Summer 2017

FIGHTFOR EVERY HEARTBEATbhf.org.uk

FREE

Best of all worldsWhat other countries can teach us about heart health

PULL OUTAND KEEPBARBECUERECIPE CARDS

Strike a balance How to make your special diet heart-healthy

Holidaying with a heart condition Advice from the experts

Paul's plotted a course through his heart problems

HELMBack at the

2 Heart Matters

It’s summer – and for many people it’s a time for travel and holidays.

Our cover star, Paul, has returned to his passion for sailing and an active, adventurous life, despite heart problems that made him fear he’d never lead a normal life (page 38). That’s also true of Caroline, who found that travel helped her put heart problems in the past. Gradually, she saw that her heart attack didn’t mean a permanent end to doing the things she loves. Read her story on page 12.

Even back at home, we can all take inspiration from around the world. Turn to page 16, or play with the interactive tool on our website, to see what other countries can teach us.

A global approach is vital in research, too. Dr Rajiv Chowdhury is studying the effects of arsenic on your heart in Bangladesh and beyond (page 34), while Dr Marc Dweck tells us about his inspirational year in New York and how it continues to contribute to his research in Edinburgh (page 31).

If you’re wondering whether your heart condition will affect holiday plans, turn to page 44.

To keep getting great articles like these, see the enclosed form to renew your membership or switch to online membership, by Friday 18 August.

Whether you’re travelling or staying put, I hope you have a happy summer.

Sarah Brealey, Editor

YOUR BHF4 Your letters6 News

Research links heart disease to air pollution

8 Spotlight on... the smoking ban We look back on 10 years of progress since the smoking ban

10 Behind the headlines Are artificially sweetened drinks bad for you?

49 Dictionary Medical terms explained

50 Information and support A guide to our free resources

MY STORY12 Flying high

A heart attack hasn’t stopped Caroline travelling the world

38 Back at the helm How Paul rediscovered his adventurous life

NUTRITION24 Strike a balance

How to make sure your special diet is heart-healthy

27 Ask the expert Can you eat too much fruit? And fermented foods explained Plus Recipes: healthy barbecue

RESEARCH28 Big ambition

Meet our new Medical Director

31 Transatlantic trials A trip to the Big Apple helped Dr Marc Dweck’s research

34 Bordering on genius We take a cross-continental journey through BHF research

WELLBEING16 Best of all worlds

Top tips to boost your health and wellbeing from countries around the globe

44 Ready for a holiday? Expert tips when you’re travelling with a heart condition

MEDICAL11 Ask the experts

Why DVT is a problem, and dealing with fluid restriction in hot weather

20 Testing times: angiograms Different varieties and what they’re used for

Inside the magazine of the British Heart FoundationSummer 2017

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bhf.org.uk 3

Heart Matters is published by Wardour on behalf of the British Heart Foundation, Greater London House, 180 Hampstead Road, London NW1 7AW.

The British Heart Foundation is a registered charity in England and Wales (225971) and in Scotland (SC039426). ISSN 1745-9753

Views expressed in this magazine are not necessarily those of the British Heart Foundation or Wardour. The BHF does not endorse third-party products and services featured in Heart Matters. Information correct at time of going to press. © BHF 2017. Heart Matters is printed on paper from sustainable forests. G204/0617

23 Vital statistics: blood sugar Why you might need to know your numbers

41 Life lines We look at the support available for people with inherited heart conditions

ACTIVITY46 Top 8 park pastimes

The ultimate outdoor activities to sample this summer

Meet the BHF researchers whose work takes them all over the worldTurn to page 34

Global research

Online exclusivesbhf.org.uk/heartmattersmag

≠ Watch: Discover the work of a BHF researcher aiming to find a new drug to reduce risk of blood clots that cause heart attacks and stroke.

≠ Learn: Do you know the difference between a heart attack and a cardiac arrest? Watch our quick animation to find out.

≠ Recipe videos: Mouth-watering macaroni cheese, pizza and spaghetti bolognese – comfort food that’s good for you.

≠ Play with our fun interactive tool to see what other countries can teach us about our health.

≠ Watch: Around 60,000 people develop deep vein thrombosis (DVT) in the UK each year. Find out what it is and how our research could stop it.

For BHFEditor: Sarah BrealeyFeatures Editor: Lucy TrevallionProduction Editor: Annette WardContent Officer: Sherry-Lee JacksonDigital Content Producer: Sarah HuntingtonPrint: Eclipse Colour Print Ltd

For WardourManaging Editor: Rachael HealyArt Director: Colin WilsonDesigner: Louise HewlettCreative Director: Ben BarrettProduction Director: John FaulknerProduction Manager: Jack MorganAccount Director: Georgina BeachManaging Director: Claire Oldfield Chief Executive: Martin MacConnol

Our expert team

BHF Professor in Cardiovascular Sciences and Cellular PharmacologySteve Watson

(page 11) is a Professor at the University of Birmingham. He trained in pharmacology before working on platelets, cells in the bloodstream that prevent bleeding but cause thrombosis. He took up the BHF Chair in Birmingham in 2004. He researches pathways that lead to activation of platelets. He hopes to use this research to develop medicines to prevent thrombosis.

Recipe writerMoyra Fraseris our resident food writer and comes up with our recipes. She’s

a former food columnist at The Telegraph and author of numerous cookery books.

BHF Associate Medical DirectorDr Mike Knaptontrained at the University of Cambridge. He

has been a GP for 30 years and is a director at Addenbrooke’s Hospital, Cambridge.

Senior Cardiac NurseChristopher Allenhelps manage the BHF’s Genetic Information

Service and also has a specialist interest in congenital heart disease.

Senior Cardiac NurseEmily Reevehas worked in general and cardiology

nursing. She also has experience working in cardiac rehabilitation.

4 Heart Matters

YOUR LETTERSWe love to read your emails, letters and tips, so keep writing: HMeditor@bhf.org.uk or Heart Matters, British Heart Foundation, Greater London House, 180 Hampstead Road, London NW1 7AW

Bell ringing after heart surgeryAre any Heart Matters readers also bell ringers? I would welcome any experience or advice on returning to ringing after heart problems.

In October 2016 I had heart bypass surgery. In January this year, after a collapse, I had a pacemakerD implanted. A week later I had a catheter ablation to treat an irregular heart rhythm. I’m now looking forward to getting back to ringing.Katherine Scholfield, Wakefield

Christopher Allen, BHF Senior Cardiac Nurse, says: “As bell ringing involves the person lifting their arms above their head to pull the bell, it would be appropriate to wait until the sternum is fully healed before returning to it, which is at least 12 weeks after surgery if things have gone well. We would recommend completing a cardiac rehab programme. The staff at the

programme can also advise on whether it’s OK for you to resume the activity.”

If you have any tips for Katherine, write to Heart Matters at the address above, or email hmeditor@bhf.org.uk, and we’ll pass it on to her.

STAR LETTER

Feeling luckyI was walking to a friend’s house when I suffered a cardiac arrestD. What are the chances of an off-duty paramedic driving past at that moment? Straight away, she started giving me CPR and called for the ambulance. To restore my heart to its normal rhythm I was shocked with a defibrillator and taken to Jersey General Hospital. After two days I was flown by air ambulance to John Radcliffe Hospital where I was fitted with an implantable cardioverter defibrillator (ICD)D.

If it was not for this woman, who I call my guardian angel, I would not be writing this story. Her skill and professionalism saved my

life. Jersey is the type of island where you’re always bumping into people and I often see her and give her the biggest hug. My life now could not be better. I have fully recovered and I am so lucky to still be in contact with my guardian angel.Phil McCulloch, Jersey

Heart Matters Editor Sarah Brealey replies: That’s wonderful that a passer-by saved your life. Most people who have an out-of-hospital cardiac arrest don’t survive, which is why the BHF is working hard to create a Nation of Lifesavers – you don’t have to be a paramedic to do CPR. Find out more at bhf.org.uk/cpr or call 0300 330 3300.

FIND USFacebook “f ” Logo CMYK / .eps Facebook “f ” Logo CMYK / .eps

facebook.com/BHF @TheBHF instagram.com/the_bhf

READER’S TIPI am going to love trying your new ways to eat my porridge oats [Spring 2017 issue, page 26, or bhf.org.uk/porridge], as I eat them all year round. I’m currently enjoying it with fresh fruit, a teaspoon of coconut oil, a teaspoon of cinnamon and a good pinch of cayenne pepper. It gives you a nice gentle glow to face a chilly day.Jacqueline Wilkin, Frome

Victoria Taylor, BHF Senior Dietitian, says: “Porridge is a great base for all sorts of flavour combinations. The cayenne and cinnamon are great ideas for adding flavour without needing extra sugar or salt. As coconut oil is high in saturated fat, a spoonful of low-fat Greek yoghurt or a teaspoon of no-added-salt-and-sugar nut butter would be good alternatives to give the porridge some extra creaminess, but with less saturated fat.”

Our cycling range is ideal for your daily commute or a BHF challenge

and has been designed with comfort in mind. Our star letter writer can win a BHF-branded

cycle jersey worth £45. Designs may vary depending on

stock availability

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If you’d like to share your story with Heart Matters, email HMeditor@bhf.org.uk or write to Sarah Brealey, Heart Matters, British Heart Foundation, Greater London House, 180 Hampstead Road, London NW1 7AW.

Share your story

Next issue 50 years of heart transplants, research to better treat heart attacks, heart-healthy teatime treats and tips for dealing with stress.

Time to danceIn response to George Illsley’s letter about folk dancing [Winter 2016-17], I would like to add that it’s never too late to take up such an activity, but it’s also never too early. I began square dancing at the age of 13 and am still involved 45 years later.

These clubs would love to welcome more young adults, and could be especially helpful to those with chronic health problems who are looking for a safe activity in a supportive environment.

I would also like to add that I suffered a strokeD four years ago and returned to my local square dance club five weeks later. Although the exercise was both mentally and physically demanding, I found it to be of immense benefit to my recovery.Zoe Bremer, Nottingham

bhf.org.uk

Guy Heywood was only 29 when he was diagnosed with a heart valve problem. He was told he needed a new heart valve and had to make a big decision. He could choose a tissue valve or a mechanical valve, which would last longer but would require him to be on warfarin for the rest of his life. You shared your support on Facebook.

My son was 22 when he had to make the same decision. He was a football coach so he decided to go with tissue. His story is so similar to yours. He also only has two flaps instead of three. He is three years down the line now and doing fine. Hope you’re well, Guy!Sue Allen

This is exactly the same diagnosis my husband had four years ago at the age of

46, and he also chose the tissue valve. He has been fighting fit ever since, on no medication and we will both be doing the BHF Hadrian’s Wall Hike this year.Debbie Harris

I had to make the exact same decision almost two years ago! I went for the mechanical option. I now work from home and spend much more time with my

family. Every day that I get to see my kids growing up is simply fantastic!Philip Scott

My husband had his aortic valve replaced, but he wasn’t given a choice. He has a mechanical valve and is doing fabulously! Taking warfarin every day for the rest of his life is a small price to pay.Donna Fieldhouse

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Have your say on Heart Matters

Tell us what you enjoyed about this issue of Heart Matters and what could be

improved, so we can meet your needs better. Go to bhf.org.uk/heartsurvey to take our short survey. You can take

it even if you did our Spring 2017 issue survey. If you don’t have internet access, post comments to Editor Sarah Brealey

at the address below.

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≠ Heart surgery riskThis spring, hospitals sent letters to people who had certain types of heart surgery since January 2013, making them aware of a small risk of infection linked to some devices used to keep blood and organs at the right temperature during surgery.

NEWS BITES

Heart Matters

BHF research shows far-reaching effects of air pollution

NEWS

Our research has shown for the first time that tiny particles of air pollution – such as those from vehicle exhausts – can work

their way through the lungs and into your bloodstream. Inhaling these nanoparticles also potentially increases the risk of heart attackD and strokeD.

Researchers from the University of Edinburgh tested what happens when you inhale nanoparticles by using ultra-fine gold particles – these move in the same way, but are harmless and easier to see. Fourteen healthy male volunteers inhaled the particles for two hours, while cycling on an exercise bike. Within

24 hours, the gold had travelled through the lungs, and was visible in the bloodstream. It was still detectable in the blood three months later.

The researchers did further tests, in patients at risk of a stroke, and made another breakthrough. Nanoparticles accumulated inside blood vessels, in the fatty plaques that cause heart attacks and stroke. Dr Nicholas Mills, Professor of Cardiology and a co-author of the research, said: “We have always suspected that nanoparticles in the air that we breathe could escape from the lungs and enter the body, but until now there was no proof.”

Professor Jeremy Pearson, BHF Associate Medical Director, said: “There is no doubt that air pollution is a killer, and this study brings us a step closer to solving the mystery of how air pollution damages our cardiovascular health.

“More research is needed to pin down the mechanism, but these results emphasise that we must do more to stop people dying needlessly from heart disease caused by air pollution. The government must put forward bold measures to make all areas safe and protect the population from harm.”

≠ Learn more about what air pollution does to your body at bhf.org.uk/pollution.

The risk is low – estimated to be one in 5,000 for heart valve surgery patients, and lower for other types of surgery (such as heart bypass or transplant).

The infection can take several years to develop. People who had surgery before January 2013 are not thought to be at risk, and no cases have yet been found in patients who had surgery since January 2015.

If you’ve been told this risk applies to you, remember that the risk is low. The only thing you need to do is tell your GP when you next visit and make sure details of your surgery are in your medical records. Read more at bhf.org.uk/experts.

≠ Active commute helps heartsNew research reveals cycling to work is associated with

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4–9 July Royal Society Summer Science Exhibition, London. Free showcase of cutting-edge science. Look out for our stand and meet some of our researchers, including those from King’s College London, who are making robotic hearts that the public can hold. Visit royalsociety.org or call 0207 451 2500.

16 July Bournemouth Pier to Pier Swim. The UK’s biggest charity swim – brave the English channel in this 1.4-mile open water challenge. Visit bhf.org.uk/P2P or call 0845 130 8663.

22–23 July Glasgow to Edinburgh Trek. Take on one of Scotland’s hardest walks – 60 miles and 30 hours of overnight trekking – to help fight heart disease. Visit bhf.org.uk/G2Etrek or call 0845 130 8663.

30 July RideLondon. Cycle the 2012 Olympic route on 100 miles of traffic-free central London roads and beautiful Surrey countryside. Visit bhf.org.uk/ridelondon17 or call 0844 847 2788.

2 September Eight Peaks Challenge. Join us on this unique peak-chasing challenge! Take on three, five or eight peaks in a single day, with the dramatic backdrop of the Lake District National Park. Visit bhf.org.uk/8peaks or call 0844 847 2788.

2–4 September London to Paris On-Road Bike Ride. An unforgettable finish by the Eiffel Tower awaits on this 200-mile, three-day challenge. Visit bhf.org.uk/L2P, or call 0845 130 8663.

23 September London to Brighton Off-Road Bike Ride. Conquer Europe’s biggest charity mountain bike event. Visit bhf.org.uk/L2Boffroad or call 0845 130 8663.

1 October Blenheim Palace Runs. Runners of all abilities can enjoy this scenic event. Choose from a half marathon, 10K or 2K fun run. Visit bhf.org.uk/Blenheim or call 0845 130 8663.

