Helping patients stay heart-healthy

Dr Ali Khavandi Consultant Interventional Cardiologist Royal United Hospital NHS Foundation Trust Bath

Dr Ali Khavandi

Consultant Interventional Cardiologist

STP lead prevention & promoting health

RUH Bath

Disclosures

• I am an enthusiastic Interventional Cardiologist (heart plumber)

• I am enthusiastic about modern interventional treatments (stents, lasers, coronary drills, implantable defibrillators) . . . and life-saving drugs including Statin

• Unusually for an interventional Cardiologist I am equally passionate about diet and lifestyle

• The Cardiologists perspective

Angioplasty – my ‘bread & butter’ Transformed the treatment of CAD

Primary angioplasty

Pacemakers & defibrillators

Revisions & Re-dos

What are cardiovascular

diseases?

The problem

• Cardiovascular diseases are the leading cause of death & disability globally

• 1 in 3 deaths are due to CV disease in the UK (In Europe 40% of all deaths < 75 years age)

• An increasing number of people now survive heart attacks and stroke, but are left at enormous risk of further events and morbidity

…is BIG

. . . and a growing global issue

37% of Americans currently have

CVD, forecast to grow to 41% in 2030.

The associated cost of medical care is

forecast to spiral from $273bn to

$1094bn

Regional variations

in CVD are primarily

due to dietary

differences

CVD is now responsible

for more deaths in

Africa than TB, HIV and

Malaria combined

31% of deaths in

the UK due to

CVD and 40% of

deaths >75 yrs

“ CV disease has become a true pandemic that respects no

borders” (World Health Organisation)

Data from the NHS

. . . but preventable

80% of cardiovascular disease can be prevented through diet and lifestyle!

We have precognition – risk factors predict disease

We’ve known this for some time

Traditionally we have only targeted the high risk with established pre-

illnesses (and established damage)

JBS3 “lifetime risk”, not

short-term risk of CVD

• Large new groups of “well

individuals” identified as

high risk for developing

heart disease over the

next 20 or 30 years

• They will be told their

solution is

lifestyle & diet change

• There will be the need for

clear guidance &

solutions

“Introducing the concept of chronological age and heart age can make patients aware of their long term risk of heart disease with new software able to illustrate how lifestyle changes can bring heart age back into line with chronological age.” Dr Alan Rees, Former Chairman of Heart UK

Healthy Pre-illness Disease

Health is a spectrum, where prevention is better than treatment

Birth Death

Follow an appropriate diet and lifestyle from the beginning Lengthen the ‘healthy’life phase

Example of pre-illness (high blood pressure or cholesterol ) If diagnosed by GP whilst mild they will advise you to ‘Change your lifestyle’

You fail to address the problem and now have significant high blood pressure – your heart and arteries have already sustained some damage. The GP starts you on tablets which can have side-effects. Stops some people taking them and masks the underlying issues

You have a heart attack The result of years of slow damage from the blood pressure and cholesterol. You are now motivated to improve your lifestyle and diet to reverse the damage.

Point of intervention

Low Risk

Moderate Risk

High Risk

Very High Risk

Small changes make = big prognostic advantages

Risk factors Potential health impact Lifestyle cause Potential benefit of diet/lifestyle changes

Raised Blood Pressure (hypertension)

40% of UK adults • Elevated risk of CVD

66% of hypertension related to excess weight

A small reduction in blood pressure = • 50% reduction in stroke risk • 30% reduced stroke death • 30% reduction in heart attack risk • 20% reduced heart attack death

High Cholesterol

60% of UK adults • Biggest risk factor

(c50% of all heart attacks)

• Increased risk of stroke, angina and other circulatory diseases

Majority of high cholesterol issues are related to diet and lifestyle

A small reduction in cholesterol = • 50% reduction in stroke risk • 30% reduction in heart attack risk • Almost 20% reduced death risk

Clinical evidence shows that early identification of risk factors and

lifestyle changes have a huge impact on health outcomes

An increasing number of our patients

Metabolic syndrome

High cholesterol

Poor blood sugars

control/ diabetes

High Blood pressure

Overweight (particularly around the

belly)

Metabolic syndrome is the fastest growing disease in the world and directly linked to diet. The combination of factors is a potent recipe for cardiovascular disease (100% increase in risk!).

