JBS3 Report

reposted from: http://www.jbs3risk.com/pages/report.htm

crabsallover highlights, key points, comments / links.

Recommendations from each section

General Recommendations

• Use JBS3 risk calculator to estimate both 10-year risk and lifetime risk of CVD in all individuals except for those with existing CVD or certain high risk diseases i.e. diabetes age >40 years, patients with chronic kidney disease (CKD) stages 3-5, or familial hypercholesterolaemia (FH).
• Total cholesterol and HDL-cholesterol from a non-fasting blood sample should be used for lipid profile estimate of CVD risk in the JBS3 calculator
• Non-HDL-cholesterol, measured from a non-fasting blood sample as total cholesterol minus HDL-cholesterol, should be used in preference to LDL-cholesterol as the treatment goal for lipid-lowering therapy.
• Intensive risk factor modification with diet, lifestyle intervention and pharmacological therapy in patients with existing CVD, without the need for estimation of CVD risk.
• Intensive risk factor modification with diet, lifestyle intervention and pharmacological therapy, in individuals at particularly high risk of developing CVD: i.e. diabetics age >40 years, patients with CKD stages 3–5, or FH without the need for estimation of CVD risk.
• Diet, lifestyle intervention and pharmacological therapy in people at high short-term risk. Thresholds for treatment with statins based on 10-year CVD risk will be informed by NICE guidelines.
• Diet, lifestyle intervention and for some people, pharmacological therapy, in those with increased modifiable lifetime risk as informed by JBS3 calculator metrics.

2. Lifestyle Recommendations

Smoking

• Professional support on how to stop smoking should be given, at every available opportunity, with provision of self-help material and referral to more intensive support, e.g. stop smoking services.
• The JBS3 risk calculator emphasises the benefits for early smoking cessation and the diminishing but still substantial returns for quitting at an older age.
• Patients should be offered behavioural counselling, group therapy, pharmacotherapy or a combination of treatments that have been proven to be effective.
• Nicotine replacement therapy (NRT), varenicline or bupropion should be offered to people who are planning to stop smoking as part of an abstinent-contingent treatment in which the smoker makes a commitment to stop smoking on or before a particular date (target stop date).
• People who have heart or respiratory diseases, and those who live with them, should be made aware of the risks of both active and passive smoking (second-hand smoke).
• For specific recommendations on quitting smoking in pregnancy and following childbirth, see NICE public health guidance 26.
• The importance of stopping smoking during pregnancy should be emphasized and guidance from the National Institute for Health and Clinical Excellence (NICE) followed.[1]

Diet
Professional support to consume a diet associated with the lowest cardiovascular risk should be provided based on the following principles:

• Intake of saturated fat to <10% of total fat intake (preferably in lean meat and low-fat dairy products)
• Replace saturated fat with poly-unsaturated fat where possible
• Consume five portions per day of fruit and vegetables
• Consume at least two servings of fish (preferably oily) per week
• Consider regular consumption of whole grains and nuts
• Keep salt consumption <6 g per day
• Limit alcohol intake to <21 units per week for men and <14 units per week for women
• Avoid/reduce consumption of:
  • Processed meats or commercially produced foods which tend to be high in salt and trans fatty acids
  • Refined carbohydrates, such as white bread, processed cereals
  • Sugar-sweetened beverages
  • Calorie-rich, but nutritionally poor snacks, such as sweets, cakes and crisps
• Children and young people should be supported to consume a diet based on the same principles.

Physical activity and exercise

• An increase in overall levels of sustained physical activity and avoidance of prolonged sedentary behaviour are important for reduction of CVD risk.
• Emphasise walking, cycling and other aerobic physical daily activities, at moderate intensity, as part of an active lifestyle, for at least 150 minutes per week in bouts of ≥ten minutes, or 75 minutes per week of vigorous physical activity, or a combination of the two.
• Muscle-strengthening activities performed on at least two occasions per week

Exercise training
General population and those at low to moderate risk of CVD:

• Exercise training, incorporating a warm up and cool down period, should be performed at moderate to high intensity two to three times per week for 30 to 40 minutes each time.
• The mode of exercise should be aerobic and, where possible, continuous allowing for a steady progression in effort, e.g. walking programmes, cycling, jogging, swimming.
• The time spent exercise training contributes to meeting the 150 minutes per week physical activity recommendation (as above).

Patients with established CVD and those considered at higher risk of CVD:

• A more structured approach is needed in managing patients and in all cases, assessment and specific goal setting, with risk stratification, delivered by professionals skilled in health-related exercise is preferable.
• Exercise on referral and community-based exercise initiatives are recommended for patients at risk of CVD.
• Cardiac rehabilitation programmes are recommended for patients with established CVD and in those following a CVD event.

3. Childhood and Adult Obesity Recommendations

• Multidisciplinary approaches to obesity management in children and young people are required with a 'lifetime risk' message. These include interventions during the early post-partum period as well as regular monitoring of childhood weight and family counselling.
• With appropriate training all health care professions should be able to Ask and Assess adiposity and Advise appropriate adult patients on evidence based ways to target weight change.

4. Lipid Recommendations

• Non-fasting blood samples should be taken to measure total cholesterol (TC) and HDL-cholesterol. The JBS3 risk calculator enables entry of these two measures and it is expected that non-HDL-c (TC minus HDL-c = non-HDL-c) will gradually replace LDL-c in clinical practice as well as in clinical trials.
• All high risk people should receive professional lifestyle support to reduce total and LDL-c, raise HDL-c, and lower triglycerides to reduce their CVD risk.
• Cholesterol-lowering drug therapy is recommended in:
  • Patients with established CVD
  • Individuals at particularly high risk of CVD: diabetes age > 40 years, patients with CKD stages 3-5, or FH
  • Individuals with high 10-year CVD risk (threshold to be defined by NICE guidance)
  • Individuals with high lifetime CVD risk estimated from heart age and other JBS3 calculator metrics, in whom lifestyle changes alone are considered insufficient by the physician and person concerned
• Statins are recommended as they are highly effective at reducing CVD events with evidence of benefit to LDL-c levels <2 mmol/L which justifies intensive non-HDL-c lowering.
• Statins are safe with trial evidence showing no effects on non-cardiovascular mortality or cancer. There is a small increase in risk of developing diabetes but the benefits of cholesterol lowering greatly exceed any risk associated with diabetes. If statin intolerance develops a stepwise strategy involving switching agents and re-dosing is recommended.
• Despite low HDL-c levels contributing to CVD risk, drug therapy to raise HDL has not been shown to reduce CVD risk and is not currently indicated.

