Food for thought at H·E·A·R·T UK Patient`s Day Genetics: Cascade

“Eat your
grains!”
Food for thought at
H·E·A·R·T UK Patient’s Day
Financial matters: Windfall wisdom
Genetics: Cascade testing
Reader offers
ADVICE · LETTERS · NEWS · FOOD & DRINK · PERSONAL STORIES · LATEST RESEARCH
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Helpline
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On this day
1 August On this day in 1774 Joseph
Priestley (1733 – 1804) discovered a gas
which he called ‘dephlogisticated air’ – it
later became known as oxygen. Swedish
chemist Carl Wilhelm Scheele (1742 –
1786) is also known to have independently
discovered it.
On this day in 1965 cigarette advertising
was banned from British television.
5 August Queen Victoria (1819 – 1901)
and US President James Buchanan
(1791 – 1868) exchanged greetings in
1858 to inaugurate the first transatlantic
telephone cable.
10 August The Mines Act came in force
in the UK in 1842 releasing all women
and girls, as well as boys under ten, from
underground employment.
director’s cut:
compasses &
weather cocks
12 August IBM’s first personal
computer was released in 1981.
24 August ‘If St Bartholomew’s Day be
fair and clear, then a prosperous autumn
comes that year’. (Traditional saying).
11 September In 1895 the FA Cup
Michael Livingston
No this is not about
Trafalgar Anniversaries
– though notable and
close to my heart, and
particularly this year,
they are. And despite
the Nelson touch being
like an ‘Electric Shock,
and some shed tears, and all approved,
it was new, it was Singular, it was
simple’. I may return to that on another
occasion, as a subject in parallel for the
future of H·E·A·R·T UK. Meanwhile, no,
it is not about the great weather stories
of this country, although exactly a
hundred years ago, the Barmouth lights,
considered a weather phenomenon,
appeared briefly and were never seen
again. But it is rather about one’s
attitude to life’s rich pageant.
It’s knowing if you are a compass or
weather cock person – a steady person
set on one or more courses of action but
nonetheless intent upon achievement
without change for the forecast future.
Or if you are a person who changes with
the wind, adjustment after all, which
ignored, may cause disaster along the
way. The world is a forcefully changing
place, bombs in London, SARS on the
wing, and footballers’ heart concerns,
so H·E·A·R·T UK must adapt but still
retain its long term and steady vision of
a world without inherited heart disease.
Your Charity is both.
It will continue to use the two in
combination and find its unimpeded
way; for knowledge of more than one
direction finder will help direct us in
all ways.
No. 97 Volume 19
Hyperlipidaemia Education And Research Trust UK
7 North Road, Maidenhead, Berkshire SL6 1PE
Tel: 01628 628 638 Fax: 01628 628 698
e-mail: [email protected]
website: www.heartuk.org.uk
© 2005 H.E.A.R.T UK ISSN 1741-7864
Charity Registration No: 1003904
Company limited by guarantee No: 2631049
H·E·A·R·T UK DIGEST
Editor: Gill Stokes
Associate Editorial Team: Julie Foxton, Baldeesh Rai, Marianne Wightman, Emma Buitendag, Maria Whitehouse
email: [email protected] · website: www.heartuk.org.uk · advertising: 01628 628 638
fax: 01628 628 698 · main office: 01628 628 638
was stolen from a shop window in
Birmingham where Cup winners Aston
Villa had placed it on display. It was only
in 1963 that an 83 year old man admitted
he had melted the trophy down to make
counterfeit coins.
19 September In 1893 New Zealand
became the first country in the world to give
women the vote in parliamentary elections.
Coming soon!
Thanks to those who have kindly sent
their comments on the new-look Digest
– all of whom, so far, approve the
makeover! Please continue to let us
know your views and any suggestions for
improvement and we will do our best to
accommodate them. In the meantime, I’m
delighted to report that Dawn Davies, FH
patient and H·E·A·R·T UK Trustee, will be
penning a regular column from October in
which she will share her expertise from a
patient’s perspective with our readers. So
please write to Dawn via the H·E·A·R·T
UK office too!
regular: news & research
News, news, news...
Food & children’s health
The metabolic syndrome
Independent food watchdog The Food
Commission has calculated that for every
£1 spent by the World Health Organisation
on promoting healthy foods, the food
industry spends £500 on promoting
unhealthy foods.
Website: www.foodcomm.org.uk
An expert panel from the International
Diabetes Federation (IDF) has devised a
simple and practical new set of criteria that
can be used by primary care professionals
and researchers alike, for defining the
metabolic syndrome.
To find out more about the campaign for new
food legislation to protect children’s health,
visit: www.children’sfoodbill.org.uk
Meanwhile, a report published by the Soil
Association and Business in the Community,
‘Looking for Innovation in Healthy School Meals’
(November 2004), finds that healthy school
meals made with fresh unprocessed ingredients
lead to improved pupil behaviour. Pupils eating
these school dinners, and who have access
to drinking water, have better concentration
and are calmer in class. Besides an increased
capacity to learn, they are less likely to be
absent from school.
For further information,
visit: www.soilassociation.org/foodforlife
• Central obesity (waist circumference over
94cm for Europid men and over 80cm for
Europid women; over 90cm for S. Asian men
and over 80cm for S. Asian women; and over
85cm for Japanese men and over 90cm for
Japanese women).
In this
issue…
“The main feature is to establish visceral obesity
as the major driving force”, said Professor
Paul Zimmet, of Melbourne, Australia,
“If someone’s got central obesity, waist
circumference is a clear indication
for primary care staff to look
for other risk factors.”
Low-fat diet is more effective with extra vegetables & whole grains
Avoiding saturated fat is one of the best ways of
lowering total cholesterol levels. A low-fat diet is
far more effective if it also includes plenty of fruit,
vegetables and whole grain.
65 and healthy. They all had a body
mass index (BMI) of 31 or less and
their cholesterol levels ranged from
3.3 to 4.8 mmol/L.
A study of 120 Americans showed that a traditional low-fat
diet lasting for one month reduced total cholesterol levels
by 0.24mmol/L. Participants in the study who ate exactly
the same diet but with added fruit, vegetables and whole
grain showed a reduction of 0.46mmol/L in their total
cholesterol levels. At the end of the four-week trial it was
also shown that this group had a reduction in LDL-C levels
of 0.18mmol/L.
The study states that the improved
levels of cholesterol were probably
due to extra fibre, garlic and plant
sterols in the diet.
All the study diets were matched to ensure they contained
identical levels of protein, carbohydrate, cholesterol, fat and
saturated fat. All participants were aged between 30 and
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News & research 3
Prize winners 5
Genetics 6
Financial matters – Windfalls 7
Globalinx 8
Personal account 10
Plus any two of the following:
• Raised triglyceride level: equal to or over
1.7 mmol/L or specific treatment for this
abnormality.
• Reduced HDL cholesterol: equal to or less
than 0.9 mmol/L in males and below 1.1
mmol/L in women.
• Raised blood pressure (BP): systolic BP equal
to or greater than 130 mmHg or diastolic BP
equal or greater than 85 mmHg, or treatment of
previously diagnosed hypertension.
• Raised fasting plasma glucose: equal to or
above 5.6 mmol/L or previously diagnosed
type 2 diabetes. (If above 5.6 mmol/L, oral
glucose tolerance test (OGTT) is strongly
recommended but is not necessary to define
presence of the syndrome.
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Heart failure, part 4 12
H·E·A·R·T UK Patients’ Day 14
Nutrition counts 15
Low Glycaemic Index (GI)
recipes 16
Book review & reader offer 20
05
07
17
More on statins & grapefruit
Subsequent to an article in June’s Digest
by Dr Mike Schachter from Imperial
College, London, in which he talked
about the potential interaction between
grapefruit juice and atorvastatin and
simvastatin, Mike has contacted us with
the following latest news:
“A few recent reports have suggested
that there is in fact a possible problem
with the actual grapefruit as well as the
juice. Although it seems to have less
effect than the juice it is sensible to be
cautious. Other fruits, including oranges,
should be free of any risk”.
Dr Mike Schachter,
Senior lecturer & Honorary Consultant Physician,
Department of Clinical Pharmacology,
Imperial College, London
digest
August / September 2005 heartuk.org.uk
03
regular: more news
freeaction pack
the blood pressure association launches action pack to
help meet hypertension targets – available free of charge
The Blood Pressure Association, with the
help of primary care health professionals
and their patients, has produced a brand
new set of resources to help GP practices
and the individual to achieve the targets for
hypertension. The BPAction packs provide
guidance and information to help people
with hypertension become involved in the
management of their condition and provide
a resource of good practice tools for
health professionals.
“If we who work at the community level
are ever to make a serious impact on
hypertension, logistics dictate that it must be
the patient who takes responsibility for their
care, striving to reach their targets with the
help of health care professionals,” says Dr
Mike Mead, Leicester GP and Chair of the
BPA’s Healthcare Advisory Panel. “Whether
by self-monitoring, adopting lifestyle measures
to reduce hypertension or achieving full
compliance with medication, the patient must
always be encouraged to participate actively
in their own care. The BPAction pack will help
primary care professionals to support patients
in doing just that.”
The Blood Pressure Association has
developed the new BPAction pack with
support from The Big Lottery Fund. “The
BPAction pack is an essential resource for
nurses to empower all patients to achieve
control of their blood pressure,” says
Joanne Wilkins, Vice-Chair of the Nurses
Hypertension Association. “The pack contents
are comprehensive, incorporating evidencebased guidance and support for nurses
working to achieve hypertension targets.
The leaflets in the pack are written in patientfriendly language and relay the key messages
of how to lower blood pressure to target and
reduce the risk of heart attacks and strokes.”
Jan Gower, Practice Nurse and member of
the BPA’s Healthcare Advisory Panel adds,
“This pack is educational for patients, userfriendly for all healthcare professionals and a
good way of ensuring a quality and consistent
approach to the management of high blood
pressure and its sequelae. Any tool that
helps the patient achieve his or her target of
optimum blood pressure, as well as assisting
the nurses who are undertaking the majority
of this work to achieve Quality Outcomes
Framework targets, has to be welcomed.”
