ANNUAL GENERAL MEETING
The Chairman welcomed our new President, Stephen Rex, at this year's Annual General Meeting. Stephen is one of the new cardiologists at Wexham Park Hospital. He qualified as a doctor in 1994 and prior to moving to this district he completed his training as a Senior Registrar at both the Royal Brompton and at Harefield.His special interests within cardiology are interventional cardiology (angioplasty and stent insertion) and the implantation of pacemakers and defibrillators (ICDs) in the treatment of heart failure and sudden death syndrome.
Dr. Rex, who lives within the THROB catchment area, is married and has two young children. His interests outside work include golf skiing and travelling. I am sure all THROB members will join with me in welcoming Dr. Rex as our new President and may his association with THROB be a long and happy one.
David Read
ANNUAL THROB LECTURE
The Tenth Annual THROB Lecture was given by Tim Grove, one of our exercise instructors who has recently succeeded in obtaining a Master's degree with financial assistance from THROB. Tim based his lecture on the work he did for his final dissertation which gathered and analysed information on the exercise habits of THROB members. To start, Tim reminded us of what cardiac rehabilitation was all about: "A structured programme of education and activity, guided towards lifestyle modification, increasing functional ability and peer support".
The current exercise guidelines from the Department of Health are for 30 minutes of moderate intensity physical activity performed on five days per week, while the British Association for Cardiac Rehabilitation recommend 20 - 40 minutes of moderate to vigorous physical activity on four or five days of the week. Another interesting recommendation from Germany gives 5 - 6 hours of vigorous intensity physical activity which is sufficient enough to expend between 1500 and 2000 calories per week. Tim's dissertation looked at Phase IV participants to see whether or not they complied with these current exercise guidelins to improve health and fitness.
He gave a brief overview of coronary heart disease and the risk factors which affect it. Since the participants in the study had differing cardiac backgrounds the main coronary interventions were discussed as the volunteers were divided into three groups depending on their cardiac history, as explained later. Tim reviewed the benefits of exercise in lowering risk factors such as lowering of blood pressure, reduction of body weight, lowering of bad low-density cholesterol/ increasing good high density cholesterol, lowering blood sugar levels, and reducing stress and depression. He told the tale of the London Transport bus crews - conductors who ran up and down the stairs countless times a day, had a much lower incidence of coronary heart disease than the drivers whose job was completely sedentary.
In all Tim distributed 153 questionnaires to THROB members at exercise classes (and apologised for not covering all twenty-odd classes), 127 of which were returned. Of these 106 were used in the investigation, 19 coming from female members. The 106 people wer divided into three groups: Group A - people who had only had a heart attack, Group B - people who had only coronary interventions (bypass, angioplasty, stent), and Group C - people who had both a heart attack and coronary interventions. The three groups had 26, 33 and 47 subjects respectively and the median age of all subjects was 70 years ranging from 46 to 86 years. The average time that the subjects had been in Cardiac Rehabilitation was group A - 8years, Group B - 3 years and Group C - 4 years. There was little difference in the amounts of exercise undertaken by each group but there was a suggestion that Group B, those who had only coronary intervention, exercised less than the other two groups. My personal interpretation of this was that those who had had the "plumbing job" were in the clear and didn't have to worry so much as those who had had heart attacks!
Tim's conclusion was that about 70% of his subjects were doing OK or to put it more succintly: the time spent during moderate physical activity and total energy expenditure were below the recommended thresholds needed to modify Coronary Artery Disease risk factorsand reduce mortality in 31% and 28% of cases respectively. Are you one of the back-sliders????
David Read
STATINS
Some of your readers may have been alarmed to read a series of articles in the Daily Mail earlier this year, suggesting that your statin tablets may not be as safe as you had been led to believe, even casting some doubt on the whole "cholesterol" theory of arterial disease. Surprisingly, I am told even the Telegraph reported on the book produced recently by Dr Malcolm Kendrick. I have been asked to write a short note to 'THROB' reassuring your readers that Dr Kendrick's lone voice against the cholesterol hypothesis is just that: a lone voice. 90,056 randomly chosen subjects from across the Globe however are inclined to disagree with him. That is the number of subjects in whom the safety and effectiveness of cholesterol-lowering treatment has been carefully tested in well designed, randomised controlled trials: i.e. neither doctor nor the subject could have predicted the outcome of the trial.
