free date of birth home/work phone mobile phone no smoking ... · stopping smoking is the single...

NOT A MEMBER? JOIN TODAY!Your details1

Why are you signing up for Heart Matters membership? For myself Because I’m caring for someone with a heart condition For my work Other (please specify)

Your Heart Matters membership Please tell us how you would prefer to read your Heart Matters magazine (select one option only). Magazine delivered to me every two months. Online version of Heart Matters magazine every two months (we will send you an email to tell you when the magazine is available online).

Please ensure you have provided us with a valid email address above.

In addition to your Heart Matters membership, you can receive a bi-monthly e-newsletter with the latest news from Heart Matters. Tick here to receive it (please ensure you have provided us with a valid email address above).

2

By providing the BHF with any personal data, you consent to the collection and use of this information in accordance with the above purposes and our privacy statement, which can be found at bhf.org.uk.

FILL IN THIS FORM, TEAR, FOLD, MOISTEN AND SEAL

Title First name Last name

House name/number Street

City/Town County Postcode

Date of birth

Home/work phone Mobile phone

Email

We would like to let you know about the work of the British Heart Foundation (BHF) and its associated companies, and what you are helping it to achieve. Please let us know what areas you are most interested in. Campaigns Events Fundraising Raffles and prizes Retail (eg, high street and online shopping) Volunteering

How would you like the BHF to talk to you? Select if you DO NOT want the British Heart Foundation to contact you by post about its work. Select if you DO NOT want the British Heart Foundation to contact you by phone about its work. Select if you DO NOT want the British Heart Foundation to contact you by email about its work.

We may want to share your information with other organisations that are in partnership with the BHF and that support its aims and objectives.

Please tick here if you would prefer us NOT to share your details.

Keeping in touch3

This section is for healthcare professionals or Heart Support Groups only

Name of your organisation

What is your profession? Community dietitian Dietitian Doctor Pharmacist Community nurse Practice nurse Hospital nurse

Other (please specify)Are you a member of a Heart Support Group? Yes No

How many printed copies of Heart Matters magazine (per issue) would you like to receive? 1 10 25 50 100

4

Stopping smoking is the single best thing you can do for your heart healthnosmokingday.org.uk

©Br

itish

Hea

rt F

ound

atio

n 20

14, r

egis

tere

d ch

arity

in

Engl

and

and

Wal

es (2

2597

1) a

nd in

Sco

tland

(SC0

3942

6).

no Smoking day12 march 2014

FIGHT FOR EVERYHEARTBEATbhf.org.uk

FREE

March/April 2014

How Eric battled heart disease while grieving for his wife and daughter

Weatheringthe storm

Budget mealsSave cash and stay healthy

DIABETESYour defi nitive guide

STOPPING THE CLOTSBetter blood-thinning drugs on the horizon?

Freepost Plus RTCH-BSST-GALYHeart MattersValldata House2A Halifax RoadMELKSHAMSN12 6YY

M21E

FREE

It’s easy to sign up. Just fill in the form attached and send it back to us at no charge.

Or visit bhf.org.uk/heartmatters to sign up online today.

Heart Matters magazine is full of inspiration. I feel truly blessed that you’re here to help”Nicholas Field, 64, Gloucestershire


FREE

March/April 2014

How Eric battled heart disease while grieving for his wife and daughterWeatheringthe storm




ENJOYED READING THIS MAGAZINE?Receive your own copy and much more…Join Heart Matters – the FREE programme that can change your life.

• Kick-start your healthy lifestyle: your membership pack includes the latest issues of Heart Matters magazine, an introduction to the BHF, a tape measure and a recipe folder.

• Be inspired: our bi-monthly Heart Matters magazine with real-life stories, the latest research and tips for keeping healthy.

• Collect healthy recipes: in your recipe folder.• Stay up to date: regular e-newsletters.• Get online: take advantage of our online

healthy eating tools, online community and sign up for our motivational emails on eating healthily, getting active and more.

• Ask the experts: call our Helpline on 0300 330 3300* for anything heart related.

