2007 H·E·A·R·T UK
Annual Patient/Members’ Workshop
28 June 2007 • Heriot-Watt University, Edinburgh
The enchanting city of Edinburgh played host to this year’s Patient & Members’ Meeting. We hope in future to be hosting informal regional symposia for patient members and their families, nurses and dietitians, and we’d welcome your suggestions!
Michael Livingston, Director of H·E·A·R·T UK, welcomed our guests and introduced the day’s programme by speaking about the many changes that have taken place in the delivery of our healthcare in recent years. Not least of these changes are the welcomed shift towards a patient/healthcare provider partnership and the recognition of the benefits attained by patients with expert knowledge of their condition.
Cardiovascular disease (CVD) remains the biggest killer in the developed world and thus prevention becomes ever more important. Patients must have a significant voice in the research, prevention and management of CVD and H·E·A·R·T UK fully supports patient and families’ representation across all these areas. Michael briefly described the work of the charity’s Medical, Science & Research Committee and Patients’ Committee. There are opportunities to transmit patient and family views through campaigning and representation to NICE (National Institute of Health & Clinical Excellence) and the Department of Health - on, for example, such issues as reimbursement of prescription costs for patients with familial hypercholesterolaemia (FH).
“It’s quite likely that most GPs are unaware of FH,” said Michael, “so there is much we can jointly do to further raise awareness and increase knowledge of CVD risk, and inherited high cholesterol in particular.”
Investigating a family history of premature heart disease is key to the identification and treatment of those at risk of CVD, and, as you may have read in previous Digests, the Department of Health has funded the London IDEAS Genetic Knowledge Park to carry out the FH Cascade (family) Testing Audit Project. The next few years shows great promise in the field of genetics and the identification of more of the many FH mutations.
H·E·A·R·T UK is setting up a Steering Group to pilot the first of regional Family Support Centres (FSCs) - of which more later! Concluding his welcome address, Michael pledged increased cholesterol awareness campaigning by the charity in Scotland later this year.
Patient advocates
Our first guest speaker, Dawn Davies, recounted her experiences before being diagnosed with FH, the subsequent management of her condition by LDL-apheresis and her patient advocacy work. Dawn is a tireless campaigner for raising awareness of FH and frequently contributes articles and interviews to the media, including, of course, her regular Digest slot! To read Dawn’s inspirational story, please click HERE. Having found comfort, support and advice from our telephone helpline, she decided to join the charity as a Trustee and Patient Committee Member and she is also a patient representative on the NICE FH Guideline Development Group. Some sage words of advice from Dawn on working with the media: “...it’s important you have a good relationship with your health team as you may occasionally be misquoted in the press. Also to be prepared for your story not to be featured if something ‘bigger’ comes along, as you may experience feelings of deflation from time to time.” Media training has helped stand Dawn in good stead in dealing with the press.
We moved on to group discussions on what Family Support Centres could offer, general issues and ways forward. Several ideas were suggested, including the following:
Some great ideas – thanks to all those who contributed! Please send us your suggestions and we will submit them to the FSC Steering Group too.
Our guests chatted to some of our medical and nutritional experts and Trustees over a leisurely lunch before re-convening to learn about ‘Superfoods’ and the ‘Portfolio Diet’ from the charity’s dietitians, Linda Main & Baldeesh Rai.
Superfoods, said Linda, are reported to promote the growth of gut-friendly bacteria, strengthen the immune system, boost digestion and the absorption of nutrients, strengthen bone density, prevent the early stages of cardiovascular disease or cancer, and slow ageing. They may be rich in ‘at risk’ nutrients such as folate, zinc, riboflavin or antioxidants and include the so-called ‘functional foods’ such as the cholesterol-lowering spreads and drinks.
Linda went on to describe the benefits of carotenoid-rich foods such as kale, spinach, peas, broccoli, carrots and sweetcorn. These vegetables contain lutein – a fat-soluble nutrient that has been aptly described as ‘suntan lotion for plants’! Lutein is taken up by the eye to absorb harmful blue light and helps prevent damage to the macula. A regular intake of 6-10mg lutein daily appears to be protective against macular degeneration, a condition that can lead to visual loss.
Cholesterol and triglyceride-lowering nutrients include:
Potassium and calcium are needed for blood pressure control, and a moderate alcohol intake may also be helpful – too much alcohol raises blood pressure, however, so stick to recommended levels. Whilst the relationship between antioxidants and heart health seems very positive, work with antioxidant-containing supplements has not always been positive. So the message is to get yours from foods rather than supplements. Lowering homocysteine through an increased intake of B vitamins may also be cardioprotective but studies are ongoing. Vitamin K is necessary to maintain flexible and healthy arteries, and lutein and natural salicylates (chemicals related to aspirin) appear to have similar benefits.
Linda concluded her presentation by providing some general recommendations. These included eating a diet low in saturated fats, using poultry, fish and soy protein (the latter to replace fatty meat), having a moderate fat intake predominantly from nuts, vegetable oils and pulses, trying to consume three portions of whole-grain cereals each day, including 2-2.5g of plant sterols and stanols from enriched spreads and/or other dairy products and to include 2-3 portions of low fat dairy products (skimmed/semi skimmed milk, low fat cheese, low fat yoghurt or calcium fortified soya alternatives) each day. We should also ‘choose a rainbow’ of fruit and vegetables each day (at least 5 portions) – the best way to ensure a good mix of all the natural and beneficial plant compounds they contain.
Regular readers will have read about the ‘Portfolio Dietary approach’ in the last edition of the Digest. A Portfolio Diet, containing viscous fibre, vegetable protein, plant sterols and almonds, can reduce blood cholesterol levels by 20%, and when combined with a particular type of cardioprotective diet, a further 10% reduction can be achieved, said Baldeesh. Additional benefits include regulation of blood sugar levels and reduction in levels of an inflammatory substance that can damage blood vessels called C-reactive protein.
Research into the Portfolio Diet and familial hyperlipidaemia in adults and children is expected to be published within the next two years, Baldeesh concluded. In the meantime, you can view Linda and Baldeesh’s presentations on: www.heartuk.org.uk
Trish White, Cardiac Rehabilitation Nurse, had us all on our feet for the final presentation – ‘The benefits of exercise’!
Research from fifty years ago demonstrated that bus drivers and postal clerks had a higher incidence of heart attack than bus conductors and postmen, Trish said, and the World Health Organisation reports that regular exercise can reduce the incidence of coronary heart disease (CHD) and diabetes by up to 50%! However, the protective benefit of a lot of exercise in one’s youth doesn’t confer a long-term benefit in middle age unless it’s sustained! Thirty minutes of moderate intensity aerobic exercise daily is the recommended level for cardioprotective benefits. But what constitutes ‘moderate intensity’? Trish provided us with the following useful guide:
Light intensity per 30 min
Ironing: 69 kcals
Cleaning/dusting: 75 kcals
Walking/strolling: 75 kcals
Moderate intensity
Painting & decorating: 90 kcals
Hoovering: 105 kcals
Golf: 129 kcals
Badminton: 135 kcals
Brisk walking: 150 kcals
Mowing lawn: 165 kcals
Cycling (10-12mph) 180 kcals
Vigorous intensity
Aerobic dancing: 195 kcals
Swimming (50 yards per min): 240 kcals
Tennis (singles): 240 kcals
Cycling (12 – 14 mph): 240 kcals
Running (6mph): 300 kcals
Tricia’s top tips... Enjoy it ! ! !
We rounded off a stimulating but sedentary day exercising our grey matter with Trish taking us through an enjoyable and energetic cardiac rehabilitation exercise routine.
Gill Stokes
