ‘bad’ cholesterol in the blood. As well as consuming plant sterols, looking at “food swaps” to get yourself healthier and reduce cholesterol is a positive step. This could involve cutting out sugary breakfast cereals and eating foods containing oats and barley, which have beta-glucans and have been shown to lower cholesterol or switching to dairy-free alternatives which have also been shown to reduce saturated fats from the diet. This could also involve reducing red meat intake and having beans and pulses instead at some meals, as well as eating plenty of fruit and vegetables. Maintaining a healthy body weight also cuts the risk of coronary heart disease. “While statins have a role, and it is fine to take plant sterols, which have a different mechanism of action to statins, a first approach would be to try and get yourself healthy. Take a 360-degree look at all aspects of health and diet and the way you live your life,” says Hobson, who has an ambassadorial role with Flora ProActiv. It is vital for people to manage their cholesterol in order to lower cardiovascular risk, this can be done through lifestyle and diet interventions with the use of plant sterols in the diet.

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Increased testing is needed to screen children for FH Familial hypercholesterolaemia (FH) is an inherited condition which can cause extremely high cholesterol levels. It is passed down through families in the genes.

ithout treatment, FH can lead to heart disease at a very young age. But once it’s been diagnosed, it can be treated with medicines and a healthy diet and lifestyle. Given this is a genetic condition, the earlier you are diagnosed the better.

WRITTEN BY Jules Payne Chief Executive, Heart UK

Lack of disease awareness The condition affects around one in 250 people, that means that around 250,000 people will have FH across the UK. Many of those are not aware they have the condition, sadly we know less than 10%. HEART UK have led the charge for the UK National Screening Committee to accept child parent screening for FH as a national screening programme across the UK. However, to date they have declined to do so. Pilot programme for FH screening In England, there is a pilot programme for child parent screening for FH in seven areas. This programme is extremely important in setting the way for national adoption. This is done through a GP practice who is involved in the pilot. The child is tested when they are at their immunisation appointment between the age of one and two, with the

The condition affects around 1 in 250 people, that means that around 250,000 people will have FH across the UK. consent of the parents of course. If the child has high cholesterol a genetic test is then done and if that proves positive, the child has FH. A process called cascade testing then takes place. Cascade testing is when specific family members are also tested. How to manage the condition is discussed between the healthcare professional and the affected family members. Diet and lifestyle are very important but medication will be needed at some stage.

HEART UK has an information rich website (heartuk.org.uk) with lots of information about FH, including videos, children and young people materials and much more.

Without treatment, FH can lead to heart disease at a very young age. But once it’s been diagnosed, it can be treated with medicines and a healthy diet and lifestyle. ~Jules Payne, Chief Executive, Heart UK

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The importance of lowering high cholesterol earlier Early identification of elevated cholesterol levels in younger adults can have significant long-term benefits later in life.

INTERVIEW WITH Professor Philip Calder Head of Human Development and Health, University of Southampton

WRITTEN BY Mark Nicholls

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Identifying disease risk Lifestyle and dietary choices If people take action early on, even modest decreases in Figures show that if you lower cholesterol by 10% in someone cholesterol can have benefits, explains Professor Philip who is middle-aged, you can decrease the risk of heart Calder, Head of Human Development & Health, University disease in later life by 50%. of Southampton, who has an interest in nutrition and By highlighting the risk to people earlier in life, he says they disease risk. can make lifestyle and dietary choices to reduce later risk. While there are different types of Weight loss, reducing alcohol intake, doing cholesterol in the blood, it is LDL (low more physical exercise and changing diet are density lipoprotein) cholesterol that is the all important. “There is a direct link between harmful, or ‘bad’ cholesterol. what people eat and their blood cholesterol “It increases risk of heart disease Figures show that if you concentration,” says Professor Calder. because cholesterol can be deposited in Saturated fats, such as, in animal fat, lower cholesterol by the blood vessel wall and that starts the butter, high-fat cheese and palm oils can process of clogging up the arteries. It is raise cholesterol. He suggests people switch 10% in someone who is very important for people who have high to unsaturated fat by using margarine-type middle-aged, you can cholesterol to lower their levels,” he says. spreads, vegetable oils and eat more fibre.

decrease the risk of

Early intervention Plant stanols in food heart disease in later However, while there is a focus on finding “In addition, people might want to think people with high cholesterol and trying about plant stanols,” he says. “For example, life by 50%. to get them to lower it through lifestyle Benecol® products contain plant stanols and interventions or statin drugs, Professor these partly stop you taking up cholesterol Calder believes that younger people with lower cholesterol into the body, and that can lower cholesterol.” should also be aware of the potential future risk. Plant stanols are found naturally in foods, so combined “Cholesterol levels go up as we age, so it makes good with other lifestyle interventions, food with added plant sense to catch people sooner and try to help them not stanols can help people to take control of their cholesterol go along the path of having high cholesterol,” he adds. levels, one of the risk factors for coronary heart disease. “Tackling cholesterol earlier, before it has got too high, is very important.”