5. Blood Pressure Recommendations

• Hypertension should be suspected when office BP is persistently elevated, i.e. ≥140/90mmHg.
• Ambulatory BP monitoring (ABPM) is recommended to confirm the diagnosis of hypertension (Daytime mean ABPM ≥135/85mmHg).
• All high risk people should receive professional lifestyle support to reduce their blood pressure which may avoid the need for, or complement the use of, drug therapy for hypertension and reduce CVD risk.
• People with an office BP >160/100 mmHg, an 24-hour day time ABPM average or home APBM average of >150/95 mmHg (stage 2 hypertension) should be offered pharmacological therapy to reduce BP.
• People with an office BP >140/90 mmHg, but <160/100 mmHg, a 24-hour daytime ABPM average or home APBM average of >135/85 mmHg (stage 1 hypertension) and established CVD, hypertensive target organ damage, diabetes, CKD, or a high lifetime risk assessed by JBS3 calculator, should be offered pharmacological therapy to reduce BP.
• People with stage 1 hypertension without established CVD, hypertensive target organ damage, diabetes, CKD, or a significant increase in lifetime risk assessed by JBS3 calculator, should receive advice on lifestyle interventions and be scheduled for annual BP and lifetime risk assessment to inform future need for therapy.
• Pharmacological treatment for patients with hypertension should follow the current NICE guidance (CG127) treatment algorithm:
  • Patients <55 years of age should be offered an ACE inhibitor or ARB as preferred initial therapy
  • Patients aged ≥55 years should be offered a Calcium Channel Blocker (CCB) as preferred initial therapy
• Combinations of drug treatment are usually required to optimise BP control for the majority of patients.
• Thiazide-like diuretics are an alternative to CCB and are preferred for patients intolerant of CCBs, or with heart failure or at high risk of heart failure.
• Beta-blockers are not preferred unless there are specific indications for use, i.e. in patients with symptomatic angina or chronic heart failure.
• For pregnant women or women planning pregnancy, when BP treatment is being considered, the recommendations of the NICE guideline CG107 Hypertension in pregnancy should be followed.

Short bursts of exercise at home good for the heart

reposted from: http://www.nhs.uk/news/2013/February/Pages/Short%20bursts-of-exercise-good-for-heart.aspx

crabsallover highlights, key points, comments / links.

Short bursts of exercise, such as raking the lawn and climbing the stairs, are an excellent way of warding off health problems such as high blood pressure, high cholesterol and diabetes, the Daily Mirror and many global media outlets reported.

The news is based on the results of a cross-sectional study which suggested that even less than 10 minutes of moderate or vigorous activity, such as climbing stairs, ‘count’ and may be as beneficial as longer periods of exercise.

This useful and well-conducted study measured the physical activity of more than 6,000 adults, in addition to measuring various health markers such as blood fats, blood sugar and blood pressure, that are known to be risk factors for chronic conditions including diabetes and heart disease.

The study found that performing moderate or vigorous activity of any duration – either short bursts of less than 10 minutes or for longer – was associated with improved measurements of several cardiovascular risk factors.

The study suggests that even people who do not have time to go to the gym or an exercise class can get many of the health benefits of exercise from adopting an ‘active’ lifestyle.

While the study cannot directly prove cause and effect, it would suggest that any moderate or vigorous exercise you can fit in during the course of a day, benefits your health.

10-minute exercise programmes

NHS Choices has produced a series of 10-minute exercise programmes you can do in the comfort of your own home:

• 10-minute home cardio workout
• 10-minute legs, bums and tums home workout
• 10-minute home toning workout

Don’t forget to warm up before, and then cool down after, exercising.

Where did the story come from?

The study was carried out by researchers from Bellarmine University and Oregon State University. The source of funding for this study was not declared.

The study was published in the peer-reviewed American Journal of Health Promotion.

This study was covered by the Daily Mirror and the Mail Online. Although the gist of the story is correct, the researchers looked at short bursts of moderate and vigorous physical activity, rather than the ‘light exercise’ reported in the Mail Online.

How active should I be?

To stay healthy, adults aged 19-64 should try to be active daily and should do:

• at least 150 minutes (2 hours and 30 minutes) of moderate-intensity aerobic activity such as cycling or fast walking every week, and
• muscle-strengthening activities on two or more days a  week that work all major muscle groups (legs, hips, back, abdomen, chest, shoulders and arms)

Read more about physical activity guidelines for adults

What kind of research was this?

This cross-sectional study aimed to determine whether short bursts of physical activity were associated with a decreased risk of metabolic syndrome.

Metabolic syndrome is a term used to describe a combination of related risk factors for chronic conditions such as heart disease and type 2 diabetes – these factors include high waist circumference, blood fats, blood sugar and blood pressure.

The researchers also looked at some additional biological markers known to be risk factors for cardiovascular disease.

They looked at whether there were any differences in risk factors for short bursts of activity versus more prolonged bursts.

Cross-sectional studies have a inherent limitation as they cannot prove causation (a direct cause and effect), they can only highlight possible associations.

So in this case, the researchers cannot conclude that it is the short bursts of activity directly affecting the biological markers measured.

Also, because participants aren’t followed over time we don’t know what came first, so we don’t know:

• if people who exercise a certain way are healthier
• if people who are healthier exercise a certain way

What did the research involve?

The researchers used data collected as part of the US National Health and Nutrition Examination Survey, which collects annual health and nutrition data on a random sample of US citizens. For this study, data from 6,321 non-pregnant adults with data on physical activity from the 2003-2004 and 2005-2006 cycles was used.