*Lines are open 9am–5pm, Monday to Friday. Costs are similar to 01 and 02 numbers.

Fold along this line

FIGHTFOR EVERY HEARTBEATbhf.org.uk

WELCOME

2 Heart Matters

16

14

22

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 2014 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 2014. Heart Matters is printed on paper from sustainable forests. G204/0314

Sarah Kidner, Editor

Whether it’s rising fuel bills, growing food and housing costs or a static income, many of us are feeling the

pinch on the household purse and with the Budget coming up on 19 March, the issue is at the front of many people’s minds.

Food bills are one of the ‘elastic’ parts of the household purse and, therefore, an obvious target for saving money – but can you cut costs and stay healthy?

This is the challenge we set our dietitian Victoria Taylor. Her findings on page 26 include useful tips and suggestions for making healthy food on a budget. We also have some mouth-watering recipe ideas.

Maintaining a healthy diet is especially important if you have diabetes. In our Focus on feature (page 16) we speak to someone living with type 2 diabetes, a cardiologist, a professor of metabolic medicine and a senior dietitian.

Obese people have a higher risk of diabetes, a key risk factor for coronary heart disease. Find out how Professor Susan Jebb thinks we should be tackling the obesity crisis in our Big interview (page 24).

Changing habits isn’t easy, whether it’s ditching the chocolate or quitting cigarettes. Turn to page 36 for tips on breaking those vicious circles, plus information on No Smoking Day. If you’re looking for inspiration to start exercising, read Simon Clark’s story (page 42) of learning to ride a bike, aged 49.

For BHFEditor: Sarah KidnerDeputy Editor: Sarah BrealeyProduction Editor: Daniela SchichorMedical Editor: Doireann MaddockHead of Heart Matters: Judy O’SullivanPrint: The Artisan Press Ltd

For WardourManaging Editor: Ruth GanthonySub Editor: Zoë SlaterArt Director: Daniel CoupeSenior Designer: Lynn JonesCreative Director: Ben BarrettProduction Director: John FaulknerProduction Artworker: Jack MorganAccount Director: Lucy Tatton-BrownAccount Manager: Joe FaithfullSenior Account Director: Andrew Strange Managing Director: Claire Oldfield Chief Executive: Martin MacConnol

HAVE WE GOT YOUR DETAILS WRONG?

Membership no.

Title First name Last name

The address this magazine was sent to

Postcode

If you answer any of the questions on this form, please make sure you fill in all of this section so that we can find your details.

This means we will stop posting the magazine to you, but you can still read it online at bhf.org.uk/heartmattersmag

Have you moved house?

Would you like to be an online-only member?

What is your old address?

My old address is City/Town

County Postcode Home phone number

What is your new address?

My new address is City/Town

County Postcode Home phone number

FILL IN THIS FORM, TEAR, FOLD, MOISTEN AND SEAL

Would you like to cancel your Heart Matters membership?

Yes, I would like to stop receiving the magazine by post.

Yes, please cancel my membership. I no longer wish to receive Heart Matters magazine or emails.

DUE TO THE TIME TAKEN TO PROCESS THIS INFORMATION, CHANGES MAY NOT HAVE BEEN MADE BEFORE THE NEXT ISSUE IS POSTED.

Please enter your email address here:

We’d be grateful if you could tell us the reason for cancelling your membership. This helps us to improve our service and make sure our records are up to date.

I don’t need it any more.

The person who normally reads it has passed away.

I no longer find it useful.

I get this information and support from somewhere else.

Other

If so, please explain where:

Stopping smoking is the single best thing you can do for your heart healthnosmokingday.org.uk

©Br

itish

Hea

rt F

ound

atio

n 20

14, r

egis

tere

d ch

arity

in

Engl

and

and

Wal

es (2

2597

1) a

nd in

Sco

tland

(SC0

3942

6).

no Smoking day12 march 2014


FREE

March/April 2014

How Eric battled heart disease while grieving for his wife and daughter

Weatheringthe storm




Freepost Plus RTCH-BSST-GALYHeart MattersValldata House2A Halifax RoadMELKSHAMSN12 6YY

COD

MORE THAN A MAGAZINE

FREE

Visit bhf.org.uk/heartmatters to discover what your Heart Matters membership gives you.