“We know that managing high blood
pressure is a massive task for people in
primary care,” says Sarah Ransome, Head
of Information and Support for the Blood
Pressure Association. “The aims of the Blood
Pressure Action pack are to help patients
reach their target blood pressure and to help
health professionals and surgeries reach their
locally-set targets for hypertension.”
The BPAction packs are free of charge for
GP surgeries, but there are a limited number
available. They can be ordered via the BPA
website – www.bpassoc.org.uk - and
surgeries may order one pack each.
The pack contains:
Multiple copies of a range of information
materials for patients:
• Straightforward ‘How to’ leaflets on eating
less salt, eating more fruit and vegetables,
being active and taking medicines
• Information sheets on lifestyle changes,
taking medicines and measuring blood
pressure at home
• Patient-held record card
A CD-Rom with resources for both health
professionals and patients:
• Animations on the facts about blood
pressure and how blood pressure
is measured
• Videos and articles on patients
describing how they have come to terms
with and managed their blood pressure
• National guidelines
for managing hypertension
• Guidance for nurse-led
hypertension management
• Tools for medicines management
and lifestyle change
For more information, please contact:
Sarah Ransome, tel: 020 8772 4990,
email: [email protected]
The Blood Pressure Association is a UK
registered charity that provides information
and support to people with high blood
pressure. A fundamental part of the
charity’s work is to draw attention to the
need to improve detection, management
and treatment. Through the ongoing “Know
Your Numbers!” campaign, the BPA is
determined that everyone in the UK will
realise the importance of knowing their
blood pressure levels.
Defining the role of statins in diabetes
Cardiovascular risk is increased in people
with diabetes and effective reduction of
all risk factors in people with diabetes is
therefore essential. Several studies have
shown that statins significantly reduce
the risk of cardiovascular disease even
in people with an LDL-C level of less
than 3mmol/L.
04
heartuk.org.uk August / September 2005
digest
The Collaborative Atorvastatin Diabetes Study
(CARDS) showed that statins reduce LDL-C
levels and reduce major cardiac events in people
with type 2 diabetes. Other studies have shown
that 10mg rosuvastatin brings 94% of people
with diabetes down to European LDL-C goals
and 79% of those on atorvastatin 10mg to the
same level.
Studies such as “Treating to New Targets” are
investigating the potential advantages of more
effective lipid-lowering using high dose statin
therapy. Lastly, studies would also suggest that
combining niacin or a fibrate with a statin could
give people with diabetes more comprehensive
lipid control.
regular: fundraising
inspirationalfundraising
Sponsored abseil
A group of five colleagues –
Helena Mackenzie, Jo Walmsley, Cally
Archer, Alexandra Carter and Elizabeth
Risdon – from the Yorkshire office of
Sweet and Maxwell (part of the Thomson
Corporation), participated in a hair-raising 170
ft charity abseil down the Baitings Reservoir
dam, Ripponden, on Sunday 15 May.
The group raised several hundred pounds
for charity, including H·E·A·R·T UK, as a
result of individual effort and support from the
company. All at H·E·A·R·T UK sincerely thank
these fearless five for taking on this challenge
to raise funds for the charity, and to all those
who generously supported them.
When the red, red robin comes bob, bob, bobbing along...
Be an early bird and order your H·E·A·R·T UK
Christmas cards today!
This year’s humorous cards were designed
exclusively for and at no cost to H·E·A·R·T UK,
for which we are all very grateful, by Sarah
Jones, a design graduate from Wokingham.
They are available in packs of 12 (6 designs
per pack) for the price of £6.00 per pack
(plus £1.00 p&p per pack).
To order, please send name, address and
cheque, payable to H·E·A·R·T UK Trading
Company, to:
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PRIZEWINNER
“I was stunned to receive a phone call
from Stephen Adams to inform me that I
had won the star prize of a night for two
including breakfast at the Savoy Hotel.
My husband and I have just returned from a
most enjoyable weekend in London, made
all the more special by the experience of
a stay at the Savoy. As one would expect
the ambience was an oasis of calm and
efficiency, the service was impeccable
and our room luxurious. The hotel is ideally
situated for exploring Covent Garden
and other places of interest including the
National Gallery.
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H·E·A·R·T UK
7 North Road
Maidenhead
Berkshire
SL6 1PE
Breakfast was enjoyed overlooking
the Thames on a bright, sunny Sunday
morning. All in all an extremely pleasurable
experience and we would like to thank all
involved at H·E·A·R·T UK.”
Or, to pay by credit card, please telephone:
01628 628638 between 9.30am and
3.30pm on Monday to Friday.
Dinah McKellar
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Thanks for your support.
COFFEE MORNING
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H·E·A·R·T UK member Lynn Ferguson recently raised £230 for
the charity by holding a coffee morning. The bulk of the money
was raised on the day but the sale of magnetic faces made by
Lynn’s daughter also raised £50.
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Prizewinners
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The August prize draw has been won
by the following H·E·A·R·T UK members:
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Mr Alan Froud: Race meeting at Stratford-on-Avon
Mr Brian Foster: Race meeting at Brighton
Mrs E Brown: Race meeting at Bangor-on-Dee
Mr David Richardson: A day at ‘Tales of Robin Hood’, Nottingham
Mrs Janet Langford: A trip to Windsor Castle
We hope our winners enjoy themselves and we’d be pleased to
publish their account of the day in the Digest!
Lynn told us that to be able to organise and run a coffee
morning, to bake, pot plants and to hear people say how
much better you look is wonderful, and thanks the doctors,
researchers and our helpline for all the help she has received.
We are very grateful to Lynn for all her hard work in organising
this event on behalf of H·E·A·R·T UK and to all those who
attended and made the day such a great success. A special
mention must be made too of Lynn’s ‘crafty’ daughter –
everyone in the office was much impressed with the magnetic
face that you sent us!
Stephen Adams, Fundraiser.
digest
August / September 2005 heartuk.org.uk
05
genetics
the london ideas genetics knowledge park
Gaye Hadfield
regular: genetics
the department of health familial hypercholesterolaemia cascade testing audit project
In the last issue my colleague Mabella Farrer
(Genetics Nurse) told you about the work of
the Genetics Knowledge Parks - ensuring that
genetic knowledge is applied in the NHS to
an informed population. She also introduced
you to our work in tracing families with Familial
Hypercholesterolaemia (FH). Now it’s my
turn to tell you about the exciting role I play
at the London IDEAS Knowledge Park. My
name is Gaye Hadfield and I’m the Project
Co-ordinator for the Department of Health FH
Cascade Testing Audit Project.
Finding people affected by FH, a genetic
disorder that leads to high cholesterol levels,
is very important so that they can be given
lifestyle advice and offered appropriate
medicines to prevent them suffering from
cardiovascular disease early in life. Our
estimate is that there are over 80,000
undetected people with FH in the UK.
There have been several UK studies that have
shown that tracing and testing families of
people affected by FH is a good way of finding
affected individuals and an active programme
has been running in the Netherlands for over
10 years. So people often ask me “Why hasn’t
it been before?” There are many reasons,
but the main one is that it takes a lot of time
to systematically make a record of the family
(drawing a family tree or pedigree) and then
to trace and test family members at risk. This
in turn costs money, and the funds to support
this haven’t been available within the NHS,
so in the past consultants have advised FH
patients to tell their relatives to see their GPs
for a cholesterol test but they haven’t had the
resources available to check that the patient
has contacted all the at-risk relatives or to
check that relatives have had a test done.
When the White Paper on Genetics and
the NHS: “Our inheritance, our future”, was
published in 2003, funding for a pilot of FH
family tracing was announced. In this project
the DH is funding five full-time nurses to
work in locations across England to find out
whether family tracing for FH is acceptable in
today’s social structure and if it is practical in
the NHS.
NHS Trusts in Birmingham, Bournemouth,
Guildford, Manchester and Nottingham have
been selected to test how the tracing works in
a variety of different settings:
• Sites covering urban or rural areas;
• Multiracial or predominantly white British;
• Single large clinics or groups of
smaller clinics;
• Clinics with computerised databases and
those without.
The first nurse was appointed in 2004 and
all five nurses are now in post. They start by
identifying the FH patients from the records
available in the clinic, and they document what
is known about the family from the patients’
notes. This gives a baseline against which
we can measure the effect of increasing the
resources for cascade testing. The nurses then
invite FH patients to visit the clinic to draw a
family tree, and to offer cholesterol testing to
first degree relatives (parents, siblings and
children). If they identify a new FH patient they
then offer to test their 1st degree relatives
and hence we get a cascade (spreading out)
effect. Targeting testing, using our knowledge
of genetics and how the disease is inherited, is
more cost-efficient than screening populations.
You’ll be hearing more about the genetics of
FH from Professor Steve Humphries in the
next issue of the Digest.
There are several aspects to my job; most
important is to ensure the project nurses have
the tools they need to do the job as effectively
as possible, that all the stakeholders are kept
up-to-date with progress, and that the project
runs to budget.
To help the nurses we have given them
detailed written protocols to follow, as well
as templates of letters to use, for example, to
GPs. They also all have a laptop computer with
software to draw the family trees and track
patient information, and special equipment to
do cholesterol tests when the patient visits
(near-patient testing). Most importantly we
have given them lots of training. A two day
training course at the beginning of the project
covered a wide range of subjects to reflect the
Gaye Hadfield, Project Coordinator
London IDEAS Genetics Knowledge Park
Email g.hadfi[email protected]
06
heartuk.org.uk August / September 2005
digest
differing expertise of the nurses. Some come
from a background in coronary heart disease
and lipids with little or no knowledge of
genetics, whilst others are genetic counsellors
who need information on FH. Twice a year I
organise update meetings and we recently
got together at the H·E·A·R·T UK meeting in
Cardiff to share experiences. In between times
we use teleconferencing to keep up-to-date.
