NICE widens guidelines for statin prescribing

Under newly published National Institute for Health and Clinical Excellence (NICE) guidelines on statins, the so-called ‘cholesterol-busting wonder drugs’, are to be offered to those who are at high risk of heart attacks and strokes (such as smokers, the overweight and older people) – in order to prevent a first life-threatening or disabling heart attack or stroke, as well as to prevent a second such life-threatening or disabling event – and to those with high cholesterol levels. This equates to almost 15% of adults (approximately 6 million) in England and Wales who are now eligible for statin therapy.

Currently, statins are prescribed to approximately 1.8 million adults in England and Wales, which is estimated to save roughly 7000 lives a year. Under the new NICE guidelines a further 10 000 deaths could be prevented annually, with about 3.4 million people being prescribed the drugs.

NICE said that making statins more widely available will cost local primary care trusts between £55 million and £82 million annually, although a spokesman for the institute said that taking into account the cost of treating future heart problems means the actual cost will be below £9 million per year.

The chairman of the independent appraisal committee that developed the guidelines, David Barnett, said that he expects 50% of all newly eligible adults to take statins; he also expects this to increase in coming years.

Statins have also been found to be beneficial in preventing sepsis, which can cause multiple organ failure.
The Times, 25 January 2006

FSA advertorial on salt intake in breach of advertising code
A nutritionist has complained to the Advertising Standards Agency (ASA) about an advertorial published in The Sun newspaper by the Food Standards Agency (FSA) which implied that an entire family, who had taken part in a ‘salt challenge’, had lowered their blood pressure by reducing salt intake.

The nutritionist claimed it was highly unlikely that reducing salt was the sole contributor in lowering the family members’ blood pressures. In fact one family member had cut out snack food, and started drinking more water, fruit juice and vegetable drinks. The complainant said that the increase in potassium intake, by eating more fruits and vegetables, could have accounted for the lowering.

The ASA said the advertorial was in breach of the advertising code in relation to social responsibility, substantiation and truthfulness. The ASA said: ‘They [the FSA] agreed that the ad misleadingly implied the whole family lowered their blood pressure as a result of reduced salt intake and that those claims were not supported by the evidence.’

An FSA spokeswoman said: ‘We regret this. However, this does not undermine the key message of the advertorial.’

Professor Graham McGregor, of Consensus Action on Salt and Health, when questioned whether the judgement was necessary, said: ‘The facts are that high blood pressure is the major cause of heart failure, heart attacks and stroke and salt is one of the main factors in high blood pressure. The adjudication does not raise any doubts about this.’
BBC News, 1 February 2006

Unnecessary deaths caused by ignorance of stroke symptoms
Twenty-five thousand of the 67 000 annual deaths from stroke in the UK could be prevented by increasing awareness of its symptoms, say campaigners. A survey of 1000 adults by NOP found that a fifth of pollsters failed to recognise the symptoms of stroke.

Forty per cent of those polled said that upon developing facial, arm and leg weakness and speech problems, they would not call an ambulance. When asked what they would do if a friend or relative developed the above symptoms 33% said they would tell them to lie down and 12% would wait for the symptoms to worsen before calling an ambulance.

This lack of awareness varied between counties, with Yorkshire being the least aware and those in East Anglia the most aware.

Joe Korner of the Stroke Association said: ‘These survey results show that much, much more investment is needed to raise awareness of stroke symptoms. As a charity we simply don’t have the funds to do more than scratch the surface in terms of raising awareness.’

He added: ‘The fact that only 7% correctly identified stroke as a major burden on the NHS highlights the extent to which stroke is overshadowed by other conditions such as heart disease and cancer.’
BBC News, 4 February 2006

Lottery funds a rehabilitation centre for heart attack survivors
Northumberland Care Trust has set up a rural rehabilitation programme for heart attack survivors and those recovering from surgery, thanks to a £110 000 grant from the National Lottery.

Rehabilitation programmes such as those run by the Northumberland Care Trust have been shown to reduce the risk of further heart attacks by 25%.

The project is carried out by a team consisting of a fitness instructor, volunteers and a community nurse.
BBC News, 19 December 2005

Prostaglandin holds promise as future treatment for strokes
A US–Japanese research team is developing a new way to treat stroke and degenerative brain diseases such as Alzheimer’s. They have successfully tested drugs, on mice, that can stimulate the brain to produce antioxidants, which can repair damaged nerve cells.

