WHAT THE PAPERS SAY

SLIMMER WAISTLINES - can reduce your chances of suffering cardiac heart disease and also diabetes which is very much "on the up" these days.The National Obesity Forum said that thousands of lives each year could be saved by reducing waistlines. They quoted an interesting statistic - for a 15st. 10lb. person the loss of four inches from the waist measurement was equivalent to losing 22lb. of dangerous abdominal fat. That would be like 44 packets of lard! According to guidelines any woman with a waist line above 35in. and any man with a waist above 40in. are at serious risk and doctors should take more notice of this in their patient assessment than the Body Mass Index (weight divided by height squared). Apparently not all health professionals are aware of the importance of the widening waist.

WOMEN BEWARE - since heart disease is a bigger problem than for men and interestingly ten times more common that breast cancer, or so it was reported to the European Society of Cardiology. Prof. Ian Graham from Dublin said that women are less likely to be investigated for heart disease, diagnosed correctly, referred for specialist investigation, offered artery procedures or be offered appropriate drug therapy. After the menopause women are more at risk of developing heart disease than men of the same age and are then more at risk from dying from it. Prof. Peter Weissberg of the British Heart Foundation said that women are less likely to be referred for treatment, less likely to have diagnostic tests and because they are not at this level of care, are not included in trials.

NEW DRUGS - that cut cholesterol and those for high blood pressure could prevent thousands of premature deaths from heart disease and stroke. In addition it has been found that thousands of patients could be saved from developing diabetes by this drug therapy. These are the findings from the Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT). The trial was halted in December last year when early results proved so promising that it was no longer fair to deprive the control group of the new drugs. In Britain the modern drug combination would prevent 100,000 heart events and the procedures needed to treat them. It would mean 40,000 fewer strokes, 35,000 fewer deaths from heart and arterial disease and 90,000 people would be prevented from developing Type 2 diabetes. The National Institute for Clinical Excellence (NICE) will be considering the findings of the study with a view to changing guidelines of the National Service Framework for Cardiac Heart Disease and for Hypertension. An interesting footnote - the co-Chairman of the Steering Committee for the study, Prof. Sever of Imperial College, said that "the patients seen in ASCOT were those generally seen in everyday practice. They had high blood pressure but three additional factors, being over 55, MALE or a smoker." The item above entitled WOMEN BEWARE was certainly on the ball!

DRUG PROFILE

ANTI-PLATELET THERAPY

Pharmaceutical Name: Clopidogrel

Sold as: Plavix

Purpose: Anti-platelet drug. Prevents internal clotting. Used post deep vein thrombosis, (DVT) post- MI, post stroke, and after insertion of stent. Works in a different way from aspirin and so can be used for people who cannot tolerate aspirin. Equally clopidogrel is often used in conjunction with aspirin. It can also be used like aspirin as a preventative for heart attack and strokes.

How does it work?: You would have to be a biochemist to understand this but put as basically as possible it inhibits platelet aggregation by stopping adenosine diphosphate (ADP) binding to its receptor in the clotting mechanism pathway. (Well you did ask!!).

Typical dosage: one 75mg tablet daily. Following stroke, DVT, acute MI or coronary artery stenting the length of time that patients should be prescribed clopidogrel is for one year post event. This has recently been confirmed by new NICE guidance as there has been confusion and variability in the length of time the drug should be used.

Side effects: Possible side effects include excessive tiredness, head ache, dizziness, upset stomach, stomach pain, diarrhoea, constipation and nose bleed. Rare but serious side effects are a rash, itching, difficulty breathing or swallowing, swelling of face, throat, tongue, lips, eyes, hands, feet, ankles, or lower legs, black and tarry stools, red blood in stools, bloody vomit, vomiting material that looks like coffee grounds, unusual bleeding or bruising, slow or difficult speech and weakness or numbness of an arm or a leg.

If any serious side effects occur patients should stop taking the drug immediately and inform their doctor urgently. Under normal circumstances all drugs should be taken as prescribed and at the doses and times prescribed.

