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READ How the Men’s Shed got one soldier back on his feet P10
READ Joey Reid, 73, on living with atrial fibrillation P04
READ How tech can help keep blood pressure healthy P06
Heart and Stroke Dr Angie Brown “Women are six times more likely to die from cardiovascular disease than breast cancer.”
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IN THIS ISSUE
Dr Ronan Collins Explores how checking your pulse regularly can prevent a stroke.
P4
Michael’s story Living with heart failure: “You’ve only got one heart, so you have to look after it.”
Dr Maeve Durkan How people with Type 2 diabetes can reduce their risk of cardiovascular diseases. P8
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Tackling Ireland’s number one killer, together
Let’s work together to cut heart and stroke deaths, says Dr Andrew Maree, Consultant Cardiologist at St James’s Hospital and Senior Lecturer at Trinity College Dublin. Fast, high-tech treatment, greater awareness and community action is improving heart and stroke care in Ireland. Improvements cannot come a moment too soon: 36 per cent of all Irish deaths – around 10,000 annually – result from cardiovascular disease, which includes heart attacks, strokes and circulatory disease. Heart disease is Ireland’s biggest killer.
New initiatives improving cardiovascular care Acute care is being boosted by speedy reactions in cases of STElevation Myocardial Infarction (STEMI), where one of the heart’s major arteries is blocked. The target is to transfer patients to a specialist cardiac centre within 90 minutes, where cardiology specialists aim to open the blocked artery within 120 Follow us
minutes of first medical contact. The service, maintained 24/7, 365 days a year, has boosted STEMI survival rates. Meanwhile, for the 15th year running, cardiology specialists including surgeons, physicians, nurses, trainees and representatives from pharmaceutical and medical device companies will meet at the PCI Live/15th International Live Course in Cardiac Intervention in Dublin to see surgical demonstrations and keep up-to-date with the latest advances in cardiology.
CPR training in schools saves lives In the community, the widespread distribution of defibrillators and the training of more people in CPR is saving lives that would previously have been lost. CPR is being taught in schools,
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so children and staff know how to use defibrillators. Prevention initiatives include campaigns to raise awareness of heart disease and strokes, and an anti-obesity campaign, educating people about the need to avoid excessive sugar in the diet, especially for children.
Dr Andrew Maree MB MSc, Ph.D Consultant Cardiologist, St James’s Hospital and Senior Lecturer, Trinity College Dublin
“Heart disease is Ireland’s biggest killer.”
A healthy lifestyle is key Swift, hi-tech medical interventions and community initiatives can only go so far. People can take action to reduce the risk of heart disease and strokes for themselves. A number of simple measures can cut your personal risk. ■■ Adopt a heart-healthy diet: eat less sugar, salt and highly-processed food, and take 40 minutes of cardiovascular exercise five days a week, such as walking, swimming or cycling. Whatever it
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is, aim to build up to a level where you can feel your heart beating but are still able to hold a conversation. Maintain that for 10 to 15 minutes before winding down. ■■ Monitor your blood pressure and cholesterol, via your pharmacy or GP clinic, and learn how to take your own pulse. An irregular pulse could mean an increased risk of stroke. ■■ Press for the installation of more defibrillators in the community, learn how to give CPR, and encourage your children to do so. Get a flu jab – research shows that flu increases the risk of STEMIs. Heart and stroke care is improving in Ireland, but by working together, health professionals, the community and individuals can help make it even better.
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Treating heart failure in the community eVirtual consult; a novel way of using technology to deliver care into the community. One in five of us will develop heart failure in our lifetime. There are up to 90,000 people in Ireland living with heart failure and the estimated cost of heart failure is €660 million. Many challenges remain in the management of heart failure, with suboptimal implementation of guideline-recommended therapies, a changing profile of patients who are older and have multiple conditions and a high rate of early re-hospitalisation for heart failure. Use of modern communication systems has the potential to revolutionise primary care-secondary care interactions to improve patient care. Heart failure, with the correct supports can largely be managed in the community. For GPs, the heart failure virtual consult (HFVC) provides a dynamic learning environment, improved knowledge base, peer to peer support and most importantly the necessary supports to maintain and treat heart failure patients in the primary care setting. This application can host at one sitting up to 25 GP practices, enabling not only online, real time specific case discussion but also a dissemination of practical tips in heart failure care between GP and special-
diagnostics in a timely manner.
Ciara Keane Director of Operations, The Heartbeat Trust
ists. This strategy offers an alternative to standard clinic assessment, and can provide the GP with all the information that he/she requires, reducing need for onward direct referral and, therefore, can reduce unnecessary travel for the patient and their family – a very meaningful bonus for this type of interaction given the age and frailty of many patients with heart failure. This intervention also provides a user-friendly method to update the care strategy for a patient without necessarily requiring the patient to travel, and provides facilitated access for GPs to specialist
Easier access for patients and GPs By managing heart failure in the community, the HFVC removes a step in the traditional care pathway facilitating interaction between the specialist/GP. The HFVC care pathway is cost efficient and creates a dynamic, collaborative communication environment compared to the traditional referral letter pathway. This, in turn, reduces costs and the need for patient travel and family inconvenience. Moreover, the HFVC reduces the need for out-patient department referrals, which frees up hospital out-patient slots for those in need of standard clinics resulting in shorter waiting times and speedier reviews. To date, there are 150 GPs signed up across the East Coast, Midlands and the Carlow/Kilkenny region with 100 per cent of GPs agreeing that the HFVC advice was useful in treating their patients and that the patients themselves benefited as a result of their participation in the HFVC. The patients themselves were also happy to have their conditions discussed with expert and
groups of GPs and relieved not to have to travel to the hospital. Over the initial 18 month study period, 142 patients were referred to the service. Only 17 per cent required review in the outpatient department with the majority of issues dealt with through the virtual consultation service. The travel distance saved for patients referred to this service was 10,552km, especially important for this frail, elderly population. A total of 30 GP practices utilised the service during the study. Usability and improvements in self reported efficacy were high for the GPs involved.