• An online version of Heart Matters magazine packed full of extras such as extended interviews, picture galleries and videos.

• Online tools, including a recipe finder, interactive eatwell plate and a fruit and veg portion guide.

• Email support on healthy eating, quitting smoking, getting active and improving wellbeing.

• Our online community where you can chat to others about your experiences. Visit community.bhf.org.uk.

Simon Whiteley, 67, Gloucestershire

Change of details? Let us know by completing the form opposite

And don’t forget, you can also call our Heart Matters Helpline, staffed by cardiac nurses and heart health advisers on 0300 330 3300 (lines are open 9am–5pm, Monday to Friday; costs are similar to 01 and 02 numbers).

I signed up to the Heart Matters motivational emails for extra encouragement”

Help us spread the wordIf you’re a healthcare professional, you can get multiple copies of Heart Matters magazine to distribute to your patients. Log in to your account at bhf.org.uk/heartmatters and go to the ‘My Account’ page to tell us you’re a healthcare professional and choose how many copies you’d like of each issue.

Fold along this line

FIGHTFOR EVERY HEARTBEATbhf.org.uk

WELCOME

2 Heart Matters

16

14

22

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 2014 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 2014. Heart Matters is printed on paper from sustainable forests. G204/0314

Sarah Kidner, Editor

Whether it’s rising fuel bills, growing food and housing costs or a static income, many of us are feeling the

pinch on the household purse and with the Budget coming up on 19 March, the issue is at the front of many people’s minds.

Food bills are one of the ‘elastic’ parts of the household purse and, therefore, an obvious target for saving money – but can you cut costs and stay healthy?

This is the challenge we set our dietitian Victoria Taylor. Her findings on page 26 include useful tips and suggestions for making healthy food on a budget. We also have some mouth-watering recipe ideas.

Maintaining a healthy diet is especially important if you have diabetes. In our Focus on feature (page 16) we speak to someone living with type 2 diabetes, a cardiologist, a professor of metabolic medicine and a senior dietitian.

Obese people have a higher risk of diabetes, a key risk factor for coronary heart disease. Find out how Professor Susan Jebb thinks we should be tackling the obesity crisis in our Big interview (page 24).

Changing habits isn’t easy, whether it’s ditching the chocolate or quitting cigarettes. Turn to page 36 for tips on breaking those vicious circles, plus information on No Smoking Day. If you’re looking for inspiration to start exercising, read Simon Clark’s story (page 42) of learning to ride a bike, aged 49.

For BHFEditor: Sarah KidnerDeputy Editor: Sarah BrealeyProduction Editor: Daniela SchichorMedical Editor: Doireann MaddockHead of Heart Matters: Judy O’SullivanPrint: The Artisan Press Ltd

For WardourManaging Editor: Ruth GanthonySub Editor: Zoë SlaterArt Director: Daniel CoupeSenior Designer: Lynn JonesCreative Director: Ben BarrettProduction Director: John FaulknerProduction Artworker: Jack MorganAccount Director: Lucy Tatton-BrownAccount Manager: Joe FaithfullSenior Account Director: Andrew Strange Managing Director: Claire Oldfield Chief Executive: Martin MacConnol

bhf.org.uk

Cove

r pho

togr

aphy

: Tom

Jack

son;

pho

togr

aphy

: Kei

th M

eath

erin

gham

, Will

iam

Sha

w

Online at bhf.org.uk/heartmattersmagn Find out more about how your

patient records could be shared. n Read the full stories of three of our

amazing researchers.n Get seven days of sample menus for

eating healthily on a budget.n All you need to know about what

to do when someone dies.n The Medical Director of the London

Marathon talks about how he works to keep the runners safe.n Inspiration to get on your bike from Bikeability instructor Rob Williams.n More of your letters.