The team (from the Burnham Institute for Medical Research in La Jolla, California, and four Japanese Universities: Iwate, Osaka City, Iwate Medical and Gifu) say the new drugs, based on prostaglandins that are found throughout the body, stimulate the production of antioxidants, which combat free-radicals associated with disease and can, therefore, slow down the natural decay process of nerve cells.

The team said that stroke and degenerative brain diseases cause a build-up of glutamate (which in the non-diseased state allows effective communication between nerve cells) that over-stimulates nerve cells causing the release of free radicals, which cause degenerative damage.
BBC News, 10 January 2006

Job-related stress increases the risk of developing heart disease
Researchers at University College London have demonstrated that work-related stress can increase the risk of developing heart disease and diabetes.

They also demonstrated that chronically stressed men are twice as likely, and women five times more likely, to develop the metabolic syndrome compared with those who do not suffer from work-related stress, although fewer women were found to experience chronic stress at work.

A ‘job-strain’ questionnaire was used to assess chronic stress: if participants met the pre-defined criteria for job-strain on three out of the four occasions they were assessed, over 1 year, they were classed as suffering from chronic stress.

The 14-year study consisted of more than 10 000 civil servants from across 20 government departments, aged between 35 and 55 years at the start of the study.

Other risk factors that the study authors analysed included diet, alcohol consumption, smoking status and physical activity undertaken routinely.

‘A dose-response association exists between exposure to work stress and the metabolic syndrome,’ the study concluded. ‘Employees with chronic work stress have more than double the odds than those without work stress, after other risk factors are taken into account.’
The Guardian, 20 January 2006
The Times, 20 January 2006 

Misinterpretation of Act hampers important medical research
A report from the Academy of Medical Sciences (AMS) has published a report stating that excessive regulation not required by law is holding up important large-scale medical research into conditions such as heart disease, diabetes and cancer.

The AMS said that studies, involving tens of thousands of people, that are necessary to investigate the causes and treatments of many diseases cannot be carried out because of overzealous interpretation of the Data Protection Act of 1998.

The Data Protection Act restricts access to an individual’s personal information, such as medical records, to others without the individual’s explicit consent. However, the act contains a specific exemption for ‘necessary and proportionate’ medical research.

The AMS panel, which compiled the report under the chairmanship of Professor Robert Souhami of University College London, found that study regulators are ignoring the exemption and denying access to patient records.

Although the AMS is calling for this exemption to be amended in the act, the Government is proposing a ‘patient guarantee’, which will restrict the patient’s medical records to only those who are directly involved in their care, thus, possibly, further hampering the efforts of necessary large-scale trials, said the AMS.

Professor Simon Wessely, of King’s College London and a member of the AMS panel, said that his work on cancer on Gulf War veterans had been affected by such over-interpretations. He said: ‘It is not the law that is the main problem but its interpretation.’

Studies of stroke and diabetes, in Edinburgh and Dundee respectively, are also reported to have been held up by such restrictions.
The Times, 18 January 2006

Increasing fruit and veg intake further reduces risk of stroke
Pooled data (from eight studies across Europe, USA and Japan) from more than 257 500 people shows that eating more than the Department of Health’s recommendation of at least five portions of fruit and vegetables a day helps further lower the risk of stroke.

The study found that people who ate three to five portions of fruit and vegetables a day had an 11% reduced risk of suffering a stroke compared with those who ate fewer than three. Those who ate more than five portions a day had a further reduced risk, by 26%. Based on the study results the Department of Health says that eating more than five portions a day cuts the risk not only of strokes but also of heart disease and cancer.

Fruit and vegetables are full of nutrients such as vitamin C and potassium. Professor Graham MacGregor, Head of Cardiovascular Medicine at St George’s Hospital Medical School, an author of the study said: ‘We know that if you give people additional potassium it lowers blood pressure. By increasing to five [portions] a day from three you would increase your potassium intake by about 50%.’
BBC News, 27 January 2006

CARDIO LITE
A tikka a day keeps the doctor away
A visit to the curry house could be the answer to all of your cardiac problems: the active ingredient of the spice turmeric, curcumin, could protect against heart disease and diabetes, researchers from University College London say.

The researchers say that curcumin works as an antioxidant. It can also help other diseases such as pancreatic and gastric disease.
Daily Mail, 10 January 2006


Heart attack survivors to enjoy thumping beats
A ‘grand survivors’ reunion party is to be held by the Staffordshire Ambulance Service for those it successfully treated for heart attacks. The service claims that its paramedics save more lives compared with other services of a similar size. The soiree will allow survivors to meet their saviours.
BBC News, 10 January 2006