Cardiovascular disease

Posted on Cardiovascular disease

A diet high in fruit, veg, fibre and dairy is linked to lower stroke risk, study finds

Various media sources have reported that eating fruit, vegetables, fibre and dairy is linked with a lower risk of stroke.

This follows a large European cohort study that looked at the link between different food groups and the risk of stroke in more than 400,000 people (average age 50 years) from 9 European countries. During around 12 years of follow-up, 1 to 2 in every 100 of the study group had a stroke.

Researchers found that increased consumption of fruit and vegetables, dietary fibre and dairy were linked with lower risk of the most common type of stroke caused by a blood clot (ischaemic stroke).

In absolute terms, eating about 200g extra of fruit and vegetables each day was linked to 1 fewer stroke per 1,000 people over 10 years. Increased fibre intake was linked to 2 fewer strokes, and increased dairy intake was linked to between 0.4 and 0.9 fewer strokes per 1,000 people over 10 years.

However, the study still cannot prove direct cause and effect. Many other health and lifestyle factors are likely to contribute to an individual’s overall risk of stroke, which perhaps explains why the links with these dietary factors are quite small.

We also do not know detail about the types of food consumed. For example, whether dairy was low fat or full fat. It’s perhaps not sensible to tell people they can eat as much cheese as they like and they’ll lower their risk of stroke because cheese is often high in saturated fat, which can be harmful to cardiovascular health.

Nevertheless, the study supports what we already know about the benefits of a healthy diet which is high in fruit, vegetables and dietary fibre.

Where did the story come from?

The ongoing European Prospective Investigation into Cancer and Nutrition (EPIC) cohort is formed by a European team of researchers, centrally coordinated by researchers from Imperial College London and the International Agency for Research on Cancer in Lyon, France.

The study has received funding from extensive sources, including the UK Medical Research Council, Cancer Research UK and the Wellcome trust.

The current study is published in the European Heart Journal, and is free to read online.

What kind of research was this?

EPIC is an ongoing prospective cohort study, reportedly one of the largest in the world. It was designed to look at the relationship between diet, nutrition and lifestyle and various chronic diseases, including cancers.

Large cohort studies, which follow people over time, are a good way at looking at the link between an exposure (such as diet) and the effect on a health outcome (such as stroke). The main drawback is that they can never prove direct cause and effect with complete certainty, as other factors could be having an influence.

What did the research involve?

This analysis involved 418,329 adults (average age 50) who were recruited to the EPIC cohort between 1992 and 2000 from 9 European countries (Denmark, Germany, Greece, Italy, the Netherlands, Norway, Spain, Sweden, and the UK). The cohort actually includes 10 countries, but France was excluded from this analysis as they did not collect information on stroke.

Participants completed diet and lifestyle questionnaires at recruitment, in addition to an assessment of body measurements and physical activity level. The food questionnaires asked about dietary intake over the past year and assessed:

  • meat products (red meat, processed meat, and poultry)
  • fish (white fish and “fatty” fish)
  • dairy products (milk, yoghurt, cheese)
  • eggs
  • cereals and cereal products
  • fruit and vegetables (combined and separately)
  • legumes, nuts and seeds
  • dietary fibre (total fibre, plus cereal, fruit, and vegetable fibre separately)

A small sample (8% of the cohort) also completed one-off 24-hour computerised food diaries.

Stroke was the main outcome of interest in this study, specifically broken down into ischaemic stroke (caused by a blood clot) and haemorrhagic stroke (caused by a bleed). These events were as documents in medical records, using recognised diagnostic criteria.

The researchers looked at the link between diet and stroke, taking account of potential confounders including:

  • age, gender and country of residence
  • smoking and alcohol use
  • physical activity
  • total energy (food) intake
  • education and employment
  • diabetes, high blood pressure and high cholesterol

What were the basic results?

Over an average 12.7 years of follow-up there were 4,281 new cases of stroke (affecting 1% of the cohort), 2 in 3 of which were ischaemic, and 1 in 3 haemorrhagic.