Many groups are interested in this project’s
progress and what we learn from it. It’s
important in the context of FH, because if this
pilot is successful the Department of Health
will consider funding the service throughout
England, but it’s also important in the wider
context of genetics and your future health.
FH is a common genetic disorder, with
about 1 in 500 people in the UK affected,
which is roughly the same as the number
with “childhood” insulin dependent diabetes.
However, as we find the genetic causes for
other even more common diseases such
as high blood pressure, Type 2 Diabetes,
osteoporosis or dementia, the lessons from
this project can be rapidly applied to them in
the future. I plan to give you regular updates
about this really interesting project, and if you
would like more information then please visit
our web site at www.fhcascade.org.uk
regular: financial matters
A few weeks ago an acquaintance broke a
piece of news to me by suddenly admitting
that he had come into a windfall and he went
on by asking me what I think he should do
with it.
He then suddenly became quite “cagey” and
appeared to have already regretted that he
had mentioned the matter to me. After all,
personal wealth is almost a taboo subject,
certainly too vulgar for general conversation
with all but one’s most intimate friends and
relatives, but freely discussed between an
accountant or solicitor and his client. He never
did tell me how much was involved, but my
curiosity had been aroused and with a mixture
of both delight for my acquaintance and a
streak of envy, my mind started playing around
with what I would do if I were in his position.
I stressed to him that I am not authorised
to give investment advice and that he
really should seek advice from a registered
independent financial advisor. With everyone
seeming to be suing everyone for bad advice
these days, I had to be very careful not to
upset either my acquaintance or any of the
professional bodies or regulators, who all
seem to so fond of wrapping up our lives with
red tape these days. So, I quickly decided
that all I could really do was to look at the
problem logically and lay down the various
alternatives in simplistic terms, as I saw them,
and then leave it to my acquaintance to draw
his own conclusions:
Interest Payable: Interest payable on loans is
not normally subject to any form of tax relief.
In descending order of cost, the following is
a rough guide of the annual cost of various
types of loan, for which no tax relief is normally
available – but he should check this out with
his financial advisor:
• For car or similar purchase – Anything
from 7-15% and if significantly less then
it can be fairly assumed that the basic
purchase price has been “loaded” to
subsidise the interest charges.
• Approved bank overdraft - typically 8 -10%
(and make sure it is an approved overdraft
facility or it will be vastly more expensive!).
• Mortgage loan – typically 5 - 6.5% APR
(including associated costs both in advance
and on redemption), depending on fixed/
variable terms and duration.
Interest Receivable: Most income is subject to
income tax, when the standard tax rate is 22%
(but 40% in the case of higher rate taxpayers).
Frank Fermor
a
handlingwindfall
Examples of net annual interest that can be earned are shown below:
Max. Net of Tax
a. Taxable
Building Society interest (gross 1.5 - 5.0%)
Say
FTSE 100 share investments
(gross average 3.2%, plus/minus capital gains/losses)
@ 22% @ 40%
3.9
3.0
2.5
1.9
5.0
5.0
3.5
3.5
Premium Bonds (currently 3.25%, but variable – and there is the remote,
but recently doubled prospect of a top prize)
3.2
3.2
b. Tax Exempt
Cash ISAs (gross typically 4.7 - 5.2%)
Say
National Savings
(Note: Over the last four decades, a domestic
property has been outstandingly the best
investment for most people and the proven
formula has been to borrow “to the hilt” and
buy the most expensive property that you
can possibly afford. However, potential major
increases in council tax could effectively
produce a wealth tax and a first home is now
out of reach for most youngsters. House
prices, as a multiple of average earnings,
are around an all-time high and in the short
term either house prices must surely come
down or, at best, hold steady until earnings
catch up. My acquaintance should think very
carefully before putting a significant portion of
his windfall into a more expensive home at the
present time).
I would have thought that his first logical
priority would be to reduce the cost of interest
payable. Only after exhausting all prospects
for costly loan repayment then the second
priority should presumably be to maximise
income – with the main focus on the ultimate
net rate of income received, whether it be tax
exempt or net after tax liability.
Alternatively, if he is fortunate enough still to
be in a well administered and well funded
final salary (ie “defined benefit”) pension
scheme, but unlikely to achieve Inland Revenue
maximum benefits, then he could consider AVC
contributions to that scheme. He would receive
full tax relief at his top tax rate and thus achieve
a substantial subsidy from the Inland Revenue.
Finally, and before he has spent all his good
fortune, he may wish to consider sharing
some of his luck with “the gods” by making
a generous donation to a favourite registered
charity. Such a payment, made subject to a
Gift Aid declaration, would enable the charity
to boost its relevant net income by 28%,
while my acquaintance, as a top tax rate
payer, would obtain further income tax relief
– but that must all be the subject of a future
Financial Matters article.
My acquaintance should first consider
reducing (or even repaying in full - providing
that there are no early redemption penalties),
all forms of borrowing where the overall
costs exceed the best net income that can be
achieved without speculation. Secondly, he
should maximise his use of Cash ISA’s which
are currently limited to £3,000 per annum,
with increased scope if he considers doubling
his investment by using his partner’s similar
maximum potential investment limit). Thirdly,
he should consider spreading any surplus
between tax exempt National Savings and
Premium Bonds.
digest
August / September 2005 heartuk.org.uk
07
regular: globalinx
globalinx
The broader perspective on heart health Dunedin leads the way in co-operation
To know or not to know
Will healthcare become patient-centred?
New Zealand
The broader perspective on
heart health - Dunedin leads the
way in co-operation
The opening, by His Worship the
Mayor of Dunedin, of the newly
refurbished combined premises of
Diabetes Otago and the Dunedin
branch of the Heart Foundation,
marked a significant step forward
by two organisations with similar
aims and aspirations, and to some
extent a similar clientele.
The Chief Executive of the
National Heart Foundation of NZ
and President of Diabetes New
Zealand, emphasised that New
Zealand is a small country and heart
health can only be achieved on a
wider scale by collaboration. In this
instance Dunedin has set a unique
example of relevant and effective
co-operation at a local level.
Alexandra Chisholm, PhD
Lecturer/Research Dietitian
University of Otago, Dunedin, New Zealand
Email: [email protected]
Adrian van Bellen,
chair Bloedlink Foundation
(The Netherlands)
Email [email protected]
Maria-Teresa Pariente
Fundacion Hipercolesterolemia
Familiar, Spain
Email: [email protected]
Web: www.colesterolfamiliar.com
Netherlands
“This is the only sensible way forward if we
are going to tackle two critical worldwide
epidemics which seem to be a hallmark of the
21st century. The opening of the centre is a
shining example of the maxim “Think nationally;
act locally”. As we cannot rely on governments
it is up to organisations such as the National
Heart Foundation of NZ and Diabetes New
Zealand to lead the way” stated Professor
Jim Mann in his remarks to the sizeable group
gathered for the opening.
Professor Mann, wearing as he said two of his
many hats as Patron of Diabetes Otago and
Chairman, Scientific Advisory Group, National
Heart Foundation of NZ, reminisced about the
early meetings of the small group set up to work
on the project. “There were the representatives of
two groups sitting on opposite sides of the room,
with clearly no understanding that diabetes and
heart disease have a lot in common. In the last 10
years there has been an increase in appreciation
that much CVD (cardiovascular disease) has its
origins in DM (diabetes mellitus).”
Dunedin has a long record of heart health
programmes with “smoke free” being
advocated as early as 1979. About the same
time Professor Ted Nye established the Phoenix
club, which encouraged post-MI (heart attack)
patients to take exercise. A walk on the Milford
Track, extending over several days, was led by
Professor Nye for members of this group, and
confounded the gloomy predictions of some
who expected the group to return from the
venture in a worse state of health – possibly
being conveyed home by ambulance.
Mrs Carmel Cadzow, Chairperson, Frederick
Street Building Committee is a Dunedin heart
health advocate and the driving force behind
the project.
As with most community projects funding was
an issue and Mrs Cadzow paid tribute to a
number of local businesses and organisations
who provided the financial support without
which the project would not have been
possible. The refurbished building is well
placed near the hospital with easy access for
people coming to education classes.
The only point in common those many years
ago, the joint possession of a building, has
grown into a truly co-operative project working
for the benefit of the wider community.
Alexandra Chisholm, PhD
Professor Jim Mann would be interested to
hear of any similar co-operative ventures in the
UK on: [email protected]
08
heartuk.org.uk August / September 2005
digest
To know or not to know
One of the main ethical issues regarding
genetic conditions is ‘the right not to know’.
Particularly in the case of diseases which until
today can’t be treated is this right prevailing.
However, the choice is up to the individual.
I know as many people with a non-treatable
disease who categorically decline a genetic test
as those who can’t live with their suspected
condition without confirmation by a genetic test.
In my opinion both sides are right.
When we’re talking about treatable genetic
diseases it’s a different ballgame. A genetic
condition is as much a personal as a family
property. If early treatment can prevent poor
health outcomes in later life, early knowledge
is an asset that can’t be denied to the others
at risk - one has the moral obligation to inform
other ‘owners’ in the case of a treatable disease.
This attitude is more or less the flipside of ‘the
right not to know’. Familial Hypercholesterolemia
(FH) is such a treatable disease. Many adults
in FH-families who are offered DNA-analysis
(a genetic test) request a simultaneous test for
their children. Below the age of 16 years that’s
a parent prerogative. From an experienced
patients’ perspective I warmly welcome farsighted people who check their youngsters at
primary school age. FH is a dominant condition,
which is passed on to on average half of all
children; the more data, the easier and better the
course. If only one could prevent kids with FH
from smoking, a deadly dangerous combination
for the majority, the future would be much
brighter. To stop smoking when started proves a
mission impossible for youngsters.
Yet many adults in FH-families don’t ask for a
genetic test of their children, as they wish their
offspring to have a so called ‘care-free youth’.