8 October Royal Parks Foundation Half Marathon. A spectacular half marathon through some of London’s Royal Parks and past famous sites including Buckingham Palace. Visit bhf.org.uk/royalparks or call 0844 477 1181.

Dates for your diary

bhf.org.uk

Embrace your wild side by becoming a Heart Flyer and raise

funds on a tandem skydive. Get ready for 10,000 feet of pure exhilaration, all while raising money for the BHF’s life saving research. There are drop zones all around the UK – simply

register, raise a minimum of £400 in sponsorship, turn up, strap in and fly!

≠ To get your hands on a free Heart Flyers fundraising pack visit bhf.org.uk/heartflyers or call 0300 330 3322.

Get involved locallyBHF Community Fundraising Groups are growing across the UK – would you like to represent us in your local community?

Our network of 260 groups is made up of empowered, dedicated volunteers who raise vital funds and awareness on our behalf. They host exciting fundraising events and reach out to their communities. This could be anything from extravagant balls, golf days or garden parties, to collections and bag packs, and it’s a great way to meet people in your community too. We have groups of all different ages and backgrounds and our

diverse volunteers bring a variety of skills, and valuable local contacts.

Roles are available as Schools and Youth Volunteers, Community Speakers, In Memoriam Secretary, Collection Tin Volunteer, Group Member and Group Leader.

≠ For more information, contact communityvolunteer@bhf.org.uk, telling us your name, address and phone number. We will call to chat through the opportunities with you. If you don’t have access to email, call us on 0300 330 3322.

a 45 per cent lower risk of developing cancer and a 46 per cent lower risk of heart disease, compared with a non-active commute. The study, from the University of Glasgow, analysed data from 264,337 participants, who were asked questions about their usual mode of commuting and then followed up for five years.

≠ More stroke patients in A&EPeople attending A&E in England following a stroke rose by around 30 per cent from 2008 to 2016. This is likely to be due to greater awareness of symptoms. Yet the number of UK people dying from a stroke remains high. We’re funding 31 research projects worth £16.5m into causes of stroke and developing new treatments.

Bored of bake sales?

Raise money for theBHF with a thrilling tandem skydive

Heart Matters

Spotlight on…

NEWS

This month marks 10 years since UK citizens were banned from smoking in enclosed public spaces. Lucy Trevallion looks at how it’s changed our health

BANThe smoking

2007APRIL Smoking ban

enacted in Wales and Northern Ireland. JULY Ban rolled out

in England.AUGUST Government

announces cigarette packets must carry picture

warnings from 2008. OCTOBER Smoking age rises from 16 to 18.

2008FEBRUARY Report

estimates that, without urgent action, global

death toll from tobacco will exceed eight

million a year by 2030.OCTOBER UK becomes

first EU nation to introduce picture

health warnings on all tobacco packaging.

2009FEBRUARY Scotland

unveils a bill (passed a year later) banning

cigarette vending machines and the display of tobacco products in shops,

and introducing tougher measures on shops selling to underage smokers.

2010JULY YouGov poll

for ASH shows that public support for the smoking ban

continues to grow and that support among

smokers has doubled since 2007.

2011OCTOBER Tobacco

vending machines banned in England – those breaching ban

face a £2,500 fine. BHF campaigners worked

hard to achieve this to protect children from easy cigarette access. Bans start coming in

across the UK.

STUBBED OUT 10 YEARS SMOKE-FREE

Hazy pubs and cigarette-scented restaurants are now nothing more than a memory. Ten years ago – on 1 July 2007 – it became illegal to smoke

in any pub, restaurant, nightclub, and most workplaces and work vehicles, anywhere in the UK.

The smoking ban had already been introduced in Scotland (in March 2006), Wales and Northern Ireland (April 2007). Breaching the law is punishable by a fine, and millions were set aside to help enforce it.

Toby Green, Tobacco Policy Lead at the Royal Society for Public Health (RSPH), says the ban was “one of the biggest public health interventions we’ve seen in the last 15 years”.

Before the ban there was a large body of research linking passive smoking to health problems. Studies showed breathing in second-hand smoke increased an adult non-smoker’s risk of lung cancer and heart disease by a quarter, and of strokeD by 30 per cent.

Breathing in other people’s smoke is particularly harmful for children because their lungs are still developing, resulting in a higher risk of respiratory infections, asthma, bacterial meningitis and cot death.

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Effects of the ban“Directly after the legislation, more people were trying to quit smoking, and more people succeeded because it’s much easier to avoid those situations,” says Hazel Cheeseman, Director of Policy at ASH (Action on Smoking and Health).

Research in the British Medical Journal estimated there were 1,200 fewer hospital admissions for heart attacksD in the year following the ban – improved air quality and fewer smokers will have contributed to this.

In 2006, 22 per cent of adults smoked, whereas in the latest statistics (2015) 18 per cent did. This is part of a gradual decline in UK smoking rates since 1974, when the government first began gathering this data.

In UK bars before the ban, air pollution from cigarette smoke was much higher than the ‘unhealthy’ threshold for outdoor air quality (set by the US Environmental Protection Agency), a University of Bath study found. Levels in Scottish and Welsh bars were often twice as high as in English bars. After the ban, air pollution in UK bars reduced by as much as 93 per cent.

“There was concern that if people can’t go to the pub and smoke they might stay home and smoke

around their children, but the opposite has been true,” says Hazel. “We’ve seen a great shift to people smoking outside, so most children in the UK now live in smoke-free homes.”

A Glasgow University study showed that, before the smoking ban, the number of hospital admissions of children with asthma was increasing on average by five per cent each year in Scotland. In the three years after the ban, admissions decreased 18 per cent per year.

In the three months after the ban there was a 6.3 per cent drop in the volume of cigarettes sold in England.

As you can see below, the smoking ban is one of a series of moves to discourage smoking. “The ban is part of a trend towards policies that denormalise smoking,” Toby says. “It helped create a shift in culture.”

The BHF is proud to have campaigned to reduce the use and harm of tobacco, working closely with ASH. We’re active members of the Smokefree Action Coalition, and continue to fund research into the link between air pollution and premature death. Hazel says: “The value of the BHF’s continued support and funding cannot be overestimated.”

2012APRIL UK-wide

public consultation on plain tobacco

packaging is launched by the Westminster

Government.

2013JUNE Report

reveals more than 300 UK newborns die

every year because mothers smoked while

pregnant. OCTOBER UK medical

journals announce they will no longer publish

research funded by the tobacco industry.

2014FEBRUARY European Tobacco Products

Directive passed by the EU. From May 2016 picture warnings must

cover 65 per cent of cigarette packaging;

packs of less than 20 cigarettes no

longer sold; flavoured cigarettes prohibited.

2015MARCH MPs vote to

introduce standardised cigarette packaging.

Hundreds of BHF campaigners had asked

MPs to support this. OCTOBER It is illegal

to smoke in cars with children in England and

Wales (and Scotland from December).

2017JANUARY–MARCH

Northern Ireland consultation on banning

smoking in cars with children present.FEBRUARY Treating

smokers’ illnesses costs £1.1tn ($1.4tn) globally each year,

warns the World Health Organization.

6.3%DROP IN CIGARETTE

SALES IN THREE MONTHS AFTER

THE BAN

1mFEWER ADULT

SMOKERS SINCE THE BAN WAS INTRODUCED

7mTOBACCO-RELATED

DEATHS WORLDWIDE EACH YEAR

“Two-week holiday could be the death of you”News reports have suggested that being less active on a two-week holiday could be deadly.

Researchers asked 28 fit young adults to reduce their daily steps by 80 per cent from 10,000 (the amount the NHS recommends that we aim for) to just 1,500.

On average, their activity reduced from 161 minutes a day of moderate to vigorous activity to 36 minutes a day, and their sitting time increased by an average of 129 minutes.

Our Senior Cardiac Nurse Emily Reeve said: “Sedentary behaviour is recognised as a risk factor for heart and circulatory disease, and we know that breaking up long periods of time spent sitting can help improve your heart health. Don’t let this coverage put you off going on holiday: instead, try to include some fun activities such as walking or swimming, to make the most of your break.”

“Diet drinks TRIPLE risk of stroke and dementia”

The Daily Mail 20 April 2017

The Telegraph 18 May 2017

BEHIND THE HEADLINES

Drinking diet fizzy drinks every day could mean you are up to three times more likely to have a strokeD, researchers suggested.

A study from Boston University found that people who have diet drinks every day were nearly three times more likely to suffer an ischaemic stroke or develop Alzheimer’s disease than those who drank them less than once a week.

Non-diet drinks, sweetened with sugar, were not associated with an increased risk of stroke or dementia, the study, published in Stroke, the journal of the American Heart Association, found.

It is important to stress that the researchers found an association, rather than cause and effect, and don’t know why artificial sweeteners are linked to stroke.

The research looked at nearly 3,000 adults, with an average age of about 60, and asked them to complete a food-frequency questionnaire, which included their soft drink consumption.

One issue with this is that it relied on people accurately remembering and stating how many soft drinks they’d consumed over the previous year. The researchers admit in the report that this could “introduce error”.

These people were then followed up for 10 years, during which there were 97 cases of stroke and 81 cases of dementia. To put

this into perspective, only three per cent of the people in the study had a stroke and five per cent developed dementia.

Tracy Parker, Heart Health Dietitian at the British Heart Foundation, said: “The study is interesting and highlights the need for more research in this area. However, it doesn’t show a causal link between fizzy drinks and developing stroke and dementia. Further research is needed before we draw any definite conclusions.

“Sugar-sweetened drinks are bad for our teeth and the excess calories can make us put on weight, which is a risk factor for heart disease. Although artificially sweetened drinks may be a better choice for those looking to lose weight or control their blood glucose levels, they should be drunk as an occasional treat rather than a daily drink.”

Heart Matters

According to the University of Liverpool press release, after 14 days they had lost muscle and their waistlines were on average 1cm larger. Because putting on weight around your middle is a risk factor for heart problems, the researchers suggested that this two-week reduced step count could be linked to heart problems and diabetesD.

Their fitness levels also declined – they were not able to run as fast or for as long. Two weeks after they resumed their 10,000 daily steps, their lean muscle and waistlines were not the same as before the study.

Newspaper headlines equated two weeks of inactivity to a holiday in the sun. However, none of the study participants were actually on holiday. We don’t know whether people tend to reduce their activity levels this much while on holiday.

The media coverage is based on a presentation at an obesity conference and accompanying press release, not a published research paper. We don’t know what the overall increase in risk from a two-week period of inactivity actually is.

The Sun used the headline “CHILLAX ON HOL IS ‘DEADLY’”. But the study did not look at relaxing – it looked at reducing activity and increasing sedentary behaviour. ‘Deadly’ may also be an overstatement, as no one died as a result of the study.

The 28 people in this study were all young (an average age of 25), healthy and more active than the UK average. It is difficult to apply these results to the wider UK population, or people older than 25.

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Our panel of experts answer your health questions

ASK THE EXPERTS

Staying hydratedQ I have heart failure and

have been told to limit my fluids, but I feel thirsty when it’s hot. What can I do?

Senior Cardiac Nurse Emily Reeve says: We all need to drink more in hot weather and those with heart failure are no exception. Becoming dehydrated can lead to lower blood pressureD, which may cause dizziness, so it’s important to achieve the right balance. Chat to your GP or heart failure nurse, who can support you

and help you manage your fluid intake at such times.

A fluid restriction is used as a way to avoid overloading your heart if you have heart failure, as more fluid in your bloodstream makes it harder for your heart to pump. For the same reason, your doctor may prescribe a medicine known as a diuretic, or water tablet, to help get rid of excess fluid. Your doctor may advise

you to stop taking it in hot weather, when you have no fluid retention or when your blood pressure gets too low.

If you’re on a fluid restriction, record your fluid intake to check

you are within your daily limit. This may need adjusting in warmer weather. You should also record foods that contain a lot of water, like gravy, fruit (especially watermelon), yoghurt, jelly, ice lollies, sorbet and soup.

If you feel thirsty, try chewing gum, a sugar-free

Need more information? Go online to bhf.org.uk/experts for more of your questions answered.

Call the Heart Matters Helpline on 0300 330 3300 for more information. To suggest a question, email HMeditor@bhf.org.uk.

How to get in touch

Deep vein thrombosisQ I recently developed

a pain in my leg which turned out to be deep vein thrombosis (DVT). How worried should I be?

BHF Professor Steve Watson says: A deep vein thrombosis (DVT) is a serious condition that needs to be dealt with promptly. DVT is a blood clot in one of the deep veins in the leg, usually in the calf. It causes pain, swelling and redness and is a medical emergency because if the clot dislodges it can travel to the lung, causing a potentially fatal pulmonary embolism. If you have pain, swelling and tenderness in

your leg and you develop breathlessness and chest pain, seek immediate medical attention.

Around 60,000 people develop DVT in the UK every year. DVT can develop in anyone, but is more likely if you’re sitting or lying down for a long time. People with heart failureD are also at increased risk, because the heart is less effective at pumping

blood. Other risk factors include smoking, being physically inactive, being overweight, and some medications.

DVT is usually treated by anticoagulant

medication (such as heparin or warfarin),

compression stockings, or in a minority of cases, placing a mesh filter in your vein to stop large pieces of the clot travelling to the heart and lungs. Having a DVT means you’re at increased risk of another one, so you should keep taking

anticoagulant medication, until your doctor says otherwise.

The processes that cause DVT are still not understood, and thanks to BHF funding, myself and my colleagues Dr Alexander

Brill and Dr Phillip Nicolson at the University of Birmingham are working to change that. We have been exploring how small cells in the blood (platelets) are activated, how this may lead to DVT and ways to prevent activation without causing bleeding. We have identified a protein on the surface of the platelet, CLEC-2, which is involved in this. We’ve also identified a drug that is already used for another condition, which could be used to block platelet activation.

Thanks to the BHF, we are doing some early tests on humans so we can go on to a clinical trial and help patients.

Around 60,000 people develop DVT in the UK every year”

mint, or pieces of frozen fruit (such as grapes or strawberries). You can also rinse your mouth with water, but don’t swallow it. If your lips feel dry, try lip balm.

It’s also important to restrict salt, which makes your body hold extra fluid. But in warm weather you lose salt in sweat, so if you are having leg cramps, increasing salt intake may help.

Weighing yourself daily is useful too. If you suddenly gain more than 2kg (4lb 6oz) in three days, see your doctor.

MEDICAL

≠ Watch our short animation to find out more at bhf.org.uk/DVT.

12 Heart Matters

MY STORY

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Caroline Tippen has been travelling since the day she was born. Her father was an oil engineer, and after her mother gave birth to her on an oil rig in the Arabian Gulf, they were both airlifted over the Iraqi desert.

“I was flown to a hospital in Baghdad, and I’ve been flying ever since,” she says.

Now 65, she’s been to Canada, Thailand, Cuba, the Greek islands and Norway, to name a few places. For Caroline, exploring and meeting new people have always felt like part of her identity, so it was a double blow when she had a heart attackD, and felt scared to leave her house, let alone the country.

Caroline was sitting at home, watching the snow falling outside, when she had a heart attack, aged 58. “There was nothing classic about my symptoms,” Caroline says. “No pain or indigestion: I just couldn’t get comfortable and my fingers felt clammy. I was hot and cold at the same time. No one was more surprised than me when I was told I was having a heart attack.”

Caroline had an angioplastyD procedure at Harefield Hospital in London, and returned home feeling weak and unwell.