A participant’s physical activity was determined by collecting data using an accelerometer. Accelerometers measure the participant’s change in velocity over time (acceleration) allowing the intensity of physical activity to be measured, as well as the duration.

Participants had data on physical activity for at least four days, and at least 10 hours each day. The researchers classified the intensity of physical activity into moderate or vigorous using cut-offs for accelerometry readings.

The researchers also classified activity levels by duration, into two main groups:

• less than 10 minutes duration (‘nonbout’)
• more than 10 minutes duration (‘bout’)

Each period of activity was terminated if accelerometry readings fell below the cut off for three minutes or more.

The researchers also calculated whether a participant met physical activity guidelines, defined as engaging in 150 minutes of moderate-intensity activity or 75 minutes of vigorous-intensity activity or some combination of the two per week, and whether a participant met the criteria by only performing short, less than 10 minute duration ‘nonbout’ periods of activity.

The US National Health and Nutrition Examination Survey also collected data on a participant’s cardiovascular risk factors, including:

• metabolic syndrome – defined as having three or more of the following symptoms: a high waist circumference, a high level of triglycerides (a type of fat), low levels of high-density (‘good’) cholesterol, elevated blood pressure, elevated fasting blood sugar
• systolic and diastolic blood pressure
• blood levels of C-reactive protein (an inflammatory marker), high-density cholesterol, low-density (‘bad’) cholesterol, total cholesterol and blood sugar
• anthropometric measurements including waist circumference, skinfold thickness and body mass index (BMI)

The researchers also collected data on age, gender, smoking status, race/ethnicity, current health status, and whether the participant was taking any medication.

The researchers analysed whether there was an association between short ‘nonbout’ periods of activity and longer ‘bout’ periods of activity and cardiovascular risk factors.

They also looked at whether there was any difference in risk factors when physical activity guidelines were only met by performing short ‘nonbout’ periods of activity.

In these analyses, the researchers controlled for age, gender, smoking status, race/ethnicity, and current health status.

What were the basic results?

The researchers found that on average, participants performed 23.6 minutes of moderate-to vigorous-intensity physical activity per day in short, ‘nonbout’ bursts, and 6.6 minutes in 10 minutes or longer bursts (this rather confusing figure is due to some people not doing any moderate to vigorous physical activity in bouts of 10 minutes or longer, during some days).

A total of 42.9% of participants met physical activity guidelines if nonbout physical activity was included, but only 9.7% met guidelines if only 10 minutes or longer periods only were included.

Both ‘nonbout’ and ‘bout’ physical activity were associated with a reduction in cardiovascular risk factors. The associations were strongest when enough activity was performed to meet physical activity guidelines.

The strengths of associations were generally similar for ‘bout’ and ‘nonbout’ physical activity for all risk factors measured, with the exception of BMI.

To make sure the results weren’t due to the fact that people who performed the longer periods of activity were also performing the shorter periods of activity, the researchers repeated the analyses controlling for 10 minutes or longer periods of activity.

Short ‘nonbout’ physical activity was still associated with a reduced risk of metabolic syndrome; favourable levels of C-reactive protein, high density lipoprotein cholesterol, triglycerides; and favourable sized waist circumference, skinfold thickness and BMI.

Again, the associations were strongest when enough ‘nonbout’ physical activity was performed to meet the physical activity guidelines.

Finally, the researchers compared the mean levels of biological markers in people meeting the physical activity guidelines solely through performing short ‘nonbout’ periods of physical activity and those meeting guidelines by performing longer periods of activity.

There was no statistical difference between the level of any marker except for BMI. Participants who met guidelines through longer periods of activity had significantly lower body mass indices (25.85) than those meeting guidelines through short periods of activity (27.49, p<0.0001).

How did the researchers interpret the results?

The researchers conclude that these results show that “with the exception of BMI, meeting physical activity guidelines using an ‘active lifestyle’ approach (nonbout activity) as opposed to a more structured exercise approach (bout activity) resulted in similar health outcomes.”

They suggest that “to reduce levels of adult adiposity (body fatness), adults are encouraged to engage in bouts of physical activity of at least 10 minutes in duration; however, for other health outcomes, an active lifestyle approach (for example, climbing a flight of stairs vs. taking the elevator), particularly of vigorous intensity, may be beneficial for initiating physical activity behaviour among inactive adults as well as being sufficient to elicit improvements in health parameters.”

Conclusion

The results of this study suggests that even short periods of physical activity ‘count’ and are associated with improved levels of several risk factors for cardiovascular disease. The study found that the strength of this association was generally as strong for short periods of activity as longer periods of activity.

This study has strengths and weaknesses. The strengths are that both physical activity and the levels of the biological markers were measured objectively, and did not rely on self-reporting, and that it was performed using a large sample of US adults.

However, it was a cross-sectional study, and cross-sectional studies have the limitation that they cannot show causation, in this case, the researchers cannot conclude whether it is the short bursts of activity that affect the biological markers measured.

Also, because participants aren’t followed over time we don’t know what came first, so we don’t know if people who exercise a certain way are healthier or if people who are healthier exercise a certain way.

However, overall this study supports the suggestion that any level of physical activity is better than no activity.

Even if you don’t feel ready to join your local gym, you can still begin making changes to your lifestyle today to improve your activity levels – read more about how you can get fitter without the gym.

Analysis by Bazian. Edited by NHS Choices. Follow Behind the Headlines on Twitter.

Links to the headlines

Well, I'll go to the foot of the stairs! Light exercise around the house is as good for your heart as workout. Daily Mirror, January 31 2013

Forget the gym and try the stairs! Short bursts of exercise are just as beneficial as a regular workout. Daily Mail, January 31 2013

Taking the Stairs, Raking Leaves May Have Same Health Benefits as a Trip to the Gym. Sciencedaily.com, published online January 28 2013

Links to the science

Loprinzi PD, Cardinal BJ. Association Between Biologic Outcomes and Objectively Measured Physical Activity Accumulated in >10-Minute Bouts and <10-Minute Bouts. American Journal of Health Promotion. Published online January 2013

Cardiovascular Disease Risk Prediction Charts

reposted from: http://heartuk.org.uk/health-professionals/resources/risk-charts

crabsallover highlights, key points, comments / links.