Plus: past issues of Heart Matters magazine... healthy eating tools... email support... online community

26

42

Contents

3

I never thought I’d be able to ride a bike”

4 News Research and heart health stories, plus a special report on how sharing your medical records could help save lives

8 Your letters9 Day in the life: BHF volunteer

Meet BHF shop volunteer Vanessa Moores

10 Ask the experts Your health questions answered

12 Inspirational researchers For these BHF scientists, the fight against heart and circulatory disease is personal

14 World-class research talent Meet Kinya Otsu, who’s relocated from Japan to carry out research into heart failure

16 Focus on… living with diabetes20 Drug cabinet: aspirin

An expert answers common questions

22 Stopping the clots BHF-funded research could lead to the development of anti-clotting medications with fewer side effects

24 Nutritional values A leading nutrition scientist on the obesity crisis

26 Food for thought Tips and recipes to help you eat healthily on a budget

30 Focus on… eggs Secrets of the perfect poached egg

32 Weathering the storm How Eric Pemberton coped with the loss of his daughter and wife, plus serious heart problems

35 Break the habits of a lifetime It’s never too late to change bad habits; we’re here to support you

38 Coping with a death One woman’s moving story of losing her husband. Plus advice on dealing with bereavement

42 As easy as riding a bike Simon Clark on how Heart Matters got him learning to ride a bike as an adult

44 Going the extra mile Inspiring stories of people running the marathon to raise money for our life-saving work

47 Join the fight We meet Steve Syer, who’s been a BHF fundraiser for 30 years

49 Medical dictionary Medical terms demystified

50 Information and support Helping you live a heart-healthy lifestyle

48 Win

a luxury coastal break in Cornwall

bhf.org.uk

49

Angioplasty: A treatment to widen

a narrowed artery.

Atheroma: Fatty material (plaques) that can

build up within the walls of the arteries.

Bypass surgery: See Coronary artery

bypass graft.

Cardiac arrest: This is when a person’s

heart stops pumping blood around

their body and they stop breathing normally.

It is the ultimate medical emergency. Many

cardiac arrests in adults happen because the

person is having a heart attack.

Cardiomyopathy: A disease of the heart

muscle in which the heart muscle becomes

weakened. The heart muscle may become

thickened, enlarged and/or sti� , depending

on the type of cardiomyopathy. It a� ects

people of all ages and is usually inherited.

Cardiovascular disease (CVD): It includes all

diseases of the heart and circulation – for

example, coronary heart disease (angina

and heart attack) and stroke.

Coronary artery bypass graft: Sometimes

called ‘CABG’ or ‘bypass surgery’, this is an

operation to treat coronary heart disease.

The arteries from your chest wall or arm, or

veins from your leg, are used to bypass the

blocked or narrowed coronary arteries. This

helps to improve the � ow of blood to your

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 fatty

deposits called atheroma. CHD can lead to

angina or a heart attack.

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 is

unable to use the insulin that is produced

e� ectively, usually because excess fat in

organs leads to resistance to the normal

e� ects of insulin. Having diabetes increases

your risk of developing CVD.

Heart attack: The medical term for

a heart attack is a myocardial infarction,

or MI for short. This is when there

is a sudden loss of blood � ow

to a part of the heart muscle.

Most heart attacks are caused

by atherosclerosis, which is the gradual

build-up of atheroma (fatty material) within

the artery walls. If the atheroma becomes

unstable, a piece may break o� and lead

to a blood clot forming. This can block a

coronary artery, causing a heart attack,

which could lead to irreversible damage to

the heart muscle. A heart attack is a medical

emergency and can lead to a cardiac arrest.

Heart block: When the electrical

impulses of the heart are slowed

down, delayed or blocked.

Some heart blocks can cause

a bradycardia (a slow heart rate).

Heart failure: A condition where the heart

becomes less e� cient at pumping blood

around the body.

Heart transplant: An operation to replace

a diseased heart with a healthy heart from

a human donor.

