Developing health policy to protect the heart and circulation

Diseases of the heart and circulation are the commonest preventable cause of disability and death in the UK and elsewhere in the developed world. Heart and circulatory disorders are also rapidly overtaking communicable diseases as serious health problems in less developed countries. Policy makers need to take an increasing interest in encouraging lifestyle approaches aimed at reducing the incidence and severity of these serious disorders of the heart and circulation.

This one day symposium, with speakers from Hong Kong, the Netherlands, Spain and the UK was organised by the healthy heart charity the Cardiovascular Research Trust in partnership with the Fellowship of Postgraduate Medicine.

David Slovick, Leslie Morgan OBE DL, Donald Singer, Wade Dimitri, Ken Redekop, Alison Halliday, Robin Poston

FPM President and CRT chair Donald Singer said: “Despite recent efforts, obesity and diabetes are increasing epidemics in the UK and internationally. Political leaders have a huge opportunity to improve both national health and wealth by a sustained increase in the effective public health measures needed to prevent and address the major risk factors for premature heart, stroke and other vascular disease.”

Speaker Professor Kornelia Kotseva from Imperial College in London said: “Cardiovascular disease (CVD) is a leading cause of mortality accounting for 17.5 million deaths every year globally and 4.3 million deaths every year in Europe. The proportion of all deaths attributable to CVD is greater among women (49%) than in men (40%), with large geographic inequalities between countries.”

Speaker Professor Alison Halliday from the University of Oxford and President of the European Society of Vascular Surgery added: “Stroke causes many thousands of deaths in the UK every year and is the country’s leading cause of disability. Billions of pounds are spent on treating the causes and the results of stroke – hypertension, heart disease, diabetes, smoking, but the greatest risk factor is age, and, despite attention to known modifiable risk factors, the numbers of new and recurrent strokes have not fallen significantly in recent years.”

Professor Bernard Cheung from the University of Hong Kong and Editor of the FPM’s journal the Postgraduate Medical Journal said: “The biggest news in the world of hypertension is the publication of the latest American guidelines (ACC/AHA) on the prevention, detection, evaluation and management of high blood pressure. The most controversial change is in the definition of hypertension, which now includes a systolic blood pressure of 130-139 mmHg or a diastolic blood pressure of 80-89 mmHg. This change will, at a stroke, make a sizeable proportion of the general population hypertensive.”

Professor Ken Redekop from Erasmus University in Rotterdam and Editor-in-Chief of the FPM’s journal Health Policy and Technology noted that “Precision medicine (PM) refers to the separation of patients into more homogeneous subgroups, with the rationale being that patients who will benefit from a treatment should receive the treatment while patients who will not benefit should not.” He added: “When all factors (including cost-effectiveness) are considered, a precision medicine strategy may or may not be the best one in the effort to improve cardiovascular health, and health outcomes in general.”

Heart surgeon Wade Dimitri commented that: “heart surgery in the UK has led the development and refinement of many techniques and health technologies and has resulted in significant reduction in cardiovascular mortality and morbidity. Such progress and improvements have not followed in the developing world where mortality and morbidity remain high, approaching 60% in certain countries. Urgent efforts are needed to reverse this trend and improve outcomes of adults and children with heart disease undergoing heart surgery in less developed countries.”

Professor Ramon Estruch, Barcelona said: "The Mediterranean diet has strong research evidence as an effective healthy lifestyle approach to protect the heart and brain. Similar healthy diet cultures are found in other regions on the 40th parallel in both the north and southern hemispheres around the world."

Papers from the symposium will be published in the journals of the Fellowship of Postgraduate Medicine (Postgraduate Medical Journal and Health Policy and Technology.

Note for Editors
For more on the themes of the event,
email: fpm.chandos@gmail.com or call 07494 450 805.

Speaker abstracts and biographies

Meeting programme: Health policy for the heart and circulation

Why have a National Blood Pressure Week?

 In the UK, over 1,500 venues are offering free blood pressure checks during National Blood Pressure Week (12-18 September 2011). Why all that effort?   High blood pressure is a major preventable and treatable risk factor for serious heart diseases and stroke syndromes throughout the world. And even at the age of 20 around one in 20 people may already have high blood pressure, increasing to around 1 in 2 people by the age of 70.

An annual blood pressure week provides an important focus to remind the public and health professionals about risks of high blood pressure, how to prevent it, measure it accurately and use lifestyle and drugs in people in whom blood pressure is too high.

Blood pressure should be as low as possible, with, for adults, the upper level, when the heart has contracted, below 140mmHg and the lower level below 90mmHg, when the heart is relaxed between heartbeats. These thresholds should be much lower in people at increased risk of blood pressure complications, such as diabetics and people with kidney disease.