To me that’s an ‘ostrich policy’ because the
ongoing process of (silent) clinical disease
development will not be halted by surrogate
ignorance. The supposition that teenagers
with FH will later behave responsibly and
volunteer for medical prevention once they
reach the age of 18 years is completely false.
The real consequence is that young people
with FH without prevention have a hundredfold
increased risk of dying in their third and
fourth decade when compared with their
contemporaries without FH. So it’s much more
important to worry about a ‘care-free youth’ for
your grandchildren - to grow up as an infant
with only one parent is much more dramatic
(and foolish) than simple early expert coaching
of young people with FH. Therefore an effective
regular:
regular:globalinx
genetics
Spain
early disease-prevention strategy
would seem more intelligent to me.
Will healthcare become
patient-centred?
Interesting in this respect is that
future life is a rising issue in the
jurisdiction. An example is the
separation of the twins Mary and
Judy a few years ago in the UK.
The parents were confused by an
overload of media attention and
wished to be left alone with their
burden. However, A British court
intervened and judged in favour
of a separation on the grounds
that if nothing were done, both
girls would die. By creating a legal
framework to separate, one girl at
least would have an opportunity
to survive. Another example was
a court case in the Netherlands in
which the judge valuated the life of
a future child to be more important
than the right of a woman to have
a child. The sad case concerned a
young mother who neglected and
molested her daughter so badly
that she eventually died. As the
chance of recidivism was high,
the court ruled that the woman
concerned be denied any further
right of reproduction, and that the
authority would be responsible for
the woman not getting pregnant
during detention or on probation.
All involved in the healthcare system state
the need for patients to be active in decisionmaking, moving away from the old days and the
image of patients as ‘victims’ as the only way to
be heard. That picture does not match the 21st
century meaning, where the empowered patient
will mean a better informed society – a necessity
that needs the compromise of all stakeholders
for better management of resources.
What’s in the best interest of
affected newborns is also one
of the establishing principles
in newborn screening, with
secondary consideration given
to the interests of unaffected
newborns, families, health
professionals and the public.
Future life and a future healthy
life are about two of one kind.
As patients’ organisations we
have the nice task to educate
our community that to prevent is
much better than to ‘cure’. For
the moment there exists no cure,
we can only control. The wisdom
is that the earlier we control, the
bigger the ‘window of opportunity’
and the lower the costs. Also in
our own interests; we owe the
next generation a bright future.
Adrian van Bellen
Within “the Europe of the 25” that is taking shape
right now, patients’ movements in Brussels
are calling for access, quality and security;
constitutional rights that are supported by
strong and well-resourced civil society networks
lobbying the European Parliament in the search
for greater representation. That move coincides
in part with our efforts in Spain, claiming too our
constitutional rights that had been neglected due
to inequalities in our recent past.
The ‘Basic Law of the Patient’s Autonomy’,
in 2003, established citizens’ rights to
participation, not only on clinical decisionmaking, but also on planning policy and
healthcare management. However, its legal
development is perceived slow and with some
difficulties, because not all seventy counties of
our nation help to ensure that the principles of
equity and solidarity are upheld.
The Familial Hypercholaesterolaemia
Foundation (FHF) have stated those differences
and insist on the need to create strategies that
help to allocate adequate resources and political
priorities to this important citizens’ concern. The
challenge of how to bridge the widening gap
between people living in different communities
must be solved by the institutions. A great effort
is necessary to unblock the paths allowing
patients to achieve legal representation. We
cannot remain ‘paralysed’ by the debate – for
patients to be involved in the decision-making,
the political interest must remain aside and
firmly advocate the space where patients’
voices will be heard.
Besides “where” patient representation
is located, we need to be clear “who”
will represent them. The FHF backs the
constitutional proposal of creating a legal
framework for Patients’ Organisations
to be accredited according to specific
requirements, essential to generate confidence
in such organisations. There is no doubt that
organisations with a clear and responsible
mission do a very praiseworthy job, which
must be recognised and given more economic
support by governments, and consequently
their deserved representation. Their members
are better informed and more involved with their
condition, as well as more responsible about
their role in their treatment, which will contribute
towards better cardiovascular prevention.
In an empowered position, patients will be able
to get involved in the decision making-process.
From this perspective the health system should
formulate a fair system of representation,
without forgetting that only with equality will we
be able to address all patients’ voices at the
centre of health care.
We all share the reality that patients’
organisations are still very fragmented, with
not even 3% of associated members, due
in part to our incipient association move.
However, this is changing. The FHF has always
promoted a transactional model, based on
the conjunction of doctors, nurses, dietitians
and researchers, to fulfil FH patients’ needs,
not only in clinical care, but also in the genetic
field, impelling greater technology innovation
for furthering medical progress. The FHF is
a reference for the genetic hyperlipidaemias,
and to accomplish its mission with a sense
of professionalism, expertise, accountability
and transparency, the support of both the
administration and the members is necessary.
Every day, patients seek advice and support.
Our work is praised by and large, which
demonstrates once again that a strong civil
society should become better resourced.
But what is even more important is that
membership has to grow, because the
strength of the organisation is measured
by the number of associated members.
Therefore, if we want our voices to be heard
at the very centre of healthcare, the support
of all the organisations’ members is the most
important warranty for success. Our motto:
“Do not stop, please keep moving”.
Maria-Teresa Pariente
digest
August / September 2005 heartuk.org.uk
09
mystory
Brian Ellis
regular: personal account
patient power
“My name is Brian Ellis and I am 61 years old.
This story begins on a Monday afternoon in
September 1998, in that while I was talking
with a friend, I suddenly felt nauseous and
apparently went quite ashen. Fortunately my
friend did not panic but sat me down and went
to get help – this is where the second part
of my good fortune comes into effect. At the
time I was working in a research department
associated with a major London hospital,
so my help came in the form of a cardiology
registrar who was working a few doors along
the corridor. Having assessed my condition,
the registrar decided to take me to the
Accident and Emergency department, and
dealt with the formalities with a little help from
myself. The A&E registrar thought that my
condition was equivocal but proceeded on the
basis of my suffering a myocardial infarction
with ECG, the appropriate blood tests and
GTN administration, and arranged for a
hospital bed to be made available.
“She was so
concerned about my
condition that a pillow
was supplied to fit
between the seatbelt and my chest.
Furthermore, any sign
of a pothole induced
a swerve to avoid any
unnecessary jolts.”
Brian Ellis
10
heartuk.org.uk August / September 2005
digest
The following morning came the treadmill test
– I thought that I was doing quite well but
this illusion was shattered by the technician
supervising the test who called it to a halt and
left to find a consultant cardiologist. More
bad news – I had not done very well at all and
the consultant decided that a prolonged stay
in hospital was called for while an angiogram
was arranged.
Two days later I had the joy of an angiogram
– the sedative did its work and everything
proceeded as desired. Later that day back on
the ward a consultant cardiothoracic surgeon
visited me with a sheet of paper on which
was a drawing of a heart. Superimposed
on the arteries were black marks that I soon
learned referred to the amount of blockage that
the vessel in question was subjected. Even
I realised that marks indicating 100% and
95% were not good news! A coronary artery
bypass graft (CABG) operation was proposed!
Although I could refuse this option, that did not
seem to be a sensible approach to the problem
– so, my stay in hospital was to continue until
the operation could be performed.
As events transpired I had four days in which
to come to terms with this life-changing
experience. On the morning in question I was
provided with a small batch of disposable
razors and asked to completely shave my body
– just to complete matters I also removed
the beard that I had worn for nearly 30
years (although not an absolute requirement
this would apparently help the anaesthetist
with inserting a central line via the neck). I
remember being in the theatre ante-room where
the anaesthetist carried out his task but after
that a blank until the high dependency ward
and being comforted by my wife and daughter.
Life back on the regular ward for the next
week went reasonably quickly because of the
number of visits that I had from colleagues.
Mind you, many walked straight past my
bed as they failed to recognise me without
my beard! I had resolved to grow the beard
again straight away and had to persuade
some of the nurses that my dishevelled look
was intentional and not the first signs of
depression! After a week I was deemed fit
enough to be allowed home, and so followed
a car journey of 25 miles with the same
person who had been with me at the start of
this episode. She was so concerned about
my condition that a pillow was supplied
to fit between the seat-belt and my chest.
Furthermore, any sign of a pothole induced a
swerve to avoid any unnecessary jolts.
Being at home was great although I was
apprehensive about life without professional
support being readily available. But much of
that was alleviated following a rehabilitation
course at the local hospital – the staff were
wonderfully reassuring and the advice helpful.
The next problem to resolve was the mental
aspect of the experience – I was 54 at the
time and should be working (albeit that not
commuting to London in the winter rush hour
had much to recommend it). I eventually
persuaded my GP that I was fit enough to
return to work although I now wish that I had
been more attentive to her advice, but I was
definitely going “stir-crazy”.
Unfortunately, some four months after
returning to work I collapsed again and
was subsequently admitted to undergo
further investigation, including an angiogram
and electrical stimulation studies, with the
conclusion that two of the grafts were partially
blocked and I was/am subject to arrhythmia.
The view of the cardiologists was that I would
benefit significantly from removing the (mental
and physical) stress of a working environment.
Consequently I retired on medical grounds a
few months later. A follow-up angiogram three
years later confirmed these findings and added
to the belief that it was the correct decision.
My retirement was some five years ago and
since then I have adapted to a new lifestyle
that revolves around exercising in a local gym,
participating in an active retirement association
(for which I am currently a committee member)
including acting as facilitator for a genealogy
group, attending adult education art classes
and an art group. For a while I played short
mat bowls but am finding it difficult to fit that
in with the development of the other interests –
one cannot always do everything! If I have not
made the most of my retirement by someone
else’s expectation, I would say that “life is a
subjective matter and I am grateful for the care
and support that I have received”.
Did this story really begin in 1998? On
reflection one might argue that it started in
June 1943 at my conception when I received
the genes that would lead me to have a high
risk of hyperlipidaemia and atherosclerosis.