eHealth is the future We are passionate about the future advancement of eHealth in Ireland, and are optimistic about the use of technology for wider dissemination of heart failure knowledge and community based care. Resourcing of this method of integrated care is required to ensure that both specialist and GP teams can participate fully without compromising other patient care. The use of this type of webconferencing is easily transferable to other disease areas nationally.
The Heartbeat Trust has been at the forefront of the development of structured care programmes for the prevention and management of heart failure (HF), including a “virtual consultation” service to enable specialists and GPs to discuss cases and reduce the need for outpatient department referral. The Heart Failure Virtual Clinics are used to disseminate expert heart failure advice and education to GPs. Using a web conference platform GPs can log in remotely, following presentation of a short CME topic GPs can discuss their cases with Prof Ken McDonald, Consultant Cardiologist and Medical Director of the Heartbeat Trust, Dr Paddy Barrett, Consultant Cardiologist and their specialist team. The HFVCs provide online, real-time conversations between the GP and specialist allowing speedy focused interactions. The HFVC has been running successfully as a service for twenty-four months. These virtual consultations are held bi-weekly from St Michaels Hospital, having recently expanded into the Carlow Kilkenny region through support from the HSE.
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Joey Reid Croi Atrial Fibrillation Patient
Living - and moving - with atrial fibrillation Having been diagnosed with an irregular heart rhythm, Joey Reid, 73, describes what it means to live with the condition. Atrial fibrillation is a heart condition that causes an irregular or abnormally fast heart rate through abnormal electrical impulses within the atria. It affects five per cent of the population at the age of 70. As the condition increases the risk of stroke by around four to five times, with the potential to be symptomless – Joey is aware of the importance and good fortune of her early diagnosis. Taking my pulse highlighted my AF Since suffering a ‘very mild stroke’ in 2011, Joey, from Galway, has been involved in support group fitness classes to aid her rehabilitation. The support group classes played a huge part in early detection of the illness. “I do exercise classes once a week where they keep an eye on my health, check my blood pressure and help me with my diet. The instructor takes my heart rate at the beginning, middle and end of class,” says Joey. Although Joey thought her heart rate remained quite high, she didn’t worry about it until, while taking her heart rate at the end of a class, it became clear that something was wrong. “When the instructor took my heart rate at the end of the class, it was pumping far too fast. They took the reading again when I sat down and it was still too fast. I was sent straight to my GP,” says Joey. After referral to a cardiologist, Joey was officially diagnosed with atrial fibrillation and put on to regular medication. Treating AF with electric shock therapy Treatment of atrial fibrillation is dependent on the individual and assessed against your age, health, type of atrial fibrillation, symptoms and potential for underlying causes. “I was put on medication, which seems to be working. It makes me tired but all medication has side effects,” says Joey. Joey is in the process of considering treatment options, including a cardioversion; a procedure that delivers an electric shock through special paddles applied to the chest walls. “Admittedly, I’m not particularly keen on that idea, although it does work most of the time,” she said. However, as she awaits an echocriogram to determine any underlying cause for her condition she maintains the healthy lifestyle she always had. Support groups and early detection made a massive difference to Joey’s condition The medication and support Joey has received since diagnosis has made living with atrial fibrillation as undisruptive as possible to her life and routine. “I still go out with my walking group and my dog, Mindy, and I continue my exercise classes. It’s a good quality of life,” she says. “I am more than happy I was diagnosed. Sometimes people don’t know they have it and have a stroke or a heart attack as a result. Early detection was key to my quality of life – I’m very positive about that,” says Joey. It’s the hard work, support and dedication of independent support groups who have aided in Joey’s understanding of and progression with her diagnosis. “Moving forward, it’s about doing my exercises, getting out in the fresh air and to live life as best as I can,” she says. With the treatment options and support network at her disposal, living with atrial fibrillation won’t stop Joey enjoying the Galway sunshine. More information about Croi’s patient support groups on: croi.ie
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The silent heart condition that causes strokes
One of the main causes of stroke is a condition most people have never heard of, but getting smart on ‘atrial fibrillation’ might just save your life.