The researchers found:

  • 200g higher fruit and vegetable intake per day decreased stroke risk by 13% (hazard ratio [HR] 0.87, 95% confidence interval [CI] 0.82 to 0.93)
  • 10g higher fibre intake per day decreased risk by 23% (HR 0.77, 95% CI 0.69 to 0.86)
  • 200g higher milk intake per day decreased risk by 5% (HR 0.95, 95% CI 0.91 to 0.99)
  • 100g higher yoghurt intake per day decreased risk by 9% (HR 0.91, 95% CI 0.85 to 0.97)
  • 30g higher cheese intake per day decreased risk by 12% (HR 0.88, 95% CI 0.81 to 0.97)

The researchers calculated that in absolute terms, eating 200g more fruit and vegetables each day would lead to 1 fewer stroke per 1,000 people over 10 years, while this level of fibre would lead to 1.7 fewer strokes, and dairy between 0.4 and 0.9 fewer strokes per 1,000 over 10 years.

They also found that eating 20g more eggs per day was linked with a 25% increased risk of haemorrhagic stroke, which equated to about 0.7 more strokes per 1,000 people over 10 years. But this was the only significant link found.

How did the researchers interpret the results?

The researchers conclude that a high intake of fruit and vegetables, dietary fibre and dairy was linked with lower risk of ischaemic stroke, while higher egg consumption increased the risk of haemorrhagic stroke.

Conclusion

This is a valuable study that has made use of data collected from the EPIC cohort to look at the links between diet and stroke. The study benefits from the large number of participants, giving wide representation across European countries. The large participant size has also allowed the researchers to analyse the results by specific type of stroke.

The findings support general understanding that a higher consumption of fruit, vegetable and fibre is beneficial to cardiovascular health, including reducing risk of the most common type of stroke.

However, cohort studies can never prove direct cause and effect. Although the researchers have tried to account for various confounders, we can never be sure that the influence of all other health and lifestyle factors has been removed.

Even though higher intake of these foods did reduce risk, the absolute reductions are fairly small, at around 1 to 2 fewer strokes per 1,000 people over 10 years. This perhaps goes to show that many other factors are likely to contribute to stroke risk in any individual. Nevertheless, even these small differences from a healthy diet could make a difference at the population level.

With dairy and egg consumption it’s worth using some caution with the results. The links with dairy were fairly weak and close to the 1.00 threshold of statistical significance.

We also do not know anything about the type of dairy eaten. For example, whether it was low-fat or full-fat varieties. Suggesting, for example, that eating as much cheese as you want will reduce your stroke risk would not be sensible, considering that cheese is often high in saturated fat.

Also, we should not conclude with certainty at this stage that eggs are definitely bad for you because of small links with the rarer type of haemorrhagic stroke.

Interestingly the study found no link with red meat or processed meat and stroke. But again, caution needs to be taken before concluding that a high intake of red or processed meat is now “safe”. The study has only looked at stroke, not at other cardiovascular outcomes such as heart disease, or cancers.

It’s also worth remembering that food frequency questionnaires that ask people to average their diet over the course of a year can never be entirely accurate, particularly when estimating quantities.

Analysis by Bazian
Edited by NHS Website

Posted on Cardiovascular disease, Rheumatoid arthritis

Rheumatoid arthritis patients at increased risk of surprise heart attack

Image result for nhs heart attack

 

Patients with rheumatoid arthritis are at increased risk of a surprise heart attack, according to new research presented today at ICNC 12 by Dr Adriana Puente, a cardiologist in the National Medical Centre “20 de Noviembre” ISSSTE in Mexico City, Mexico. Risk was increased even when patients had no symptoms and was independent of traditional cardiovascular risk factors such as smoking and diabetes.

Dr Puente said: “Our study suggests that one quarter of patients with rheumatoid arthritis and no symptoms of heart disease could have a heart attack without prior warning.”

ICNC is organised by the Nuclear Cardiology and Cardiac CT section of the European Association of Cardiovascular Imaging (EACVI), a registered branch of the European Society of Cardiology (ESC), the American Society of Nuclear Cardiology (ASNC), and the European Association of Nuclear Medicine (EANM). ICNC 12 is held 3 to 5 May 2015 in Madrid, Spain.

Dr Puente said: “Rheumatoid arthritis affects 1.6% of the general population and is the first cause of consultation in the rheumatology service. The condition nearly doubles the risk of a heart attack but most patients never knew they had heart disease and were never alerted about their cardiovascular risk.”