(My paternal grandfather had died aged 50 of
feature: poets & writers
poets
& writers
the once orange badge poetry supplement
a heart attack and my father was to follow this
pattern at the age of 54.) I then added to my
own problems by following a relatively poor
diet for many years – one of the disadvantages
of commuting a distance and the associated
problems is the temptation to use “fast foods”,
even home-cooked, more than is advisable.
Add to this the great mistake of smoking for
approximately 30 years – I have not smoked
since that fateful day in 1998. Being in
hospital it was relatively easy to stop smoking
and I resolved to leave hospital as a “nonsmoker” rather than as an “ex-smoker”.
That attitude has obviously worked for me.
Does this story have a moral?
If it has, it is many-fold:
(1) intelligence is no barrier to stupidity,
and I like to think of myself as
reasonably intelligent;
For poets and writers everywhere whose lives have been
touched by illness or disability.
The Once Orange Badge Poetry Supplement was founded in
December 2002 by Dean-Martyn Heath shortly after suffering
his fourth stroke at the age of 26. The supplement was
intended to be a free outlet for ‘disabled’ writers, but due to
on-going requests, the editor has now included non-disabled
writers whose lives have been touched by illness or disability
in some way or at some time.
The most recent issue has so far circulated to over 350 poets
world-wide.
The supplement continues to grow without any financial
funding and there is a non-profit subscription charge of £1.25
per issue. Poems continue to be selected on merit, and each
accepted poet will receive one complimentary copy of the
issue - whether they subscribe or not!
The Editor, Dean-Martyn Heath, also runs a free newsletter
twice a year: ‘The Orange Leaf Newsletter’ and is also the
author of the self-help quotation book ‘Brave Enough to
Be Afraid’ and of the forthcoming poetry booklet ‘Poetry in
December - The Notebook Collection’.
(2) be aware of your diet, and, perhaps more
importantly, that of your children;
(3) ensure that exercise is part of your life
– remember that feet were invented
before the motor car!”
For writers wishing to submit poems - no preference
towards style, length or subject - please send, with a
stamped self-addressed envelope to:
Dean-Martyn Heath, P.O. Box 184,
South Ockendon, Essex, RM15 5WT, United Kingdom
Telephone 01708 852827
e-mail to: [email protected]
Special Ticket Offer
to the Nutrition & Health Show
Hear from the health experts at the Nutrition & Health Show,
Olympia, 24-25 September 2005.
“nutrition – healthy eating – fitness – free health tests – free one-to
one with a dietitian – fitness – relaxation – lectures - demos”
H·E·A·R·T UK is pleased to announce that it will be supporting this
important event and will be running a question and answer heart
health clinic on their stand.
Some of the tests available at the show include blood cholesterol,
fitness tests and body mass index for determining healthy weights.
A sample of just a few demos and talks of interest:“Lifestyle approaches to optimise heart health”
“Having an MOT can save your life”
“Making sense of food labelling”
Celebrity appearances include: Dr Hilary Jones, GP and GMTV
presenter & Amanda Ursell, Nutritionist Author and GMTV presenter.
Show ticket offer
Buy two for the price of one! (£10 in
advance, £12 on the door, under 16s free).
Quote code: HRT.
Book now: Tickets are available from
Ticketmaster: 0870 4000 889 or in person,
at ticket centres in selected Virgin mega
stores, Beatties and Tourist Information
centres nationwide, or book online at:
www.nutritionandhealthshow.co.uk
For further information please visit
www.nutritionandhealthshow.co.uk
digest
August / September 2005 heartuk.org.uk
11
regular: cardiovascular matters
Hugh McIntyre
heartfailure
wires, devices and beyond
This is the final instalment in a series of
articles about heart failure by Dr Hugh
McIntyre. The series began with the
medical treatment of heart failure and
the importance of maintaining stable
fluid balance and introduction of specific
medications. The second article addressed
organisational changes being made, with
an emphasis upon an early “treatmentcentred” phase of acute medical care
usually involving hospital review, followed
by a more “supportive” phase of care,
increasingly delivered by nurses within the
local community. The most recent paper
looked at the broader impact of heart
failure upon the quality of life for individuals
and their carers. This final article looks
at the latest methods for monitoring and
treating heart failure.
“The best way to treat
heart failure is to
prevent it. This is already
occurring through better
management of heart
attacks and elevated
blood pressure.”
Hugh McIntyre
The best way to treat heart failure is to
prevent it. This is already occurring through
better management of heart attacks and
elevated blood pressure. The first indication
of heart failure is often breathlessness or
ankle swelling. Local systems should be
in place that recognise the importance of
these symptoms (particularly in someone
with previous heart problems) and can
deliver rapid, definitive diagnosis - ideally in
a local setting, and establish a structured
management plan.
The importance of establishing a stable fluid
balance has been emphasised. Education
to help people understand how to monitor
weight, fluid intake and ankle swelling
forms a central component of nurse-based
care for patients. There is an increasing
recognition of the individual as a “partner” in
and “provider” of their care; this has led to
greater emphasis on helping individuals with
heart failure understand their condition and
the rationale behind treatments.
Monitoring Technology
The need to monitor cardiac status has been
a central focus of new technologies, which
are already in use in the USA. In the UK
research is underway to evaluate the benefit
of automated weighing scales and pulse and
blood pressure monitoring devices.
More sophisticated devices estimate the
total body fluid (by a mechanism referred
to as impedence estimation) which can
be incorporated into weighing scales. The
individual is encouraged to use the equipment
on a regular basis and to either telephone or
automatically (by internet or telephone) send
information to a central monitoring station.
These interpret any change in status and make
treatment recommendations. Some versions
will remind the patient if they have “forgotten”
to use the equipment after a couple of days!
Some of the newer pacemaker systems (see
below) can also incorporate a monitoring
facility that can estimate fluid retention in the
lungs. This can detect changes even before
a patient experiences symptoms and can
warn the patient to see their doctor. As yet
there is little research into the overall benefit
of these techniques. Some patients find them
particularly helpful.
12
heartuk.org.uk August / September 2005
digest
Wires
Unfortunately, despite appropriate support
and medication, some individuals develop
persistent limiting symptoms such that
even daily activity is severely restricted. In
a smaller group the heart rhythm may be
dangerously abnormal leading to episodes
of collapse. For both these conditions there
have been major advances in treatment
options in the last two years.
Cardiac Resynchronisation Therapy
Cardiac resynchronisation therapy (also
called a biventricular pacemaker) is set to
become one of the major treatment options for
more advanced heart failure. The technique
involves the insertion of a pacemaker with
three leads, one to the top chamber of the
heart (or atrium) to allow overall co-ordination
of electrical activity, and one to each of the
two ventricles (the major pumping chambers
of the heart). In normal hearts the electrical
stimulus for contraction arises in the atrium
and travels simultaneously to both left and right
ventricles, which contract together. In people
with more advanced heart failure conduction
of electrical activity within the heart is delayed.
This means that contraction of the ventricles
becomes uncoordinated, and ventricular
pumping becomes less and less efficient.
Biventricular pacing (i.e. delivering electrical
activity to both ventricles) restores co-ordinated
electrical activity throughout the heart. This
makes pumping more efficient. Insertion of
biventricular pacemakers, which is performed
under local anaesthetic, can take up to four
hours and requires specialist clinical skills.
These devices have recently been shown to
produce remarkable benefit, with reversal of
abnormal cardiac dilation in some; however
they are not suitable for all patients. About
a third do not seem to derive any benefit.
Improvement in symptoms and survival has
only been shown in patients with evidence of
severe cardiac dysfunction in whom there is
uncoordinated ventricular contraction. This can
be difficult to assess. There is much research
being undertaken. Cardiac resynchronisation
therapy is one of the fastest growing areas of
heart failure treatment. This has implications
for the local health economies however, as an
individual unit can cost up to £20,000.
regular: cardiovascular matters
Medtronic InSync Sentry CRT System
Defibrillators
Assist devices
In a minority of people with severe heart failure
the cardiac rhythm becomes unstable and may
cause loss of consciousness. Any patient with
heart failure who has episodes of collapse
without warning should tell their doctor. In
some, the cause may be ventricular tachycardia
or fibrillation (fast, irregular electrical activity of
the heart that makes pumping very inefficient).
This can be treated with a defibrillator. This is a
special type of pacemaker implanted within the
ventricle which can detect abnormal electrical
activity and, by delivering a small electrical
shock (de-fibrillation), correct the abnormal
rhythm automatically.
A crucial advance in this area has been the
introduction of left ventricular assist devices
(known as LVADs). These are mechanical
pumps originally introduced to act as a
“bridge” to transplantation. They were
designed to provide support to the failing
heart whilst a donor organ could be found.
Because of a shortage of donor hearts the
use of these devices spread to individuals for
whom transplantation was not an option, but
who continued to have severe heart failure.
In such patients the LVAD was regarded as
“destination” therapy in so far as it would
be used for the rest of the individual’s life.
With increasing usage it was observed that,
remarkably, it was occasionally possible for an
LVAD to be removed because cardiac function
had improved so much.
It has recently become apparent that there
is considerable overlap between the type
of patient who might benefit from cardiac
resynchronisation therapy and from a
defibrillator. Whilst cardiac resynchronisation
and defibrillators are occasionally implanted
as a single unit it appears likely that
resynchronisation therapy alone may be
sufficient in many.
TRANSPLANTATION AND DEVICES
Transplantation
In a very small number of patients heart failure
remains impossible to control. Such individuals
often have minimal quality of life and may
require constant support. The mainstay of
treatment has been cardiac transplantation,
first performed in South Africa in 1967. About
150-200 heart transplants are carried out in
the UK each year three quarters of whom are
still alive after a year.
There are many restrictions to transplantation.
More complex medical and personal
assessments are required. There needs to
be compatibility between donor and recipient
blood groups. Furthermore, the recipient
must be capable of withstanding strong
immunosuppressant therapy for many years.