Risk charts

How to use the Cardiovascular Disease Risk Prediction Charts* for Primary Prevention

These charts are for estimating cardiovascular disease (CVD) risk (non-fatal myocardial infarction [MI] and stroke, coronary and stroke death and new angina pectoris) for individuals who have not already developed coronary heart disease (CHD) or other major atherosclerotic disease. They are an aid to making clinical decisions about how intensively to intervene on lifestyle and whether to use antihypertensive, lipid lowering medication and aspirin. The use of these charts is not appropriate for the following patients groups.

• Those with: CHD or other major atherosclerotic disease 
• Familial hypercholesterolaemia or other inherited dyslipidaemias 
• Chronic renal dysfunction 
• Type 1 and 2 diabetes mellitus

The charts should not be used to decide whether to introduce antihypertensive medication when blood pressure (BP) is persistently at or above 160/100 or when target organ damage (TOD) due to hypertension is present. In both cases antihypertensive medication is recommended regardless of CVD risk.

Similarly the charts should not be used to decide whether to introduce lipid-lowering medication when the ratio of serum total to high density lipoprotein (HDL) cholesterol exceeds 7. Such medication is generally then indicated regardless of estimated CVD risk.

To estimate an individual’s absolute 10 year risk of developing CVD choose the table for his or her gender, smoking status (smoker/non-smoker) and age. Within this square define the level of risk according to the point where the coordinates for systolic blood pressure (SBP) and the ratio of total cholesterol to HDL-cholesterol meet. If no HDL cholesterol result is available, then assume this is 1.00mmol/l and the lipid scale can be used for total serum cholesterol alone.

Higher risk individuals (red areas) are defined as those whose 10 year CVD risk exceeds 20%, which is approximately equivalent to the CHD risk of >15% over the same period indicated by the previous version of these charts. As a minimum those at highest CVD risk (greater than 30% shown by the line within the red area) should be targeted and treated now. When resources allow, others with a CVD risk of >20% should be progressively targeted.

The chart also assists in the identification of individuals whose 10 year CVD risk moderately increased in the range 10-20% (orange area) and those in whom risk is lower than 10% over 10 years (green area).

Smoking status should reflect lifetime exposure to tobacco and not simply tobacco use at the time of assessment. For example, those who have given up smoking within 5 years should be regarded as current smokers for the purposes of the charts.

The initial BP and the first random (non-fasting) total cholesterol and HDL cholesterol can be used to estimate an individual’s risk. However, the decision on using drug therapy should generally be based on repeat risk factor measurements over a period of time.

Men and women do not reach the level of risk predicted by the charts for the three age bands until they reach the ages 49, 59, and 69 years respectively. Everyone aged 70 years and over should be considered at higher risk. The charts will overestimate current risk most in the under forties. Clinical judgement must be exercised in deciding on treatment in younger patients. However, it should be recognised that BP and cholesterol tend to rise most and HDL cholesterol to decline most in younger people already possessing adverse levels. Thus untreated, their risk at the age 49 years is likely to be higher than the projected risk shown on the age-less-than 50 years chart.

These charts (and all other currently available methods of CVD risk prediction) are based on groups of people with untreated levels of BP, total cholesterol and HDL cholesterol. In patients already receiving antihypertensive therapy in whom the decision is to be made about whether to introduce lipid-lowering medication or vice versa the charts can act as a guide, but unless recent pre-treatment risk factor values are available it is generally safest to assume that CVD risk is higher than that predicted by current levels of BP or lipids on treatment.

CVD risk is also higher than indicated in the charts for:-

• Those with a family history of premature CVD or stroke (male first degree relatives aged <55 years and female first degree relatives aged <65 years) which increases the risk by a factor of approximately 1.5 
• Those with raised triglyceride levels 
• Women with premature menopause 
• Those who are not yet diabetic, but have impaired fasting glucose (6.1-6.9mmol/l) 
• In some ethnic minorities the risk charts underestimate CVD risk, because they have not been validated in these populations. For example, in people originating from the Indian subcontinent it is safest to assume that the CVD risk is higher than predicted from the charts (1.5 times). 
• The charts may be used to illustrate the direction of impact of risk factor intervention on estimated level of CVD risk. However, such estimates are crude and are not based on randomised trial evidence. Nevertheless, this approach maybe helpful in motivating appropriate intervention. 
• The charts are primarily to assist in directing intervention to those who typically stand to benefit most. 

*Cardiovascular Disease Risk Prediction Chart reproduced with permission from The University of Manchester Department of Medical Illustration, Manchester Infirmary.

All-in-one 'polypill' could save lives, says report - Health News - Health & Families - The Independent

All-in-one 'polypill' could save lives, says report - Health News - Health & Families - The Independent

World Hypertension Day: Beware two silent killers - High blood pressure & salt

Blood pressure news

World Hypertension Day: Beware two silent killers

17/05/2009

More than 7 million people die around the world every year due to two silent killers: high blood pressure and salt. Yet, more than 2.5 million lives could be saved,  if everyone reduced their salt intake by half, the World Hypertension League has revealed today (World Hypertension Day 17 May 2009).

Silent killer #1 – High blood pressure

How high blood pressure kills: High blood pressure is a killer because it puts extra strain on your body and its vital organs. This excessive pressure quietly damages your blood vessels, heart and kidneys without causing any visible signs.

Because high blood pressure doesn’t normally produce signs or symptoms, the damage to your body builds up silently over many years. In fact, many people don’t know they have high blood pressure until they have a stroke or a heart attack.

For more, please see: What is high blood pressure?

What you can do about high blood pressure: The first step to tackling high blood pressure is to find out if you have it or not. The only way to know for certain is to have regular blood pressure checks (preferably once a year).

The second step is to change your lifestyle to be more blood pressure friendly. The good news is that these changes will also reduce your risk of cancer, heart attacks, strokes, dementia, kidney disease and diabetes too.

A blood pressure friendly lifestyle means:

eating less than 6g salt a day

eating at least five portions of fruit and vegetables a day

being the right weight for your height

being active for 30 minutes five times a week.

