High rate of unrecognized heart problems in apparently healthy people

Researchers from the UK have just reported in the Postgraduate Medical Journal that unrecognized heart problems are surprisingly common in apparently healthy middle-aged people. 

The study used standard heart scans by echocardiography to look at heart valves and heart muscle in 362

Echo machine with image of the heart

men and women in England aged 50 – 74 years without known heart disease. 178 -  almost half -  had abnormalities of a valve or muscle or irregular heart beat. Many had more than one cardiac abnormality.

Premature cardiovascular disease in a leading cause of death in the western world.   Despite the decline in the rates of mortality, largely due to reduction of deaths from ischaemic heart disease, cardiovascular disease remains an important cause of death. This is at least partly related to the fact that a number of patients with cardiac conditions remain largely undiagnosed and present late in the natural history, missing the window where maximum benefit could be offered with timely intervention.

Study author Cardiologist Constantinos Missouris said:

“Patterns of heart disease are changing, with rheumatic heart disease becoming less common but an increase in rates of degenerative valve disorders, heart failure and serious arrhythmias such as atrial fibrillation. Our study shows that unrecognised cardiac abnormalities are very common in middle-aged men and women with no overt symptoms. Echo offers a simple way to identify the need for early medical intervention.”

Clinical Pharmacologist Donald Singer and co-author of the study added:

“Finding effective ways to identify and treat people with unrecognized heart problems is vital to reduce the risk and severity of preventable heart disease.  Our results point to the need for doctors and patients to be more aware of the risk of heart problems and how to detect and treat them

Notes for editors

This report refers to the paper entitled ”Registry report of structural and functional cardiac abnormalities diagnosed by echocardiography in an asymptomatic population” published on 19th February 2016 in the Postgraduate Medical Journal

Postgraduate Medical Journal is an international medical journal owned by the Fellowship of Postgraduate Medicine. The PMJ has published papers and reviews on many of the important medical advances over the past 90 years. The PMJ publishes work on clinical medicine, with the aim of educating medical professionals, junior doctors, teachers and clinicians.

The Fellowship of Postgraduate Medicine, founded in 1918, pioneered educational programmes in all branches of postgraduate medicine. The FPM publishes 2 international journals: the Postgraduate Medical Journal since 1925 and Health Policy and Technology since 2012.

Further information

Donald Singer
President, Fellowship of Postgraduate Medicine, London, UK
Tel. +44 7447 441 666
fpm.chandos@gmail.com

Is cannabis dangerous? A review of research over the last 20 years ...

From commentary in The Independent
7.10.14

"A newly published paper reminds health professionals, policy makers, and the public, of the potential acute and long-term risks of cannabis use. 

In his report, Professor Wayne Hall at The University of Queensland Centre for Youth Substance Abuse Research, considers how the evidence has evolved over the past 20 years. He points out potential risks, both in the short term, and higher risks for three settings: long-term heavy use, use in adolescence, and during pregnancy."

With acute use, risks of cannabis include psychological effects – some people have an unpleasant dysphoric rather than euphoric response – and impaired concentration and coordination, with risk of road and other accidents, enhanced in the presence of alcohol or other drugs. Risks from exposure during pregnancy include reduced birth weight and impaired post-natal educational development, at least until adolescence. Risks of sustained use from adolescence also include impaired intellectual development. Other reported adverse effects of long-term use of cannabis include dependence, the risk higher in those who start in adolescence, and an increased risk of psychotic symptoms, especially in those with a family history of psychotic disorders or those who start young.  Regular use in older adults increases the risk of heart attack and chronic bronchitis. Cardiovascular and respiratory risks of cannabis are increased by concomitant tobacco use.

 See more from the commentary ...

Microcirculation and the 2012 UK-US international Conference

@HealthMed The MicroCirc2012 conference at Keble College Oxford, 4-6 July, was co-organized by the British Microcirculation Society and the US Microcirculatory Society. 

Why study the microcirculation? The microvessels - small arteries, capillaries and small venules - play a vital role in providing nutrition to and removing waste products from vital organs. Microvessels are also critical for healthy maintenance of blood pressure. 

D Singer and PhD student H Saedon at MicroCirc2012

And in a wide range of diseases, a spectrum of inflammatory factors, acting on and/or derived from the microcirculation, contribute to disease causation and severity, and provide both biomarkers and targets for prevention and treatment of serious diseases from cardiovascular syndromes to diabetes, inflammatory disease and cancer, and from early abnormalities in the fetal circulation to diseases of ageing. 

A series of delegates posts are now appearing from the MicroCirc2012 conference, from a wide range of specialists, from molecular biologists to imagers, and from 1st year PhD students to senior academics. 

See more about the microcirculation and the 2012 Conference in reflections of principal organizer Professor Chris Garland, posts from delegates and in video interviews with Professor Giovanni Mann from King's College London, and Professor Steven Segal from Columbus, Missouri, USA.

Why a national No Smoking Day?

@HealthMed See the interview on the impact of no smoking initiatives by the University of Warwick's Knowledge Centre to coincide with the UK's National No Smoking Day.

Below is a summary of key points for smokers wanting to quit

No Smoking Day (March 14th) is an excellent time for UK smokers to think about stopping and to get started on the best ways to stop. Around 1 million people across the UK use No Smoking Day as the start to quitting smoking for good. 

World No Tobacco Day? UK smokers have two major calendar dates as prompts to stop, No Smoking Day on March 14th, a UK initiative, and World No Tobacco Day (annually on 31st May), organized by the World Health Organization.