This is necessary to prevent “rejection” of the
donated heart by the recipient. “Matching” of
donor and recipient tissue characteristics is
made as close as possible and further limits
the process. In addition, there is an increasing
shortage of donor organs for transplantation.
The LVAD is a mechanical rotary pump.
Because of their size initial devices had to
be implanted in the abdomen. The most
recent device is far smaller (about the size
of your thumb), and can be implanted in the
chest. LVADs require power supplied through
portable battery packs. Research in the United
Kingdom is currently investigating the benefit
of these latest devices. With the increasing
shortage of transplant donors, the wider use
of “destination” LVAD therapy, particularly
whilst allowing optimisation of other treatments
is becoming more likely.
Beyond
Merely a peripheral aspect of cardiac disease
20 years ago, heart failure is now a central
component of a successful cardiovascular
healthcare programme. This is because of the
huge expansion in our understanding of the
extent and impact of heart failure. At the same
time large international studies have shown
the benefits of several new treatments that
can improve both quality of life and survival.
Networks of care are being developed to
ensure that these benefits are available to all
who require them.
The 1990s was the decade of
pharmacological advances (treatment with
medication). The emphasis is now shifting to
wires and devices which add further benefit.
We have yet to fully understand the potential
of pacemaker and assist devices.
One of the most remarkable recent
observations is that heart muscle can
apparently partially regenerate. This seems to
occur when “travelling” cells within the blood
stream “home in” to damaged areas of the
heart, settle there and adopt properties of
cardiac muscle. We know this happens but
we do not yet understand how to fully harness
the promise this offers. Huge research
projects are looking at genetic techniques
which encourage existing cells to adapt into
heart cells, and “stem cell” technology where
“young” cells are delivered to damaged areas
of the heart so they may be incorporated into
functioning tissue.
Within the foreseeable future the dream of
fixing a broken heart may become a reality.
Afterword
If you have heart failure it should be possible
for you to have access to all of the treatments
discusses in these articles. This particularly
applies to full assessment of treatment options
and access to nurse support.
Please remember that some of the more
recent techniques (defibrillators, biventricular
pacemakers) have only been shown to work in
specific groups of patients.
Services in some areas are better developed and
equipped than others, however if you have read
something that you feel might be appropriate for
you please ask you local doctor.
It is intended to combine the four articles in a
booklet. Dr McIntyre would welcome comments
on this series of articles. Suggestions for
improvements or alterations that could be
made to help the individual with heart failure
understand their condition, the rationale
behind treatment and the possible options
available to them would be particularly welcome.
Dr McIntyre can be contacted at
[email protected]
Further information is available from the British
Heart Foundation website www.bhf.org.uk
(search for heart failure), or from
www.heartfailure.co.uk
Copies of the National Institute of Clinical
Effectiveness guidance: “Management of
heart failure: Understanding NICE guidance,
information for people with heart failure, their
carers, and the public”; is available from:
www.nice.org.uk/page.aspx?o=79729
digest
August / September 2005 heartuk.org.uk
13
regular: conference report
conferencereport
patients’ day
Our first guest presenter, Grant Wright from
the David Lloyd Leisure Group, spoke about
exercise and why it is good for us, and began
with a few interesting facts on the average
diet in the UK today. There has been a 50%
increase in portion size and a staggering
100% increase in soft drink sales in recent
years, he said, and this, along with a lack
of fruit and fibre in the diet, has contributed
towards the obesity epidemic which has
tripled in the last 20 years and is still growing unlike in the US, where it now appears to have
reached a plateau. Currently one in five adults
and one in ten children in Britain are obese,
and obesity-related disease accounts for the
highest health expenditure during the last ten
years. People are working longer hours, eating
later and expending 20% - 50% less calories
per day. Incredibly, while £886 per head is
spent on treating illness each year, just £1 per
head goes towards promoting wellness via
activity and sport.
More exercise facilities are needed yet,
currently, for every new swimming pool
opened three are closing down. Something
familiar to many reading this is the New Year
resolution to get fit resulting in a gleaming new
piece of exercise equipment laying dormant in
the garage when, come February, those good
intentions have faltered ... evidently 80% of us
are guilty of this!
Mr Antony Worrall Thompson, celebrity chef
& author of a new cookbook on the GI diet.
It was good to welcome old and new
H·E·A·R·T UK members to this year’s
patient workshop which is held alongside
the main meeting at the charity’s annual
two-day conference.
Mr Grant Wright, Marketing Director,
David Lloyd Leisure
Patients’ Workshop at the H·E·A·R·T UK 19th Annual
Medical & Scientific Meeting, 30 June 2005, University of Glamorgan
Mr Wright recently witnessed, on a trip to
Boston, USA, a strength-training class full of
enthusiastic nonagenarians, an initiative that has
proven very successful in averting many mental
and physical health problems in this age group.
So there really is no excuse not to exercise for
those of us with rather fewer miles on the clock!
Cardiology. But who better an exponent of why
healthy eating is good for us than our second
guest presenter, celebrity chef and food writer,
Antony Worrall Thompson.
How can we improve matters? Enabling GPs
to write prescriptions for exercise, paid for
by the Primary Care Trust, would be of great
benefit, both in terms of the management and
the prevention of disease.
The David Lloyd Leisure Group works with
schools, providing tennis coaching and other
fitness training activities, and has also initiated
the ‘Great Mile Runs’ throughout the UK, which,
as an activity accessible to many, have proved to
be a great success. In addition, in some areas a
number of free sessions at the club are offered,
and the question of extending this by offering
discounts nationally to those who need exercise
the most but can’t afford subscription costs was
also raised by a member of the audience.
Interestingly, research recently presented at
the Diabetes UK conference indicated that
increasing sports activity in schools is too
simplistic a solution. Apparently very young
children have a sort of built-in ‘activity-stat’.
For adults, the ‘Green Gym’ schemes are an
excellent way of keeping fit and socialising
while helping with environmental projects such
as tree-planting.
The solution, said Grant Wright, is all about
balance – we need to view exercise as an
integral part of health delivery in the UK and
fund it accordingly.
A comment that will surely resonate with many
of us is the need for a wider choice of suitable
gym-wear beyond size 10!
This year’s concurrent Medical & Scientific
Meetings were all about the metabolic
syndrome (the latest definition of which is
featured on page 3); and the full report on the
conference will appear in the British Journal of
14
heartuk.org.uk August / September 2005
digest
Three years following a diagnosis of metabolic
syndrome (or Syndrome X, as it’s sometimes
known), Antony has successfully reversed
the symptoms of this condition by losing two
stones in weight, increasing his activity levels
and changing his diet – and he no longer has
the syndrome.
An overload of refined carbohydrates (high
glycaemic index - GI – foods) contributes to
insulin resistance and the metabolic syndrome,
and, as Antony reminded us, sugar is the main
culprit, useless in its refined state. There is
more on the GI diet in our recipe feature on
pages 16 and 17. Hydrogenated products are
also bad news, and a health warning label is
being considered for such products in the USA.
Antony thinks that as a nation we’re forgetting
how to cook and should regain this disappearing
skill fast by re-introducing lessons in schools
and fostering a renewed passion in youngsters
for real food and nutrition. The demise of family
meals, lack of education, ‘pester power’ upon
parents and the explosion of easily-available
snack foods, both in and out of school (with an
average £2 spent per person each day on snack
food in the UK today), have all contributed to the
‘sofa-loafer’ climate we live in today.
More nutrition training is needed for health
professionals too - doctors in particular, whose
general training is at the moment dismally
lacking in nutrition and its impact on the health
of the nation.
An animated ‘question time’ followed in which
there was a plea for more cookbooks using
cheap, healthy ingredients and a brief insight
into the type of questions we receive on our
helpline (including lots on prawns and eggs).
Our thanks to the presenters who duly left us
with plenty of ‘food for thought’!
Gill Stokes
regular: nutrition
nutritioncounts!
A recent independent survey carried out by
ICM and funded as part of an educational
grant from Alpro UK has found that practice
nurses feel under-resourced in providing
adequate diet and lifestyle advice to their
patients, but are actively looking to improve
the help that they can offer. What follows is a
brief insight into the science and policy that
is driving diet & lifestyle strategies in primary
prevention, and the increasing role of the
practice nurse.
From science to policy
Accumulative scientific evidence demonstrates
how diet and nutrition is one of the most
important determinants of health. Studies
show how specific nutrition and activity habits
can significantly decrease risk of several
chronic diseases.
The World Health Organisation has adopted
a global strategy on Diet, Physical Activity
and Health to provide member states with
a range of global policy options to address
two of the major factors responsible for
non-communicable diseases, including
cardiovascular disease, diabetes, cancers and
obesity related conditions – which account for
6 out of 10 global deaths.
In 2003 the National Institute for Clinical
Excellence (NICE) went further than any
government body before in suggesting that
patients have a responsibility to make lifestyle
changes to help health professionals better
manage progressive diseases. More than
ever before this direction brought official
responsibility to both patients and carers about
the importance of providing proper guidance
on following a healthy lifestyle.
While £1.7 billion is spent on treating heart
disease in the UK, less than 1% of that
figure is spent on preventing the incidence of
cardiovascular disease. The Government has
been forced to acknowledge that action needs
to be taken at an earlier stage, integrating all
levels of society to prevent the development
of the predominant diseases in the UK: CVD,
obesity, diabetes and cancer. In 2005, the
focus has turned to primary prevention, with
many diet and lifestyle strategies taking a
leading role in tackling health inequalities.
We are finally embarking on a new era of
healthcare prevention and treatment where
nutrition will continue to play an even bigger
and more vital role.
From media coverage to clinical practice
Media interest in healthy living continues
to grow. However, the headlines are often
inaccurate, leading to confusion and conflicting
information. Too often single pieces of
research are not reported within the context
of all previous related research. Findings are
often exaggerated, and animal research has
conclusions and recommendations that have
no relation to human metabolism. This can
put people off tuning into important health
messages and lead them to tread much more
carefully, looking for information and experts
with recognised qualifications who have proved
themselves trustworthy.
