The cholesterol argument will not go away it seems. After highlighting the Dr. Malcolm Kendrick article in the Daily Mail in our February issue and the response by our local expert, Dr.Ian Walker in May, we now find the matter being aired in the Daily Telegraph. In this latest piece reference is made to an article in the Lancet which supports the claim by Dr. Kendrick, that for men who did not have heart disease and for all women, there was no evidence that life expectancy would be increased by a single day. So statins won't affect the date on your death certificate but might change the cause of death as you will be less likely to die from cardiac heart disease.The Medical Research Council report that men with heart disease who have been on statins for many years might expect an increase in life expectancy of nine months – Dr. Kendrick estimates about two months. The sting in the tail from Dr. Kendrick is his assertion that the side effects of statins are not well tolerated, especially by the elderly.
Lesley Richards drew my attention to an interesting paper on statins which she discovered on the internet and which is reproduced in this issue. To my mind it is important since it is based on clinical practice and not clinical trials. The latter trials generally seek to separate out all secondary influences on the outcome so one is left with a clear cut result. Clinical practice means that you are lumping all the data together and the only thing the participants in the the assessment have in common, is that they are all taking statins of one make or another - or they are not. This report considers 1.5 million people, over 230,000 people on statins and almost 1.3 million not on statins – "a data mining exercise" in the words of the author. The conclusion of this survey is that you might expect two years increase in your life expectancy if you are a statin user.
So there you have it – to take statins or not to take statins – the choice is yours. .....
David Read
ANTI-INFLAMMATORY DRUGS
There was a recent report on the use of anti-inflammatory drugs causing heart attacks on which I thought a comment in THROB News might be useful. The headline in the Times read 'High-dose Ibuprofen doubles the chance of a coronary' with a second headline 'Household pain killers shown to increase all heart diseases'. When the actual figures are looked at, it is seen that there were three more heart attacks per 1000 people every year in those who were taking either Ibuprofen or Diclofenac than in the control leg. This analysis involved 140,000 people who had not already been diagnosed with heart disease. The Director of the research did say that people should not panic at the findings as the heart attack rate was small and related to patients who took 'about twice what the normal person would take'. Obviously we, who have already been diagnosed with heart disease, do need to be extra careful in the use of these anti-inflammatories.
However, in a separate article Dr Stutterford, while accepting the risks, which for antiinflammatories include indigestion or gastro-intestinal complications, took a view that 'the art of medicine lies in assessing relative risk' and suggested that many millions of people have benefitted from the development of anti-inflammatory drugs and are able to continue with their chosen lifesytle only because of them. The potential side-effects need to be defined, but then patients can decide to take those risks for the benefits in relief of pain or increase in mobility.
For members of THROB who are taking anti-inflammatories on an occasional basis there is no reason to stop doing so. If you need them on a regular basis then it would be sensible to talk with your doctor about the risks, if you have not already done so.
Roger Mills
PISTACHIO NUTS
According to recent research carried out in the United States pistachio nuts in the diet can significantly reduce cholesterol and thus reduce the risk of heart disease. Volunteers who ate three ounces of pistachio nuts per day had an average reduction of their total cholesterol of 8.4% and a reduction of 11.6% in their low density lipoprotein. Then comes the bit I find hard to believe: "the study participants ate an average American diet consisting of 35% total fat and 11% saturated fat for two weeks before the start of the study". Even a glass of water would reduce your cholesterol after that! Still, it's worth a try, pistachio nuts go down very nicely with a gin and tonic........
David Read
TRAVEL INSURANCE
Alan Bousher, one of our THROB members, reports that he has used Travelability for his insurance this year and has found them very satisfactory. He has also been recommended to Holiday Insurance Services (0845 331 6688), who are in the ARP Magazine, and the Holiday Shop (01753 400128), but has not tried either to date. I have also acquired (from where I know not!) a cutting from a magazine entitle "Yours" giving yet another useful sounding company which I have reproduced below. If anyone contacts this lead I would be grateful to hear the outcome.
"Finding travel insurance if you have a medical history can be frustrating. MIA 0nlineLtd has a product that will allow those with an imperfect medical history to travel with a reasonably priced policy, without a high excess. Anyone with controlled angina, blood pressure and arthritis is able to take out an.MIA (Medical Information Anywhere) travel insurance policy. The only people likely to be refused are those who have been advised not to travel.
"With the policy you will be given a free MIA membership which includes a personal ID card with key-ring containing your emergency details. Should you require medical assistance while abroad, the treating facility will be able to contact MIA for your medical conditions and emergency contacts.
"Prices start from £44.50 for 17 days, regardless of the number of illnesses you may suffer from or the amount of medication you take. The policies also have a normal excess of £150 for medical expenses. At the moment MIA can only offer European travel insurance, but is hoping to be able to extend policies to worldwide cover in the future. For more information visit www. miaonline.co.uk or Telephone 01268 782745.