For more, please see our How to lower your blood pressure area.

Silent killer #2 – Salt

How salt kills: The more salt you eat, the higher your blood pressure. The higher your blood pressure, the more damage is being done to your blood vessels, heart and kidneys. Over many years, this damage will build up and may lead to a stroke, heart attack or kidney failure.

Salt contains sodium, which makes your body retain water and eating too much salt means that your body holds on to too much fluid. This extra fluid raises your blood pressure. By eating less salt, your body will hold on to less water and this will reduce your blood pressure.

What you can do to reduce your risk: The first step is to become “salt aware” by reading food labels to see how much salt is in your foods.

The second step is to reduce your salt intake as much as possible by eating foods that are low in salt. To help you do this, and to celebrate World Hypertension Day (17 May 2009), the World Hypertension League has issued a list of foods that are High, Medium or Low in salt (or sodium).

High in salt – cut down on these foods: Anchovies, bacon, cheese, salted chips, coated chicken, powdered sauces, noodle snacks, olives, pickles, prawn, salami, salted nuts, salted fish, sausages, smoked meat and fish, soy sauce, stock cubes, table sauces and canned meats.

Medium in salt – eat fewer servings of these processed foods: Baked beans, cookies, breakfast cereals, bread products, burgers, cakes, pastries, cooking/table sauces, stuffed/canned pasta, meat pies, pasta sauces, pizza, ready meals, soup and sandwiches.

Low in salt – eat more of these foods: Low-salt breakfast cereals, couscous, eggs, fresh fish, meat and poultry, fresh cheese, fruits and vegetables (dried, frozen or fresh), homemade bread/sauces/soups, mozzarella and ricotta cheese, pasta, rice, unsalted nuts, plain cottage cheese, plain popcorn, yogurt, peas, beans, lentils and seeds.

It is also important to avoid adding salt when cooking or at the table.

For more, please see our Salt information area.

an epidemic of neurological diseases, such as Alzheimer's

Biochemist Gregory Petsko makes a convincing argument that, in the next 50 years, we'll see an epidemic of neurological diseases, such as Alzheimer's, as the world population ages. His solution: more research into the brain and its functions.




Glaucoma is just Alzheimers of the eye.

High blood pressure - a global problem

reposted from: http://www.bpassoc.org.uk/mediacentre/Bloodpressurenews/Highbloodpressure-aglobalproblem

30/06/2008

New research published in The Lancet has found that

high blood pressure causes at least 7.6 million premature deaths worldwide - about 13.5% of the global total.

According to researchers, that means that almost one in five premature deaths each year are caused by high blood pressure and the problem is fast becoming a global epidemic.

Mike Rich, Executive Director of the Blood Pressure Association said: "This research rightly shows the size of the global problem with 7.6 million deaths attributed to high blood pressure annually.

The majority of the burden of high blood pressure is clearly being felt in the developing world and it is vital that something is done about it, but it is also clear that the UK picture is nothing to be proud of.

"Even with the availability of effective blood pressure lowering medicines and knowledge of the lifestyle changes that will reduce hypertension, the UK is still failing to effectively reduce blood pressure related disease.

"Every day there are 350 preventable strokes or heart attacks in the UK due to high blood pressure. This research highlights the continuing need for us to help the 16 million people in the UK who have high blood pressure, including the third who do not even know they have it."

References: C Laws, S Vander Hoorn, A Rodgers, for the International Society of Hypertension. ‘Global burden of blood-pressure related disease, 2001’, The Lancet. Friday 2 May 2008.

Blood Pressure test

I bought a MicroLife /BPA Blood Pressure monitor here at £34.99 this week

According to Blood Pressure Association an ideal blood pressure is less than 120 over 80. At this level, you have a much lower risk of heart disease or stroke. Normal blood pressure is having a blood pressure reading that is above 120 over 80, but below 140 over 90. If your blood pressure is normal, this is good, but you should be taking steps to bring it down, or to stop it rising any further.

Crabsallover BP was 112/72. Thats down from 130/75 when tested last (10/06). BPA say "an ideal blood pressure is less than 120 over 80"

BPA say "If your blood pressure is ideal, this is great news. By following our healthy living advice, you will be able to keep it this way."

1. Blood Pressure Diet - Eat less salt

Too much salt raises your blood pressure, so it is important to eat as little as possible. In fact, some people with high blood pressure may be able to avoid blood pressure medicines by cutting down on salt.

Most of the salt you eat is not what you add to your food, but is in prepared foods like bread, breakfast cereals and ready meals.

Don’t add salt to food when cooking or at the table.

When shopping for food, check the labels and choose low-salt options when you can.

More on how to eat less salt

2. Blood Pressure Diet - Eat more fruit and vegetables

Eating more fruit and vegetables helps to lower your blood pressure. Adults should eat at least five portions of fruit and vegetables every day.

A portion is 80 grams, or roughly the size of your fist.

Try to eat a range of different fruits and vegetables. Dried, frozen and tinned are fine, but watch out for added salt, sugar or fats.

More on how to eat more fruit and vegetables

3. Blood Pressure Diet - Keep to a healthy weight

Losing weight, if you need to, will help lower your blood pressure and reduce your risk of health problems. The best way to lose weight is to choose more low-fat and low-calorie foods, and increase your physical activity.

Set yourself realistic goals.

Make small changes to your eating habits and activity levels that you can keep to for life.

More on how to keep a healthy weight

4. Blood Pressure Diet - Drink less alcohol

If you drink too much alcohol, this will raise your blood pressure over time. The current recommended limits are 21 units of alcohol a week for men, and 14 units a week for women. A unit is roughly half a pint of beer or cider, a small glass of wine, or a single pub measure of spirits.

If you keep to the recommended alcohol limits, this should help keep your blood pressure down.

More on the recommended limits for alcohol

5. Blood Pressure and Exercise - Get more active

Being moderately active for 30 minutes five times a week can keep your heart healthy, and can lower your blood pressure.

If you can’t find 30 minutes in your day, increasing your activity by even a small amount can help.

Think about how you can be more active in your daily life. Any activity that leaves you feeling warm and slightly out of breath is ideal.

