My JBS3risk.com

reposted from: http://www.jbs3risk.com/

crabsallover highlights, key points, comments / links.

Crabsallover Blood Pressure

123/81 today as measured by nurse 'Very Good'. Blood test for total cholesterol, HDL, triglycerdies and CRP (C-Reactive Protein). Cardiac specialist nurse Sue Morse said 'she never heard of CRP test'.

from http://crabsalloverhealth.blogspot.com/2008/11/statin-use-may-benefit-healthy.html

We randomly assigned 17,802 apparently healthy men and women with low-density lipoprotein (LDL) cholesterol levels of less than 130 mg per deciliter (3.4 mmol per liter) and

high-sensitivity C-reactive protein levels of 2.0 mg per liter or higher

to rosuvastatin, 20 mg daily, or placebo and followed them for the occurrence of the combined primary end point of myocardial infarction, stroke, arterial revascularization, hospitalization for unstable angina, or death from cardiovascular causes,

Normal levels of cholesterol and high levels of CRP were associated with increased health when statins were taken.

Blood Pressure Test - crabsallover

Result today: 119mm / 71mm using Blood Pressure Association monitor cf. 112/72 a few days ago.

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/)

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:

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.

The evidence I've considered for Statin treatment - to reduce cholesterol & risk of Cardiovascular disease

this blog copied in full from my crabsallover blog February 2007.

This week SIGN (Scottish Intercollegiate Guidelines Network) published Guideline No 97 - Risk estimation and prevention of Cardiovascular Disease (CVD):-

• Full Guideline (this review references this booklet)
  
• Patient Guideline
  
• Quick Reference Guide
• Costs and Resources to implement in Scotland
  

Cardiovascular Disease (CVD) is any disease which affects the heart and blood vessels (examples include coronary heart disease, peripheral heart disease, stroke and heart failure).

Coronary Heart Disease (CHD) is a disease of the heart and coronary arteries caused by a build of fatty materials in the blood vessels which supply the heart with oxygen. This can cause a heart attack, or chest pain or angina.

My risk of CVD in the next 10 years is 1 in 12.5 (8%) according to my 'ASSIGN' score (table 1). So for every 1000 persons with my CVD risk, 80 will have a CVD event in the next 10 years.

Other Factors - not accounted for by 'ASSIGN' score

• At 102cm I have borderline abdominal obesity (defined as greater or equal to 102cm waist measurement in men). (4.7 pg 15)
• waist hip ratio is 102cm/98cm = 1.04 (<0.95>
• I'm overweight BMI >25 (12st 6 pounds, height 5'7.5", BMI 27.5).

I've reviewed Statins in several other blogs. Statins inhibit cholesterol synthesis in the liver, activate hepatocyte LDL receptors and increase uptake of LDL from the circulation (9.3 pg 28)

In October 2006 my blood tests were:

• 5.1 mmol/l total cholesterol (NHS normal: <=5.0)
• 3.0 mmol/l LDL 'bad' cholesterol
• 1.02 mmol/l HDL 'good' cholesterol (normal >1.03) (4.7 pg 15)
• total cholesterol/HDL cholesterol ratio = 5.0
• Blood pressure = 130 systolic/70 diastolic (normal <130/85)
• On 30th April 2007 my figure (ex Poole Hospital 110/70)
  