“To say a heart attack is life-changing is an understatement,” she says. “It’s a terrible shock to realise that you’re vulnerable. At that point I thought I’d never do anything with my life. It was all unknown. You think of all the things you did and the person you were and that you might never get that back,” she says.

Adventuring againIt was support from Len, her lifelong love, that helped Caroline recover. They’d met when she and her friend Pauline were Saturday girls in a London jeweller. One day, Pauline’s brother came in. “Apparently, he went home that night and told Pauline he was going to marry me,” says Caroline. “And he did! We fell in love immediately; it was fabulous. He played in a bluegrass band and I sat on the front row in all his gigs. We married at age 18.”

After her heart attack, Caroline thought she would never travel again, and was very nervous, but Len encouraged her. “I didn’t want to be a person who just sat around wondering if they’re going to have another heart attack,” she says. “I wanted to get on with enjoying my life; travel is such a wonderful way of doing that.”

Caroline also travelled with her best friend Janice, who works for an airline. Janice took her to Sri Lanka, three years after her heart attack. Caroline, still regaining her confidence, had to be persuaded to go on a jeep safari. She regretted her decision when the elephants they were watching became aggressive and their jeep broke down – but the story ended

After a heart attack Caroline’s confidence plummeted, but

she wouldn’t let it hold her back from travelling the world, as she

tells Lucy Trevallion

HIGHFlying

Caroline took many memorabletrips with husbandLen (top), and hassince adventuredabroad with herfamily (left)

14

safely. “It was scary at the time, but brilliant too,” she says. “The experience I had made me feel alive. Sometimes it’s worth taking a chance. Life’s full of risks,

including everyday ones.” After she recovered from her heart event,

Caroline returned to her job as a Young People’s Services Manager in local government for six months, but decided

to take early retirement, aged 59.“Having a heart attack makes you rethink

your life,” she says. “I was lucky that I was in a position where I could retire, so I did.”Giving up work gave Caroline and Len the

freedom to travel the world together. Some stand-out moments were travelling down the Mississippi river on a paddle steamer, and visiting Nashville and Memphis, where Len could play bluegrass.

But sadly, Len developed lung cancer, and died in January 2016, after 45 years of marriage. Caroline says: “He had the treatment, and we thought we were on the home straight, but unfortunately it wasn’t to be. It was devastating. I’d been with him my whole life; he was my best mate.”

“The funny thing is, without the heart attack I would still have been working until after Len passed away. Instead, we had some fantastic travels together. Although it’s hard to think anything positive about a heart attack, it changed my life in a way that gave me some wonderful memories.”

Moving forwardCaroline’s passion for travel helped her through her grief. “One strategy to cope with Len’s death is to have things to look forward to on the bad days,” she says.

Janice helped Caroline get back into travelling, and their first trip after Len died was to Borneo, to see the orangutans. At one point, they were deep in the jungle with a tour group. Everyone had been told to wear natural colours, since orangutans are attracted to bright colours, but one woman wore a red dress. She ended up screaming and running through the jungle with an orangutan attached to her. “He was in love with

MY STORY

Caroline has collected mementos from her travels inSri Lanka, Memphis, Norway and more

15

her and trying to grab her bottom,” Caroline says. “We laughed so much.”

She recommends that everyone takes the time they need after a heart attack. “There’s no mad rush to go off and do things,” she says. “But if you

enjoyed travel before, you will like it again.” She also advises to prepare thoroughly before a trip, then forget about your heart condition and enjoy yourself.

“I do understand, having been there myself, what a heart attack can do to your confidence,” says Caroline. “I want to let people know that I felt like that and it doesn’t last. You can get back to enjoying life – there are still so many lovely things to see and experience.”

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The heart attack changed my life in a way that gave me some wonderful memories”

Go online ≠ Watch our short film of Caroline’s story, at bhf.org.uk/caroline.≠ Find out more about heart attack symptoms at bhf.org.uk/heartattack.

1 Do your researchIf you’re going abroad, check the Foreign Office website for travel advice about where you’re going, including health information. Your GP can advise on what vaccinations you need, or look at the website of the National Travel Health Network and Centre at travelhealthpro.org.uk.Look at the expected climate of the country you’re going to, pack the right clothes, and book air-conditioned transport and accommodation.

2 Find subsidised passesOlder people get free bus passes, which can be used across the UK, and there are railcards offering discounts for over-60s,

disabled people, young people, families and couples.

3 Compare pricesGo on a price comparison website to find the cheapest flights and accommodation and find a good deal. If you’re not confident on a computer, most libraries have computers and the staff are usually happy to help. While you’re online, read reviews of the places where you’re thinking about staying.

4 Shop around for insuranceI use comparison websites to get a list of providers and prices, so I can choose the best policy for me. It’s worth checking what is offered for the price. I’ve never had a problem getting cover with my heart history.

5 Be flexible If you’re not too worried about travelling on specific dates, you may be able to pick up a bargain flight.

6 Get in the spiritYou don’t have to go miles. You could go to the next county and explore something different or jump on your local bus and see where it takes you.

≠ Turn to page 44 for tips on holidaying with a heart condition.

Caroline’s travel tips

16 Heart Matters

WORLDS

WELLBEING

What do Cambridge, London, Edinburgh and Southampton have in common? They are all home to global research institutes, academic centres built on the idea that collecting and sharing health

information from around the world can save lives. “Global health is a relatively new idea,” says

Dr Edward Fottrell, Senior Lecturer in Epidemiology (the study of the patterns, causes and effects of disease) and Global Health at University College London.

Previously, global health work was based on the idea that richer countries can help poorer countries develop better healthcare and reduce diseases or risk factors, he says. Now it’s recognised that gathering and sharing knowledge benefits all the countries involved.

“It’s much more about learning from each other and global partnerships,” says Dr Fottrell. “Studying health globally captures the idea that national boundaries aren’t real things – risk factors and habits, as well as disease, transfer across boundaries very quickly.”

Beyond research, we can all take inspiration from other countries to get healthier – even if it’s simply including fresh fruit and vegetable dishes you enjoyed on holiday in your diet when you get home.

We’ve looked at habits of people around the world that positively affect their health to discover new ways to be healthy ourselves.

Best of all

What healthy habits do other countries have, and what can we learn from them? Lucy Trevallion looks across the globe at customs that could help us boost our health

Salt reductionHow do you feel about salty tea? In 2011, Mongolian people were found to be consuming on average 11g of salt a day, 30 per cent of which was from suutei tsai, a traditional tea with added salt. (The UK government recommends no more than 6g of salt a day.) Other major sources were sausages and smoked meats, pickled vegetables and fast food.

In 2011, the Mongolian Ministry of Health started a national salt reduction strategy. The food industry cut salt in bread, and the meat industry and mass catering services followed suit. The government launched TV adverts, posters and a social media campaign encouraging people to look at food labels and choose lower-salt options.

There have been similar moves in the UK. Since 2001 the salt content of packaged bread has been cut by more than 20 per cent. But we still eat too much salt – 8g a day on average. Try to pick green nutrition labels. If there isn’t a colour-coded label, a product is ‘low’ in salt if it contains less than 0.3g (or 0.1g sodium) per 100g.

≠ See how salt affects blood pressure: bhf.org.uk/salty. ≠ Order our free booklet, Cut down on salt, from 0870 600 6566 or bhf.org.uk/HMpublications.

MONGOLIA

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Portion controlJapan is famed for its long life expectancies, which are attributed to the healthy Japanese diet high in vegetables, fish and grains. From 1970–2000, people in the Okinawa region of Japan consistently had the longest life expectancies in the country.

Many Okinawans practise ‘hara hachi bu’, which translates to ‘eight parts out of 10’. This means people stop eating when they are 80 per cent full.

“We could learn from this,” says BHF Senior Dietitian Victoria Taylor. “Next time you have a meal, try putting down your cutlery between mouthfuls and eat slowly so that you recognise when you start feeling full.

“If you fancy a dessert as soon as you finish your main course, why not wait a little while? You might realise that you don’t need it,” she adds.

≠ Find out more about portion sizes at bhf.org.uk/perfect-portions, or order our free booklet Facts not fads from 0870 600 6566 or bhf.org.uk/HMpublications.

Community supportResearch found that feeling part of your community can provide a buffer against physical and mental health problems. There is a strong sense of community in New Zealand, where 99 per cent of people believe they have someone to rely on in times of need.

In the UK, 93 per cent of us believe we know someone we could rely on when we

need them. Meanwhile, OECD research found that a weak social network can result in feelings of isolation. And a study in the Journal of Cardiac Failure found that people who were isolated were almost twice as likely to be readmitted to hospital after a heart attackD, compared with people with high social integration.

≠ Find a Heart Support Group near you at bhf.org.uk/heartsupport or by calling 0300 330 3300. ≠ Find lunch clubs and community centres at bit.ly/gov-support-group. Or check for local book clubs, craft groups or walking groups by searching online or calling your local council.

JAPAN

NEW ZEALANDCooking from scratchA quarter of UK adults eat out at a café or restaurant once a week or more. Chinese residents tend to cook at home and spend longer preparing and cooking food than people from other countries, according to research from the School of Public Health at Peking University. It found that people spent, on average, two to three hours every day preparing meals, although this is changing slightly as technologies such as microwaves have become more popular.

Victoria Taylor, our Senior Dietitian, says: “Most of us tend to eat less healthily when we eat out at pubs, restaurants and cafés. If you are eating out, try to stick to one course, have a side of veg, and be aware of your portion size. For my 10 tips to eat out healthily see bhf.org.uk/eatingout.”

≠ Ready meals are often high in salt and saturated fat, too. If you’re short on time, try our healthy recipes that take less than five minutes to prepare, at bhf.org.uk/quick-healthy-meals.

CHINA

18 Heart Matters

WELLBEING

Road to fitnessEach Sunday and public holiday in Bogotá, Cali, Medellín and other Colombian cities, the main streets are blocked off to cars, so that runners, skaters and cyclists can use them. At the same time, stages are set up in city parks for aerobics instructors, yoga teachers and musicians. The roads are known as ciclovías, a Spanish term meaning ‘cycleway’. Approximately two million people use Bogotá’s weekly ciclovías.

Cycling, running and walking are great low-cost ways to get active and get outdoors. If you want to get active like a Colombian, why not visit your local park or see if there’s an off-road cycle route near you?

≠ Find a BHF bike ride near you at bhf.org.uk/bike-rides or call 0845 130 8663.

COLOMBIA

VolunteeringThe Dalai Lama once said: “Our prime purpose in this life is to help others.” He may have been on to something – people who volunteer are more likely to feel healthier and report a higher life satisfaction than those who don’t, the OECD Better Life Initiative found.

In Canada, nearly half of all adults (44 per cent) do formal volunteering

each year. This is compared with an average of 26 per cent for OECD countries. In the UK, 32 per cent of adults volunteer – slightly more than the OECD average.

As well as helping the community, volunteering brings benefits for the volunteers themselves, as they gain skills and meet people, the report said. For example, people who volunteer were more likely to have higher literacy, numeracy and problem-solving skills and receive higher wages, on average, than non-volunteers.

≠ Volunteer at an event or in a BHF shop. Find out more at bhf.org.uk/volunteer or call 0300 456 8353.

Axing alcoholA small city near Los Angeles could hold the secret to a longer life. Studies have shown that people in Loma Linda, California, live up to 10 years longer than most Americans, and enjoy better health in their later years.

This may be because about half of the 24,000 residents there are Seventh-day Adventists. This evangelical Christian community believes that we should respect our bodies. They eat a plant-based diet, don’t smoke, don’t drink, and go to bed early.

Drinking more than the recommended 14 units of alcohol a week can cause abnormal heart rhythms, high blood pressureD, damage to your heart muscle and other diseases such as strokeD, liver problems and some cancers.

≠ Read more about alcohol and your heart at bhf.org.uk/alcohol.

CALIFORNIA

CANADA

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Find out more≠ Turn to page 28 to read how BHF-funded research around the world is helping us understand more about heart and circulatory disease.

Mediterranean dietYou probably already know that the Mediterranean diet is associated with a longer life – not to mention lower levels of obesity, and reduced risk of diabetesD, raised blood pressure and high cholesterolD. It’s working for residents of Greek island Ikaria, where people regularly reach 100 years old and stay active

into their 90s, and there are low rates of cancer and heart disease.

The University of Athens’ Ikaria Study found that the people of Ikaria are sticking to a traditional Mediterranean diet, including a lot of beans, home-grown or wild vegetables, and not much meat or added sugar.

≠ Even if you can’t grow your own vegetables, you can still practise the Mediterranean diet by eating plenty of fruit and vegetables, fish, nuts and olive oil.≠ Swap your favourite meals for a Mediterranean alternative with our fun interactive tool at bhf.org.uk/makeitmed.

Extra vegIn the UK, we struggle to eat enough fruit and vegetables, with just one in three people getting their 5-a-day. But in Chad, Africa, people eat more fruit, vegetables, nuts and wholegrains than anywhere else in the world. The research, published in the journal Lancet Global Health, assessed the quality of diets in 197 countries.

However, it is not as simple as just having a good diet. The life expectancy in Chad is just 51, showing the vital role of good healthcare and living conditions too.

Researchers found that when a country became more westernised, its diet contained more unhealthy things, such as processed meats, sugar-sweetened drinks and saturated fat.

Victoria Taylor explains: “The ideal would be to combine the benefits of a westernised system, such as good healthcare and living standards, alongside a more traditional diet containing less processed food and more wholegrains, nuts, fruit and vegetables.”

≠ Watch our video for some handy ways to add veg to your diet without even noticing at bhf.org.uk/veg.

CHAD

GREECE

Go online ≠ Discover even more healthy habits on our fun interactive tool at bhf.org.uk/globe.

A lot of people think the purpose of an angiogram is to find if there is any disease in any of the coronary arteries. However, the tests mentioned above will usually have given the consultant a good idea that you probably have narrowing in one or more arteries. In most cases the purpose of the angiogram is to find out where the blockages are and what to do about them.

Heart Matters20

Angiograms explained

TESTING TIMES

MEDICAL

This is a common test for people with possible heart symptoms. Professor Julian Gunn explains the different types of angiogram to Senior Cardiac Nurse Emily Reeve

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Q When would I have an angiogram?

A There are around 250,000 coronary angiograms performed across the UK every year. CT angiograms are less common at the moment, but in the future they will become more common. There are three circumstances where you might have an angiogram:1. Other tests suggest a high

likelihood of narrowings in

CV Professor Julian Gunn

≠ Professor of Interventional Cardiology, Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield

≠ Honorary Consultant Cardiologist at Sheffield Teaching Hospitals NHS Foundation Trust

≠ Supervisor of BHF-funded research to develop new computer-based tool for doctors to assess which coronary heart disease patients need stents

Q Why would I have a coronary angiogram?

A You’d usually have an angiogram because you have signs of coronary heart disease (CHD)D, such as chest pain, and often because other tests, like an electrocardiogram (ECG)D, have suggested you might have CHD.

CHD is caused by the build-up of fatty deposits in the coronary arteries. This reduces the blood flow to the heart and leads to a number of problems, including anginaD or in more serious cases a heart attackD.

Most people are referred by their GP to see a consultant cardiologist. You’d usually have one or two appointments in a cardiology clinic before a coronary angiogram.