Provided people are otherwise healthy, the ideal blood pressure is now considered by international experts for the upper value to below 120, the lower below 80, recorded as ‘below 120/80mmHg’.

It is very important that patients help by following a healthy lifestyle. This is both helpful to prevent high blood pressure, and for patients with hypertension, to reduce its severity. People should aim for a healthy weight, using fresh foods as far as possible, keep salt intake low, and alcohol intake within healthy limits, be active and have regular good sleep.

This year it is timely the UK’s National Blood Pressure Week comes just after the launch of important new blood pressure guidelines prepared by the National Institute for Health and Clinical Excellence (NICE) advised by experts from the British Hypertension Society (BHS).

The NICE guidelines contain new advice on blood pressure measurement, including involvement of patients in their own management, supported by home blood pressure readings.

It is of course very important that any blood pressure monitor, whether for clinical or home use, should be accurate. A helpful list of accurate devices is on the British Hypertension Society's website.’

If you have high blood pressure, you should make sure that your doctor knows about any over the counter tablets or herbal remedies you are taking, as these can interfere with the actions of blood pressure tablets.

There are now seven major types of blood pressure treatments. For best blood pressure control, prescribers need to the right drug options for the right kind of patient, taking into account, for example, age, ethnicity and potential risks in pregnancy. If single drugs are not sufficient to control blood pressure, the NICE guidelines provide advice on which drug combinations are best to use.

Useful websites:
British Hypertension Society – includes information on which blood pressure monitors are accurate  http://www.bhsoc.org
Blood Pressure Association – includes a list of venues for free blood pressure checks http://www.bpassoc.org.uk/
NICE guidance on hypertension for patients and carers: http://guidance.nice.org.uk/CG127/PublicInfo/pdf/English

Exercise and cardiovascular health on Everest

Jesuit priest Father Jose Acosta, wrote of his crossing the Andes in the late 16th century problems with sickness and vomiting which he attributed to the "thinne air", so "delicate as it is not proportionable wth the breathing of man". In 1865 the first man to climb the Matterhorn, Edward Whymper, recently commemorated in London by a blue plaque, was an early student of sickess at altitude. In recent modern times, climber Charles Houston made a major contribution to research into mountain sickness, his interest inspired by his episode in August 1953 of unconsciousness high on K2. He crystallised key ideas on mechanisms in his 1980 book "Going Higher: Oxygen, Man and Mountains".  Speaking about his talk at the 14th July Symposium on 'Exercise and Cardiovascular Health’ organized by the Cardiovascular Research Trust, Professor Chris Imray commented: "increasing numbers of people travel to altitude for both leisure and work purposes. On ascent to altitude, there is a reduction in atmospheric pressure, and there is consequently a reduction in the inspired levels of oxygen. The resulting physiological challenge stresses the body both at rest and further during exercise.

The cardio-respiratory challenges and the subsequent responses of ascending to high altitude will be discussed in detail, as will the role of ‘altitude training’."

Professor Imray will present "unique data from the Caudwell Xtreme Everest expedition, including arterial blood gases and the response to exercise at extreme altitude ...".

These studies provide important messages for health and risk for climbers at high altitude. They raise interesting questions about impact on brain and heart function of working at high altitude for border guards who are not acclimatised to low oxygen levels. They also provide insight into the physiological challenges and pressure for emergence of survival genetic variants for populations historically living at altitude.

See the symposium website for the programme.

Exercise and cardiovascular health

The good news is that even mild activity can be helpful in keeping healthy and in reducing risk of joining the pandemic of cardiovascular disease in the 'developed' world and emerging epidemic of heart attacks and strokes in less developed countries.

At the elite end of the exercise spectrum, internationally competitive athletes benefit from positive feedback effects of exercise on the heart and circulation. 

And for patients with established clinical heart problems, exercise under medical supervision is now well recognised to help to complement medical and surgical treatments to aid recovery and reduce the risk of future heart disease.
Not a good idea though for the out-of-condition to go from none to extreme exercise. What advice should the health or sports professional consider ?
These themes form the programme for a symposium on 'Exercise and cardiovascular health' in London on the afternoon of Thursday 14th July 2011. 

Of interest to a diverse audience - sports professionals and health professionals and students looking for an update on benefits and risks of exercise, from prospective to the elite athletes interested in benefits of exercise for their health and performance, to people with heart conditions wanting to find out more about exercise and the heart. And as an interesting case study on extreme athletes, surgeon and Everest researcher and mountaineer Professor Chris Imray will be discussing exercise at extreme altitude. 

See the symposium website for the programme.