USE OF ASPIRIN

Most, if not all of us, will be taking an Aspirin tablet every day and it might be of interest to know the scientific background to this.

There have been over 195 clinical trials on the use of Aspirin in the prevention of coronary-vascular events, (heart attacks and strokes to most of us), and a systematic review of these was carried out recently. This review gives conclusive evidence for the benefit of antiplatelet drugs, either Aspirin or Clopidrogel, for patients who have suffered a heart attack or stroke. Overall serious cardiovascular events occurred in 10.7% of patients on antiplatelet drugs, primarily aspirin, compared with 13.2% in the control group which means that three patients out of every hundred were saved from a serious cardiovascular event by taking the drugs. The report emphasised that the drug should be used indefinitely in all these patients.

The review did comment on the risk of potential side effects, the most frequent of which is gastric bleeding. However, the absolute benefits of taking Aspirin far outweigh the risk of any hazards, particularly when the dose used is 75mg. There are a few patients for whom Aspirin is contra-indicated and for these Clopidrogel is taken. However, it is felt that the number of patients who are generally intolerant of Aspirin is small and there is no evidence that Clopidrogel is any better than Aspirin in preventing further CV events. More surprisingly, the report concluded there was no evidence that using enteric coated or buffered formulations of Aspirin provide less risk than the standard dose of 75mg in dispersible form.

The report concluded that there was no reason to take both Aspirin and Clopidrogel together, except on a short-term basis, before and after angioplasty.

So once again the conclusion is 'keep on taking the tablets'!

LACK OF HEART NEWS

For those of you who are missing the regular copy of Heart News which very sadly died when the BHF withdrew its subsidy, it may be of interest that the British Cardiac Patients Association have a regular Journal which you will find interesting. The BCPA can be joined for a modest sum and you then receive the Journal bimonthly. The BCPA can be contacted on 01954 202022.

DANCING

Dancing has suddenly become the thing to do. I might be accused therefore of simply jumping on the bandwagon of the latest craze but it hasn't exactly been like that.

Those of you who have spied me at the annual THROB dance may well have realised that I've always enjoyed dancing, or perhaps it would be better described as 'bopping'. That's what my generation did. We missed the boat on partner dancing and ballroom dancing in particular was considered to be very much an outdated and stuffy way to enjoy yourself. We just kind of leapt about a bit to the music we enjoyed. In the last few years I have 'dabbled' a little with partner dancing, having taken some ballroom lessons for a couple of years and tried my hand at salsa but for a number of reasons outside my control I was not able to pursue these activities long-term even though they were very enjoyable.

This year though has been different. It has been 'the year of the dance' and from the humble beginnings of one class a week I am now officially an addict and go dancing 3-4 times a week. After three months I cancelled my membership at the gym (I was sweating more, moving more, and losing more weight than I ever did in the gym) and used dancing as my aerobic workout. What's more I no longer suffer from motivation problems, just the opposite, I count the hours till I can be out on that dance floor again. It is, for me, pure joy and I can honestly say I have never experienced a hobby like it – I grin from ear to ear constantly.

So what is my particular dance genre? For me it is Ceroc. For those who may never have heard of Ceroc it is 'modern French jive' and is a cross between salsa and jive. It can be very fast and energetic but the beauty is that it can be danced to almost any music with a regular beat ( unlike salsa), so you get to slow down a bit too. My absolute favourite is Ceroc with a Latin influence but there are 'swing', 'jazz' and 'tango' versions too (I won't mention the 'dirty dancing' version, this is after all a family newsletter!!) I even get to do some dips and drops- that's when your partner flings you about a bit to make it look fancy.

How addicted am I? Well addicted enough to go on a Ceroc holiday which I'm considering at the moment- and certainly addicted enough to go on a Ceroc dancing weekend in September.

So how about you dancers out there? Ceroc may not be quite your thing but I bet you haven't forgotten your jiving, rock'n'roll or ballroom days. There have never been so many classes available in so many places since the success of TV's Strictly Come Dancing and it's a wonderful way to keep fit. So what's stopping you? Its also a social activity and I can vouch for that- I've found a whole new bunch of friends and my social life has not been so good since I was at college. In fact my daughter, now heavily pregnant, when learning of my activities was heard to remark " going out with men? Out dancing every night? Ignoring work and study? Sounds like University to me!!"

Too true. She's only jealous.

Lesley Richards

FROM OUR EAST END CORRESPONDENT

Wotcher,

My old china, Fred, 'as 'ad a spot of bovver. He was walkin' down the frog an' toad last Thursday - that day it was a bit Rawlpindi, when 'is titfer blew clean orf 'is loaf. 'E belts an' braces after it and dahn he goes. Never was nimble on 'is plates. Some geezer calls the ambulance and it's into the Royal Free.