Angiograms find out where the blockages are and what to do about them”

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49

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A Ablation A procedure to correct or control certain

types of abnormal heart rhythms. It involves using radiofrequency waves to destroy the abnormal electrical pathways. Angina An uncomfortable feeling, tightness or pain in your chest that may also be felt in your arms, neck, jaw, back or stomach. The symptoms of angina are usually caused by coronary heart disease.Atrial fi brillation (AF) An abnormal heart rhythm in which the atria (the upper chambers of the heart) beat in an irregular pattern. People with AF have an irregular, sometimes fast, pulse.

B Bypass See coronary artery bypass surgery.

CCardiac rehabilitation Also called ‘cardiac rehab’, this

is an education and exercise programme to help you recover from a cardiac event and get back to as full a life as possible.Cardiomyopathy Disease of the heart muscle in which it becomes weakened. It may become thickened, enlarged and/or stiff , depending on the type of cardiomyopathy. It aff ects people of all ages and is usually inherited.Cardiovascular disease (CVD) Includes all diseases of the heart and circulation, such as coronary heart disease and stroke.

Cardioversion Treatment for some abnormal heart rhythms

to help restore a normal heart rhythm. It can be done using medicines (chemical cardioversion), or by giving the heart a controlled electric shock with a defi brillator (electrical cardioversion).Coronary artery bypass surgery An operation to treat coronary heart disease. Arteries from your chest wall and arm, or veins from your leg, are used to bypass the blocked or narrowed coronary arteries, improving blood fl ow to the heart muscle.Coronary heart disease (CHD) When the walls of the coronary arteries (the arteries that supply blood to the heart muscle) become narrowed due to a gradual build-up of plaques, called atheroma.

D Diabetes A condition in which glucose (sugar)

levels in the blood are too high. There are two main types of diabetes: type 1, where your body stops producing insulin, and type 2, where your body can’t use the insulin it produces, usually because excess fat in organs prevents the insulin from working eff ectively. Diabetes increases your risk of developing cardiovascular disease.

E Echocardiogram Sometimes called an ‘echo’. A test to

examine the structures within the heart, for example the heart valves, and to see how well the heart is pumping. It is similar

to the ultrasound scan used during pregnancy.

FFamilial hypercholesterolaemia (FH) A genetic condition that results in very high cholesterol

levels. Having FH gives you a much higher risk of getting CHD.

H Heart attack Known medically as a ‘myocardial infarction’,

or ‘MI’. This describes a sudden loss of blood fl ow to part of the heart muscle. Most heart attacks are caused by atherosclerosis, the build-up of atheroma (plaque) within artery walls. If the atheroma becomes unstable, a piece may break off and lead to a blood clot. This can block a coronary artery, causing a heart attack and irreversible heart muscle damage. It is a medical emergency and can lead to a cardiac arrest.Heart failure Condition where the heart becomes less effi cient at pumping blood around the body. High blood pressure Also called ‘hypertension’. High blood pressure is when the pressure required to pump blood is consistently higher than the recommended level. This puts extra strain on your heart and blood vessels, and over time can increase your risk of having a heart attack or stroke.High cholesterol Cholesterol is a waxy substance that is mainly made in the body and plays a vital role in how every cell works. However, high cholesterol, when

MEDICAL TERMS EXPLAINED

Call the Heart Matters Helpline on 0300 330 3300 if you want to know more

there is too much in the blood, can increase your risk of getting cardiovascular disease which includes having a heart attack or a stroke.

I Implantable cardioverter defi brillator (ICD) A small

device implanted under the skin on your chest, connected to your heart by one or more wires (leads). It monitors your heart rhythm and can deliver a controlled electric shock if you have a life-threatening abnormal heart rhythm.

P Pacemaker A small device implanted under the skin

on the chest, connected to your heart by one or more wires (leads). Monitors the heart’s electric signals and can stimulate your heart to contract and produce a heartbeat if required.

S Stroke An interruption of blood fl ow to part of the

brain, causing brain cells to die or become damaged. This happens if an artery carrying blood to your brain becomes blocked, or if an artery bleeds into your brain. A stroke is a medical emergency.

V Ventricular tachycardia Also called ‘VT’. A very fast,

abnormal heart rhythm that starts in the ventricles (the lower chambers of the heart). This is a medical emergency that, if not treated, can lead to a cardiac arrest.

DICTIONARYMedical words, identified by a small symbolD, are explained in plain English in our dictionary on page 49.

Dictionary

the coronary arteries and you have significant symptoms.

2. You have come into hospital with a ‘mild’ heart attack, you have a resting ECG that shows abnormalities, and a blood (troponin) test indicates some heart damage.

3. If you’re having a major heart attack, you’d be brought directly to the cardiac catheter lab to have an angiogram as part of an urgent angioplastyD procedure. An angiogram and angioplasty can often be performed together if you need urgent treatment. An angioplasty actually widens your artery, using a small

a Polo mint. You will have dye injected through a vein in your arm. You slide into the scanner, which takes a picture by circling very quickly around your body. You need to hold your breath for a couple of seconds and stay very still. It produces a 3D image of the coronary arteries, but the pictures are less detailed than a conventional angiogram. It could be used, for example, if you come into hospital with chest pain but the cause of it isn’t clear – a CT angiogram could rule out CHD. If the CT angiogram showed significant disease, you may then have the conventional angiogram and possibly an angioplasty.

tube up the artery to your heart, then inject contrast dye through the tube. This is a clear liquid that shows up under X-ray. An X-ray picture of your arteries appears on a screen and the X-ray camera is moved around to create a 3D image showing where the narrowings are and how bad they are. The tube is then removed and a plastic cuff is put on the wrist to stop any bleeding.

Q What does a CT coronary angiogram involve?

A This newer, non-invasive procedure involves lying still in a 3D scanner – it’s round and white with a hole, rather like

inflatable balloon – usually a stent is also put in, which acts as a scaffold and holds open the artery.

Q What does a conventional coronary angiogram involve?

A In the majority of cases, it takes 20–30 minutes and you won’t have to stay in hospital overnight. You are awake, comfortable and lying down in the catheter lab – a room that looks similar to an X-ray room. The cardiologist will put local anaesthetic into an area of your wrist (for the radial artery) or, less commonly, your groin (for the femoral artery). They will slide a very narrow plastic

Q Do I need to do anything to prepare?

A For both types of angiogram, you’ll need to have a blood test to check your kidney function – the kidneys need to remove the dye from your body, so it’s important to check they are working well. For a CT angiogram, you may be offered a beta-blockerD to control your heart rate.

You should have an appointment where the procedure is explained in detail and you’ll be asked to give your consent. On the day of the procedure, you don’t have to fast, and you should usually take all your regular medication.

Q Will it hurt? A Neither test should hurt. For

the conventional angiogram you’ll have some local anaesthetic injected in your wrist through a tiny needle, and once it’s numb a small incision will be made, in order to insert the catheter. You may be offered a sedative if you are very nervous, and pain relief if you do experience any discomfort, but most patients don’t need it.

Q Are there any after-effects?A For the CT angiogram,

generally no. And for the conventional angiogram, most people have no problems – fewer than one in 1,000 suffer complications.

The most common minor problem is a small bruise on your wrist (or groin). The bleeding risk is higher if the procedure is performed through the femoral (groin) artery, rather than the radial (wrist) artery, particularly if

you are taking blood-thinning tablets such as warfarin. There is a very small (about one in 3,000) risk of a strokeD or short-term symptoms that mimic a stroke. This is more likely if you are frail.

You will usually be encouraged to drink more water after the procedure to flush out the dye, which is particularly important for those with kidney problems.

Q Should I worry about the risk of radiation?

A For either type of angiogram, the amount of radiation used in modern equipment is about equivalent to a couple of holidays in the sun. You are not under the X-ray camera for long at all.

Q When do I get the results?A For the coronary angiogram

you will get the results straight away. If there is significant narrowing, or if you’ve just had a heart attack, you may have an angioplasty at the same time. If a number of coronary arteries are blocked or narrowed

in places, then you may be referred to a cardiac surgeon for bypass surgery.

Often the results of the test will be discussed at a weekly multi-disciplinary team meeting, where cardiologists and surgeons discuss your case and the best treatment. This removes the risk of individual bias. That decision may come through at your next outpatient visit, or within a few days if you are still in hospital.

For a CT scan, it takes time for the images to be processed, so you will get the results at your follow-up appointment.

Q What are the latest developments in this area?

A When I first started performing angiography in the 1980s, it was done with large tubes inserted through the groin. Bleeding and blood vessel damage were more common; a nurse would need to apply pressure afterwards and you’d be in hospital for a night or two. Now catheters are much smaller, they are usually inserted through the artery in

the wrist, and the X-ray dose is lower. It can be done in an afternoon and it’s much safer.

The image quality is far better now, due to digital technology. The amount of narrowing can be measured precisely. In some centres, blood flow in the narrowed areas can be measured directly using an additional pressure wire test, in which a wire with a small sensor at its tip is used to measure blood flow and blood pressureD in or beyond the narrowed areas.

In Sheffield, we are working on an exciting development, partly funded by the BHF, to build a computer model of blood flow through the narrowed artery without needing the pressure wire test. This is exciting because any patient having an angiogram could have our software applied to their pictures, and the doctor would instantly know whether that narrowing needed treatment or not. This is being used in CT angiography, but it is needed in conventional angiography for better planning. This could be the next revolution in angiography.

Heart Matters22

Enjoyed this article?≠ Watch our short films about angiograms at bhf.org.uk/angiogram.≠ Read about ECG and echocardiograms at bhf.org.uk/testingtimes, or order our free booklet, Tests for heart conditions, on 0870 660 6566.≠ Read about stress tests in our Autumn 2017 issue.

MEDICAL

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MEDICAL

Why does this matter?We all need sugar in our blood to provide cells with energy. The hormone insulin allows sugar (glucose) in your bloodstream to enter your cells, where it can be used for energy. If you don’t have enough insulin, sugar stays in the bloodstream. Over time, high blood sugar levels damage your blood vessels. This can cause other problems, such as coronary heart diseaseD, kidney disease and diabetic eye disease.

It’s important to know whether you have high blood sugar so that this can be controlled, reducing the risk of damage.

A high blood sugar level would mean you either have diabetesD (type 1 or type 2) or have a high risk of developing type 2 diabetes. Although diabetes can have symptoms, such as thirst, urinating a lot, blurred vision, weight loss, recurrent infections and tiredness, you may only get these mildly, or not at all. That’s why it’s important to get tested.

I’ve had a heart attack, should I get my blood sugar checked?If you have heart and circulatory disease, this should be done as part of your routine blood

blood sugar levels?WHY SHOULD I KNOW MY…

VITAL STATISTICS

checks. If you are concerned, talk to your GP.

What about people who don’t have any existing conditions?If you are at risk, your blood sugar will be tested as part of an NHS Health Check in England (for those aged 40–74 with no existing condition). Arrangements vary in the rest of the UK, but again, ask your GP if you are concerned.

Am I at risk of diabetes?Any of the following can mean you’re at risk, especially if more than one of these applies: ≠ being over the age of 40≠ south Asian, Chinese, African-Caribbean or black African background≠ a close relative has diabetes≠ overweight or large waist size ≠ high blood pressureD

≠ pregnancy or previous gestational diabetes ≠ polycystic ovary syndrome, schizophrenia, bipolar illness or depression, or you are taking antipsychotic medication.

Learn more about your diabetes risk using the online tool at riskscore.diabetes.org.uk.

What if I have diabetes?Monitor your blood sugar levels at home using a glucose meter. This involves pricking your finger and applying a drop of blood to a test strip.

Self-monitoring can be a helpful part of diabetes management. Regular blood sugar tests help you see how specific changes, for example around diet and physical activity, affect blood sugar levels. Monitoring can also help your healthcare team adjust your treatment to best prevent any long-term complications. Your doctor should also check HbA1c levels at least yearly to assess long-term blood sugar control.

Our Associate Medical Director Dr Mike Knapton tells Senior Cardiac Nurse Emily Reeve why it can be important to know your numbers

Next issue Why should I know my blood pressure?

More online≠ Find out why it’s important to know your blood cholesterol and your weight and waist size at bhf.org.uk/vitalstatistics.

bhf.org.uk

Your GP can test your blood for a substance called HbA1c (glycated haemoglobin), to diagnose type 2 diabetes, or to monitor long-term blood sugar control if you have diabetes. This is different from the finger-prick blood sugar test.

Measuring HbA1c gives a picture of your average blood sugar levels over the past eight to 12 weeks. If you have diabetes, your HbA1c should be tested every three, six or 12 months. The higher the HbA1c, the greater the risk of developing complications.

The test for gestational diabetes is a bit different and is called an oral glucose tolerance test. Usually you’ll be given a glucose drink and your blood sugar will be tested before and after.

What do the numbers mean?Persistently high blood sugar usually means you have diabetes. If HbA1c is more than 48 mmol/mol or fasting blood glucose is more than 11 mmol/L, your blood sugar is high. For most people without diabetes, normal blood sugar levels are:≠ between 4 and to 6 mmol/L before meals≠ less than 8 mmol/L two hours after eating.

If you have diabetes, it’s key for your blood sugar levels to be as near normal as possible.

How is blood sugar measured?

People with diabetes will be used to the

finger-prick blood test

STRIKING A

24 Heart Matters

Special diets are big business. You only need to look at the ‘free from’ shelves in the supermarket, where there has been an explosion in products in recent years. As well as

people who can’t eat certain foods due to allergies or conditions, avoiding certain foods has become an increasingly popular dietary choice too. In the UK the number of vegans has grown by 360 per cent in 10 years to more than half a million, according to the Vegan Society, while other special diets, such as gluten-free and dairy-free, are even more common.

People choose these diets for reasons of ethics, health or personal preference. Whatever your motive, it’s not something to be taken lightly, so think carefully before you embark on one of these diets. Changing your diet while still looking after your heart health can seem daunting. Look on the positive side by focusing on what you can eat, or could eat more of.

Cutting things out doesn’t mean you have to stick to the ‘free from’ shelves. It does, however, mean you may need to add other foods to your diet to ensure you’re getting the nutrients you need.

Here’s our expert guide to the most common special diets, and what you should include to keep them balanced as well as heart-healthy.

VEGETARIANA healthy vegetarian diet includes plenty of fruit and veg, pulses, beans, wholegrains and unsalted nuts. This is also in line with the heart-healthy Mediterranean diet.

Some vegetarians worry about missing out on protein, but most people in the

UK get more than they need. You might have heard talk about meat being a ‘complete protein’ and the need for vegetarians to eat certain food combinations to get all the amino acids,

but this is a bit of a myth: as long as you have a varied diet, you don’t need to worry.

Milk and dairy foods are a great source of calcium and protein, but don’t rely on

NUTRITION

More people are embracing special diets, but cutting food out means you need to add

25

things in for a balanced and heart-healthy diet. Senior Dietitian Victoria Taylor explains how

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these to replace meat and fish, or you might consume too much saturated fat and not enough iron. Include pulses, eggs, nuts, sprouted beans and seeds as sources of protein in your diet. Green

leafy vegetables, dried fruit and fortified products such as breakfast cereals and bread (choose wholegrain versions) are all sources of iron and good additions to a healthy, balanced diet.

GLUTEN-FREEA gluten-free diet rules out of some starchy carbohydrates, but doesn’t mean you need a low-carbohydrate diet. According to the Eatwell Guide (the government’s recommendations for healthy eating), just over a third of our food should be starchy carbohydrate. A gluten-free diet can include potatoes, brown rice, buckwheat, quinoa, sorghum, gluten-free oats and gluten-free muesli.