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ncidences of stroke are on the rise in Ireland, but as many as 80 per cent of cases are thought to be preventable. By stopping smoking, becoming more active and drinking alcohol in moderation, a person’s likelihood of experiencing a stroke is significantly reduced. Another contributory factor to stroke, albeit less wellknown, is atrial fibrillation (AF), a condition characterised by an irregular heart beat. “If you think of a mixer, mixing cement or batter, the top part of the heart works along the same principle: agitating the blood before delivering it to the lower chambers of the heart that perform the pump action,” says Dr Ronan Collins, National Clinical lead for Stroke and Consultant Physician at Tallaght Hospital in Dublin. “With atrial fibrillation, the heart doesn’t perform its mixing action effectively, making it easier for a ‘lump’ to form in your mixture – in this case, a clot.” When that happens, the results can be catastrophic. The clot, says Collins, often dislodges and moves into the heart’s lower chamber – the ventricle. This fires it down the circulation pipeline “like a bullet from a gun,” causing a blockage of blood flow to the brain and, then, stroke.
Most sufferers have no symptoms While some people with AF will experience symptoms such as palpitations, faster heart rate, or breathlessness, the majority affected by the condition will have no symptoms at all. “Unfortunately, the first time that many people are aware of AF and that a clot has formed is when it’s already caused a blockage and they experience symptoms of stroke,” says Collins. The clot will usually travel to the brain as the first pipes off the system go there. However, sometimes the clot will get jammed in an artery that serves another part of the body, such as the leg or gut, where it also causes a severe threat to life or limb. A stroke arising as a result of AF is likely to have particularly devastating consequences. “They tend to be more severe and disabling strokes, and are also more likely to kill you,” says Collins. “Atrial fibrillation causes larger clots, which often prove more difficult to dissolve or extract.” Although adults of any age can develop AF, it is primarily seen in older age groups. Among the over-60s, an estimated five per cent will have AF; a figure that rises to 10 per cent in the over-75s. Other risk factors associated with developing the condition include high blood pressure, obesity and diabetes and control of these risk factors earlier in life could reduce risk of developing AF. Regular pulse checks can alert you to potential AF Collins advises a visit to the GP for patients in high-risk groups, where the doctor will perform a simple pulse test to check for irregularities. However as the condition is often intermittant it is helpful to know how to take your own pulse. Organisations such as Irish Heart also have instructional videos on their website that show you how to check your pulse. “The videos tell you how to find the pulse and what
Dr Ronan Collins Director of Stroke Services and Consultant Physician, Tallaght Hospital
“AF-induced stroke is more severe, more disabling, and also more likely to kill you.” it should feel like. If yours is abnormal in regularity , it’s important to see your doctor who can arrange an ECG or onward referral for further monitoring,” says Collins. Because AF can be intermittent and the condition is more likely to develop over time, pulse checks should be taken regularly. There are also many smart phone attachments that allow you to take a recording of your pulse. Collins advises knowing what your blood pressure is and maintaining a healthy weight and active lifestyle, as well as limiting your alcohol intake to reduce the chances of developing AF in the first place.
Anticoagulants and surgery are both treatment options To thin the blood in patients with AF, anticoagulants have traditionally been used. While these can be very effective in preventing clots, they can also cause bleeding and do need regular review and occasional blood tests. Once prescribed with anticoagulants for AF, it’s important that patients continue to take their medication as directed. “The condition can sometimes be fixed with an electrically-controlled shock called ‘cardioversion’, or with a minimally invasive surgical procedure called ‘ablation’, where an instrument is inserted into the chamber of the heart, to laser overactive electrical areas of tissue and restore a regular rhythm,” explains Collins. However, the condition may come back and is more likely to do so if you are older so it is important to continue to take your medication to prevent stroke unless otherwise directed by a specialist. Whatever your age, it makes sense to get into good habits: stop smoking, be more active, keep your weight in check, know what your blood pressure is and should be for your age, and learn how to take your pulse. “It’s a good skill to know,” he says. Read more on: healthnews.ie
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Technology has a key role to play in helping people to keep their blood pressure at healthy levels.
How tech can help you look after your heart Professor Liam Glynn Professor of General Practice, Graduate Entry Medical School, University of Limerick
• Over half of all adults in Ireland over the age of 45 have hypertension (high blood pressure). • Uncontrolled hypertension is a major risk factor for heart and kidney diseases and stroke. • The only way to know if you have high blood pressure is to have it checked. • A new website (myBP.ie) contains lifestyle tips for people with hypertension. • Here the three experts who have contributed to the website give their top tips on lifestyle changes to help manage high blood pressure.
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Whether it’s banking, shopping, or even learning something new, technology is continually impacting our behaviour and even our health, and blood pressure-related tech is abundant and accessible.
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Professor Glynn believes that technology can be helpful in many ways. “Whether it is using a step counting app to measure your physical activity and set your own goals or using your own blood pressure monitor to record your blood pressure, use technology that works for you, the way you live, and how able you are to use it, whether you are on your own or have support available to you.”
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“Not for nothing is walking described as man’s best medicine,” he says. Exercise makes the heart and blood vessels more flexible and efficient and produces positive hormones that can benefit a whole range of health conditions. In borderline-high blood pressure, exercise can even reduce or avoid the need to use medication.
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Technology can help you to understand the impact of your lifestyle on your blood pressure, record useful information for future GP consultations and even offer you reminders to take your medication. But, perhaps one of the most useful benefits of health technology, says Professor Liam Glynn, is that it can support people to get active, particularly when they are busy.
Sponsored by A.Menarini Pharmaceuticals Ireland Ltd. and Daiichi Sankyo Ireland Ltd.