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Platform optimises health through science-backed recommendations Leveraging biotech and AI innovations, an evolving digital platform is helping create personalised nutrition and lifestyle programmes. For one athlete it allowed him to return to sport following a heart attack.

rofessional triathlete Tim O’Donnell was pushing hard in the Challenge Miami middle-distance triathlon when he started getting chest pains. “There was a shooting pain down my left arm and my jaw started to lock,” he recalls, but pushed on to finish 11th in the race last March, then headed to hospital.

INTERVIEW WITH Dr Gil Blander Co-Founder and Chief Scientific Officer, InsideTracker WRITTEN BY Mark Nicholls

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insights, I can get background information that might raise some flags I can take to my doctor before anything happens and help me stay on track as I start back into full training. “Being able to monitor how I am doing under the stress of training with my condition is a very important part of the comeback.”

Making actionable plans Understanding the prognosis InsideTracker is a human optimisation Tests confirmed he’d suffered a heart platform that analyses blood, DNA attack. A blocked artery was cleared and and fitness tracker data to provide Being able to monitor a stent fitted, enabling Tim, now 41, on the personalised, science-backed nutrition and how I am doing under road to recovery. lifestyle recommendations that optimise the stress of training It emerged he had a genetic strength, endurance and longevity. predisposition to increased arterial plaque Dr Gil Blander, co-Founder and Chief with my condition is and inflammation. This means keeping Scientific Officer of InsideTracker, created a very important part an eye on the blood biomarkers tied to the company to help people “live a cardiovascular health is essential. healthier, longer life based on what happens of the comeback. Cleared to return to training, he inside the body.” partnered with InsideTracker, which helps The platform uses an artificial fine-tune exercise, nutrition and lifestyle for performance intelligence (AI) algorithm to analyse up to 43 blood and longevity as he strives to qualify for the IRONMAN World biomarkers, individual DNA profiles and fitness tracker data. Championships. “That allows us to get a high-resolution picture of your body, based on that we can give science-backed Monitoring training stress recommendations of what food to eat, what supplements Tim uses the technology to keep a close record of his fitness, to take, exercise and lifestyle changes to make.” bloods, DNA, diet, sleep patterns and other vital signs. “The product is designed not just for athletes like Tim “So much happens inside the body that we need to pay but for anyone who wants to live longer.” attention to. With the blood biomarker tracking and DNA

INTERVIEW WITH Timothy O’Donnell Professional Triathlete

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Online cardiology education can benefit everyone Better informed cardiologists will improve outcomes for patients. It is essential to ensure the most up to date information reaches more people.

T INTERVIEW WITH Jelena Spyropoulos Executive Director, Sales and Strategy Team Lead, Medscape WRITTEN BY Linda Whitney

Paid for by Medscape

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he cardiology industry never stands still. There is a greater need than ever to deliver more and better education about cardiovascular conditions to cardiology professionals – and now to patients, high risk groups and the public. “Cardiovascular medicine and treatment are becoming a partnership that includes patients. Wider continuing medical education and public awareness will improve cardiovascular health,” says Jelena Spyropoulos, Executive Director, Sales and Strategy Team Lead at Medscape.

need it and how they need. For example, it routinely polls their members about their specific needs via surveys and need assessments. Based on those needs, it has introduced ‘microlearning’ for cardiologists seeking specific information on demand. “We now offer a range of videos that are typically less than five minutes long,” says Spyropoulos. “They are more user-friendly than the traditional long lectures, which is important as COVID-19 means cardiologists have less time to pursue information and continuing professional education.” Second, it extends the reach of traditional In the past, patients largely Spreading the word around the world live meetings and conferences by using gained information about Medscape, a cardiology platform providing their proprietary hybrid meeting platform. their conditions from educational resources for cardiologists and “People can meet live or virtually which is physicians, but now patients much more accessible now that flying to the wider HCP community, started in the US but is now accessible in the UK through meetings is more difficult,” Spyropoulos can find cardiovascular the acquisition of specialist healthcare says. “This also promotes equality in health education. publisher MGP. It has also been extended education because sessions are more cost to more than 5 million physicians across efficient to access for specialists in lesser every country worldwide. In addition to the UK, it has developed countries.” language and country -specific editions in Germany, Third, it offers parallel tracks of education for both HCPs France, Spain, Italy and Portugal, where it delivers news and patients. “Patient and carer education is key to the and education about cardiology developments in those success of treatment,” says Spyropoulos. In the past, patients markets in their national languages. largely gained information about their conditions from physicians, but now patients can find cardiovascular health Staying ahead of educational needs education, including the benefits of exercise, nutrition and Over the years the platform has evolved but remains lifestyle, online. “Patient education is something we are focussed on key pillars of educational need: skilled at, as our parent company is the healthcare education First, it delivers education to cardiologists when they site WebMD,” says Spyropoulos.

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