Fresh fruit and vegetables, lean meat and fish, pulses, beans and eggs are all healthy gluten-free foods to add to your diet. Cooking from scratch with these ingredients means you can prepare meals which are gluten-free and heart-healthy – low in saturated fat and salt and providing fibre, vitamins and minerals.

Remember, gluten may be present in many pre-prepared products such as soups, sauces, ready meals, cakes, biscuits, crackers and even beer. Check nutritional information on all the foods you consume.

Look for high-fibre and low-salt versions of gluten-free products like breads and pasta. Many gluten-free cakes and biscuits are now available, but remember they are still high in sugar, fat and calories. Choose healthier snacks such as unsalted nuts, dried fruit or low-fat plain yoghurt.

Look on the positive side by focusing on what you could eat more of”

BALANCE

If you remove meat andfish, balance your dietwith pulses, tofu, leafyveg and nuts

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VEGANMany meat-eaters could benefit from eating vegan meals now and then. This could help you cut down on red and processed meats and high-fat dairy products and increase the amount of fruit, vegetables and pulses in your diet.

Nuts, seeds, beans, lentils and wholegrains are all good plant sources of protein to add to a vegan diet.

If this a long-term change, you need to plan carefully to avoid missing out on iron, calcium, vitamin B12 and iodine. Green leafy veg, fortified cereals, pulses and dried fruits will provide iron. Choose non-dairy milk with added calcium.

Vitamin B12 is only found naturally in substantial amounts in foods from animal sources, so vegans should consume three portions a day of fortified foods, such as non-dairy milks and breakfast cereals (choose wholegrain versions without added sugar). Check the label to make sure they have B12 added. B12 is found in nutritional yeast powders. Yeast extracts such as Marmite also contain B12, but because of their salt content should be used sparingly. Otherwise, taking a B12 supplement is recommended.

Iodine is available in some plant foods such as bread, nuts, fruit and vegetables, but the amounts are smaller than in fish, shellfish and dairy products. An iodine supplement may be needed, but talk to your GP first, as too much iodine can cause problems. Seaweed supplements are best avoided as they can provide unreliable, sometimes excessive, amounts of iodine.

LOW-CARBOHYDRATE DIETThere are many versions of low-carbohydrate diets, and they’re often adopted for reasons of weight loss. The most extreme, including the Atkins and Dukan diets, limit starchy carbohydrates like bread, rice, potatoes, pasta and even fruit, pulses and beans. It is true that low-carbohydrate diets have also been linked to benefits such as controlling of blood sugar levels in people with diabetesD. But we still don’t know what long-term effects they have on your body. A low-carbohydrate diet is also hard to stick to and can leave you feeling tired, unable to concentrate, and possibly constipated, as many sources of dietary fibre are excluded. If you want to try it, talk to a dietitian first.

Rather than trying to cut out all carbs, being more aware of the amount you are eating, and choosing healthier types, is a sensible and possibly more sustainable approach. Controlling your portion sizes and choosing wholegrain or high-fibre carbohydrates can help you control your weight and blood sugar levels. Brown rice, wholewheat pasta, bulgur wheat and oats are wholegrains, which are higher in fibre so help you feel fuller for longer.

To manage your portion sizes, use a measuring spoon to serve yourself, or weigh out your portion before cooking.

Another good option is cutting back on free sugars: the type in juices and smoothies, sugar-sweetened drinks, jams, cakes, biscuits, sweets and puddings. These provide energy from the carbohydrate they contain, but little other nutrition.

DAIRY-FREECheese and other dairy products are among our biggest sources of saturated fat. In theory, avoiding this group could have benefits for your heart health. But it’s not straightforward. Dairy products are an important source of calcium, riboflavin (vitamin B2) and iodine, so you need alternatives that will provide these nutrients.

To get enough calcium, add foods such as tinned sardines or tinned salmon (which have bones in – don’t worry, they are soft and edible), green leafy vegetables such as broccoli, okra or cabbage, and tofu and nuts.

Riboflavin (vitamin B2) is found in eggs, fortified breakfast cereals and green veg. Make sure you include white as well as oily fish in your diet to get enough iodine. Some non-dairy milks are fortified with calcium and riboflavin, making them a convenient alternative to dairy products. Dairy alternatives can come with added sugars, so choose unsweetened versions of milks and check the labels of yoghurts and desserts.

Coconut-based products have also become popular dairy-free options, but may be high in saturated fat – products which sound healthy may not be in reality. A food is considered ‘high’ in saturated fat if it has more than 5g per 100g or more than 6g per portion – this would appear ‘red’ if there is a traffic light nutrition label.

NUTRITION

Call the Heart Matters Helpline on 0300 330 3300 for more information. To suggest a question, email HMeditor@bhf.org.uk.

How to get in touch

Our Senior Dietitian Victoria Taylor shares nutrition advice

ASK THE EXPERT

Fermentation fadQ Should I be eating

fermented foods to improve my heart health?

Victoria Taylor says: Fermentation has been used to preserve foods for thousands of years. Some of these foods will be familiar, such as yoghurt, sauerkraut and crème fraîche. Others, such as kimchi (Korean fermented vegetables), kombucha (a drink made from fermented tea), miso (a Japanese flavouring made from

fermented soya beans) and kefir (a fermented milk drink), are less well known. Fermented foods can contain ‘probiotics’ – live bacteria and yeasts that are thought to have health benefits. This may make these foods a useful addition to our diets.

There are many health claims about them, from preventing cancer to reducing cholesterol and obesity, but most aren’t supported by research. There

is some evidence linking certain probiotics with benefits for some digestive problems. More studies are needed to

Enjoyed this article? Find all of our nutrition information at bhf.org.uk/nutrition.

understand how the benefits of individual probiotics seen in clinical trials translate to eating these in foods – for example, we need to know how much we’d need to eat to see any benefit, or which foods are the best sources.

Although there is still much to learn about fermented foods, for most people there is no harm in trying them. Just remember that any benefit is an ‘add-on’ to a healthy balanced diet; they can’t counteract the effects of an otherwise unhealthy diet.

Check nutrition labels carefully and remember that

Forbidden fruitQ I eat a lot of fruit,

especially in the summer. Is it possible to eat too much?

Victoria Taylor says: According to the Eatwell Guide (the official government recommendations for a healthy diet), about 40 per cent of the food we eat should be fruits and vegetables and we should aim for at least five portions a day. It’s best to have a variety, but there’s no specific advice on how the five should be split between fruit and vegetables.

It’s possible to have too much of anything, even healthy foods like fruits and

vegetables. But as around three-quarters of us don’t meet the 5-a-day recommendation, most of us shouldn’t cut back on fruit or veg.

Whole fruits generally contain less sugar than foods like cake, biscuits and chocolate, and come without the added fat. Because of their water and fibre content they will fill you up for relatively few calories. A medium banana, for example, contains less sugar than

a standard 50g bar of milk chocolate and half

the calories, making fruit a good swap for sweet treats.

The exception is fruit juice – stick to one 150ml portion a

day. Fruit juice is high in sugars and comes without the other benefits you get from

eating a piece of fruit. The juicing process releases

sugars from the cells of the fruit, turning them into free sugars – the type we all need to cut down on. And because it’s much easier to drink a glass of juice, which might

fermented foods should be ‘live’ so need to be kept in the fridge. If they’re from a supermarket shelf, be wary – heat treatment that may be used to preserve these foods destroys probiotics.

Some of these foods, such as sauerkraut, kimchi and miso, are often salty, so check the label and choose reduced-salt versions if possible. A food is classed as ‘high’ in salt if it contains more than 1.5g (0.6g sodium) per 100g and ‘low’ if it has 0.3g (0.1g sodium) or less per 100g. If you’re buying yoghurt, choose low-fat versions without added sugar.

contain several fruits, than to eat the equivalent in whole fruits, you consume a greater amount of sugar too.

If you have diabetes and your blood sugar levels are too high, rather than immediately cutting out fruit, check your portion sizes, spread your intake out over the day and look at where else sugar might be coming from in your diet. You can also talk to your diabetes specialist nurse or dietitian if you have any concerns.

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≠ How many sugars can you name? Discover them all at bhf.org.uk/sugars.

NUTRITION

bhf.org.uk

BIG INTERVIEW

28

After a distinguished scientific career, our new Medical Director Professor Sir Nilesh Samani is helping us shape the direction of research in the UK and beyond. He talks to Sarah Brealey

When I started training as a doctor,” says Professor Sir Nilesh Samani, “around two-thirds of people didn’t survive a heart attackD. Now, more than seven in ten survive.”

Professor Samani started his medical training in the mid-1970s. Now, he’s Medical Director of the BHF. During this time, there have been developments ranging from new surgical techniques and tests for inherited heart conditions, to the availability of statins and the introduction of angioplastyD.

“Our ability to treat heart and circulatory disease has advanced enormously, and I’ve had the privilege to live through this,” he says. “I think there have been more advances in the treatment of heart and circulatory disease in the last 20 or 30 years than almost any other area of medicine – maybe only cancer comes close.”

The BHF has played a big role in these advances and also supported Professor Samani’s own research career. “There is no aspect of heart treatment that BHF research has not helped to advance,” he says. “I don’t want to say the BHF is responsible for all of it, but it has undoubtedly had a major impact in improving patient care.”

There are still many more discoveries to be made. “I think the next 20 years will be even better,” says Professor Samani. “And the BHF has a critical role to play in terms of making sure research happens and is carried out with patients and the benefits to them in mind.”

This, really, is what being the BHF’s Medical Director is all about. It’s a role well suited to a world-leading researcher and cardiologist, who was knighted in 2015 for services to medicine and medical research. Professor Samani continues to work once a week as a cardiologist at Glenfield Hospital in Leicester. He does this alongside

BIG AMBITIONleading his research team at the University of Leicester, so it’s a lot to fit in, but the patient contact shapes and enriches both his research and his role at the BHF.

Patients first“Patients are at the heart of everything we should be doing,” says Professor Samani. “The questions I want to answer in the lab are often informed by what I have seen in the ward. This is not only in terms of treatments, but causes and prevention because, ultimately, the goal of the BHF is to prevent heart disease.”

This is something he has put into practice in his own research career, which has focused on the role genes play in heart disease. Ten years ago, Professor Samani and his colleagues in Leicester identified one of the first common genetic variants linked to risk of heart attack. Now more than 90 of these variants have been discovered, most of these through an international collaboration established by Professor Samani.

The BHF was pivotal in this research. With a large BHF grant, Professor Samani and BHF Professor Stephen Ball in Leeds, set up the BHF Family Heart Study in the late 1990s, studying families where more than one person had coronary heart diseaseD.

Some inherited conditions are caused by a single gene mutation, but heart attacks aren’t like that. “You may be born with some variations that increase your risk and some that reduce your risk,” says Professor Samani. “It’s like a game of cards – it’s about the total hand that you are dealt.

“If you carry one variant, it doesn’t mean you will have a heart attack. If you carry 40, 50, or more, this is associated with a six times higher lifetime risk of heart attack.”

This is important because it opens up the way for better prevention and treatment of heart attacks. “At the moment, we don’t look at someone’s risk of heart disease until they are in their 40s, when they might have already had a heart attack, and certainly some furring up of their arteries has happened,” Professor Samani says. “If you really want to prevent this,

Heart Matters

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I hope that we will take major steps to realise the potential of regenerative medicine”

29bhf.org.uk

Professor Samani hopes tohelp turn BHF research intotreatments and tests that willimprove people’s lives

30 Heart Matters

you need to give lifestyle advice and treatments much earlier. We can’t do that for the whole population, but if you can identify people who are at high risk you can do much more.

“For example, in future we could give statins early to people who were born with the highest risk, who could get the maximum benefit in terms of preventing heart attacks.”

This is the idea behind personalised medicine – understanding which drugs and treatments will help individuals most, and treating them accordingly.

Identifying genes that cause heart attacks can offer insight into how the disease develops. “Most of these genes don’t affect your risk in ways we know about, for example by raising cholesterol or blood pressureD,” he says. “There must be other mechanisms and understanding these has the potential for profound benefits in terms of developing new treatments.”

Further down the line, we might even learn how to influence the action of these genes, in order to reduce a person’s risk in a very individualised way.

Joined-up researchThis kind of research relies on data from vast numbers of patients, and collaboration from researchers around the world. Professor Samani says: “I want to increase the amount of international collaboration that we fund in partnership with other organisations. The research we do has benefits that are not confined to the UK. Working across borders will be more productive, so will bring more value to the money our supporters raise for us.”

He wants to encourage more joint working between UK universities and researchers, too. This is an area where BHF funding can play a big role. “We want people in different locations to get together and decide the key questions and how to answer them,” he says. “We will still fund the projects and individuals that

I want to do things that haven’t been done before. These are exciting times”

we already fund, but we want to encourage people to work together. If we can raise more funds, that will give us more money to do this.”

Professor Samani also wants to build on the work of his predecessor, Professor Peter Weissberg, who helped to establish BHF Centres of Regenerative Medicine. These focus on ways to repair the heart when it gets damaged, which isn’t possible at the moment, meaning heart attack and other conditions can lead to debilitating and incurable heart failureD.

“We are currently reviewing the achievements of the Centres and awarding new grants to take the work forward,” says Professor Samani. “I hope that in my time as BHF Medical Director we will take major steps to realise the potential of regenerative medicine for patients. At the moment, the only real option for people with advanced heart failure is a heart transplant – but it would be so much better if we could make more muscle grow in the heart.”

The BHF is funding researchers to take advantage of the latest technologies. These include creating stem cells from a patient’s own skin, and editing genes so we can understand what causes diseases. Another area of huge potential is the use of new computing techniques, such as machine learning, to analyse large or complex datasets to provide insights in ways currently not possible.

“I want our researchers to use these new approaches,” says Professor Samani. “I want them to innovate, to do things that haven’t been done before. These are exciting times.”

≠ Watch: how we’re finding the genes that cause heart disease. Visit bhf.org.uk/genes.≠ Turn the page to discover how international collaboration is vital in research.

CV Nilesh Samani

≠ 1978 BSc (Medical Sciences, first class), University of Leicester

≠ 1981 MB ChB University of Leicester

≠ 1981–85 Clinical training≠ 1985–88 MRC Clinical Training

Fellow, University of Leicester≠ 1988–93 Lecturer in Cardiology,

University of Leicester≠ 1993–97 Senior Lecturer in

Cardiology, University of Leicester≠ 1997–present Professor of

Cardiology, University of Leicester, and Honorary

Consultant Cardiologist, Glenfield Hospital

≠ 2003–16 British Heart Foundation Personal Chair in Cardiology, and Head of Department of Cardiovascular Sciences, University of Leicester

≠ 2009–present Director of NIHR Leicester Biomedical Research Unit in Cardiovascular Disease

≠ 2015 Knighthood for services to medicine and medical research

≠ 2016–present Medical Director, British Heart Foundation

BIG INTERVIEW

31

RESEARCH

What do you do if you want to work with top experts in your field? If you’re a BHF-funded researcher, you might cross the Atlantic to meet

them. That’s what Dr Marc Dweck, Senior Lecturer and Consultant Cardiologist at the University of Edinburgh and Edinburgh Heart Centre, did. As part of his BHF-funded Clinical Research Fellowship, he spent a year in New York, working with world-leading experts in scanning the heart and the arteries.