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By Ailsa Colquhoun
myEXERCISE Helping YOU manage your High Blood Pressure MyBP.ie is a website for people diagnosed with high blood pressure (hypertension). Simply visit www.mybp.ie where you can find videos and advice on the lifestyle changes that can help you manage your high blood pressure. MyBP.ie is not intended to diagnose any medical condition or to replace consultation with your healthcare professional.
Simple lifestyle changes can improve your overall heart health.
5 ways to manage your stress and reduce your 5blood wayspressure to manage your 5 ways to manage your stress and reduce your stress and reduce your blood pressure blood pressure
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How to improve your diet How to improve your diet How to improve your How to improve your diet How to improve yourdiet diet for lower blood pressure for lower blood pressure for lower blood forfor lower blood pressure How to improve your diet lower bloodpressure pressure for lower blood pressure Paula Mee, Consultant Dietitian has extensive experience in clinical nutrition. Here she offers a few manageable tips on how to tweak your diet, improve your health and manage your blood pressure.
How improve your diet How toto improve your diet for lower blood pressure for lower blood pressure How to improve your diet for lower blood pressure How to improve your diet How to improve your diet for lower blood pressure for lower blood pressure How to improve your diet for lower blood pressure There is great need to take more care over our diet. “High blood pressure is a significant independent risk factor for heart disease and one we shouldn’t neglect,” said Mee. “Sodium and potassium are the two important factors that keep our blood pressure in-check; maintaining a balance is important.”
Paula Mee Consultant Dietician, past president of the Irish Nutrition and Dietetic Institute
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“Another significant factor impacts pressure is alcohol, Hypertension andthat stress canour goblood hand in hand, yet it’s often overlooked. Drinking a lot of alcohol can not only increase find out how to counter those feelings. your blood pressure but also impacts food choice negatively, which can have an adverse affect on your weight and aggravate health problems,” says Mee.
The direct relationship between long-term stress and blood pressure is still very much an area of ongoing research. The dangers to our health often come from the decisions we make when under stress. “What is happening is that our stress levels are Stress and decision-making affecting our behaviour and then our behaviour is and affecting our blood Stress decision-making The direct relationship between pressure,”stress says Wilson O'Raghallaigh. long-term and blood pressure is So what can we doarea to manage our still verydirect much an of ongoing The relationship between stress better improve ourhealth lifestyle? research. Theand dangers toblood our long-term stress and pressure is
5Train ways to manage your for stress stress and reduce your blood pressure Dr Jennifer Wilson
Having gained awareness of O’Raghallaigh your own stress levels, Principal Clinical managing the body to Psychologist, Hospital ‘comedown’Beaumont from the stress response is beneficial. “Relaxation, breathing By Alex van den Broek exercises and meditation can Train for stress make a big difference in reducing chronic stress,” says Train forawareness stress Having gained of Wilson O'Raghallaigh. your own stress levels,
managing bodyawareness to Havingthe gained of ‘comedown’ the stress your ownfrom stress levels, Lifestyle change & response is beneficial. managing the body to support groups “Relaxation, breathing ‘comedown’ from the stress exercises andismeditation response beneficial.can Maintaining a healthy diet and not make a big difference in “Relaxation, breathing engaging in ‘self-soothing’ behaviours reducing chronic sayscan exercises and stress,” meditation through alcohol and smoking is Wilson O'Raghallaigh. make a big difference in important for sustainable stress reducing chronic stress,” says management. However implementing Wilson O'Raghallaigh. change can be problematic. Lifestyle change & “It’s very difficult to change behavior… people support feel they needgroups to change achieve change Lifestyle & by themselves linking diet in support like a Maintainingbut a healthy and not support groups class/exercise group is really engaging in ‘self-soothing’ behaviours important,” saysa Wilson O'Raghallaigh. through alcohol and smoking Maintaining healthy dietisand not
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HEALTHNEWS.IE 7
Lifestyle change & support groups Maintaining a healthy diet and not engaging in ‘self-soothing’ behaviours Train for stress through alcohol and smoking is important for sustainable stress Having gained However awareness of management. implementing your owncan stress levels, change be problematic. “It’s very managing bodybehavior… to difficult tothe change people ‘comedown’ from the stress feel they need to achieve change by response is beneficial. themselves but linking in support like a “Relaxation, breathing class/exercise group is really exercises andsays meditation can important,” Wilson O'Raghallaigh. make a big difference in reducing chronic stress,” says Wilson O'Raghallaigh.
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“Exercise is a massive stress buster. Thirty minutes of moderate physical activity a day, five days a week makes a huge difference in peoples stress levels,” says Wilson O'Raghallaigh.
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Novo Nordisk has had no input to the content of this editorial; the views expressed are the sources’ own
Dr Maeve Durkan Consultant Endocrinologist, The Cork Clinic
5 steps for reducing your risk of cardiovascular disease By James Alder
These five steps are key to breaking down mental barriers and reducing cardiovascular risk for patients with Type 2 diabetes, says Dr Maeve Durkan.
1.
Act on your blood sugar levels
Patients, despite the ability to monitor blood sugar levels, still fail to act on them effectively. “When you’re driving, you use road signs to guide you along the way. Why not use their blood sugar readings in exactly the same way?” By using their readings to guide food intake and exercise habits on a daily basis, patients with Type 2 diabetes can better maintain a steady blood sugar level.