Why stop? As well as causing well-known problems such as premature skin ageing and impotence, smoking is the leading preventable cause of death in the UK, causing around one in five deaths, and killing one in two lifetime smokers. Smoking causes increased risk of serious illness and of premature death from heart and lung disease and a wide range of cancers. And these risks not only affect smokers: they are transferred by passive smoking to adult friends and family, children and babies, and people who just happen to be near to smokers.

How quickly does quitting smoking help? Very. A recent report from Glasgow has shown a large decrease in the number of premature births and the underweight babies with reduced smoking by pregnant mothers. An for example in the first 10 months after the smoking ban in public places in Scotland, there were 1 in 7 fewer admissions to hospital for acute coronary disease among smokers, and a 1 in 5 reduction in former smokers. There was also a large early impact of reducing passive smoking, with ~1 in 5 fewer coronary events both in people who had never smoked and in ex-smokers.

How can drugs help? Drugs such as nicotine replacement treatments are helpful when smokers first start to quit. And nicotine replacement treatments and other drugs such as bupropion can help people who have stopped to stay quit of smoking. Drugs work best when combined with the kind of support available from the NHS Stop Smoking Service. Local NHS Stop Smoking staff can advise smokers on which medicines can help.

Who can help? Depending on personal preference NHS Stop Smoking support can send mailed information, text messages, emails and provide online help. Other helpful advice is available from the British Heart Foundation ‘WeQuit’, which has over 20,000 volunteers ready to help smokers who want to stop. And several helpful smartphone apps are now available.

Helpful links

More on why and how to quit smoking
WeQuit  
NHS Local Stop Smoking Services
My Last Cigarette smartphone app
Smoking, medicines and hip fracture risk

A good time to get weight in trim

New Year is a familiar time for people to make resolutions and aims to improve lifestyle.

Why bother about overweight?
Excess weight increases the burden of cardiovascular risk (high blood pressure, raised cholesterol and diabetes mellitus); causes premature ageing of arteries, leading to heart attacks, strokes and other serious disorders of the heart, brain and circulation; contributes to risk of sleep dusturbance and sleep apnoea syndrome; causes premature joint ageing with arthritis; non-alcholic fatty liver disease is the commonest cause worldwide of liver damage; and increased risk of cancers - weight gain and overweight estimated to be linked to 1 in 5 cancers.
People who have no difficulty in maintaining normal weight may find it difficult to understand the challenges. For those who are currently overweight, the challenges in regaining a more healthy weight include beating the psychological, physical and social addiction to causes of overweight, and resisting peer pressure.

Getting started
Importants steps on the path to reducing excess weight include being ready to think about action, to think about taking action and to prepare to take action. That might mean telling friends and family you are serious about losing weight, and to seek whatever help may work - e.g.  family doctor or nurse or other health professional, and support groups for the overweight.

What works? 
Smaller portion size, cutting down on processed foods and increasing exercise are the big 3 factors that help. Keep a weight chart and if possible find a friend with whom to lose overweight. Wear a belt. Pace your eating and drink water with your food. Eat regular small meals. Avoid snacking, Research evidence suggests that successful measures include recording weight regularly, knowing the approximate energy intake of what you eat, and regular activity.
It is also clear that insight into the personal health risks of overweight provide extra incentive to lose weight. Better of course to reduce excess weight before serious clinical effects of overweight occur.
There are many support groups and diet plans available to order, often at high cost.

Research evidence suggests that success in maintaining weight loss is associated with clear strategies for coping with life stresses and with 'continued adherence to diet and exercise strategies, low levels of depression and disinhibition, and medical triggers for weight loss'. In contrast, unsuccessful weight maintainers are erratic or inconsistent in recording their weight and being vigilant in keeping to healthy types and amounts of food and in continuing regular activity.
Once overweight people have maintained a weight loss for 2-5 years, the chances of longer-term success in maintaining a healthy weight are much greater.
 
Apps
 There an increasing variety of 'apps' for smartphones and PCs, that reinforce the combined impact of healthier dietary intake and maximising exercise. Many are free, with myfitnesspal an excellent example. These and other free lifestyle apps are like your personal health bank. The more active you are, the more energy balance you have towards losing weight, the more you eat, the less reserves in your health bank.

© DRJ Singer
@HealthMed 

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

New UK guidelines on managing high blood pressure

High blood pressure is a major preventable and treatable risk factor for heart disease and stroke syndromes both in the developed and the developing world.

In an innovative partnership between a UK government agency - the National Institute for Health and Clinical Excellence (NICE) - and a professional organisation - the British Hypertension Society (BHS), NICE guidelines for managing hypertension in primary care were first issued in 2006. Key elements to those guidelines included a stepped care approach starting with different first line options for younger vs. older patients with a 55 year age boundary, and for patients of black African or Carribean origin compared to other ethnic groups. The 2006 guidelines also highlighted risks of new onset diabetes mellitus from beta-blocker treatment.

On 24th August, five years on, NICE, again supported by experts from the BHS, has released updated hypertension guidelines which include several key developments of interest to prescribers and patients. These include adding blood pressure measurements away from the clinical setting to confirm the diagnosis for patients with mild to moderate increases in clinic blood pressure readings. With even higher office readings, advice remains to treat based on those office readings. There is detailed advice both on blood pressure measurement using ambulatory devices as well as more systematic involvement of patients in their own management, supported by home blood pressure readings. It is of course important that any blood pressure monitoring device, whether for clinical or home use, should be validated. A helpful list of validated devices is is listed on the British Hypertension Society's website.

As an update on treatment options, the new 2011 guidelines now suggest systematic use of calcium channel blockers as first line treatment in older patients, with now specific, named diuretics as alternative options for specified indications. The 2011 guidelines for the first time also highlight the clinical and cost effectiveness of evidence-based treatment of hypertension in older patients, and in particular the over 80s.

For more information, see the summary documents and more detailed reports on the NICE website.

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