David Read
THE VIRTUES OF REHAB
The British Heart Foundation has recently put out a page on its website (www.bhf.org.uk) extolling the virtues and benefits of rehab and are to launch a National Campaign for Cardiac Rehabilitation. The BHF describe cardiac rehabilitation as an inexpensive treatment that saves lives but 60% of patients who need it do not have access to it. The campaign will call on the government and the local health authorities to keep their promises to fund this vital treatment to anyone who needs it. The BHF claim that cardiac rehabilitation is one of the most effective life-saving treatments available and heart patients who do not avail themselves are 25% more likely to die in the following two to five years. As we THROB members are only too well aware good cardiac rehab provides much more than extra years. The organisers of the campaign are urging people to write to their local MP (explaining how to get the address from the internet!) and provide a sample letter. They also suggest that they write to their local paper about the matter. I shall be interested to see who complains about rehab services in our area which have been available for the past sixteen years and now provide over 20 continuation classes a week in the area.
David Read
GOOD NEWS FOR THROB MEMBERS…..AND OTHERS
A study published recently in the British Medical Journal offers good justification for THROB members to go home and open a bottle as it shows that men who drink alcohol have a lower risk of heart disease than those who do not. The bad news for our female members is that this does not apply to women.
In a report on 50,000 people, evenly split between men and women, it was found that men who drank alcohol at least once a week had a lower risk of heart disease that those who drank less frequently. Happily, also, the study indicated that the risks were similar if they drank daily or weekly. Furthermore the findings suggested that, for men, the quantities drunk were less important, as long as they drank every day. For women it appeared that the amount of alcohol was more important than the freqency of drinking. It was however emphasised that the benefits of alcohol were far exceeded by the harmful effects of heavy drinking. So the end result is don't overdo it but do it regularly. The British Heart Foundation still recommends no more than 14 units per week for women and 21 units per week for men.
Figures from the Office of National Statistics show that heart disease kills one in five men and one in six women every year and is the biggest killer in England and Wales. 20% of male and 16% of female deaths are caused by Heart Disease which is far more than any other single cause, even cancers.
JOINT EXERCISES
We are starting a new regular feature on joint exercises. You will have heard your Editor banging on for ages about the importance of keeping one's mobility in later life and the need to regularly exercise joints in order to achieve this. As we get older the probability of joints becoming arthritic increases dramatically and exercise is a useful adjunct to medication to fend off the stiffness which occurs. I have asked Tim Grove, who provided the technical insights when we ran a series of articles on muscles, to assist in this series also.
Many of the joint exercises suggested can be incorporated into your regular warm-up and cool down at the THROB classes - just sneak them in while the class leader isn't watching! However, one really needs to do these exercises every day to see the benefit and to ensure mobility into old age. A little daily home "muscle and joint" routine might be worked out to good effect so that one is not relying on the THROB classes
alone.
TOES & ANKLES
Starting from the bottom we will consider the toes and ankle joints. The toe joints are hinge and gliding joints and do get exercised to some extent simply by walking. To extend the movement, stand with the feet slightly apart, raise the body up on to the toes by three to four inches and repeat the movement about ten times. This is the same movement as when exercising the calf muscles.
As with the toes, the ankles get exercised in the fore and aft movement when walking or going up stairs but in order to maintain all round flexibility it is necessary to do further exercises. Stand on one leg, with a chair handy for support if needed, and rotate the ankle joint in small circles five to eight times in one diection and then the same in the opposite direction. Change legs and repeat the circling and then go through the whole exercise for a second time. You can do this exercise laying on the floor with the leg straight up into the air and as such is a good exercise to do before you get up after relaxation at THROB classes.
Tim Grove & David Read
USE OF ASPIRIN
The Daily Telegraph carried an interesting piece a few weeks ago which urged everyone over the age of fifty to take a mini-aspirin a day to reduce the risk of heat disease and strokes. While heart attacks and strokes could be reduced by about a third, a low dose aspirin a day may also help to protect against cancer and Alzheimer's Disease. These claims were made at a recent London conference by Prof. Elwood of Cardiff University who pioneered research on aspirin and cardiovascular disease over 30 years ago. A colleague of Prof. Elwood, Dr. Bayer, also from Cardiff University, said that 80% of North American specialists thought that aspirin should be given to patients with dementia and cardiovascular problems while other evidence suggested a protective effect of aspirin against Alzheimer's Disease. Prof. Elwood also said that a study had shown that only just over half the patients who had suffered strokes or heart attacks and who should have been taking aspirin to prevent further attacks were actually doing so.
The subject is contentious as the use of aspirin also raises the risk of bleeding. Stomach bleeding can be a serious problem, possibly needing blood transfusions and in extreme cases can be fatal.
DR