• 5.9 mmol /l glucose
  

Grades of evidence The SIGN study grades evidence ranging from High quality meta-analyses (1++) to Expert Opinion (4). It grades recommendations from A to D based on this evidence. (page 2, Full Guideline) The report defines people in a 'High Risk' category if they have a >=20% risk of CVD over the next 10 years. For those with 1% annual risk of CVD ( viz. 10% over 10 years) benefits have been shown using statins (3-Hydroxy-3-Methylglutaryl-CoA (HMG-CoA) Reductase inhibitors). Annual CVD is 1% in USA and Europe. So most middle aged men and women could benefit from a statin and CVD reduction. (Full Guideline (FG) 2.4 pg 11) 8.2 Aspirin Antiplatelet therapy with Aspirin reduces Myocardial Infarction (heart attack) risk but increases stroke and major gastrointestinal bleeding risk. P S Sanmuganathan et al in Heart85:265-271 2001; concluded "Aspirin treatment for primary prevention is safe and worthwhile at coronary event risk greater than 1.5%/year; safe but of limited value at coronary risk 1%/year; and unsafe at coronary event risk 0.5%/year.^" With my 8% over 10 year CVD risk, Aspirin is of limited value or unsafe. 9 Lipid Lowering Low density Lipoprotein (LDL) makes up 60-70% of serum cholesterol. The Friedwald equation LDL = TC-HDL-(TG/2.2) (9.2 pg 32) Statins reduce Total Cholesterol TC by approx. 20% or 1mmol and LDL Cholesterol by 30% (9.3, pg 28) with a 30% reduction in CHD mortality (9.3 pg 29). With each doubling of the dose of a statin LDL levels fall by 6%. A reduction of 1.6 mmol/l halves the risk of CHD events after 2 years and this reduction can be achieved with standard doses of statins. (9.4 pg 30, table 8) My 8% (1 in 12.5) risk of CVD (table 1, total cholesterol 5.1 mmol/l) could be reduced to a 6% risk (1 in 17) (table 2, total cholesterol 3.88 mmol/l) - a 25% risk reduction. 80 people per thousand, like me, will have CardioVascular Disease over 10 years. By taking Statins that risk is reduced to 60 people with CVD. Mild muscle pains or other adverse effects (eg fever, malaise) may require reduction in statin levels or change of statin type whilst severe side effects will require statin therapy to be discontinued. (para 9.6, pg 36). Current NHS target for individuals at high cardiovascular risk is a TC level of less than 5 mmol. Reducing this target to 4.5 or 4.0 mmol/l would have major resource implications for NHS (9.7 pg 32). Zocor (simvastatin, 10mg per day) is available from Boots over the counter for £8 per month. HDL Cholesterol my level of 1.02 mmol/l HDL Cholesterol is low and may require treatment with Fibrates (raises levels 10-15%,) (9.10.2 pg 39) or Nicotinic Acid (raises levels 15-35%) (9.10.3 pg 40) 9.8 Safety of Statins Statins are safe. No increase in cancer levels has been found. Raised levels of liver enzymes (aspartate and alanine aminotransferase) occur in 1% cases which is completely reversible when treatment is withdrawn. Minor muscle discomfort is common though the incidence varies. Rare more serious Myopathy with raised creatine kinase occurs in 0.1% cases. In 0.01% cases Rhabdomyalysis (renal failure) occurs. Withdrawal of treatment leads to recovery in a majority of cases but death can occur if patient is receiving several drug treatments or experiencing multiple symptoms. Statins may possibly interact with other medications eg fibrates (niacin, nicotinic acid). Inhibitors of cytochrome P450 and grapefruit juice may increase Myopathy risk. Atorvastatin, fluvastatin, pravastatin, rosuvastatin and simvastatin are licensed for use in UK. Annex 2 pg 62 Joint British Societies (JBS2 - reference 28) proposed total cholesterol target of <4mmol/l size="4">Annex 3 pg 65 Creatine Kinase (CK) baseline pretreatment level might be useful to monitor possible muscular symptoms. Annex 4 pg 66 Liver transaminase levels advisable prior to statin treatment, 3 months after treatment and when dose level is increased. This indicates potential for jaundice, malaise, fatigue, lethargy etc. Annex 5 pg 67 Assessment of renal function is advisable before starting statin therapy. Test for serum creatinine and proteinuria. Conclusions for my health

• current risk of CVD is 8% - table 1
  
• Aspirin is of limited value or unsafe
• Statins are safe and should be taken daily after
• a baseline checkup (total cholesterol, LDL, HDL, Triglycerides, blood pressure, Creatine Kinase, liver transaminase, serum creatinine and proteinuria)
  
• Statin treatment targets
  
• 30% reduction in LDL cholesterol (from 3 to 1.9 mmol/l)
  
• 24% reduction in total cholesterol (from 5.1 to 3.88 mmol/l)
  
• reduce risk of CVD by 25% - from 1 in 12 (8%) to 1 in 17 (6%) over 10 years - table 2.
  
• Fibrates or Nicotinic acid treatment targets (after initial statin treatment)
  
• Reduce CVD risk to 5% (1 in 20) by increasing HDL cholesterol to medium levels (1.34 mmol/l) - table 3
  
• Reduce CVD risk to 4% (1 in 25) by increasing HDL cholesterol to high levels (1.73 mmol/l) - table 4
  
• Reduce CVD risk to 3% (1 in 33) by reducing systolic blood pressure from 130 to 108 mmHg by improving diet and increasing exercise - table 5
  

Table 1: Baseline 8% risk Table 2: 6% risk after Statin treatment Table 3: 5% risk after treatment to give medium HDL cholesterol levels Table 4: 4% risk after treatment to give high HDL cholesterol levels

Table 5: 3% risk after treatment to give low blood pressure