Diet and lifestyle predict risk factors … and risk factors predict disease

Our patients want to do the right thing . . .

…but they’re misguided

…and confused by unsustainable (and often unhealthy) fad diets

1. Fish oils targeting cardiovascular health top the list at £139 million

. . .so they’ve tried what's available

•Billions of pounds spent on low carb, low-fat marketed products

•More money spent on supplements than drugs in the US

•And an explosion in the functional foods industry

…because they think it’s true

Branding - which is the ‘healthiest’?

29.0g Sugar 7.25 teaspoons!

21.2g Sugar 5.3 teaspoons!

...but we’re not winning

. . . and the public now need credible guidance

. . .based on research and evidence

(which is currently exploding but requires expertise to interpret correctly vs. cherry picking)

AF “A MET a day . . . Keeps the

arrhythmias at bay”

• Cardio-FIT trail - patients with AF prescribed a tailored exercise programme

• 76% free of AF without drugs or ablation through synergistic weight loss and improved CV fitness vs 13% (4 years)

• Universal improvements in health – blood pressure and reduction in LA volumes

Modern drugs & intervention Vs. dietary & lifestyle intervention

A change of approach driven directly from within healthcare

• Attractive and engaging solutions that can compete with modern drugs and intervention

• Learn from FMCG and media communication (less ’healthcare’)

• Positive initiatives rather than negative/ restrictive advice

• A change of emphasis/ contemporary approaches

What is the definition of a healthy diet? (“Glossy” wellness vs. health)

The Cardiologists perspective: What is the definition of a healthy diet? What is “Health”? Health = avoidance of [preventable] cardiovascular diseases & premature death Healthy diet = A diet that protects us from cardiovascular risk factors*

*Based on our current modern demographic – metabolic syndrome

& dairy products

Focus on wholefoods

The health properties of wholefoods are relative

Starchy foods and low fat products

THE CARDIOLOGIST IN THE KITCHEN My personal journey . . . From interventional Cardiologist to . . .

Initially just started talking to patients (and staff) – time consuming vs prescribing a tablet

Before After

. . . the blog – use modern (attractive) communication

+ve change: hospital food improvement projects in Bath

. . . use the media – including social media

. . .write for publications that people read (much bigger impact than medical journals)

. . . learn from the mainstream media - they are much better at engaging and communicating with the public than the NHS and public health

. . . engage with local media

. . . but be cautious (diplomatically balance their agenda with yours)

. . . talk to the right people (and learn from the FMCG)

“Can we scale these concepts to provide

patients with engaging solution at the

point of emotional buy-in?”

www.cardiologistskitchen.com

120

75

!

168

100

Andy

• 55 year old male

• Angina and claudication symptoms (new)

• 127Kg (BMI 40+)

• T2DM – HBA1c 88

• Angiogram – atheroma only

88

54

127Kg

116.5Kg

Jason (& Debbie)

• 45 year old male

• Brief loss of consciousness

• New diagnosis of AF in ED (reverted and discharged)

• 119.3Kg (BMI 35) / unfit

• Echo reassuring

• No ischaemia

Debbie

Simon

• Identified CV risk factors at health check

• Hypertensive

• Lipid profile adverse

• Prescribed modifying drugs

“Things are progressing well my end. 80kg

now and on track for my 75g target by end

Aug. This will let me buy an entire new

wardrobe at 32" waist (down from 40

before we started...) ”

Cholesterol 7.6 & intolerant of Statin

TotalChol5.5mmol/l(atherogenicprofil

e)

TotalChol3.2mmol/l(healthyprofile)

3/12

Thank you – look out for next OFM 27th August 2017