Lesley Richards

MOUTH BACTERIA

Mouth bacteria may cause arterial inflammation. After diabetes, nicotine and certain genetic factors, Cardiologists have a new enemy: dental plaque. Researchers at Columbia University, New York, have just demonstrated that properly brushing your teeth could reduce the risk of cardio-vascular illnesses and have published their results in the latest edition of the magazine "Circulation". "For the first time it has been shown that the oral flora germs constitute a risk factor associated with a most important thickening of the arterial wall", explains Pierre Marie Girard, Saint-Antoine Hospital's (Paris) head of department for infectious diseases. Blocked up arteries can also be as a result of an inflammatory cause and not only because of the phenomenon of toxic deposits becoming rigid. The American researchers have measured the level of bacteria present in the mouths of more than 600 people with no known history of heart trouble. They have then measured the thickness of their arteries and demonstrated that the patients with the highest levels of certain microbes are also those with the thickest artery walls. Among the germs found were Porphyromonas gingivalis and Treponema denticola. "These are environmental germs," continues Pierre Marie Girard "not originating from a very nasty illness but rather certain gum infections" They nestle between the gums and the teeth, with a preference for roots which have worked loose. With poor brushing of the teeth they multiply. That is the time they become dangerous. " When next the teeth are brushed the germs may enter the blood stream," explains Girard. "Recognising them as strangers, the immune system triggers a local inflammatory reaction, at arterial level, inflating and thickening themselves. In this instance the arterial wall is not inert, it is not a repository of toxic fat, it is the object of an invasive inflammatory condition. Could that, by itself, be the trigger for an acute reaction of the coronary type? The researchers have not yet responded to that question. They have however discovered a new risk factor in the areas of arteriosclerosis and cardiovascular illnesses, independent and unconnected with other possible causes insists Gerard. At the moment cardiologists are only especially watchful for cholesterol, a tobacco habit, diabetes and hypertension in their patients, but do not routinely take account of the dimension of infection as a cause of arteriosclerosis. If their results are confirmed, the Columbia University researchers suggest that the control of gum disorders and antibiotics could reduce the problems of arteriosclerosis.

Julie Lasterade

(From Liberation, 8th Feb 2005. Translated from the french by Roy Arnold (Magnet, Wednesdays) to whom I am very grateful. Ed.)

JOINTS (Part 1)

The majority of people suffer some degree of arthritis as they get older. There are more than 100 rheumatologic diseases but the most common form of arthritis is osteoarthritis (degenerative joint disease), which accounts for 90% - 95% of cases. Lack of mobility due to arthritis is often seen in the joints of the fingers or the weight bearing joints of the hips, knees and spine, but can occur in any synovial joint. It is seen more in joints where injury has caused damage to the articular cartilage (the cartilage that covers bone ends). Carrying too much weight can also lead to joint degeneration.

There is an old saying 'use it or lose it', which applies itself very well to maintaining mobility and a free range of movement, as we get older. Physical activity has a huge range of benefits and we all know that aerobic endurance exercise (pulse raising) benefits the cardio respiratory system. In addition, the types of physical activity recommended for those with arthritis are stretching and strengthening exercises for the muscles that support and cross the joints.

The major aim of the instructor at THROB classes is to improve your aerobic fitness, which will reap such benefits as lowering resting heart rate and blood pressure. During the 15 minute warm-up the instructor will aim to gradually increase your pulse rate and increase the range of motion at the joints that are going to be used in the class; this includes the shoulders, hips, knees, ankles, elbows and spine.

Areas such as the neck and fingers are not usually a major focus but are incidentally mobilised to a smaller degree. Neck flexion, extension, rotation and lateral flexion can sometimes lead to dizziness particularly in those with impaired blood flow in the arteries to the brain – these movements are therefore not always included in a cardiac class. They are preferably performed very slowly and for some people in a seated position.

To maintain range of motion it is recommended that we carry out flexibility exercises on a minimum of 2-3 days per week (but ideally daily) for all major muscle groups. For muscle strengthening exercises the recommendation is one set of 10-15 repetitions on 2-3 non-consecutive days per week.

During a THROB class you will carry out some strengthening exercises if you opt to do the 'active recovery' exercises between the aerobic (pulse raising) stations in the circuit, but those of you who have progressed to good aerobic fitness levels will ideally be performing only aerobic work during the circuit part of the class (usually by doing all aerobic stations and walking briskly instead of the muscular strength and endurance stations) and will therefore need to complete some home exercises for strengthening the major muscle groups or perhaps even join a gym.

In all THROB classes the instructor will include stretches at the end of the class for those muscles, which have been challenged in the class, but again it is important to also do some stretches for major muscle groups on most days of the week Remember that muscles stretch more effectively and safely if the body is warm, when you move into the stretch slowly and the stretch is held for 15 – 30 seconds.

In the next edition the various joints of the body will be discussed – the different types in the body, the movements of which they are capable, and the exercises to keep them mobile.

Joy Martin