More on how to be more active

Blood pressure facts and figures

Blood pressure facts and figures

• High blood pressure is the main risk factor for stroke and a major risk factor for heart attack, heart failure and kidney disease. There is also increasing evidence that it is a risk factor for vascular dementia. (1)
• One in three adults in the UK (16 million) have high blood pressure. (3)
• Around a third of people with high blood pressure do not know that they have it, as there are no obvious symptoms. This is why it is often called the 'silent killer'. (5)
• High blood pressure is a level consistently at or above 140mmHg and/or 90mmHg. (2)
• 31 per cent of men and 28 per cent of women have high blood pressure. (5)
• People with high blood pressure are three times more likely to develop heart disease and stroke and twice as likely to die from these as people with a normal blood pressure. (3)

• but what is the absolute risk?

• Approximately 62,000 unnecessary deaths from stroke and heart attacks occur due to poor blood pressure control. (4)
• High blood pressure rarely has any symptoms, the only way for people to know if they have the condition is to have their blood pressure regularly measured.
• More than 77 per cent of men and 71 per cent of women with high blood pressure are either not being treated, or being controlled to below 140/90 mmHg. (5)
• Most people with high blood pressure who need to take medications, will need to take two or more to ensure that their blood pressure is lowered down to a target of 140/85mmHg (2)

• The risks increase as blood pressure rises, whether you have high blood pressure or a normal blood pressure. Between the age of 40 and 70, for every rise of 20mmHg systolic or every 10mmHg diastolic, the risk of heart disease and stroke doubles; for the range 115/75 up to 185/115mmHg. (6)

• Crabsallover Blood Pressure 130/70 (11/06) - so I'm at almost double risk of heart disease or stroke than someone with normal BP 115/75. But was is the absolute risk?
  

• 
  
• Londoners have the lowest average blood pressure. Northern England tends to have higher rates of high blood pressure than Southern England. (5)
• Someone with high blood pressure that is well controlled reduces their risk of stroke and heart disease to almost that of a person who does not have high blood pressure.

References

1. Forette F, Seux M, Staessen J. Prevention of dementia in randomised double-blind placebo controlled systolic hypertension in Europe (Syst-Eur) trial. The Lancet 1998;352:1346-51

2. Williams B et al. Guidelines for management of hypertension: report of the fourth working party of the British Hypertension Society, 2004 - BHS IV. The Journal of Human Hypertension 2004;18 :139-185 (available on the British Hypertension Society web site at http://www.bhsoc.org/)

3.The Annual Report of the Chief Medical Officer of the Department of Health 2001 (http://www.dh.gov.uk/)

4.He F, MacGregor G. Cost of poor blood pressure control in the UK : 62 000 unnecessary deaths per year. Journal of Human Hypertension 2003; 17: 455-457 (www.nature.com/jhh/)

5. Health Survey for England 2006. Department of Health publication available at www.dh.gov.uk

6. National Institutes of Health and National Heart, Lung and Blood Institute. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of high blood pressure 2003 (www.nhlbi.nih.gov/guidelines/hypertension/)

High blood pressure - a global problem

Blood pressure news

High blood pressure - a global problem
30/06/2008

New research published in The Lancet has found that high blood pressure causes at least 7.6 million premature deaths worldwide - about 13.5% of the global total.

According to researchers, that means that almost one in five premature deaths each year are caused by high blood pressure and the problem is fast becoming a global epidemic.

Mike Rich, Executive Director of the Blood Pressure Association said: "This research rightly shows the size of the global problem with 7.6 million deaths attributed to high blood pressure annually. The majority of the burden of high blood pressure is clearly being felt in the developing world and it is vital that something is done about it, but it is also clear that the UK picture is nothing to be proud of.

"Even with the availability of effective blood pressure lowering medicines and knowledge of the lifestyle changes that will reduce hypertension, the UK is still failing to effectively reduce blood pressure related disease.

"Every day there are 350 preventable strokes or heart attacks in the UK due to high blood pressure. This research highlights the continuing need for us to help the 16 million people in the UK who have high blood pressure, including the third who do not even know they have it."

References: C Laws, S Vander Hoorn, A Rodgers, for the International Society of Hypertension. ‘Global burden of blood-pressure related disease, 2001’, The Lancet. Friday 2 May 2008.

Lower blood pressure by eating less salt

Reduce salt to lower blood pressure

One of the quickest ways to lower your blood pressure (especially if you have high blood pressure) is to eat less salt. Below we show you how.

Salt raises your blood pressure. The more salt you eat, the higher your blood pressure will be.

Salt makes your body retain water. If you eat too much salt, the extra water stored in your body raises your blood pressure. This can be a particular problem if you have high blood pressure. Also, eating too much salt may mean that blood pressure medicines (such as diuretics) don't work as well as they could.

How much salt is too much?

An adult should eat no more than 6g of salt a day, but most of us eat much more than this.

Most of the salt we eat every day is "hidden". Roughly 80% of the salt we eat is hiding in processed foods like bread, biscuits and breakfast cereals, and prepared ready meals or takeaways. Only 20% comes from the salt we add while cooking or at the table.

How do I measure how much salt I'm taking in?

How to cut down on salt to lower blood pressure

To avoid the hidden salt and cut down your salt intake, it is best to eat foods that are low in salt and stop using salt when cooking or at the table.
By reading the food label, you can see if a food is low, medium or high in salt:

• Low - 0.25g salt or less per 100g of food - Eat plenty of these
• Medium - 0.25-1.25g salt per 100g of food - Eat small amounts occasionally

• High - 1.25g salt  or more per 100g of food - Avoid these completely

What sodium levels mean

Some labels may not say how much salt the food contains, but they may say how much sodium it contains. Sodium is one of the chemicals in salt, and 1g of sodium is the same as 2.5g of salt. 

Atomic Weight Sodium: 23, AW Chlorine  35, NaCl AW = 58, NaCl/Na = 58/23=2.5

So:

• Low - 0.1g sodium or less per 100g of food - Eat plenty of these
• Medium - 0.1-0.5g sodium per 100g of food - Eat small amounts occasionally
• High - 0.5 sodium or more per 100g of food - Avoid these completely

If the label does not say how much salt or sodium the food contains, look at the ingredients list. The closer to the top of the list salt appears, the more salt the food is likely to contain.