“I wanted to work with Dr Valentin Fuster, based at Mount Sinai Hospital in New York,” says Dr Dweck. “He is one of the top cardiologists in the world and I wanted to see how he runs his clinical and research teams.

I was working under Dr Zahi Fayad, Director of the Translational and Molecular Imaging Institute at Mount Sinai. He is an inspirational and charismatic guy who has pioneered the latest cutting-edge imaging techniques to look at heart disease.”

It often meant meetings at 5am or late at night, but Dr Dweck says it was worth it. “Those guys are really busy, effective people, and I had to get up early in the morning to try to meet them,” he says. “They have a fantastic work ethic and I was grateful to spend some time with them.”

As well as learning from the best people, he had a chance to use the best equipment. “I was using a state-of-the-art scanner,” he says. “The idea was that I would go out there to learn how to use the scanner, and then

bhf.org.uk

TransatlanticTRIALS

Dr Dweck and his family settled in to New York life, with plenty of

outings in Central Park

Doing world-leading research means broadening your horizons. For Dr Marc Dweck, a year in New York helped him develop advanced ways to spot and treat heart problems, as he tells Sarah Brealey

32 Heart Matters

bring that knowledge back. We now have one installed in Edinburgh and I’ve started to use it here, based on my learnings from New York. There is a whole programme of research into heart disease that is using this new machine.”

Detailed studyThe multi-million-pound scanner – one of the most complex machines of its kind – is a PET-MRI scanner. This stands for positron emission tomography (PET) combined with magnetic resonance imaging (MRI). PET means that scientists can look at processes inside the human body, at a molecular level, while MRI can show fine detail in body tissues.

In his work in New York, Dr Dweck was studying the heart muscles, trying to use

scans to see disease-causing processes within the molecules inside our cells – processes far too small to see with the human eye.

This could help diagnose rare types of heart failureD, including cardiac amyloidosis, which can be fatal without treatment. “These are quite rare conditions that are difficult to diagnose, and need a number of different tests to diagnose them,” explains Dr Dweck. “PET-MRI seems to give you all the information that you need in a single test.”

The expertise he has gained in PET is now being used in a BHF-funded trial at the University of Edinburgh. The trial will test the effects of two drugs on aortic stenosis – the most common type of heart valve disease, in which the aortic valve in your heart becomes

stiff and narrow, so the heart struggles to pump blood. The only cure is surgery to replace the valve. The scanner will allow researchers to see what effects the drugs have on the valve.

Another focus of Dr Dweck’s research is the fatty plaques that build up in arteries, especially as we get older. If one of these ruptures, it can cause a heart attackD or strokeD. Dr Dweck has spent years working on ways to spot plaques likely to rupture, so we can identify and treat high-risk patients. This has been done with a combination of PET and CT (another type of scan), but during his stay in New York, Dr Dweck and colleagues established that PET-MRI is another way to do this. He also studied plaques in the neck arteries, to try to predict

I was working in a group that have pioneered the latest cutting-edge imaging techniques”

Dr Dweck learned new ways toscan heart muscles for signs of

developing heart disease

RESEARCH

33bhf.org.uk

During Dr Dweck’s year in New York, he worked on a project to reduce

local residents’ risk of heart disease, while gathering information for research.

As part of an American Heart Association-funded study, he and colleagues visited schools in the Bronx and Harlem. They gave advice to schoolchildren and their families about healthy eating and exercise, to reduce their risk of heart disease. This is part of a global programme trying to improve health attitudes and behaviours within families.

“We took our ultrasound scanner and were scanning plaques in the neck of the children’s parents,” says Dr Dweck. “Often we were able to identify the early stages of disease, which can lead to stroke. If you can show someone plaques inside their own body, that is quite a strong incentive to have a more healthy lifestyle.”

The study brought extra benefits for some of the New Yorkers involved. “In some people we found quite advanced disease,” says Dr Dweck. “They were then referred for follow-up, and received medication and other treatment as a result.”

Lifestyle messages haven’t been lost on Dr Dweck himself, who has a family history of heart disease.

“The Dwecks all seem to have heart attacks at an early age, often in their 30s and 40s,” he says. “I am 37 at the moment, so I am thinking I had better watch what I am doing.

“The job does make you realise the importance of lifestyle, like eating healthily, exercising and not smoking, to reduce your risk of heart attacks. I spend a lot of time telling my patients to do these things, so I have to do them as well.”

Heart health in Harlem

risk of stroke. Since returning to Edinburgh last year, he’s been working on another trial to improve the prediction of heart attacks, by scanning plaques in the arteries.

Family lifeIt wasn’t just Dr Dweck’s knowledge that expanded overseas, his family grew too. “Louis, now 16 months, was born in New York,” he says. “So we experienced the American healthcare system as a patient too. It nearly meant we couldn’t go, because we couldn’t get conventional health insurance for Caroline while she was pregnant. Luckily Mount Sinai stepped in to offer me an official position so that the health insurance came with it.”

Understandably, Dr Dweck’s wife Caroline, a GP, was initially sceptical about relocating the family to New York while pregnant. However, they soon discovered many benefits. They were able to stay in a tiny but perfectly located hospital-owned flat on Madison Avenue, next to Central Park, and Tom and Eva, then five and three, thrived in school and nursery.

“Hardly anyone in New York is from New York, so you quickly feel part of the city,” says Dr Dweck. “Central Park is a brilliant place for the kids and my wife really loved all the museums and art galleries. We all had an amazing time in the end, the energy of New York is really infectious.”

Dr Dweck’s whole research career has been funded by the BHF, and it was

BHF support that enabled him to go to New York. “As part of the intermediate fellowship you are encouraged to go away for a year,” he says. “You have to think about where will add value to you and be helpful to your career.”

Although his time in New York is over, the experience will benefit his work for

£976,514BHF funding for Dr Dweck’s intermediate fellowship, which included his New York trip

years to come. “There is only so much you can do in a year in terms of research, but the connections I built will continue and develop over the next 10 to 15 years,” he says. “That is really valuable.”

Dr Dweck worked with heartexperts (top left, bottom

right); while in New York, heand wife Caroline (centre) had their third child (bottom left)

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Dr Chowdhury’s collaborative globalhealth studies look at heart conditionsin Bangladesh, Cambridge and beyond

RESEARCH

Heart Matters

The BHF has helped us set up large, landmark global cardiovascular health studies”

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£2mBHF funding for international heart expert group set up by University of Cambridge

Taking a global view of research means we can benefit from the best minds around the world. That’s what Dr Rajiv Chowdhury does at the University of Cambridge. This means collaborating on BHF-funded projects with

researchers from South America to South Asia.“Almost 80 per cent of the global population live

outside of western countries,” says Dr Chowdhury. “In these lower and middle income countries we have the majority of global cases of heart and circulatory disease. But the research that has been done in those countries has been minimal.”

The populations of different countries often have a different risk profile and genetic makeup. For example, researchers have discovered new genes linked to heart failureD in people in South Asia. This is crucial for developing new drugs. Dr Chowdhury explains: “While important genes are often discovered in specific populations, they offer crucial insights into the mechanisms of disease as a whole, and therefore can progress medicine by developing new drugs that can target those pathways. And if we discover new genes, which can help us develop new drugs, that is very important to western medications and western populations too.”

Arsenic and heart diseaseDr Chowdhury is the lead investigator on several collaborative global health projects, which are addressing local challenges and global questions. For example, with colleagues from Cambridge’s Department of Public Health (headed by BHF Professor John Danesh), he works in Bangladesh to

Heart disease doesn’t recognise boundaries and nor does our research. Sarah Brealey explains how our international approach helps patients

GENIUSBordering on

study the health effects of arsenic in drinking water and foods.

Arsenic is most often associated with an increased risk of cancer, but Dr Chowdhury is studying how it may also increase your risk of heart disease.

“In the 70s and 80s in Bangladesh there was a heavy burden of waterborne disease, so they dug deep wells underground,” Dr Chowdhury says. “That helped in reducing infectious diseases but also brought arsenic, which is present naturally in the Ganges Delta, into the water supply.”

This isn’t just an issue for people in South Asia – it has relevance for people in the UK and many other parts of the world. Research by the University of Aberdeen in 2008 found that baby rice products on sale in the UK had arsenic levels higher than those that would be allowed in drinking water. The levels depend on where the rice is grown – rice from north India and Nepal has lower levels, while rice from Bangladesh and the US has higher levels. In January 2016, maximum arsenic levels in rice products came into force in Europe, although there is no compulsory testing when rice enters the UK. The UK Food Standards Agency advises that children under five shouldn’t be given rice milk as an alternative to cows’ milk or breast milk, to reduce their exposure.

Around 65 countries worldwide have been affected by toxic mineral contamination, from the US to the UK (unsafe levels of arsenic have been found in drinking water boreholes in Cornwall). It’s in everyone’s interest that we learn more about this problem.

We know arsenic is dangerous, but there’s more to find out. Does arsenic raise the risk of heart and circulatory disease even at the low levels of exposure

bhf.org.uk

36

RESEARCH

seen in many western countries? And what happens when arsenic occurs alongside other toxic metals, such as mercury, lead and cadmium?

“We are studying the effects of these metals in combination,” says Dr Chowdhury. “We are also studying arsenic exposure in combination with air pollution, to see how it affects the risk of heart disease, pregnancy outcomes and child development.”

Dr Chowdhury and colleagues (Professor Danesh and Dr Emanuele Di Angelantonio) are gathering information from tens of thousands of volunteers, including dietary surveys, blood samples and toenail clippings.

“Toenail arsenic is the gold standard for measuring arsenic,” says Dr Chowdhury. “It is very stable and reflective of several years of exposure to arsenic. It is a reliable measure and is unaffected by other disease, such as whether you’ve had a heart attackD. It works well to compare people who have had a heart attack or not.”

Preventable problemsDr Chowdhury’s group is also looking at the effect of marriages between people who are related. “If your parents are related, you are more likely to inherit

Heart Matters

a faulty gene. Preliminary reports from his group indicate that intermarriage can significantly increase cardiovascular risk.

“In countries such as Malaysia, Pakistan and Bangladesh, up to 50 per cent of marriages are consanguineous [between blood relatives]. It’s common in many south Asian countries and some north African countries, and in many cases among migrant populations in Europe too.

The researchers are also investigating the role of lifestyle factors. “These include the use of certain cooking fats, for example ghee, and chewable tobacco consumption – common in both native and immigrant ethnic populations,” says Dr Chowdhury. “It’s important that we are able to give people information about these potentially preventable risk factors.”

Meanwhile, back in Cambridge, Dr Chowdhury says: “We are very keen for British scientists to play more of a leading role in global collaborative research, and so is the BHF. Grants this Cambridge department has received from the BHF have helped us, as a group, to set up large and hopefully landmark global cardiovascular health studies, looking at new and unexplored areas. The BHF has been crucial to our work.”

Dr Chowdhury’s work inCambridge is supportedby BHF funding

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My work in Singapore benefits my post at Imperial College London, and vice versa”

Professor Cook works inLondon and Singapore

Professor Stuart Cook tells Sarah Brealey how his work in Singapore could help patients around the world

Stuart Cook is Professor of Clinical and Molecular Cardiology at Imperial College London, but his office is on a medical campus in Singapore.

The professor is Director of the National Heart Research Institute Singapore, as well as Senior Consultant Cardiologist and Director of the Clinical Cardiac MRI Service at the National Heart Centre Singapore. Much of his research is based on international collaborations.

His biography certainly has an international tone: he grew up in Kenya, studied medicine in London and did his post-doctoral training at Harvard (during which his daughter was born). He returned to London, where he established his research career alongside his work as a cardiologist, and became a professor at Imperial College in 2010. In 2012, his work became more international.

“A chance came up to work in Singapore,” says Professor Cook. “It has a huge patient base which was very important for the work I wanted to do. My work here benefits my post at Imperial, and vice versa.”

Professor Cook leads a research team trying to understand more about the role of genes in heart and circulatory disease, improve diagnosis and develop new treatments. “We do a combination of genetic and human imaging,” he says. “If we find something interesting in human studies we take it back to the science lab to study it in more detail, with the ultimate aim to diagnose and treat disease.”

International collaboration is vital here. Researchers may need data from tens of thousands of patients, or even more, to spot genetic patterns – it’s difficult to do that in a single study.

One of Professor Cook’s team’s biggest findings is the role of a gene that instructs the body to create a protein called titin in heart failureD. With the help of BHF funding, they have shown that a difference in this gene is the most common cause of dilated cardiomyopathyD.

“This titin truncation, or difference, is present in about one per cent of the population,” Professor Cook says. “If you have it, your heart is primed to fail. It can function perfectly well, but it will be predisposed to get heart failure in certain circumstances that put it under strain, such as a viral infection, chemotherapy, or drinking too much alcohol.”

The team discovered that the titin gene is involved in many cases of peripartum cardiomyopathy – a rare type of heart failure that strikes women in late pregnancy or after childbirth. Its cause has been unexplained, and it is difficult to diagnose, but this discovery could help with both these issues.

Professor Cook’s team went on to develop a blood test for the titin gene difference. Family members of people affected can now discover their risk. In future, the test could potentially be used more widely, for example when planning a pregnancy, or before chemotherapy.

“Maybe people with this gene difference would respond to different drugs,” says Professor Cook. “We could give tailored lifestyle advice.”

The research was an international collaboration and was funded internationally, too, including by the BHF, the National Medical Council Singapore, the UK Medical Research Council, and others.

The BHF also helped fund work by Professor Cook’s team that led to a simple blood test that could diagnose all known inherited heart conditions. This means that in future, family members of people affected could be much more easily tested to see if they have a gene mutation, which will improve their care. This research was based on patient volunteers in both Singapore and London.

Professor Cook’s team is also looking at scarring in the heart. Scarring can be caused by a heart attack or other things such as high blood pressureD or genetic problems. “It is like when you cut yourself: you will get a scab and then a scar,” says Professor Cook. “In the short term that is a useful thing, but if there is chronic scarring then it can create more of a problem. In the heart, the scarring disrupts the normal function of the muscle.”

Chronic scarring can lead to problems such as atrial fibrillation (AF)D, the most common abnormal heart rhythm. AF affects more than 30 million people worldwide and can be difficult to treat. Professor Cook and his researchers are trying to control the scarring process, to reduce scarring and stop people developing AF in future.

≠ Watch how we’re finding the genes that cause heart disease at bhf.org.uk/genes.

Genetic discoveries

COVER STORY

Climbing up Mount Kilimanjaro, around 5,000 metres above sea level, Paul Covell, then aged 66, wondered why he was slower than his companions. “I got very breathless and was always at the back of the group, but put it down to my age,” he

says. “There were eight of us, and we had to leave at midnight with head torches to arrive at the summit at eight o’clock in the morning. It was probably the toughest thing I’ve done in my life.”

Paul, now 78, didn’t know that three of the four main arteries supplying blood to his heart were up to 80 per cent blocked. So he went on to his next adventure – cycling the south-west coast of Britain with two friends.

Again, he was at the back of the group, but put it down to being the oldest cyclist. “I did eight days of rigorous cycling, and got as far as a guesthouse in Taunton, where I had terrible chest pains,” says Paul. “I called 999 and they asked me three questions: ‘How old are you, where are you, and what sort of pain is it?’ I answered. They said: ‘We’ll be down in two minutes.’”

