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HEALTHY HEARTS Dr Charlie McKenna 10 February 2016 Help! Heart - - PowerPoint PPT Presentation
HEALTHY HEARTS Dr Charlie McKenna 10 February 2016 Help! Heart - - PowerPoint PPT Presentation
HEALTHY HEARTS Dr Charlie McKenna 10 February 2016 Help! Heart Attack Centre Who wants to live forever? Prevention is better than cure Coronary Artery Disease Primary cause of premature death in the UK 1:4 men and 1:5 women 1.4
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Heart Attack Centre
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Who wants to live forever?
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“Prevention is better than cure”
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Coronary Artery Disease
Primary cause of premature death in the UK
1:4 men and 1:5 women 1.4 million people with angina 300,000 heart attacks/year (1 every 2 minutes) 140,000 deaths/year (one 747 every day)
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Coronary Artery Disease Cost the UK economy around £30 billion
NHS £15.7 billion = 21% of total expenditure 250,000 working years lost due to mortality = £5.2 billion 70,000 working days lost due to incapacity = £7 billion 500,000 people provided informal care = £5 billion
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Decline in the incidence of MI in British Men
“The epidemic crested and began to fall” British Regional Heart Study; 7735 men aged 40-59 recruited 1978-80 and followed up to 2004. The hazard ratio of MI fell by 3.8% per annum (total=62%).
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Decline in the incidence of MI in British Men
Contributions Fall in cigarette smoking = 23% Fall in blood pressure = 13% Fall in cholesterol = 22% Rise in BMI = -7% No real change in physical activity or alcohol intake
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Decline in the incidence of MI in British Men
Age-adjusted hazard of first MI more than halved Half of this decrease explained by lifestyle and risk factor adjustment Other half: Modern care in hospital (25%) Secondary prevention in primary care (25%)
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The statin conspiracy theory
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Pleiotropic effects of statin therapy
Statins improve prognosis by reducing event rates Originally prescribed to lower cholesterol Mechanisms of action wider than originally thought “Plaque passivation” - ↓ plaque rupture Improved endothelial function - ↑ NO Enhanced fibrinolysis, platelet antagonism
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Lifestyle risk factors for CV disease
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Pleiotropic effects of lifestyle
Smoking/Poor diet/Inactivity Endothelial dysfunction Oxidative stress Inflammation Thrombosis Arrhythmia
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Lifestyle risk factors A large proportion of health care expenditure is attributable to poor lifestyle behaviour. Emphasis on downstream risk factors, i.e. diabetes/hypertension/dyslipidaemia, addresses neither the root cause nor its full cardiovascular consequences. The impact on health of a single behavioural change - lifestyle monotherapy - is substantial.
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Sugar and fat
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Adolescent BMI as a risk factor
The MELANY study (NEJM 2011;364:1315-1325) 38,000 USA military recruits followed up for an average of 17 years from initial induction medical (aged 17) BMI was a significant independent predictor of coronary disease (HZ 5.4) and diabetes (HZ2.8) As a continuous variable: Risk of diabetes increased by 10% for each 1 BMI unit Risk of proven CAD increased by 12% for each BMI unit
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Adolescent BMI as a risk factor
The MELANY study Only BMI in adulthood was associated with diabetes BMI in both adolescence and adulthood was associated with coronary disease Effect of BMI on diabetes is more reversible/functional than coronary disease which is more irreversible/anatomical
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