High blood pressure: Also called hypertension,

this is when your blood pressure is

consistently higher than the recommended

level. The higher pressure puts extra strain

on your heart and blood vessels and, over

time, can increase your risk of having a

heart attack or stroke.

Hyponatremia: A condition that occurs

when the level of sodium in your blood

is abnormally low.

ICD: Also known as an implantable

cardioverter de� brillator, this is a small

device that is implanted in a person’s chest,

just under the skin, and is connected to

their heart by one or more wires (leads).

The ICD monitors the heart’s rhythm and,

if necessary, delivers a controlled electric

shock. This is called ‘de� brillation’ and may

be needed if a person has a life-threatening

abnormal heart rhythm.

Lipids: Also blood lipids. The name

given to all fatty substances in the

blood, including LDL cholesterol, HDL

cholesterol and triglycerides.

Obese: The term to describe when

someone is very overweight, with

too much body fat. Being obese puts you

at an increased risk of numerous health

problems, including CHD and diabetes.

Pacemaker: A small device that is

implanted in a person’s chest, just

under the skin, and is connected to their

heart by one or more wires (leads). It is

used to monitor the electrical signals

within the heart and can stimulate it

to contract and produce a heartbeat. A

pacemaker can be used to treat numerous

di� erent abnormal heart rhythms.

Peripheral arterial disease (PAD): Also called

peripheral vascular disease (PVD), this is

a condition that a� ects the arteries that

carry blood to your legs, arms and tummy

area. Over time, the arteries may become

narrowed due to atherosclerosis – the

gradual build-up of atheroma within the

artery walls. In most people who have PAD,

it is the lower part of the body, such as the

legs, that is a� ected.

Statins: A medicine to reduce

cholesterol levels in the blood.

Stroke: An interruption of blood � ow to

part of the brain, which can damage it.

This happens if an artery carrying blood

to your brain becomes blocked, or if

it bleeds into your brain. A stroke is

a medical emergency.

Sudden cardiac death (SCD): An unexpected

and sudden death, which is thought to be,

and usually is, caused by a heart condition.

MEDICAL DICTIONARY

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

B

A

C

D

L

H

P

S

See p44

See p16

O

I

MEDICAL TERMS

NEXT ISSUESpecial report on sex

and heart disease. Plus how one taxi

driver changed his lifestyle.See p32

54 Heart Matters

NEWSNEWS

5

Imag

es: G

etty

, iSt

ockp

hoto

12 March No Smoking Day – see pages 36–37 or visit nosmokingday.org.uk for more information.

27 April Hadrian’s Wall Hike – admire the World Heritage Site on this popular 10-mile hike. Visit bhf.org.uk/hadrians or call 0845 130 8663.

27 April Dorset Bike Ride – cycle through Dorset countryside on this event with routes for all abilities. Visit bhf.org.uk/dorset or call 0845 130 8663.

7 May Tower of London Run – join us at the world-famous moat to walk or run up to 10k. Visit bhf.org.uk/toweroflondonrun or call 0845 130 8663.

8 May Patients’ open day at the National Institute for Cardiovascular Outcomes Research, London – meet the team, join discussions on what information you want from their audits, and learn how you can get involved. To find out more, contact [email protected] or 020 3108 3895.

11 May Milton Keynes Mad May Dash – walk, run, hop or skip around Willen Lake, with prizes for the best fancy dress. Contact Georgia McCormack at [email protected] or call her on 01480 731086.

11 May Elmwood Cycle Ride – choose between 16- or 30-mile routes through Warwickshire countryside and raise money for our Mending Broken Hearts Appeal. Email [email protected] for a registration form or call Jean Lewis on 07791 506921.

17 May BHF Supporters Annual Open Day, West Region – an opportunity to meet the BHF-funded researchers in Birmingham. To register or find out more, contact Donna Stokes on 0121 353 2087 or email [email protected].

Dates for your diary

Using a simple urine test, researchers hope to identify those young people with type 1 diabetesD who may be at greatest risk of developing coronary heart diseaseD (CHD) in later life.