Paul was having a heart attackD and was taken to hospital for tests. He found out about his blocked arteries through an angiogram, and was told he needed coronary bypass surgery. “It really came as a shock,” he said. “I was so lucky to be alive. The most depressing thing was that everyone had been commenting on how fit and well I was. I thought nothing could happen to me.”

Following the surgery, Paul, who lives in Buckinghamshire, did a two-month cardiac

rehabilitation course at Mount Vernon Hospital in Middlesex. “I found it so useful,” he says. “In a group you tend to push yourself more, compared to when you’re on your own. With a physiotherapist in the room, it felt like a controlled, safe environment to do that.”

Maritime passionMost of all, Paul was motivated to return to sailing. “I have a passion for the sea,” he says. “You won’t keep me away from it.”

Paul first discovered this love of the sea aged 16, when he joined the merchant navy. He was an apprentice with Manchester Liners, which carried general cargo to Canada and returned with grain. He soon became a navigating officer. “I was young, travelling to foreign lands,” says Paul. “I’d crossed the North Atlantic 52 times between the age of 16 and 21. It was a very exciting period.”

At the time, navigating officers weren’t allowed to wear glasses and Paul’s eyesight without them wasn’t good enough, so he switched careers. He worked his way up in the printing

After recovering from a heart attack, maritime enthusiast Paul resumed his adventurous life. He tells Lucy Trevallion how he did it

THE HELMBack at

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I have a passion for the sea; you won’t keep me away from it”

Heart Matters

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ink industry, becoming a marketing and sales director before he retired.

In his mid-40s, Paul returned to the sea and learned to sail. He loved it so much that he signed up to sail around the world aged 61, as part of BT Global Challenge, deemed ‘the world’s toughest yacht race’. During 177 days at sea the team dealt with a collision, skirted a Caribbean hurricane and sailed past icebergs.

During his recovery from the heart attack, Paul often thought back to this trip. “I remembered some of the magical nights there, when I would sit on the deck, looking up at the stars, listening to the swish of the water,” he says. “In the Southern Ocean you’d be under the spectacular Southern Lights, with whales or dolphins swimming by.”

After the stormBut Paul’s journey back to the water wasn’t smooth. “After three months, I went to my local swimming pool,” he says. “I remember walking down the disabled ramp into the water, confident I could swim again. I did two strokes of breaststroke and had a pain in my chest. You have to listen to your body, so I walked straight back up the ramp again. I felt I had failed, and was bitterly disappointed.”

At times like this, Paul says he would take a moment to “go into a corner and cry”. But after that, he says: “I would try to focus on how to handle it. You think of all the alternative actions you could take, make a calculated judgement on how best to handle that situation and move forward.”

Paul prepared for sailing in small steps, gradually building up his activity levels with

land-based activities like walking, tennis and badminton. “Because if I had a problem I could easily

stop,” he says. “When you’re out on the sea, you can’t

just stop and get off the boat.”

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Paul hasreturned tomaritimeadventuressince hissurgery

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Heart Matters

Advice for adventurers

≠ The length of time it takes to start or resume an activity after a heart event will depend on how damaged your heart is, and whether you have heart disease. Follow the guidance of your cardiac rehab team.

≠ Train for it. Paul says: “For the last climb I did, I was walking around my neighbourhood with weights on my back to find out just what limit I could go to.”

≠ Some GP surgeries offer Skype appointments that you can have while you’re abroad if you need to. Ask about this before you go.

≠ Make sure you’ve got adequate travel insurance for your adventure.

≠ If you’d like to, take a copy of your medical summary (a timeline of your medical history and any medications you are on). You can either write this yourself, or ask your GP to provide it well in advance of your trip. You could also take your hospital discharge summary.

He was scared he’d never sail again, and although he spoke to people who’d recovered from heart surgery, he couldn’t find anyone to speak to who’d led such an adventurous life before their operation. “I really had no idea if I’d ever get back to where I was,” he says.

Nine months after his surgery, Paul sailed again, on a week-long trip from Palermo in Sicily to mainland Italy. He felt euphoric – to him, this signalled that he’d made a full recovery.

Just three months later, he completed a 54-mile London to Brighton bike ride for the BHF. “It’s amazing what these heart ops can do!” he says. “After that, I decided to try to squeeze all of the juice out of the lemon.”

Full steam aheadAged 73, Paul did an MA in Maritime History at the University of Greenwich, partly to increase his expertise for the work he was doing, giving lectures on cruise ships. Was it hard to return to learning in his 70s? “No, you’re never too old. Anyway, everyone seems younger than me these days,” he says, “I just love a challenge.”

He also volunteered for the London Olympics in 2012, where he was based in Stratford, welcoming guests into the stadium and showing them to their

seats. Paul felt very fortunate to see events such as Usain Bolt winning the 100m sprint.

He says that before his heart attack he “was bloody stupid” and thought he was healthy, as he was always quite slim. Now, he reads Heart Matters for tips, and is more mindful of eating healthily and being physically active – trying to walk, cycle, ski and sail regularly.

He admits that he is very lucky to have such a supportive family, including his wife Gea, their three children and six grandchildren. His eldest daughter is particularly interested in nutrition, and helped him cut down on saturated fat by eating less cream, cheese and fatty meats.

“There are many things in later life that you have no control over,” Paul says. “Take control of your own health because that’s the most important thing that you have. Go out of your way to find out all the information, from reliable sites on the internet, your doctor, your pharmacist – really get involved. And then decide how you’re going to manage it.

“The splendid thing is that I virtually got back to doing the same adventures I did before. After the news about my blocked arteries, I thought my life would be limited.

“If you work at it, it’s amazing what people are capable of.”

Take control of your health – that’s the most important thing you have”

Paul sailing aroundthe world (left andcentre); in 2012 hevolunteered at the Olympics

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COVER STORY

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MEDICAL

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Inheriting a heart condition raises many questions, but support is available. Senior Cardiac Nurse Emily Reeve speaks to Lucy White about the care she’s received

Lucy, left, with nurse Bethan whohas provided information andsupport since her diagnosis

 Lucy White had no idea that a heart condition ran in her family until her brother Jack collapsed at home nine years ago.

Jack, then aged 18, was diagnosed with dilated cardiomyopathyD (DCM). This is a condition where your heart muscle becomes

enlarged, weak and can’t pump blood around your body as efficiently. There aren’t always symptoms, but Jack’s DCM was causing potentially life-threatening heart rhythms, so he was fitted with an ICDD to reduce his risk of sudden death.

DCM can be inherited, so doctors wanted to test the whole family. Lucy had an echocardiogramD and a cardiac MRI scan. She was diagnosed with DCM, aged 22.

“This all happened just a few weeks after Jack was taken into hospital,” says Lucy. “It felt like a real shock. For a long time I hated my diagnosis. I felt like ‘why us?’”

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Lucy says her diagnosis changed her life. She went from being a keen runner, who had completed marathons, to needing to be closely monitored and supported through her exercise regime. She was also told it would be safer to stop drinking alcohol. Lucy has now found a less stressful job and adopted a healthier diet. She’s still able to be active, even if not at the same level as before – for example, she’s completed a marathon since her diagnosis, but walking rather than running, and after thorough checks from her medical team.

Lucy and her family were treated at the specialist service for inherited heart conditions (also known as inherited cardiac conditions or ICCs) at the Royal Brompton Hospital in London. “The team have looked after us ever since Jack’s diagnosis and I think we are very lucky to have been referred to them,” she says.

Research advancesThe BHF has helped give Lucy’s family peace of mind. “In the last couple of years we have been told that we don’t all have the condition,” she says. “Thanks to research funded by the BHF, we had genetic testing and discovered that my mother, me and my brother Jack have the faulty gene, but my dad and my other brother Toby don’t. The team checked our whole extended family – aunties, uncles, cousins. That made everyone feel at ease.”

Lucy got married in August 2014 and she and husband Ben took advice from the team at the Royal Brompton before planning a family. They are now expecting their first child. “When I talked to the team about pregnancy, we discussed the risks for my heart and my baby,” she says. “But everything is going well

so far and although I was afraid before, I realised I don’t need to be. I know Ben worries about me a lot and he’s been really supportive.”

Lucy is getting extra care during her pregnancy. “The team are monitoring me closely, doing regular echos and scans of the baby’s heart,” she says. “Due to the inheritance pattern of the condition, there is a 50:50 chance the baby will have it. But I feel like our baby will have a great chance under such amazing care.

“It’s taken a while, but now I feel like I accept my condition. Having a heart condition doesn’t have to be scary. The research has come on so much in the eight years I’ve known about it and I know there will be even more improvements if funding continues.”

She wants to encourage anyone with an inherited heart condition to make use of the support from their specialist clinic, and to ask for a referral from a GP if they aren’t offered one. “The care at the ICC service at the Brompton has made me feel safe and less scared,” says Lucy. “Their support and BHF research has changed my life.”

Heart Matters

Find out more≠ The free BHF Genetic Information Service can provide information and help facilitate a GP referral to a specialist clinic. Call 0300 456 8383. Turn to page 50 to discover our free booklets on inherited heart conditions. ≠ Discover how BHF-funded research is helping people with familial hypercholesterolaemia at bhf.org.uk/benchtobedside. ≠ Find out more about our screening roll-out for hypertrophic cardiomyopathy at bhf.org.uk/watkins, or order our Autumn 2016 issue on 0870 600 6566.

Lucy’s mum Sharronand husband Benhelped her throughher heart condition

Lucy’s mum Sharon and husband Ben have supported her through her heart condition

MEDICAL

Having a heart condition doesn’t have to be scary”

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Lucy’s nurse Bethan Cowley, Acting Lead Nurse, Inherited Cardiac Conditions at the Royal Brompton Hospital, explains how specialist services can help

Emily Reeve: What is an inherited heart condition?Bethan Cowley: It is a heart condition that can be passed on through the family, as a result of a faulty gene. If one of your parents has the faulty gene, there is a 50:50 chance you could inherit it. In some cases, you can inherit the faulty gene without developing the condition. There are more than 50 known inherited cardiac conditions (ICCs) – the most common are familial hypercholesterolaemiaD and hypertrophic cardiomyopathyD.

ER: What usually happens when someone is diagnosed?BC: Some patients are diagnosed unexpectedly – for example, following a workplace medical check or sports screening. Some are referred due to symptoms that suggest an ICC, or after a family member’s diagnosis or sudden death.

Rigorous investigation is needed to assess risk, as this can vary widely, even within the same family. These will depend on what condition is suspected, but often include echocardiograms, electrocardiograms (ECGs)D, and questions about symptoms and family history. Once we have that information we can go through a treatment plan with them. This could be anything from medications and procedures to lifestyle adjustments. We can also refer families for genetic testing to identify family members who are at a higher risk of developing an ICC.

Once an inherited heart condition is diagnosed, people often want to do some research. Information online can be inaccurate or scary: my advice is to look at reputable websites like the BHF to get a better understanding. The risk of sudden

death is very low for the majority of patients.

ER: What support is available?BC: This can take many different forms, depending on the patient and their condition. Patients are offered support from the ICC nurse specialist team. We look after the whole family from the beginning, for as long as they need us – it’s a lifelong service. We operate a one-stop-shop, where patients can meet the professionals they need to see, such as cardiologists, clinical psychologists, consultant geneticists and others, on the same day. Other ICC services work in a similar way – the main difference is that we care for children and adults under one roof and in the same team.

ER: What if I don’t live in an area where specialist ICC services are available?BC: Ideally, you should be referred to a regional ICC service. These exist in all UK nations. This is particularly important where there is a family history of sudden death from an ICC. If you are at risk of an ICC, or have an ICC, you should at the very least be under the care of a cardiologist. It’s not enough to be under the care of just your GP.

ER: Who can access your support?BC: Anyone with an ICC or who is at risk of one. Many of our patients are family members who are known to be at risk, but are otherwise fit and well. They need just as much support as people who have symptoms – particularly from a psychological aspect. You shouldn’t be discharged from the care of an ICC service or cardiologist without the specialist giving you clear reasons why. Even family members who have been screened and do not presently show any signs of the condition or symptoms need follow-up,

because it may not rule out an ICC developing in the future. This may only be every few years.

ER: How often should a patient hear from their ICC service? BC: This can vary depending on the individual and their condition. Some of our patients who have a diagnosis do not experience symptoms, so never need more than an annual follow-up. Our patients are advised of situations when it may be appropriate to contact us, such as when they’re thinking about starting a family. This means that they can live as normal a life as possible, but we are there to provide support if they need it.

ER: What about screening of family members?BC: Genetic counselling and cascade testing is a large part of the work we do. We identify who is at risk within a family, explain what the implications of this are and then offer them screening. This is usually the immediate or ‘first degree’ relatives of the family member diagnosed. If any of them are subsequently diagnosed, then their immediate family are also invited for testing, and so on. Usually, we give the initial patient a generic letter to pass on to family members – the letter will encourage them to see their GP and ask for a referral to our service. We don’t cold call people who may be at risk.

Some people don’t feel the time is right to talk or be assessed by us, but we want them to know that they can come back and resume screening at any time.

Inherited cardiac condition services

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WELLBEING

Heart Matters

These expert tips could help you keep your heart healthy and pick up some great new habits on your summer holiday, as Rachael Healy discovers

A HOLIDAY?Ready for

If you’ve got a heart condition, you may be worried about planning a summer holiday – especially if you’ve only just been diagnosed. But with the right information, a heart problem doesn’t have to mean an end to your holidays, and it could even be a chance to pick up some healthy new habits.

Before you travelChoose your destinationThe first step of planning any holiday is deciding where to go. Both very cold and very

hot weather can aggravate certain heart conditions. “Ask your GP or cardiologist for advice,” says Dr Robert Henderson. “AnginaD is made worse by cold weather, but it can also be exacerbated in very hot weather.”

Proper preparationStock up on your regular medications before you travel and carry them in your hand

luggage to reduce the chances of losing them. “Getting medication overseas can be difficult,” says Dr Henderson. “Taking some spare medication just in case you are delayed or lose some is probably wise.” You could take a copy of your prescription, too.

If you have an ICDD or pacemakerD, take a device identification card or letter from your doctor to show airport staff before you go through the scanner. “If you need to be seen by a specialist overseas, then this will give them some background information,” explains Dr Henderson.

Travel insuranceHaving a heart condition doesn’t mean you can’t get travel insurance, but it makes the process more

complicated. Make sure you speak to your GP before you start looking, as insurers will often ask for detailed information about your medical history.

The BHF has put together a list of insurers, based on feedback from heart patients who have used them. Visit bhf.org.uk/insurance-information or call our Heart Matters Helpline on 0300 330 3300. Make sure you know what the policy does and doesn’t cover before you buy.

CV Dr Robert Henderson≠ Consultant Cardiologist, Trent

Cardiac Centre, Nottingham≠ Honorary Secretary, British

Cardiovascular Society

CV Dr Jessamy Hibberd≠ Chartered Clinical Psychologist≠ Runs private practice in London,

following eight years in NHS≠ Author of This book will... series

of self-help books

Oxygen levels in aeroplane cabins are lower than on the ground, but the majority of people with heart conditions should still be able to fly. “As a rule of thumb, if you can climb two flights of stairs there’s no reason why you should not travel on an aeroplane,” says Dr Henderson.