That large pool of solid data, stretching back now for more than twenty years, actually makes the statins one of the most thoroughly tested treatments of all. And the statins continue to amaze us by just how wide the ratio is between the 'good' effects and the undesirable side effects, wider than for most other medicines we now use. There are patients still around now who started their statin treatment in the late 1980's, and there are no signs of any long-term surprises from the treatment. The great volume of research that has been performed on the statins however does make it easier for sceptics to pick and choose odd bits of research which seem to support their own hypothesis. So far, bye-the-way, the research on Parkinsons disease and neurological problems neither supports nor disproves any causal link, the few small studies which have been done producing contradictory results.
One of the great strengths of the "cholesterol" hypothesis I think is that it is "no-one's" theory. The role of cholesterol in the formation of the plaques in our arteries has been built up gradually over decades, accumulating many small pieces of evidence from very many different research groups around the World. The evidence is now absolutely overwhelming – we can even see deposits of pure cholesterol in atheromatous plaques, under the microscope. Even better, the reverse has been shown to be true: that lowering blood cholesterol levels by whatever means really does reduce the number of ischaemic heart problems. The statins just happen to be the easiest, best and safest way of reducing cholesterol (at the present time), but anything which reduces your cholesterol by 40% will produce similar results.
The concentrations of cholesterol in your blood stream is of course not the whole story, we have known for a long time that other factors must be involved, but un-tangling those other factors has generally been more difficult - confounding, i.e. the clustering of factors together often makes this difficult. Except the cigarettes of course, working out that smoking is bad for your heart has not been so difficult!
The final proof as they say? Well, when I reach the stage where my risk of a cardiovascular event reaches 20% or more over ten years, I shall certainly start taking a statin myself! But for now I must go and write an article for the papers suggesting that smoking is actually good for your heart. It will be complete nonsense of course, but I am certain the newspaper editors will like it far better for selling their papers than a series of rather dull, incremental articles slowly revealing the truth; and it will certainly make me famous!
POLLUTION
People who live in heavily polluted cities are substantially more likely to die from heart disease or stroke than those whose homes are in the countryside. Research in America has shown that the higher the concentration of sooty particles in the atmosphere produced by vehicles and factories the greater the chance of dying from cardiovascular disease. The particle are small and cannot be seen with the normal eye, being about a thirtieth of the diameter of a human hair. The new research has suggested that this contribution to cardiovascular disease is a lot greater than previously thought.
In a previous life (before THROB) I was in the nuclear business and this reminds me of similar case involving radioactivity and its relationship to cancer. A map of the US was drawn showing the incidence of cancer per capita in each state and showed that the industrialised states were the main culprits. The states along the line of the Rockies where the granite rocks produce the highest levels of background radioacvity showed the lowest level of cancers. Maybe pollution has a lot to answer for.........
David Read
CLASSES
Monday 8.00am Magnet Centre, Maidenhead
10.00am Crown Wood Community Centre, Bracknell
3.00pm Charters School, S. Ascot
6.30pm Carnation Hall, Winkfield
Tuesday 8.00am Langley Leisure Centre
10.30am Leisure Centre, Windsor
4.45pm Haymill Centre, Burnham
5.00pm Leisure Centre, Windsor
5.30pm Carnation Hall, Winkfield
6.00pm Haymill Centre, Burnham
Wednesday 8.00am Magnet Centre, Maidenhead
12.45pm Leisure Centre, Windsor
4.00pm Wokingham Youth & Community Centre
Thursday 8.00am Langley Leisure Centre
8.00am Magnet Centre, Maidenhead
5.00pm Carnation Hall, Winkfield
6.10pm Carnation Hall, Winkfield
Friday 8.00am Langley Leisure Centre
9.15am Langley Leisure Centre (Aqua-aerobics class)
8.00am Carnation Hall, Winkfield
9.30am Carnation Hall, Winkfield
10.00am Crown Wood Community Centre, Bracknell
11.00am Leisure Centre, Windsor
Saturday 8.00am Carnation Hall, Winkfield