2.
Buy a blood pressure monitor and use it
“You can get one at your local supermarket, so there really is no excuse.” Patients should take responsibility for sending readings to ther doctor. This, Durkan says, further engages patients in their own condition. “I make my patients aware that they have to be under 140/90 (blood pressure). They know that if they’re above that, reducing salt intake and taking more exercise are the steps they need to take to bring those numbers down.”
3.
Reduce ‘lethal cholesterol’ levels
Durkan says that reducing this ‘lethal cholesterol’ count, or LDLs as they are known (low-density lipoprotein), is more important than reducing total cholesterol due to the severe damage it causes. Statins offer a “three for one” deal for patients with Type 2 diabetes, according to Durkan. “They reduce cholesterol, they reduce LDLs and they increase plaque stability, reducing the risk of cardiovascular events.”
4.
Diet: ‘Green is good, white is bad’
No surprise there, you may say. However, making patients aware that change doesn’t always have to be as drastic as they might think can help to keep them motivated and break down mental barriers. “It’s small things that make the difference to begin with. Having two potatoes instead of five, or a quarter loaf of bread instead of half.” On fruit juices, Durkan says, “avoid fruit juices like the plague. Whether it’s refined sugar or processed sugar, if you have diabetes, you can’t process that level of sugar as easily.”
5.
Exercise wherever you feel comfortable
Barriers to exercise are well documented. For those who haven’t grown up in a gym, sudden prescribed changes to their exercise regime can be daunting. Durkan argues that anywhere can be a gym, and patients have to make use of the space they have, whatever the weather. “In America, my kids would come home with instructions to run up and down the stairs 20 times each evening. Buy a pedometer, aim for 5,000 steps a day, building up to 10,000. If it’s raining, get your steps in on the stairs!” Read more on healthnews.ie
Type 2 diabetes patients top of risk pile for CVD Patients with Type 2 diabetes are most at risk of developing and dying from cardiovascular disease, with patient engagement a significant barrier to prevention of the issue. By James Alder
P
atients with Type 2 diabetes often have an above-average BMI, which can increase the risk of other conditions affecting their bodies, according to Dr Robert Kelly, Consultant Cardiologist at Dublin’s Beacon Hospital. “The impact of high blood-sugar levels and insulin-resistance can lead to a higher risk of problems in different parts of the body, which can then lead to cardiovascular disease,” he says. Dr Kelly argues that part of this risk is due to the autonomic dysfunction associated with diabetes and metabolic effects related to insulin production, with body weight and general lifestyle also contributory factors. The link between the two conditions is clear, says Kelly. “I suppose the most frightening fact is that over 50 per cent of people with Type 2 diabetes will ultimately die of cardiovascular disease.” Those with Type 2 diabetes come top of the pile ahead of other, traditional risk factors such as smoking, obesity and high blood pressure.
Type 2 diabetes is an immediate red flag for CVD “Type 2 diabetes is one of those conditions that stands out on its own in terms of the increased risk of cardiovascular disease (CVD),” says Kelly. Patients presented to cardiologists because they smoke won’t get anywhere near the same attention as someone with diabetes is likely to. Those with Type 2 diabetes, especially, will automatically be assessed for CVD. Early identification of the disease can go a long way to slowing the progression of the condition. According to Kelly, raising awareness of the indisputable link between Type 2 diabetes and cardiovascular problems among clinicians is imperitive in
Dr Robert Kelly Consultant Cardiologist, The Beacon Hospital, Dublin
“Over 50% of people with Type 2 diabetes will die of cardiovascular disease.”
terms of helping to tackle the problem. He believes that the new generation of diabetes consultants are waking up to this, referring patients on for earlier cardiovascular assessments. “In the last 10 years, the data around treatment for diabetes has changed to push that message.”
Aggressive treatment key to reducing risk of CVD Drugs that reduce cholesterol and blood pressure should be introduced immediately following a diagnosis. According to Kelly, the key for anyone with diabetes, above all else, is to control their blood pressure and bring their HBA1C down to a target
level. “If they can do that, that alone cuts their risk of mortality from CVD significantly,” he says. There is something of a uniform approach to treatment of Type 2 diabetes in terms of reducing the risk of CVD, as the condition alone Is the largest risk factor. Hardening of the arteries in the legs or neck can indicate CVD. Treatment for those with Type 2 and those without the disease who show these symptoms will be fairly similar, according to Kelly. “With diabetes, you tend to equate that with having hardening of the arteries, without necessarily checking for it.” Treatment programmes for those with Type 2 diabetes, aimed at tackling the cardiovascular risk, will start straight away. Whereas, in cardiology, those without diabetes may not start medical treatment as quickly.