We helped fund the study, which could eventually lead to treatments to reduce the risk of CHD in some teenagers and young people with type 1 diabetes.

Having either type 1 or type 2 diabetes increases your risk of developing CHD. Research to find ways of reducing that risk is vital, and this is the first study of its kind.

Researchers examined the link between levels of a protein called albumin in the urine of adolescents with type 1 diabetes, and the markers that point to an increased risk of developing CHD. This part of the study was led by the University of

Cambridge, but our BHF Professor John Deanfield at University College London has also played a key role in the work.

The study will now explore whether prescribing statinsD and drugs that lower blood pressure can reduce the risk of CHD in those young people with type 1 diabetes who are most at risk.

Dr Sanjay Thakrar, our Research Adviser, said: “This exciting early finding shows that we could identify those young people with type 1 diabetes who are most at risk of developing CHD. The researchers now need to assess whether early treatment with standard heart medication could help to keep these young people’s hearts healthy in the future.”

≠ Read more about diabetes on pages 16–19.

Reducing heart disease risk in people with DIABETES

We’ve partnered with the website OriginalGiving to offer you, your family and friends big savings on great entertainment and leisure offers. Whether it’s a family day out to a theme park, learning something new or treating yourself to a spa day, OriginalGiving offers savings of up to 70 per cent off the normal purchase price while raising money for good causes.

The great news is that, while you’re having fun and saving money,

OriginalGiving will donate 50 per cent of their commission fee for every purchase to us.

OriginalGiving is available in many areas and is expanding to cover the whole UK later this year.

To start benefiting from these great offers, visit originalgiving.com/bhf to activate your account using code BHF13.

≠ Trying to cut costs? Turn to page 26 to learn about healthy eating on a budget.

Great savings for you and your family

Planning aheadWe’ve linked up with Golden Leaves Funeral Plans to help raise funds for the fight against heart disease.

Golden Leaves will donate £15 to us for every one of their FROM50 policies bought by July 2014. The policy, which gives full cover after just six months, is suitable for anyone aged between 50 and 75. As part of the partnership, Golden Leaves has committed to raise at least £10,000, helping us to power vital research and provide support for heart patients.

Find out more about Golden Leaves at goldenleaves.com or call 0800 854 448.

≠ Turn to pages 38–41 for more about coping with a death or leaving a legacy.

A big RED thank you On 7 February it was Ramp up the Red, when we asked people to go as red as they dared to raise money and help fight coronary heart disease – the UK’s single biggest killer.

Thank you to all of you who took part and went red, organised events or made a donation.

You might have seen our adverts in January and February. One of the stars of the campaign was Gretel, who was born with heart problems and stopped breathing when she was 21 days old. She’s now doing well and has started school. She and her dad Mark went red to help raise awareness and raise money for the BHF.

If you’ve got donations to pay in or want to sign up for Ramp up the Red 2015, visit bhf.org.uk/red or call 08000 316 316.

This March we will be launching a petition calling on the UK Government to take action on junk food marketing to children.

Children are still being targeted with adverts for processed foods and drinks high in fat, saturated fat, sugar and salt on television before 9pm and online. Children have a right not to be directly targeted by junk food companies. This practice is compromising parents’ efforts to keep their kids healthy in the context of a looming obesity crisis where about one in three children in the UK is already overweight or obese.

Join the campaign by signing the petition at bhf.org.uk/ditchthejunk.

Ditch the junk

In season in March and April Beetroot, blood oranges, leeks, purple sprouting broccoli, radishes, wild garlic.

The three winners of our October member-get-member campaign (which gave members the chance to win by recommending Heart Matters to a friend) were Keith Brown, Desna Jennifer Berry and Sybil Smith. They each win a multifunctional smoothie maker, blender, grinder and juicer.

76 Heart Matters bhf.org.uk

NEWS

Your medical records could help to improve care and even save lives. Sarah Brealey reports on an innovative project

An NHS programme is aiming to improve how your medical information is used to plan and improve health services.