8 ways to eat less salt and help your blood pressure

• Don’t add salt when cooking. This includes things like soy sauce, curry powders and stock cubes.
• Get extra flavour with herbs and spices, and from seasonings like chilli, ginger, lemon or lime juice.
• Table sauces like ketchup, mustard and pickles can contain a lot of salt. Check the label and choose low-salt options.
• Bread and breakfast cereals can contain a lot of salt. Check the labels to compare brands.
• Smoked meats and fish contain a lot of salt. Avoid these if you can.
• If you are eating out, ask if your meal can be made with less salt. This may not be possible, but it is always worth asking.
• If you really want a salty favour, use a small amount of low-sodium salt substitute. If you have kidney problems or diabetes, check with your doctor or nurse first.
• Look out for low-salt recipes. There are a number of low-salt cookbooks available, or you can search for recipes on the internet.

Don’t be too concerned about the exact amount of salt you eat, instead try to always eat  foods with the lowest salt level. 6g of salt a day is the maximum you should eat, and the less you eat the better.
At first, food without salt can taste bland, but don’t give up. After a few weeks your taste buds will adjust and you will start to enjoy food with less salt.

More about a healthy blood pressure diet

Eating less salt is just one part of eating a healthy blood pressure diet, there are a number of others that will help to lower your risk of heart attack and stroke:

• Eat more fruit and vegetables to lower blood pressure
• Drink less alcohol to avoid high blood pressure
• Fats and cholesterol
• Understanding your food

Diabetes - the silent assassin

Blood pressure news

Diabetes - the silent assassin
07/10/2008

Posters will be appearing around the country featuring a dark and shadowy figure. The "silent assassin" will be pictured lurking on streets and in magazines as it waits to pounce on unsuspecting members of the public. But what is this deadly danger? It is diabetes.

This advertising campaign has been funded by Diabetes UK to make people aware of the dangers of diabetes.

The charity wants everyone to know that having diabetes dramatically increases your risk of heart disease, stroke and kidney disease.

People with high blood pressure need to be even more careful about diabetes. Diabetes and high blood pressure together will combine to form a double-whammy of danger. Both of them raise the risk of heart disease, stroke and kidney disease and, when combined, they have an even more powerful effect. For more on diabetes and high blood pressure, please see our Diabetes page.
Fortunately there is much you can do to lower your risk of high blood pressure and diabetes. Or, if you have either condition, there is much you can do to lower your risks of developing the other one.
The good news is that the advice is pretty much the same for both conditions:

• Eat less salt - see our Salt page
• Eat more fruit and vegetables - see our Fruit and vegetables page
• Eat fewer sugary foods
• Keep to the recommended daily alcohol limits - see our Alcohol page
• Keep active - see our Get active pages
• Be a healthy weight - see our Healthy weight and Losing weight pages
• Take any blood pressure medicines or diabetes medication you have been given - see our Blood pressure medicines pages.

By following these lifestyle changes you will help to dramatically lower your risk of developing heart disease, stroke or kidney disease in the future.

Related Links

• Blood Pressure: Your guide to blood pressure
• Diabetes and high blood pressure
• Healthy eating to lower blood pressure
• How activity lowers blood pressure
• Keeping to a healthy weight
• Diabetes UK

Blood Pressure - Am I normal? by Vivienne Parry

iPlayer - Listen to 21st October 2008.

a BP level of 140/90 is a high blood pressure and is the threshold to use drugs. 10 years ago high blood pressure was 160/100. Normal blood pressure is 115mm but only 15% of UK population have this pressure. The other 85% of the UK Population has a BP of over 115. At 115 to 140 you need to take preventative measures (not drugs) to reduce blood pressure. Remember the lower the blood pressure - the better - the longer you will live! Exercise, reduce salt and lose weight - can reduce blood pressure.

Most people in UK eat 10-11g salt per day. Government recommends 6g/day. As age increases the ability to get rid of salt reduces. In Orangutan - no increase in blood pressure when they get older. Increase in BP arises from our lifestyle.

In November 2006 crabsallover blood pressure was 130/70 mmHg.

http://www.bpassoc.org.uk/BloodPressureandyou/Thebasics/Bloodpressure
.. a blood pressure of 135 over 85 may be “normal” but someone with this reading is twice as likely to have a heart attack or stroke as someone with a reading of 115 over 75.

European guidelines on cardiovascular disease prevention in clinical practice: executive summary

reposted from: http://eurheartj.oxfordjournals.org/cgi/content/full/28/19/2375#top

In general, a middle aged person with a 10-year risk of CVD death of 5% or more is regarded as at high risk. Examination of the FINRISK MONICA data (which contribute substantially to the SCORE high risk population charts) suggests that the equivalent total (fatal + non-fatal) CVD risk is about 10%.

In my experience, some charts in the 2003 ESC study confused risk of CVD death with non fatal CVD risk. "The choice of CVD mortality rather than total (fatal + non-fatal) events was deliberate although not universally popular. Non-fatal event rates are critically dependent upon definitions and the methods used in their ascertainment. " (see section)

Calculating total event rates from FINRISK suggests that, at the level (5%) at which risk management advice is likely to be intensified, total event risk is about 10%.

European guidelines on cardiovascular disease prevention in clinical practice:

reposted from: http://eurheartj.oxfordjournals.org/cgi/content/full/28/19/2375

This is a major 2007 study:

Fourth Joint Task Force of the European Society of Cardiology

Figure 2: SCORE chart: 10-year risk of fatal CVD in populations at high CVD risk based on the following risk factors: age, gender, smoking, systolic blood pressure, and total cholesterol. © The European Society of Cardiology.

In November 2006 crabsallover blood pressure was 130/70 mmHg. Crabsallover total cholesterol was Total Cholesterol was 5.1 mmol/L. Crabsallover Total Cholesterol: HDL cholesterol ratio was 5.1.