The study investigated the presence of ischaemia and infarction secondary to atherosclerotic disease (coronary artery disease) in 91 patients with rheumatoid arthritis and traditional cardiovascular risk factors but no symptoms of heart disease. Inflammatory markers, rheumatoid arthritis disease activity and risk factors were measured in all patients. Existence of ischaemia and infarction were assessed using the nuclear cardiology method Gated Single Photon Emission Computed Tomography (SPECT).

The researchers found that 55% of patients had dyslipidemia (high blood lipids), 32% had hypertension, 14% were smokers and 10% had type 2 diabetes. Nearly one quarter (24%) of patients had abnormal Gated SPECT, indicating ischaemia or infarction. There was no significant correlation between the presence of ischaemia or infarction and rheumatoid arthritis disease activity, inflammatory markers or cardiovascular risk factors.

Dr Puente said: “Our study shows that one quarter of patients with rheumatoid arthritis and no symptoms of heart disease do have coronary heart disease, as evidenced by the presence of myocardial ischaemia or infarction in the Gated SPECT study. This means they are at increased risk of cardiovascular death.”

She added: “The ischaemia and infarction may be explained by the persistence of the systemic inflammation in rheumatoid arthritis which may cause an accelerated atherosclerosis process.1 Our finding of no association between the Gated SPECT results and inflammatory markers could be because all the patients were taking pharmacological treatment.”

Patients in the study were 90% women and 59 years old on average and had a similar frequency of cardiovascular risk factors as the general population. Dr Puente found that the presence of ischaemia or infarction was independent of cardiovascular risk factors.

She said: “The results highlight the importance of conducting diagnostic tests in patients with rheumatoid arthritis to see if they have cardiovascular disease, specifically atherosclerotic coronary artery disease (ischaemia or myocardial infarction) even if they have no symptoms and regardless of whether they have cardiovascular risk factors. This is essential to prevent and reduce cardiovascular mortality.”

Dr Puente concluded: “Patients with rheumatoid arthritis should be told that they have an elevated predisposition to heart disease and need pharmacological treatment to diminish the inflammatory process and atherosclerotic complications. They also need advice on how best to control their rheumatoid arthritis and decrease their cardiovascular risk factors. Patients who take corticosteroids and methotrexate for their rheumatoid arthritis are susceptible to elevated plasma lipid levels and develop hyperhomocysteinemia, respectively, which are both cardiovascular risk factors and require preventative treatment.”

Posted on Cardiovascular disease

More than one million stroke survivors live in fear of having another stroke

Image result for Stroke Association Rebuilding Lives TV Advert

More than one million(i) stroke survivors (89%) live in fear of having another stroke and are scared to go out alone (79%), leaving them afraid for their recovery (79%) in the aftermath of their stroke, according to a leading national charity. The Stroke Association’s startling new findings(ii) show how people’s recoveries are under threat from fear itself.

The charity’s latest research (of over 1,000 stroke survivors) also reveals the hidden barriers that people can face after stroke, often too scared to talk to anyone about: 

  • One in five (20%) stroke survivors said they kept their fears to themselves and didn’t talk to anyone
  • Over a third (37%) of these stroke survivors said they didn’t want to worry anyone; they were too afraid (27%) or didn’t want to sound stupid (26%) by talking about their fears.

On top of dealing with these fears and concerns, the study also shows that many stroke survivors are facing their recovery alone. This leads to a bleak attitude to recovery with almost nine in ten (88%) survivors afraid they won’t get better and four out of five (80%) fearing they would get sent to a care home when they first had their stroke. Fear prevents people from getting out and about and meeting others, two of the key factors that stroke survivors have said are integral to their recovery.

Juliet Bouverie, Chief Executive of the Stroke Association, said: “These stats are truly shocking. I am heart-broken to hear that stroke survivors felt they couldn’t speak to those closest to them about their biggest worries and fears. When you live in isolation, too afraid to leave the house and are unable to ask for help, your motivation can disappear, and can leave you in a very bad place emotionally – feeling like a prisoner in your own home.