According to a recent Mintel report, just
over 50% of the public agree they should
do more about their own health, and other
surveys show how health professionals are
increasingly being seen as the reliable source
of information on specific issues and methods
of maintaining or achieving optimum health.
Our practice nurse
Practice nurses are in a key position to
provide guidance to the public and their role
is set to expand in preventative public health
work. In a recent ICM survey 69% of practice
nurses see diet and lifestyle as solely their
responsibility. Interestingly GPs surveyed
were divided about their role in this area. 37%
of practice nurses believe diet and lifestyle
advice to be the “most important” aspect of
their role – whilst 97% of practice nurses
place diet and lifestyle advice as ‘important’.
Despite this, 7 out of 10 of practice nurses
are only ‘sometimes’ able to give enough time
to diet and lifestyle advice and 1 in 4 ‘always’
finds enough time.
There was good general awareness of a
healthy heart diet amongst practice nurses,
but less so on more specific dietary guidance
to lower blood cholesterol levels. The majority
of practice nurses use ‘traditional’ materials
to provide information to patients, such as
leaflets and posters. However, those surveyed
also wanted better resources and training, and
more information from professional journals to
keep up-to-date.
A new diet & lifestyle educational
tool for practice nurses
As a result of this research, Alpro has
been working with registered dietitians and
practice nurses to develop a diet and lifestyle
educational tool, which can be used by all
practice nurses providing diet and lifestyle
advice. It can be used in a wide variety of
cases relating to CVD, diabetes, weight
management and cancer and it is simple,
motivating and user-friendly.
This resource will be launched in autumn 2005
– with further information in October’s Digest.
All practice nurses interested in diet and
lifestyle and its impact on health should gain
a copy of this resource and use it for those
patients not only looking to optimise their
health and prevent ill health but also those with
existing health issues to improve their health.
In addition Alpro, in association with H·E·A·R·T
UK, will be running a series of educational
seminars for practice nurses on diet and lifestyle
which will also be announced in forthcoming
issues of the Digest and other journals.
Tanya Carr, freelance registered dietitian
and nutritionist, health writer, nutrition
communications consultant and a director of
Nutrition & Health.
[email protected]
This project has been directed by registered
dietitians and practice nurses and has been
funded by an educational grant from Alpro
UK Ltd.
Are you a practice nurse?
If you are a practice nurse who is getting
more involved in providing diet and
lifestyle advice in your practice and you
feel you can contribute to these local
study days please contact Tanya Carr at:
[email protected]
digest
August / September 2005 heartuk.org.uk
15
regular: food & drink
mmmmm
4 more recipes from the
New Glucose revolution third edition
Swiss Bircher Muesli
Marinated Mushroom
with mixed fresh Fruit
and cracked Wheat Salad
Mushy rolled oats, plump sultanas and
crunchy almonds combined with natural
yoghurt and milk.
Serves 4-6
A super nutritious high fibre salad.
Ingredients:
• 80 g rolled oats
• 150 ml low fat milk
• 1 tablespoon sultanas
• 100 g low fat plain yoghurt
• 40 g whole almonds, chopped
• 1 apple, grated
• lemon juice (optional)
• mixed fresh fruit, such as strawberries,
pear, plum, passion fruit
New glucose
revolution
Third edition, published by
Hodder Mobius
Particularly beneficial to those
with heart disease, established
diabetes or weight problems, this
guide to the glycaemic index (GI)
is also ideal for those who want
to do the best they can to prevent
those problems in the first place.
Method
Combine the oats, milk and sultanas in a
bowl. Cover and refrigerate overnight.
1
2 –Addmixthewell.yoghurt, almonds and apple
To serve, adjust the flavour with lemon
3 juice.
Serve with fresh fruit.
Nutritional analysis
Per Serving
• Low GI
• 50g carb
• 1540 kj
• 11g fat
The New Glucose Revolution
– third edition, tells you what you
need to know about lowering
your blood glucose, why it is
important for good health, and what
makes low GI, slowly digested
carbohydrates so essential for
lifelong health. It also contains new
recipes, more meal plans and the
very latest cutting-edge research.
Digest reader offer
To order your copy of the New Glucose Revolution at the
special price of £7.50 including p&p (RRP £8.99), please call
0870 7552122 and quote offer code BSH193. Or send a
cheque made payable to Bookshop Partnership Ltd to:
New Glucose Revolution, Offer BSH193, PO Box 104,
Ludlow, SY8 1YB. Please allow 28 days for delivery.
16
heartuk.org.uk August / September 2005
digest
• 365 kcal
• 6g fibre
Serves 4-6
Ingredients:
• 125 g button mushrooms, sliced
• 2 green shallots, finely chopped
• 160 g cracked wheat (burghul)
Ingredients: for marinade
• 3 tablespoons lemon juice
• 3 tablespoons olive oil
• 1 teaspoon brown sugar
• 1 clove crushed garlic
• 2 tablespoons parsley, finely chopped
• 1 tablespoon mint, finely chopped
Method
Combine ingredients for the marinade
in a bowl. Add mushrooms and shallots,
stirring to coat. Cover and refrigerate
for about an hour for the mushrooms to
soften and the flavours to develop.
1
Meanwhile, place the burghul in a bowl
2 and
cover with hot water. Stand for about
half an hour for the burghul to absorb the
water and soften.
Drain the burghul, squeezing out
3 excess
water by wrapping in absorbent
kitchen paper. Toss the burghul with the
marinated mushrooms and spoon into a
serving dish.
Nutritional analysis
Per Serving:
• Low GI
• 22g carb
• 810 kj
• 10g fat
• 195 kcal
• 5g fibre
regular: food & drink
mtasty recipes
Sweet Chilli Chicken
Serves 2
with Sweet Potato Mash
and Stir-Fried Greens
Ingredients: Sweet Potato Mash
• 500 g approximately sweet potato,
peeled and cut into chunks
• 85 ml low fat milk
• 1 tablespoon sweet chilli sauce
Ingredients: Sweet Chilli Chicken
• 2 single chicken breast fillets (approximately
350 g), sliced into strips across the grain
• 1 teaspoon oil
• 250 ml chicken stock
• 2 teaspoons salt-reduced soy sauce
• 1 tablespoon sweet chilli sauce
• 1 tablespoon cornflour
• 2 teaspoons grated fresh ginger
• few sprigs of fresh coriander leaves
Ingredients: Stir-fried Greens
• 1 teaspoon oil
• large handful of mange tout
• bunch of Chinese greens, such as choy
sum or baby bok choy
• 2 medium courgettes
Method
Boil or microwave the sweet potato until
tender. When cooked, drain and mash
with milk and sweet chilli sauce.
Keep warm.
1
or large frying pan with the
2 oilHeatanda wok
stir-fry the chicken until browned.
Remove from pan and set aside to
keep warm.
a further teaspoon of oil in the wok
3 orHeatfrying
pan. When hot, add the green
vegetables (chopped stalks and sliced
courgettes first). Stir-fry until lightly
cooked. Combine remaining ingredients
in a separate bowl and add to the pan
with the cooked chicken and stir until
thickened slightly.
Serve the chicken and greens over the
4 sweet
potato mash.
Nutritional analysis
Per Serving:
• Low GI
• 22g carb
• 810 kj
• 10g fat
• 195 kcal
• 5g fibre
Yoghurt Berry Jelly
Serves 2
Serves 2
An easy dessert. You could make it with
low calorie jelly if you wanted to reduce the
kilocalorie content.
Ingredients:
• 85 g packet berry-flavoured jelly
• 250 ml boiling water
• 145 g strawberries or frozen raspberries
• 300 g low fat berry yoghurt
Method
Combine the jelly and the boiling water in
a bowl, stir until dissolved – cool but do
not allow to set.
1
Roughly chop the strawberries
2 (frozen
raspberries will tend to break up
on stirring).
Fold the yoghurt and berries through the
3 jelly,
mix well. Pour into serving bowls,
over and refrigerate until set.
Nutritional analysis
Per Serving:
• Low GI
• 16g carb
• 360 kj
• 85 kcal
• fat negligible • 1g fibre
H·E·A·R·T UK
Readers’ recipes
We would like to raise funds for the work of
H·E·A·R·T UK by publishing our own recipe
book featuring readers’ favourite recipes,
including heart-healthy meals for one and two,
and meals on a budget. Anecdotes and tips,
e.g., on how to get little ones to eat their greens,
and high-resolution prints or digital pictures are
also welcome! Our dietitian will cast her expert
eye over them and add the nutritional analyses,
and they will also be featured in the Digest. A
selection of heart-healthy ‘Polymeal’ recipes
would be great too – incorporating almonds,
garlic, dark chocolate, wine, fruit and vegetables
and oily fish – so if you feel inspired to devise
your very own recipe, we’d love to hear from
you. There will be prizes on offer – including, if
we receive enough recipes, a copy of the book
on publication!
digest
August / September 2005 heartuk.org.uk
17
regular: your letters
mailbox
Dear Editor,
I understand there is a fairly
new cholesterol- lowering
treatment available called
Ezetrol. Can you tell me more
about this drug please?
your letters to the editor
“...If you
are watching
your weight
or reducing
your blood
cholesterol, you
need to be
careful how
much cheese
you eat as
it can be high
in calories...”
Dear Editor,
I am a 46 year old woman with
raised cholesterol. I follow a
very healthy diet generally but
my downfall is cheese. Can you
advise on which cheese(s) I
could have a couple of times a
week please?
Mrs A. from Birmingham
Dear Mrs A
If you are watching your
weight or reducing your blood
cholesterol, you need to be
careful how much cheese you eat
as it can be high in calories (with
one matchbox of high fat cheese
containing about 150 kcal), and
high in saturated fats.
Limit your intake to no more than
4 oz per week of high-fat cheese.
Try grating hard cheese. This
makes your portion of cheese
seem larger.
Choose low-fat cheeses. There
are some great tasting low-fat
options. Below is a list of some
cheeses available and their
fat content.