Patients must take responsibility “We’ve become very good at bailing people out, particularly in cardiology, but we’re still not doing enough to tackle the underlying problems.” While medical advances in the treatment of CVD and Type 2 diabetes have enabled earlier detection in many cases, there is still a huge issue around patients taking responsibility for their own condition. This, Kelly says, is the only way that a reduction in chronic disease-related hospital admissions can be achieved. “One fantastic development is the new technology available that monitors blood sugar, which really engages people to take control of their diabetes. Unfortunately, though, it’s the younger generation who are making the most of that, who tend to have Type 1, not Type 2.” Read more on healthnews.ie
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The menopause compounds many cardiovascular risk factors Frank Delahunty Former Defence Forces Commandant
How the Men’s Shed got one soldier back on his feet Former Defence Forces Commandant, Frank Delahunty, has lived life to its fullest. Now 71, the Men’s Shed member refuses to let health setbacks curtail his lust for life. Frank Delahunty – renaissance man You’d need to travel far and wide to find someone with a biography as interesting and diverse as that of Frank Delahunty. The Kilkenny native has packed several lifetimes’ worth of experience into a whirlwind 71 years. Four decades of service with the Defence Forces saw Delahunty rise from apprentice to Commandant. Upon mandatory retirement at the age of 56, Delahunty took up a post as a court crier with the Courts Service. Delahunty’s life entered its latest phase in 2017, when he became a founding member and vice-chairman of Thomastown Men’s Shed. What is a men’s shed? For those unfamiliar with the concept, the men’s sheds movement originated in Australia in the mid-90s. Having arrived in Ireland as recently as 2009, there are now over 400 sheds spread throughout the length and breadth of the island. Sheds themselves are community-focused, member-driven spaces where men of all ages and backgrounds come together to share skills and make new friends. Many members report that participating in a shed has a positive effect on their health and wellbeing – a fact to which Frank Delahunty can attest. Delahunty’s health difficulties began innocuously enough in 2004. Quadruple bypass “I’d always been in good health until I began to notice that something was wrong that December,” he says. “At first I thought it was just heartburn. The burning sensation got worse in 2005 and I was whisked to hospital twice, only to be told there was nothing wrong.” Delahunty’s instincts proved accurate: “I protested that something wasn’t right, and I was kept overnight in St. Luke’s Hospital in Kilkenny. They did a stress test, and it was clear there was a serious problem.” Delahunty was moved to Blackrock Clinic where an emergency quadruple bypass gave him twelve further years of “good, healthy, active life” before angina struck again in 2017. “By this time,” he says, “I had a natural interest in the Men’s Shed movement. I had four stents fitted but I kept going to the shed. I find it takes one out of oneself. It takes away the despondency and the ‘black dog’ that sometimes comes with a heart condition. I’ve got a life to live and I’m going to live it.” Deeply embedded Now the Co. Kilkenny Shed Support Volunteer for the Irish Men’s Sheds Association, the support of Delahunty’s shed-mates has also been crucial to his recovery. “People will come over discretely and ask ‘how are you getting on?’ Four of the men have military backgrounds – the camaraderie is similar to the army”. Delahunty describes himself as “deeply embedded” in the shed and is determined to wring every last ounce of joy from it. “I’m 71. I don’t have a long career ahead of me,” he laughs. “If I don’t do it now, I might not do it.” Through its ‘Sheds for Life’ initiative, the Irish Men’s Sheds Association offers shed members access to health programmes, checks and information. To find your local shed, visit: menssheds.ie/find-a-shed/
Women are six times more likely to die from cardiovascular disease than breast cancer - it’s time to get serious about heart health. How does a women’s heart health/physiology differ from that of a man? In many cases, women are even more vulnerable to risk factors for heart disease and stroke than men. Factors such as smoking, being overweight or obese, having high blood pressure, high cholesterol, being inactive or having diabetes and a family history of cardiac problems all differ in women and men. For example, women metabolise nicotine a lot faster than men, so a cigarette will increase a woman’s risk of heart attack a lot more than it will in a man. Women who smoke are also twice as likely to have a heart attack than women who have never smoked. A large percentage of heart attacks in women under the age of 50 is due to smoking. The same is true with diabetes – it increases a woman’s risk of heart disease a lot more than it will for a man. Another risk factor that’s more important for women is family history of heart disease, which can be a stronger predictor in women than in men. What are the different symptoms for women? About one third of all women in Ireland will die of cardiovascular disease. Yet, many women still view a heart attack as mainly being a man’s problem rather than being an issue for them too. In women, the symptoms of a heart attack can sometimes be quite vague. A woman may have nausea, tiredness, shortness of breath, back pain or tightness in the jaw rather than the more familiar scenario of a crushing pain in the chest that shoots down the arm. It can be very hard to diagnose and that’s why heart disease and heart attack is often missed in women. One of our most important messages is to advise women who are experiencing these symptoms not to delay. Call 999 for an ambulance and get to an emergency department. Irish research shows that one of the reasons many women die from heart attack is that they delay in getting to hospital. The research also highlights that doctors, too, have an important role in recognising that women may have heart problems. A heart attack affects men and women in the same way, but the different sexes experience the symptoms differently. Many wom-
Dr Angie Brown Medical Director, Irish Heart Foundation
en even dismiss the symptoms so they often need to be more severe or advanced before they will seek help. Women are often older at presentation and may be more likely to get fatigue and breathlessness. They are more likely to develop heart failure with a preserved ejection fraction and may have other diseases such as diabetes or arthritis, which further complicate their presentation. Often, diabetics – men or women – don’t get chest pain and are more likely to get breathlessness as an angina equivalent.