If you’ve decided to fly, it may be worth informing the airline carrier of your condition so they can have supplementary oxygen available. Consider asking your doctor if this will be necessary for you.

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Alcoholic drinks‘Holiday heart’ is an abnormal heart rhythm caused by binge drinking, which people

are more likely to do on a break. In hot climates, alcohol carries extra risks. “Try not to overindulge in alcohol,” Dr Henderson says. “It has a diuretic effect and can lead to dehydration.” Try to stay below the recommended maximum of 14 units per week. Find out more at bhf.org.uk/alcohol.

Staying activeSummer holidays are ideal for relaxation, but there are chances to get active too. “Try

to do it in a fun way,” says Dr Hibberd. “You’re probably going to be swimming already, so make time for a few lengths. If you’re doing trips, make sure there’s walking involved. Do things you enjoy.”

Some people find it easier to get active on holiday, thanks to the break from routine and extra free time. “If you’re trying to build a habit while you’re away, plan it into your morning, before you’ve had a chance to put it off,” says Dr Hibberd.

If you’re holidaying in a hot climate, morning could be the best time to get active for other reasons. Dr Henderson advises avoiding strenuous activity during the hottest part of the day.

If you’re not used to exercise, start gently, whatever the time. Chat to your doctor before you go about what might be appropriate for you.

Medical care abroad“The country you choose may not have the medical services we expect in the UK,” says

Dr Henderson. “Do a little research into where you’re going, then it’s a question of what level of risk you’re prepared to take.”

Take recent doctor’s letters, so you can show them to healthcare professionals if you need medical treatment while you’re away. Some people also take test results, such as ECGD.

If you’re travelling in Europe, pack your European Health Insurance Card – you can get one for free from ehic.org.uk or 0300 330 1350.

While you’re awayTreating yourself“Of course you’re going to have a treat, you’re on holiday,” says Dr Jessamy Hibberd. “But

it doesn’t have to be all the time. It’s about having an 80:20 rule, where you eat healthily 80 per cent of the time.”

Allow yourself the occasional treat, but think about the fruit and veg you enjoy, and eat more of those. “Make choices about what you’re eating, rather than it happening on autopilot,” says Dr Hibberd. “If there’s a buffet, it’s about taking one plate and that being it, rather than going up again.”

Proper hydrationWhether you’re getting active or not, “the most important thing is to stay hydrated,” says Dr Henderson. “Drink regularly

and before you get thirsty. If you’ve got heart failureD and you’re on large doses of diuretics, be aware that you may need a lower dose.”

Turn to page 11 for advice on staying hydrated when you’re on a fluid restriction.

After your holidayBringing habits homeKeep the holiday vibe by making healthy new habits part of your everyday routine. “It takes time to build new habits,” says Dr

Hibberd. “Set clear goals, think about what you enjoyed while you were away, and make a note of why you enjoyed doing it and the gains you got.”

Setting aside time for your chosen activity is vital too. Dr Hibberd suggests trying to work it into your existing routine, for example, do 20 minutes of exercise when you get up, make everyday journeys on foot or bike where you can, or take a lunchtime walk or swim. The longer you maintain your new lifestyle, the easier it will become.

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ACTIVITY

Heart Matters

Top 8PARK PASTIMESSummer is a great time to get your friends and family to the park and get active with outdoor fun and games, as Jess Unwin discovers

T here are around 27,000 parks and green spaces in the UK, so wherever you are, there’s probably one close by. These

spaces are ideal for free or low-cost physical activities, for all ages and

2 Boules In France, where the game comes

from, boules is usually played on a gravel court – but it’s just as fun on grass. This low-intensity activity involves throwing, bending and walking. You’ll need boules, a ‘jack’ to aim for – and perhaps a tape measure to avoid arguments! For about £5 you can buy a basic plastic boules set, which should come with instructions.

1Outdoor gyms A growing number of parks and green

spaces have free-to-use gym equipment like pull-up bars, step-ups, static bikes and parallel bars. The main UK supplier of outdoor gyms has installed more than 500 across the UK in the past 10 years.

You might also be interested in ‘Green Gyms’ run by The Conservation Volunteers. They give you the opportunity to work up a sweat digging, planting or path-clearing at 95 sites around the UK. There are sessions for all fitness levels, no previous gardening experience is necessary and it’s free. Visit tcv.org.uk or call 020 3794 8022.

fitness levels. It’s recommended that you do at least 150 minutes of moderate-intensity physical activity each week, which will help control your weight and reduce your blood pressureD, cholesterol and risk of heart disease. Here are our top eight park activities to try this summer.

Go online≠ See what happens in your body when you exercise at bhf.org.uk/exerciseanimation.

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A growing number of parks have free-to-use gym equipment”

3 Cricket and rounders Both games can be improvised

without too much equipment and are a great group activity for people of all abilities. French cricket is particularly easy to play without a pitch – it’s usually played with a tennis ball, one batter at a time, and the batter’s legs act as the wicket. Get family or friends together for a match, or contact your local council to see if they have information about rounders or cricket in your local parks.

8 Frisbee Possibly the most underrated

park pleasure. At its simplest it involves nothing more than throwing

and catching – the amount of running you do is down to you and the skill of

the people you’re playing with! You just need a friend or two, and a frisbee, which can cost less than £2.

Or work up more of a sweat with Ultimate – a team version of frisbee. Visit ukultimate.com/teams to find a team or learn the rules, or call 0844 804 5949.

6 Rowing boats Many parks with

lakes offer the chance to take up oars, while others have canoeing, sailing and pedalos for hire at varying prices. Most people find trying to row in a straight line is enough to work up a sweat, and some light rowing is great for thighs, bottoms, pecs and biceps. Even a pedalo counts towards your 150 minutes a week of moderate-intensity activity – you just need to pedal hard enough that you’re breathing a bit faster and feel a bit warmer, but can still have a conversation.

5 Tennis and badmintonHard or grass tennis courts are

available for hire at many parks, and for free at some (visit tennisforfree.com or ask your local council). Short tennis (a smaller, slower-paced version of tennis) or soft tennis (played with rubber balls) are good ways to introduce children to the sport.

Badminton is another popular racket sport – though it’s tricky on windy days! A basic set of rackets and shuttlecocks costs around £10. A fold-up net costs from £30, or you can play without one.

4 Walking, jogging and runningWalking is a free and easy way to get

active, lose weight and improve your heart health. Where better to do it than surrounded by the flowers, trees and birdsong of your local park?

For those craving a challenge, Parkruns are free, weekly 5K timed runs held in parks all around the UK (parkrun.org.uk). Running with others can be motivating, while going it alone can be a chance to clear your mind.

7 Yoga, tai chi, pilates and moreThese focus on strength, flexibility and

breathing to boost physical and mental wellbeing. Join a class that’s suitable for your fitness level – speak to the class

organiser to find out. At the gentle end, classes might not count towards your 150 minutes of moderate-intensity activity, but they can make up one of the two strength sessions it’s recommended we do per week. All you need is clothing that allows you to move easily, and perhaps a mat.

Some classes are free. If you’re in London or East Anglia, visit ourparks.org.uk. Elsewhere, check the park noticeboard or if you spot a class taking place, why not approach the organiser to find out more?

Alternatively, learn the basics at home and use your local park as a great place to practise.

*Heart Matters Helpline open 9am–5pm Monday–Friday. Similar cost to 01 and 02 numbers.

How do I follow a heart-healthy diet?

What does this diagnosis mean for me?

Why have I been prescribed this medication?

Why do I need this test?

Call the Heart Matters Helpline on 0300 333 2333* or email heartmatters@bhf.org.uk

Questions about your heart condition?

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AAngina An uncomfortable feeling, tightness or pain in

your chest that may also be felt in your arms, neck, jaw, back or stomach. The symptoms of angina are usually caused by coronary heart disease.Angioplasty A treatment to widen a narrowed artery. It involves passing a catheter (a fine, flexible, hollow tube) with a small inflatable balloon at its tip, into an artery either in your groin or in your wrist. The catheter goes as far as the point in the artery where the narrowing is, and the balloon is inflated to flatten the plaque against the inside of the artery wall. The balloon is then deflated and a stent, a short tube of expandable stainless-steel mesh, is often left in place to support and strengthen the artery wall. The catheter and balloon are then taken out. A coronary angioplasty is a treatment to widen a narrowed coronary artery (one of the arteries that supplies blood to the heart muscle), improving blood flow. A coronary angioplasty is also called ‘percutaneous coronary intervention’, or ‘PCI’.Atrial fibrillation (AF) An abnormal heart rhythm in which the atria (the upper chambers of the heart) beat in an irregular pattern. People with AF have an irregular, sometimes fast, pulse.

B Beta-blocker A medicine to reduce the amount of work

the heart has to do, by slowing the heart rate and lowering the blood pressure. Beta-blockers are often used to reduce the risk of a further heart attack in people who have already

had one, and to help prevent attacks of angina. Certain types of beta-blockers help to control arrhythmias (abnormal heart rhythms) and the symptoms of heart failure.Blood pressure As your blood is pumped around your body, it creates a pressure against the sides of the blood vessels. The measurement of this is your blood pressure. You need a certain amount of blood pressure to keep the blood flowing.

CCardiac arrest The ultimate medical emergency. This

is when a person’s heart stops pumping blood round their body and they stop breathing normally. Many cardiac arrests in adults happen because of a heart attack. Cardiomyopathy Disease of the heart muscle in which it becomes weakened. It may become thickened, enlarged and/or stiff, depending on the type of cardiomyopathy. It affects people of all ages and is usually inherited.Coronary heart disease (CHD) When the walls of the coronary arteries (the arteries that supply blood to the heart muscle) become narrowed due to a gradual build-up of plaques, called atheroma.

DDiabetes A condition in which glucose (sugar)

levels in the blood are too high. There are two main types of diabetes: type 1, where your body doesn’t make any insulin, and type 2, where your body can’t use the insulin it produces, usually because excess fat in organs prevents

the insulin from working effectively. Diabetes increases your risk of developing cardiovascular disease.

EEchocardiogram Sometimes called an ‘echo’. A test to

examine the structures within the heart, for example the heart valves, and to see how well the heart is pumping. It is similar to the ultrasound scan used during pregnancy.Electrocardiogram (ECG) An ECG is a simple and painless test to record the electrical activity of the heart. Small sticky patches called electrodes are put onto your arms, legs and chest. These are connected to a machine that picks up and records the electrical signals that make your heart beat.

FFamilial hypercholesterolaemia (FH) A genetic condition that

results in very high cholesterol levels. Having FH gives you a much higher risk of getting CHD.

HHeart attack Known medically as a ‘myocardial infarction’,

or ‘MI’. This describes a sudden loss of blood flow to part of the heart muscle. Most heart attacks are caused by atherosclerosis, the build-up of atheroma (plaque) within artery walls. If the atheroma becomes unstable, a piece may break off and lead to a blood clot. This can block a coronary artery, causing a heart attack and irreversible heart muscle damage. It is a medical emergency and can lead to a cardiac arrest.Heart failure Condition where the heart becomes less efficient at pumping blood around the body.

MEDICAL TERMS EXPLAINED

Call the Heart Matters Helpline on 0300 330 3300 if you want to know more

High blood pressure Also called ‘hypertension’. High blood pressure is when the pressure required to pump blood is consistently higher than the recommended level. This puts extra strain on your heart and blood vessels, and over time can increase your risk of having a heart attack or stroke.High cholesterol Cholesterol is a waxy substance that is mainly made in the body and plays a vital role in how every cell works. However, high cholesterol, when there is too much in the blood, can increase your risk of getting cardiovascular disease which includes having a heart attack or a stroke.

IImplantable cardioverter defibrillator (ICD) A small device implanted

under the skin on your chest, connected to your heart by one or more wires (leads). It monitors your heart rhythm and can deliver a controlled electric shock if you have a life-threatening abnormal heart rhythm.

P Pacemaker A small device implanted under the skin

on the chest, connected to your heart by one or more wires (leads). Monitors the heart’s electric signals and can stimulate your heart to contract and produce a heartbeat if required.

S Stroke An interruption of blood flow to part of the

brain, causing brain cells to die or become damaged. This happens if an artery carrying blood to your brain becomes blocked, or if an artery bleeds into your brain. A stroke is a medical emergency.

DICTIONARY

Order your free guides by calling 0870 600 6566 or visiting bhf.org.uk/HMpublications

Healthy eating and lifestyleBe active for life (physical activity information for over-65s) G364Cut the saturated fat M4Eating well G186Eat well. Shop smart. Save money (DVD – healthy eating on a budget) DVD31Everyday triumphs (for mental health service users) G972Facts not fads – your simple guide to healthy weight loss M2Get active, stay active G12Get up and go (DVD – physical activity for over-65s) DVD32Healthy living, healthy heart (information for African Caribbean communities) G532Healthy living, healthy heart (information for South Asian communities) G971/EKeep your heart healthy HIS25Stop smoking G118Taste of South Asia (South Asian recipes) G606Ten minutes to change your life – take time out G926Ten minutes to change your life – time to eat well G923This label could change your life G54Women and heart disease M37 Living with a heart conditionAn everyday guide to living with heart failure G275UAngina HIS6Atrial fibrillation – your quick guide G963Blood pressure HIS4Cardiac rehabilitation – your quick guide G964Caring for someone with a heart condition HIS20Coronary angioplasty HIS10Diabetes and your heart HIS22Electrocardiogram – your quick guide G965Having heart surgery HIS12Heart attack – your quick guide G966Heart rhythms HIS14Heart to heart: heart disease and your emotional wellbeing G954

Use our booklets, DVDs and information sheets to help you improve your heart health and get support on living with a heart condition. To see the whole range of guides, order the Take heart (G5) catalogue

50 Heart Matters

ORDER YOUR FREE GUIDES

Want to measure your blood pressure at home? Watch our short film on how to do it at bhf.org.uk/

pressure.

Heart transplantation HIS13Heart valve disease HIS11Implantable cardioverter defibrillators (ICDs) HIS19Lifelines: heart surgery and after (DVD) DVD10Living with heart failure HIS8Medicines for your heart HIS17One step at a time – living with heart failure (DVD) DVD5Pacemaker – your quick guide G968Peripheral arterial disease HIS16Physical activity and your heart HIS1Primary angioplasty for a heart attack HIS26Reducing your blood cholesterol HIS3Returning to work HIS21Stroke – your quick guide G969Tests HIS9The road ahead – your guide to heart tests and treatments DVD30

BHF SUPPORT

This booklet is for people with heart failure and their family and friends. It explains what heart failure is, what causes it, the symptoms, the possible treatments including medicines, and what can be done to help keep the condition under control.

Printer perfectYou can also print most of our information sheets and booklets at home – go to bhf.org.uk/HMpublications.

Heart failure

Order code: HIS8/0916

Fighting together

Rachel feels she has been able to count on us at every step. One day we’ll be able to count on her. Gifts in Wills play a crucial role, helping to fund world-class research, bringing hope to millions of people.

Help us deliver on our promise of fighting for every heartbeat with a gift in your Will. Please call 0300 330 3322 or email legacies@bhf.org.uk for your FREE guide.

Like the British Heart Foundation, I was born in 1961. They were nine at the time

of my original surgery and 39 when my problems started again, and they’ve been with me every step of the way. Now I fully intend to be there for them - by remembering them in my Will.”

Rachel Milledge

©British Heart Foundation 2017, registered charity in England and Wales (225971) and in Scotland (SC039426)

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