Baldeesh Rai
LOW FAT
Quark
Cottage Cheese
18
heartuk.org.uk June / July 2005
digest
% FAT
0.4
2–7
Ezetrol (proprietary name for
ezetimibe) is a cholesterol
absorption inhibitor that became
available on prescription
about two years ago. It acts
at the brush border of the
small intestine, preventing the
absorption of dietary cholesterol
and the re-absorption of
cholesterol in the bile.
When a patient is either unable
to tolerate statins at all or cannot
tolerate a higher dose of statin
to adequately control his or
her cholesterol levels, Ezetrol
may be prescribed on its own
or along with a lower dose of
statin. It is prescribed as a fixed
dose of 10mg daily, lowers LDL
(‘bad’) cholesterol by between
10 – 20% and is well-tolerated.
Side effects such as nausea and
bloating are uncommon.
Very recently a combination
of ezetimibe and simvastatin
has also become available
on prescription. Inegy is the
proprietary name in the UK of
this new drug treatment and
its dual power addresses both
sources of cholesterol in one
MEDIUM FAT
% FAT
tablet. Inegy may be prescribed
in daily doses ranging from
10mg of ezetimibe and 10mg of
simvastatin to 10mg ezetimibe
and 80mg of simvastatin. The
typical dose is 10mg/20mg or
10mg/40mg taken as a single
dose in the evening.
Dear Editor,
I am considering undergoing
an EBT scan privately which
I understand is a non-invasive
and accurate means of
assessing the presence and
degree of coronary artery
disease. Can you tell me
more about this new
technology please?
Dr Anthony Wierzbicki, Senior
Lecturer in Chemical Pathology,
St Thomas’ Hospital, London
and H·E·A·R·T UK Board
member replies:
Electron beam tomography (EBT)
is a very expensive and currently
unproven scanning technology.
It actually picks up and ‘scores’
the degree of coronary
calcification which is present in
atherosclerosis, but there are
other causes of these deposits,
such as bone disorders, and the
technology hasn’t, as yet, been
completely validated in long-term
clinical trials.
HIGH FAT
Philadelphia Light
15
Port Salut or St Paulin
Type
Cheddar Type - Half Fat
15
Danish Blue
% FAT
26
27 – 30
Fromage Frais
4
Feta
18
Dolcelatte
28
Italian Ricotta
4
Mozzarella
20
Parmesan
30
French Jockey
8
Cheese Spread
21
Philadelphia
30
Shape
9
Halloumi
23
Emmental
31
LF Spread
9
Austrian Smoked
23
Gruyere
32
LF Edam
11
Camembert
23
Wensleydale
32
Gorgonzola
24
Cheshire
32
Mini Babybel
24
Red Leicester
33
Brie
24
Blue Stilton
35
Paneer
25
Cheddar
Bel Paese
25
Double Gloucester
35
Lancashire
25
Cambazola
42
Edam
25
German Blue Brie
42
Flora Cheese Spread
25
Cream Cheese
45
Mascarpone
45
33 – 35
regular: spotlight on
Julie Foxton
spotlighton
julie foxton
These glorious early summer evenings have
kindled an interest in nature in my eight-year
old daughter (sparked I have to confess by
Bill Oddie and Springwatch). So, I find myself
wandering up and down the country lane
where we live, examining the wildlife with her.
We were strolling along quite happily one
night, when we were startled by one of those
flying fortresses commonly known as a stag
beetle. My daughter was fascinated. I have to
confess to being slightly appalled (I don’t ‘do’
creepy crawly things!). It reminded me of my
early days training to be a nurse (back in the
1980s). I was working on night duty in a very
old building (now demolished). At night, when
you entered the kitchen and turned on the
light, there was the most amazing fast scuttling
sound of cockroaches disappearing at speed
back under the fridge.
Create a smile
Membership news
Earlier this week I had a delightful
conversation with a gentleman who had sent
in his renewal payment over 8 months early.
I rang him to inform him that his payment
was not necessary at this time and that I
would write to him when his payment was
due, and he responded with a defiant “keep
it, H·E·A·R·T UK needs it more than I do”.
Emma Buitendag
Membership Manager
Emma Buitendag
This act of kindness bought a smile to my
face, and what makes my smile even larger
is the fact that I encounter such kindness
from you, the members every day. This is not
a rare event. To that gentleman (you know
who you are) and to the countless others
who religiously renew their membership
each year -thank you - H·E·A·R·T UK really
appreciates your support.
This got me thinking about my early days
as a student nurse and whether I could
have imagined back then the sort of job I do
now. Back in those early days it was all bed
baths, observations and basic nursing care.
Nowadays it is very different. Take for instance
last week; Monday and Tuesday were spent
in the office, answering patients’ queries
(the best bit of my job is maintaining patient
contact, so thank you for all those calls!);
liaising with pharmaceutical, food and other
companies; writing reports and information
leaflets and trying desperately to tidy my desk.
Wednesday was slightly odd. Up at 5am to
get to the ITN studios for a live TV slot on
the breakfast news show. H·E·A·R·T UK is
involved in a major campaign to highlight
risk of heart disease to those in the general
population who may be unaware of their
risk. A small booklet – ‘So you think heart
attacks only happen to other people’ - and a
website (where you can work out your risk
on a computer programme) are all part of
the package - visit www.heartrisk.co.uk. The
interview went very well. From the studio at
8am it was straight over to a minimalist hotel
Pastures
new
in St Martins Lane (so minimalist that no one
could find the front door) for a media briefing
breakfast with Esther Rantzen. Esther has a
personal experience of heart disease as her
husband Desmond had heart disease and died
at 67 years of heart failure. Esther herself has
high cholesterol.
The meeting was for health journalists from
various medical and general press magazines
and papers. Esther, Dr Tony Weirzbicki (one
of our medical trustees) and I gave three short
presentations to the assembled audience.
The meeting went very well and there were
journalists who requested more information
afterwards. After the briefing it was back to
the office for more paperwork and a quick
catch up with what had gone on during the
morning in the office.
Thursday morning was yet another 5am start.
Off into London again to a radio studio to do
a day of radio interviews to help support the
leaflet and website mentioned previously. It
is quite bizarre that although I never left the
studio I travelled the length and breadth of the
country. (I was doing a mix of live and recorded
interviews, each about 15-20 minutes, all
around the country with local radio stations!)
The day ended around 3pm and I just
about managed to get myself back home for
what I hoped was a quiet night in. But no,
we apparently had more stag beetles
to track down...
Julie, Esther & Dr Wierzbicki
As many of you will already know, having worked
tirelessly for H·E·A·R·T UK for the past nine years, Julie
has decided to move on to pastures new and sadly
will be leaving us at the end of August. We join the
many colleagues that have worked with Julie in the field
of lipids in wishing her every happiness in the future
and heartfelt thanks for her dedication in successfully
raising awareness of cholesterol risk in both the health
professional and general public arenas. You can read
more on Julie’s invaluable work in October’s Digest.
digest
June / July 2005 heartuk.org.uk
19
regular: diary dates
diary dates
important dates for your diary
*3 – 7 September
10 – 11 October 2005
ESC Congress 2005
National Obesity Forum Conference
Obesity: Problems & Solutions
Stockholm, Sweden
email: [email protected]
*22 – 23 September 2005
British Atherosclerosis Society Autumn Meeting
Queen’s College, Cambridge
Contact: Wheldon Events and Conferences,
tel: 01922 457 984, fax: 01922 455 238,
email: [email protected]
web: www.britathsoc.ac.uk
24 – 25 September 2005
Jury’s Gt Russell Street Hotel, London
Contact: Maria, tel: 0115 846 2109,
email: [email protected]
website: www.nationalobesityforum.org.uk
*13 – 15 November 2005
American Heart Association
Dallas, USA
Contact: Tel: +1 800 AHA-USA-1/1-800 242 8721
1 December 2005
2nd Nutrition & Health Show
H·E·A·R·T UK Members’ Day
Olympia, London
Royal Society of Medicine, London
See page 11 for details
For more details and bookings,
please contact H·E·A·R·T UK
*7 October 2005
Contact: Tel: 01628 628 638
H·E·A·R·T UK ‘Children with Familial
Hyperlipidaemia (FH) – Detection,
Management and Treatment’
* for health professionals
The Royal College of Physicians,
Regent’s Park, London
Contact: Wheldon Events & Conferences,
tel: 01922 457 984,
email: [email protected]
LipidYourDisorders:
Questions Answered
Alpro Soya Leaflets
Alpro UK Ltd has developed a series
of branded healthy eating leaflets in
association with health professionals both
for the public and for health professionals.
Publisher: Elsevier
This newly published book is designed to
help GPs and other primary care health
professionals to work with patients with
lipid disorders and their families, providing
effective, evidence-based care and
management. It is the latest title in the ‘Your
Questions Answered’ series, and the books
are in an accessible question and answer
format, with detailed contents lists at the
beginning of every chapter and a complete
index to help find specific information.
Frequently asked patient questions with
easy-to-understand answers aimed at
the non-medical reader are at the end of
relevant chapters and are also listed at the
end of the book.
20
heartuk.org.uk June / July 2005
digest
Two of the latest resources available from
Alpro which have been distributed in GP
surgeries throughout the UK for the public
include:
‘Top Tips for Healthy Living’
and ‘The New Tasty addition
to Healthy Eating’: Your
practical guide to achieving
healthy blood cholesterol
levels with 25g soya protein.
Special offer
Digest readers can order ‘Lipid disorders:
Your Questions Answered’ at the discount
price of £15.99 including p&p (rrp £19.99)
by calling: +44(0)1865 474010 and
quoting special order code AFS4
To order copies
of these call:
0800 0188180
quoting H·E·A·R·T UK
H·E·A·R·T UK DIGEST
Although H·E·A·R·T UK has endeavoured to ensure the accuracy of the entire publication, no liability
will be accepted by the Trust, Officers or members of staff, for information and opinions herein given.