Crabsallover is 52 years. Using the 50 year chart (figure 2, men, non smoker, high cvd risk) crabsallover 10 year risk of fatal CVD is 2%. Using the 55 year chart my risk is 3%.

Using the 50 year chart (figure 3, men, non smoker, low cvd risk) crabsallover 10 year risk of fatal CVD is 1%. Using the 55 year chart my risk is 2%.

Using the 50 year chart (figure 4, men, non smoker, low cvd risk, total cholesterol: HDL cholesterol ratio of 5.1) crabsallover 10 year risk of fatal CVD is 1%. Using the 55 year chart my risk is 2%.

Using the 50 year chart (figure 5, men, non smoker, high cvd risk, total cholesterol: HDL cholesterol ratio of 5.1) crabsallover 10 year risk of fatal CVD is 2%. Using the 55 year chart my risk is 4%.

In summary, whichever chart is used, my risk is 1-4% of CVD over next 10 years.

Polypill with Statins + 5, Brilliance or Ridiculous? - July 2003

• 05 July 2003
• From New Scientist Print Edition.

IT IS, depending on who you talk to, either the most important idea in medicine for over half a century or a crazy, dangerous fantasy.

"No other preventive measure would have a greater impact on public health in the western world," say Nicholas Wald and Malcolm Law of the Wolfson Institute of Preventive Medicine in London, who proposed the "polypill" in last week's British Medical Journal. "I thought it was a joke," says Steve Nissen, a cardiologist at Ohio State University. "It is stupid and ridiculous."

The idea is to combine five cheap off-patent drugs and the vitamin folic acid in a single pill offered to everybody over the age of 55. The polypill, claims Wald, would slash the risk of heart attacks by 88 per cent and strokes by 80 per cent (see "How the polypill would work"), extending people's lives without these diseases by up to 11 years. If his calculations are right, in the US alone, it could save nearly 800,000 lives a year. Given to everyone in developed countries, where heart disease is the biggest killer, it would save many millions.

Wald and his colleagues, who are patenting the idea, now hope to find a backer to finance the polypill's development. They want to carry out small trials involving a few hundred volunteers to identify the specific drugs to include in the polypill, and then larger trials involving thousands of volunteers and various different combinations of placebo and drugs to prove it really does deliver the benefits they claim.

"The necessary trials should be started immediately," BMJ editor Richard Smith told a press conference last week. But such trials will be very expensive, and big pharma companies may not be keen to back a cheap pill that could slash demand for their more expensive patented drugs. Nor will getting approval from regulators be easy.

The polypill idea is radical for several reasons. Giving drugs to healthy people to prevent disease, rather than just to those at high risk, has been proposed before, but has never been tried on a large scale. In 2001, for instance, after a massive 7-year trial showed that a statin called simvastatin (a potential polypill ingredient) reduces the chances of a heart attack or stroke by a third, without serious side effects, the researchers suggested it should be prescribed far more widely (New Scientist, 24 November 2001, p 7).

Wald points out that most people who suffer a heart attack or stroke are not known to be at risk - so if you want to make a big difference, you have got to give the polypill to everyone over 55. Efforts to prevent heart disease by changing lifestyle factors such as smoking, diet and exercise make much less difference, he says, and anyway the polypill should be seen as an addition to these efforts, not a replacement.

Critics say the polypill could have serious side effects: aspirin can cause internal bleeding, while blood pressure drugs can cause dizziness and fainting. But Wald claims the benefits will far outweigh the risks: a third of people taking it would live longer as a result, he calculates, whereas only 8 to 15 per cent would suffer any side effects.

While aspirin can cause bleeding and strokes, he admits, it prevents more strokes than it causes. And the strategy of combining three blood pressure drugs at half the usual dose will minimise any side effects. Even people with average blood pressure will benefit, Wald says. "All the evidence suggests the lower, the better."

Another contentious issue is combining so many drugs in one pill and giving the same pill to everyone. "People are different," says Nissen. "It is just not safe." Nissen sat on the US FDA advisory panel that assessed Pravigard, the first combination pill containing a statin and aspirin, which was approved last week for people suffering from heart disease. But the application was initially rejected, until Bristol-Myers Squib came back with more combinations of different doses - six in all. If the same principle were applied to the polypill, there would be over a hundred different combinations. Wald accepts the polypill may have to be adjusted to suit some individuals. But to keep costs down "you start with one-size-fits-all, then you start tailoring", he says.

There are also more mundane problems. Pravigard still comes as two pills, because of problems with the stability of a combined pill. Putting six drugs in one tablet will be even more of a challenge.

But convincing critics like Nissen may prove even harder. "Getting the idea accepted will require a shift in attitudes," says Wald. "I recognise the obstacles. But I don't think they are insurmountable."

From issue 2402 of New Scientist magazine, 05 July 2003, page 4

How the polypill would work

The four main risk factors for cardiovascular disease are high levels of low-density lipoprotein (LDL) cholesterol and homocysteine in the blood, high blood pressure, and the tendency of blood to clot or platelet aggregation. (The link with homocysteine remains controversial.) The idea of the polypill is to combine six different drugs that lower these risks in a single pill.

The reduced risk of a heart attack or stroke due to treating each risk factor individually can be calculated from the results of clinical trials. The polypill's proponents believe these trials also show that the benefits of treating each risk factor are independent of each other. In other words, if you lower cholesterol and blood pressure, the reduction in risk is greater than if you just lower one or the other.

To work out the overall effectiveness of the polypill, they multiplied the relative risks. To understand what this means, imagine 100 people at risk of heart attacks are given a statin that reduces the risk by 60 per cent over five years. Only 40 out of the 100 will then suffer heart attacks in the next 5 years. If all 100 are also given a blood-pressure drug that lowers the risk of heart attacks by 50 per cent, only the 40 still vulnerable to heart attacks stand to benefit - but only half of them (20) will suffer heart attacks. Together the two drugs will have reduced the risk by 80 per cent (60 + 20).

A key point, say the polypill's proponents, is that if someone does not benefit from one component, they could still be helped by another. If the statin does not save them, the blood pressure drugs might.