Anyway, it turns out 'e 'as a problem wiv 'is strawberry. I only twigged 'cos 'is trouble an' strife and my skin an' blister go for a tiddley wink together sometimes and she gives 'er the lowdown on the dog an' bone when fixin' up the next meet. I thought I'd better give 'im a quick butchers an 'ave a bit of a rabbit so I puts on my whistle an' orf I go at visitin' time. I must say 'e looked a bit cream crackered. Mind you once 'e'd taken 'is hampsteads out of the glass and put 'em in he looked a bit better. He wasn't feeling too pleased because'is old duch 'ad half inched all 'is bread an'honey an' 'ad it away on 'er toes to George an' Ringo, leavin' 'im on 'is tod. Proper boracic 'e was. Not 'avin brought 'im so much as a Gertie Gitana, I slipped 'im a Lady Godiva. That cheered 'im up.

"Well," I 'ollers, ('im bein'a bit Mutt an' Jeff), you look in a bit of a two an' eight, been Uncle

Dick?" "Oh! no," 'e sez, "I just 'ave to sit 'ere on my Uncle Ned, all wired up to this, 'ere box of tricks. I'm dyin' for a puff an' drag but they say I mustn't - might as well be brown bread". Along comes this nurse (very easy on the mince pies), with a cup of Rosie for 'im - I didn't score mind! "Tea!" 'e sez. "Cheer up", I sez, "you'll soon be out of 'ere, down the Blind Beggar an' back on the River Ouse".

Come out the followin' Friday, didn't 'e, right as rain. 'Ad to kip downstairs at first mind. They wouldn't let 'im up the apples an' pears on account of 'is dodgy strawberry, would they?

See yer,

EEC

(If anyone has trouble with the above article, translations are available from the editor -just bung him a Lady Godiva, or at least a couple of sovs.)

BALANCE

Maintaining a good sense of balance and co-ordination is vital to us all but may be of particular importance when you have a heart condition or are rehabilitating after an operation. Balance, co-ordination and agility are important components of physical fitness. They can improve mobility, walking speed and muscle flexibility. One way of keeping fit is partly through light strength exercise, usually included in circuit training. Another way is through rhythmic activities involving changes of direction and repeated patterns of movement.

Such exercise is also particularly useful in the prevention of falls. Falls represent the most frequent and serious type of accident in the over-65s age group, with the home being the most common place for falls. There is now a government initiative on falls prevention as part of the National Service Framework for Health. Heart disease, along with lack of mobility and weak muscles through lack of exercise, is among the list of risk factors for falls.

There are a number of useful activities, which, combined with your rehabilitation programme,

could he useful in preventing falls and could also be a source of fun and social development. In addition, the pulse will be raised, the circulation will be enhanced and the heart muscles will benefit.

T'ai Chi has proven particularly beneficial in falls prevention because it combines the maintenance of muscle strength with balance and co-ordination. This is mainly because the focus is on a lower centre of gravity in the body which is situated below the waist. This area is the source of stability whilst co- ordinating arm motions. The movements are slow, soft and circular, a bit like swimming in water. They provide conditioning for the legs and increase flexibility without causing a strain on the joints.

In addition to T'ai Chi, many leisure and community centres run safe, gentle exercise sessions which

include music and rhythm, such as the S.M.I.L.E. sessions run in our area. These classes are fun and non-competitive. If you have problems with co-ordination at first, don't worry. Making mistakes is part of the course and a great way to meet new friends! It's never too late to start, and the sooner you do start, the sooner you will feel and enjoy the health and social benefits. Begin gently and build up gradually.

(Based on information from the British Heart Foundation. Ed.)

HOLD VERY TIGHT PLEASE !

As some of you may already be aware from reading previous issues of THROBNews, I am in the final stages of completing my Master's degree in cardiac rehabilitation. At present this involves conducting a study and writing a 16,000-word dissertation on a topic of my choice. I have chosen to conduct a study on physical activity patterns in phase IV cardiac rehabilitation members in and around the east of Berkshire. The methods I have chosen to conduct this study is to review the responses of a validated questionnaire that is to be filled out by class members who wish to take part in the study. At present I have had great support from lots of class members and I have had around 70 responses so far, and I have only scratched the surface of the phase IV provision in our area. I plan to attend the majority of the phase IV classes in the hope to recruit more subjects over the coming months.

As part of my dissertation I have to write a literature review on many studies similar in nature to the study I am conducting. One particular study that I reviewed was of great interest to me, and one which I would like to share with you.