Is this worsened with age? A woman’s risk of suffering from a heart attack does increase with age. Up until the menopause, women are protected by their hormones. After the menopause, however, the reduction in oestrogen levels leads to increases in LDL (the bad cholesterol) and a decrease in the good cholesterol.
Blood pressure tends to rise also. The menopause compounds many traditional cardiovascular risk factors, including changes in body fat distribution to increase the risk of central obesity, reduced glucose tolerance (thus increasing the risk of diabetes), increased blood pressure, increased sympathetic tone, endothelial dysfunction (increases arterial stiffness) and vascular inflammation. In postmenopausal women, treatment of arterial hypertension and glucose intolerance should be priorities.
How does heart disease compare with other common illnesses? Most women think they are going to die of breast cancer, when in fact they are six times more likely to die of cardiovascular disease. One reason for this is that women are protected by their hormones and present with heart problems a few years later than men, but after the menopause, a woman’s risk of heart disease catches up with that of a man’s. Are Irish women more or less at risk than women internationally? Overall, our death rates from heart attack and stroke have decreased in Ireland over the last 20 years; we are no longer classified as a high-risk country in Europe. However, the concern is that with rising levels of obesity, hypertension and diabetes, this downward trend will be reversed and not only will levels rise but, potentially, they could start affecting younger people.
What can women do to prevent heart-associated illness? ■■ Be active for at ■■ Eat a healthy
least 30 minutes, five days a week. diet. Eat more fruit, vegetables and wholegrain foods. Eat less fat, fries and convenience foods. Eat fish twice a week. ■■ Manage your weight. Be more active and eat a healthy diet. ■■ If you smoke, try to stop. Just one year after quitting, the risk of heart attack and stroke is reduced by half. ■■ Drink less alcohol. No more than 11 standard drinks per week for women. ■■ Enjoy life. Learn to relax. Take time out for yourself and keep in touch with friends. ■■ Have regular blood pressure and cholesterol checks with your family doctor. ■■ Know your family history and know the signs and symptoms of heart attack and stroke.
Meda Health Sales Ireland launches Armolipid Meda Health Sales Ireland wish to announce the launch of Armolipid, a natural, over-the-counter food supplement.1 Armolipid supports the maintenance of healthy cholesterol. Armolipid should be taken once a day and does not require a prescription.1 It is available in pharmacies across Ireland and is recommended to be taken in combination with a healthy lifestyle and diet. The majority of cardiovascular disease is caused by risk factors that can be controlled, treated or modified. These risk factors include: high blood pressure, high cholesterol levels, overweight/ obesity, smoking, lack of physical activity and diabetes. Cholesterol is produced by the liver and is present in all the cells of the organism.
A guide to healthy cholesterol levels is outlined in this table2
Total Cholesterol
Less than 5.0
If your total cholesterol is higher than 5.0 then you need to reduce it – don’t put it off
LDL Cholesterol
Less than 3.0
This type of cholesterol is often called ‘bad’ cholesterol as it is the type that blocks arteries.
HDL Cholesterol
More than 1.0 for men. HDL is called ‘good’ cholesterol as it helps to remove LDL More than 1.2 for women cholesterol from your blood.
Triglycerides
Less than 1.8
W E N
Supports the maintenance of a healthy cholesterol level
Besides the amount physiologically produced by the body, cholesterol may be introduced exogenously with the diet. It is important to maintain appropriate levels of cholesterol. Therefore, it is important to adopt a healthy lifestyle (for example physical exercise, avoiding alcohol, nicotine and stress) and a balanced diet.1 Armolipid contains the following ingredients:1 Red Yeast Rice – produced from fermentation of rice (Oryza sativa) with a particular strain of Monascus purpureus. Fermented red rice contains Monacolin K.
as part of a healthy lifestyle and diet
Armolipid Classed as a food supplement (1) One tablet daily with or without food (1) Gluten free (1) Take in combination with a healthy diet and lifestyle (1) Available at your local pharmacy
Folic acid – contributes to the normal metabolism of homocysteine. Homocysteine is a substance physiologically produced in the organism following the metabolism of the amino acid methionine, which we introduce in our organism with the diet. The homocysteine produced is then transformed in methionine again. Coenzyme Q10 and Astaxanthin which are both Anti-oxidants. Should you require any further information about Armolipid, please contact Meda Health Sales Ireland, Unit 34/35 Block A, Dunboyne Business Park, Dunboyne, Co Meath. Tel (01) 8026624. Email info@meda.ie. References Armolipid Patient Information Leaflet. The Irish Nutrition and Dietetic Institute.
This is another type of fat found in your blood and high levels are linked with an increased risk of heart disease.
Ask your doctor or pharmacist about Armolipid
“ Armolipid has been shown to reduce cholesterol levels after 12 weeks. ” Donncha O’Callaghan
Meda Health Sales Ireland 34/35 Block A, Dunboyne Business Park, Dunboyne, Co Meath, A86 VW11 References: 1. Armolipid Information For Use.
www.armolipid.ie
Date of preparation: March 2017
Job bag no: Arm/01/advert
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How a 10-minute test could save your life
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Despite the scale of the problem, this simple test is currently only available in a handful of healthcare centres including: • • • •
Blackrock Clinic UPMC Beacon Hospital Vista Primary Care Naas Galway Clinic
• • • •
Mater Private Hospital Hermitage Clinic Cork University Hospital Wexford General Hospital
The test typically costs between €250-€400 and is available on a GP referral basis and is covered under Laya Healthcare (Vista Primary Care only) and The Garda Medical Aid.