“It takes a team to rebuild lives after stroke. When stroke strikes, part of your brain shuts down, and so does a part of you. Recovery is tough, but with the right specialist support, the brain can adapt after stroke. I’ve heard countless stories, and know countless people who, after many years continue to make remarkable recoveries. The first step to eliminating fear is to ask for help and support. If you are a stroke survivor, this could mean speaking to your doctor or social worker to get some answers. If you know a stroke survivor, reach out, ask them how they’re feeling. No one should have to live their life in constant fear.”

The Stroke Association’s research also found that:

  • Only 18% of stroke survivors were confident that they would get enough support to make a good recovery
  • 87% of stroke survivors said they feared losing their independence
  • 81% of stroke survivors said they were afraid they wouldn’t be able to look after their children or parents.

Juliet continues: “I was horrified to find out that there are still many people who feel helpless. People are missing out on the life they could have – this must change. Don’t be afraid to ask questions about your health. We want everyone to know that you can rebuild your life after stroke. Every stroke is different and so is every recovery. It can take years to adjust to a new normal.

“The Stroke Association’s Helpline is for everyone affected by stroke. There are no stupid questions. If you are worried about anything, call 0303 3033 100 and get support from one of our trained helpline staff.”

For more information about Rebuilding Lives or about stroke, visitwww.stroke.org.uk/rebuildinglives.

Posted on Cardiovascular disease, Exercise

Varidesk Pro Plus 36 – a 5 star solution to improving health and productivity in the workplace.

Height-Adjustable Standing Desk - VARIDESK Pro Plus 36 - Black

In January of last year my wife had had enough of me wandering through the house complaining of my muscles aching. (Indeed they made a very unsatisfying crack when I entered the bath).  Her solution was to send me to a flexibility class at our local wellness centre.

I underwent six weeks of hell under the tuition of a Norwegian hippie who had spent the last thirty years either in the gym, doing yoga or eating in a sensible fashion.  She was fine but I was a mess as she worked out my knotted muscles.  And there was one bit of advice that she gave me. “Get a standing desk”.

So I did.  It took about two months to get used to; but once I was up and running I was happy to do standing all that I used  to do sitting.  According to the boffins we burn 50 calories per hour when standing at your desk.  Not just that it can help lower the risk of cardio-vascular disease.  So standing at your desk for at least part of the day has to be part of everyone’s wellness programme.  (Well those of us who work at desks as opposed to people cycling the Tour de France for a living).

Over the last 18 months I have found using a standing desk has been very beneficial.  It has improved my flexibility and a lot of the aches and pains have disappeared.  In fact I have started to bore people at parties about the virtues of standing desks.

So a couple of weeks ago I was asked to review the Varidesk Pro Plus 36.  As the name suggests this is a desk (or rather an add-on to your current desk) which can be made into either a sitting or a standing desk.  As you can see from the photograph when fully extended it can add around 50cm to the height of your workspace.  Given its multilayers you end up (or at least I do) with about 50% more overall desk space.  Moving from sitting to standing takes moving two levers and a couple of seconds of your time.

When the package arrived I was slightly concerned as to how I was going to assemble it.  I’ll ‘fess up that my wife has told me that I’m fairly cack-handed when it goes to assembling furniture.  So you can imagine the wreaths of smiles on my face when I realise that it had been pre-assembled and took no more than 30 seconds to set up on my desk.  Very stable it can fit two monitors and a laptop with easy so you won’t have to worry that it won’t fit all your gadgets.

In fact it gives you the feel that you are captaining your own star ship – which for me makes it cheap at twice the price if you are a nerd like me.  It also makes taking a break easier which is good for your eyesight and fatigue levels.

Are these any down sides?  Well it is so easy to use that I’ve worked suiting down for a few hours this week but again you can move it up so fast and because it is so stable at no risk to your kit.  So there is always the temptation to make the Varidesk do what it says on the tin – that is be of variable height.  But this does mean it is great for people getting into using standing desk for the first time. 

That being said you will also need to purchase a standing mat which (see photo of below) this makes it much easier on the joints standing for a whole day at your desk.

VARIDESK TheMat 36™ Overhead

I have to say that when I first saw the price of £345 I considered it a bit excessive but after using it for 10m days I can honestly say that this will replay the cost both in improved productivity in the short term and improved health in the longer run.

If you are thinking about getting one (and I do think you should) then drop into to the Varidesk website here.  You won’t be disappointed.