The study investigated the incidence rates of heart attacks in London transport workers in 1949-1951. The study was conducted by Professor Jeremy Morris and his colleagues and was published in the Lancet in 1953. In this study Morris investigated the physical activity patterns of London double decker bus drivers and their conductors. He noted that bus conductors who climbed on average 600 stairs per working day for 11 days a fortnight, 50 weeks a year, often for decades, experienced less than half the incidence of heart attacks compared to their sedentary counterparts who drove the buses. In addition, Morris also noted that more portly conductors that were estimated by uniform size as a crude measure for obesity, still only experienced about half the number of heart attacks than the bus drivers who were more slim and lean. This suggests that the protective effect of physical activity was independent of body fatness.

This research carried out by Morris and his colleagues was the first of its kind, which has lead to further research on the benefits of physical activity and heart health. Morris et al (1953). Coronary heart disease and physical activity of work. The Lancet, 1053-1057, 1111-1120.

Tim Grove

THE TECHNICAL PAGE

NORVIT

In the last issue of the British Cardiac Patients Association Journal there was an interesting article on a recent Clinical Trial in Norway which did not give the expected results. The trial, called NORVIT, was intended to test whether high doses of B Vitamins, including folic acid, could prevent heart attacks.

Homocysteine is a breakdown product of an amino acid and high blood levels have been found in a lot of people with coronary heart disease and it is believed that the higher the level of homocysteine the greater the risk of high blood pressure, hardened arteries and strokes. It could be that the homocysteine levels cause heart disease or alternatively the high levels could be caused by the diseased arteries. It is however known that homocysteine contributes to the production of the fatty deposits in the arteries and so there is a definite possibility that reducing the homocysteine levels could be of benefit to heart patients.

It is known that deficiency of B vitamins raise homocysteine levels and so supplementing these vitamins could reduce the levels of homocysteine. Though Vitamins B6 and B12 are involved the most important chemical is folic acid. So in the NORVIT trial 3749 patients, following heart attacks, were given B vitamins or placebo over 3 years. Patients were randomly divided into four groups and given either: folic acid, vitamin B6, both folic acid and vitamin B6, or a placebo. Unfortunately for the organisers of the trial the placebo group had the lowest risk of heart attacks and strokes, which was not at all what was expected.

There are further trials in progress on this topic and there is a large trial on the use of statins in conjunction with B vitamins whose results are expected later this year. However, it is still a sensible precaution to consider taking folic acid at a level of 0.4mg daily. Alternatively you can eat foods rich in folic acid, but as these are Brussel sprouts, kale and spinach I think I prefer the tablets. These can be obtained from your local chemist for a modest sum.

Roger Mills

WHITHER THE WEATHER ?

I saw this in the Daily Telegraph on the 6th July and thought it too good to miss. So I have lifted it word for word for your delectation and information. Ed.)

The showers and thunderstorms have brought welcome relief from the gruelling heat but have generated their own round of Cassandra-like alerts. Tim Hankey, a medical statistician from the Norfolk and Norwich University Hospital, warned of an increase in strokes and heart attacks and in the numbers attending A&E with acute exacerbations of asthma.

It would be surprising if the weather did not have some effect on people's sense of wellbeing, as its variables of temperature, atmospheric pressure and humidity suggest many mechanisms by which it might influence the workings of the body.

Yesterday's storms were preceded by a sharp fall in barometric pressure that can have several undesirable consequences. Firstly, it almost certainly accounts for that feeling of gloom that lifts so drmatically the moment the storm breaks. Falling pressure allows air trapped in inflamed tissues to expand, which is why those with arthritis find their joints become more painful. It also reduces the pressure forcing oxygen into the lungs and thus its concentration in the blood.This is far too insignificant to have any effect on the healthy but could, for those with narrowing of the arteries to the heart or brain account for heart attacks and strokes.

There is, for the most part, a similarly straightforward explanation for other weather ailments. Thus a sudden fall in temperature constricts blood vessels, putting strain on the heart, while a high concentration of positive ions narrows the airways to cause asthmatic exacerbations. The first ice of December brings a peak in the number of hip fractures, which, conversely, are at their lowest in February, when the frail and old tend to stay indoors.

Nonetheless, the link between the weather and several other more exotic ailments is much more elusive. For example, a change in wind direction can cause the sinuses to become blocked and the prospect of rain result in "flatulence, shallow breathing and an extreme state of agitation"

The only weather that does not seem to have any untoward implications is when it is warm and sunny - but then doctors find their surgeries half empty.

Dr. James Le Fanu