A simple, 10-minute scan could tell you your real risk of having a heart attack. Irish technology expert, Ivor Cummins, says the scan should be made available in accordance with current medical guidelines. If so, those with progressive heart disease could be treated before it is too late. For many years, Ivor Cummins and Dr Jeffry Gerber of Denver, Colorado, have been researching the root causes of cardiovascular disease, the world’s biggest killer, including the primary causes and what you can do about them. This is a disease that half the adult population has, to one degree or another.
Strategies to halt heart disease Many seemingly healthy people at risk Sadly, millions of individuals around the world pass their medicals with flying colours, despite the fact that they have the disease called atherosclerosis. It causes soft plaques to develop in the coronary arteries. These soft plaques are constantly rupturing and healing, and eventually become calcified where they heal. But one day, they may rupture and block a major vessel, and this is what causes 70 per cent of all heart attacks. Around a third of the time this results in sudden death. The soft plaques are hard to detect. But, if there are calcified plaques, then the soft ones are there also. There is a simple Coronary Artery Calcium scan that can see the hard plaques. This scan is translated into a score. The higher the score, the greater the risk.
Calcification scans must be a priority Cummins is calling for adoption of the European Guidelines on Cardiovascular Disease Prevention in Clinical Practice, version 2012, which proposes calcification scanning for asymptomatic adults in the middle-risk category. “The scan should be available to men of over 45 and women over 55. This is an opportunity to save many, many lives, which will otherwise be lost.”
“If the scan identifies that you have disease, there is now a range of medications and effective lifestyle/nutritional interventions that can halt or greatly slow the disease progression. So find out what your disease level is, and take the required action – before it’s too late.”
Ivor Cummins BE(Chem) CEng MIEI
“The more calcified plaque in your system, the more soft plaques you have. This accurately reflects your amount of disease,” says Cummins. “You don’t need to listen to me either,” he continues, “The world’s greatest experts in cardiac imaging all say the same thing. The data is from countless human studies, and all of them are in perfect agreement.” These studies show that you have approximately eight times the likelihood of a cardiac event simply by having a non-zero score. If your score is very high, your odds of a heart attack might be 30 times that of someone with no score.
Case study: David stopped his heart disease progressing with new diet Cummins relates the story of Irish entrepreneur, David Bobbett, the CEO and majority shareholder of worldwide manufacturing group, H&K International. “He was fit, well and always passed his executive medicals with flying colours. But everything changed when he got a 10-minute calcium scan. It revealed that he had massive levels of calcium. At the age of 52, the scan showed that he was facing a 75 per cent chance of a major heart event or death within the following 10 years.” David took six months off to study this and found that, although this disease is progressive, it can be stopped in its tracks. As a result he has now got his disease under excellent control. “David knew that he should not be the only one to know this,” explains Cummins. To help spread the message, he made a documentary for RTE called “The Heart of the Matter,” and a movie called,“The Widowmaker,” which was widely acclaimed in the US and is now available to view on Vimeo. He also set up a charity in 2012 called Irish Heart Disease Awareness (www.ihda.ie), which links to all the important information in this crucial area. Cummins says, “David showed rare leadership skills, transforming a frightening personal experience into a philanthropic mission to save others.” Cummins also stresses that, “anyone can save themselves like David did, but they need the scan first to know their risk. And of course they need to take the correct actions if they have a high score.”
With an extensive worldwide research network, Ivor Cummins and Dr. Gerber have honed in on the primary root causes of coronary disease - and the primary strategies to address them. Cummins calls out a few of their dominant areas of concern here:
Cause: Underlying diabetic Strategy: A diet low in carbohydrates, but with healthy fats and adequate protein. Sugar and refined grains are the major offending carbohydrates, which exacerbate the diabetic condition. Cause: Excessive food consumption and frequency of eating, even if the individual balances with exercise and remains at a normal weight. Strategy: The diet above will control hunger and allow proper meal-spacing with traditional fasting behaviours between meals Cause: Nutritional deficiencies: Sub-optimum levels of magnesium, potassium, omega 3 oils, and many other nutrients are becoming recognised as central in the latest research publications. Strategy: Targeting foods rich in these items, or using supplements. Cause: Lack of healthy sun exposure is also a problem for many. The sun releases nitric oxide in the skin, which is important to the health of human blood vessels. It also generates vitamin, D which is important in minimising disease. Strategy: Access healthy sun exposure (without burning), as well as foods high in vitamin D. Vitamin D supplements can help, particularly throughout the winter. Low-carb diet and anti-inflammatory medicines The answer for David Bobbett was to move to a low-carbohydrate diet and start taking antiinflammatory medications. “Excessive dietary carbohydrates were driving his disease,” Cummins says, "like pouring petrol onto a fire”. David’s big discovery was that he was diabetic. “Undiagnosed diabetes is one of the main drivers of heart disease,” Cummins explains. “And like the US, Ireland has high and increasing levels of diabetes.” For many, diabetes remains undiagnosed because standard blood tests simply don’t reveal the problem. However, a high calcification score will flag it, and allow more detailed investigation to take place.