It’s called the care.data project and if you live in England, you should already have received a letter telling you about it.

The BHF is one of more than 40 charities and organisations campaigning to raise awareness of the importance of medical records and help you understand how your information can be used and how it will be kept safe.

Patient information is already used widely across the NHS, but care.data aims to improve this. The idea is to transfer information from your GP surgery to the Health and Social Care Information Centre (HSCIC), a public body that collects health data. Thousands or even millions of records could then be combined to create powerful numbers that could show anything from more effective ways of preventing, treating and managing illnesses to which hospitals perform best.

The scheme does have its opponents, particularly those concerned about patient confidentiality or the idea that combined data could be sold to companies (individual records will not be sold). But it has the potential to save lives.

Life-saving researchMedical records are also a vital resource for researchers, who often rely on patient data to help research life-saving treatments.

Health researchers already have access to a system that allows them to use anonymised data. This is separate from care.data, but is also based on information from the HSCIC, so medical research will benefit from patient records being transferred.

Dr Chris Gale, Associate Professor of Cardiovascular Health Sciences at the University of Leeds, uses NHS data to study how patients with cardiovascular diseaseD are treated and how this affects their health, looking for opportunities to improve outcomes.

One of the problems with the data is that it is collected by different organisations, so is physically separate. If it could be linked, researchers could follow the pathway of events in great detail for thousands of patients. For example, some patients with high blood pressure have a higher risk of heart attackD, which can lead to heart failureD.

Dr Gale says: “The NHS and government bodies collect huge amounts of valuable clinical data. This has been collected over many years, and includes millions of patients. It would be wrong not to use this to improve patient care.”

Spotlight on... PATIENT RECORDS

NEWS

Behind the headlinesWhy a holiday really is good for you“Getting some sunshine can lower blood pressure and cut the risk of heart attacks and strokes.

“This is according to scientists in Southampton who have found sunshine can alter levels of the small messenger molecule, nitric oxide (NO), in the skin and blood.”

The BHF says: By demonstrating a mechanism by which UVA light can lower blood pressure, this small study (of just 24 people) suggests how the shortened hours of sunshine in the north of Europe may contribute to the known seasonal increase in blood pressure and risk of heart disease.

Though intriguing, much more work needs to be done to find out whether seasonal changes in blood pressure can really be attributed to exposure to sunshine, and what the practical implications could be.

Extra quarter ounce of fibre could be the secret to avoiding heart attack“Eating larger quantities of fruit and vegetables, wholegrains and beans could cut the risk of heart disease, according to a review of the impact of dietary fibre.“Experts found that every additional 0.25oz (7g) per day of fibre added to the diet – the equivalent of eating three apples – cut the risk of coronary heart diseaseD and cardiovascular diseaseD by 9 per cent.”

The BHF says: It’s well known that eating a diet rich in fibre will help keep our digestive systems healthy, but the link between fibre intake and cardiovascular disease risk is less clear.

The good news is that foods such as fruit, veg and pulses are easy to include within a balanced diet. The researchers suggest an extra 7g of fibre each day may help your heart. This is the same as a portion of wholegrains or a couple of portions of veg.

This story received widespread coverage, including in the Guardian, Mail, Telegraph, BBC News and others.

Effervescent or soluble medicines often contain added sodium. The researchers used a large research database to look at a group of people who had had a cardiovascular event and another group of the same age who hadn’t. Everyone in the study had been prescribed either medicines containing sodium or the equivalents without sodium at least twice in previous years (the average number of years covered was seven).

The medicines looked at were mostly painkillers – including paracetamol and aspirin – or vitamins and minerals, such as vitamin C, calcium and zinc.

The study found that people who had high blood pressureD or a strokeD were more likely to have taken the sodium-containing medicines than those who had not experienced these conditions.

This was a large study that covered more than 1.2 million patients in the UK. However, the study did not prove cause and effect. There could be other factors, such as the amount of sodium in the diet in the form of salt, which could have affected the results. Also, the study only looked at prescribed medicines. Many sodium-containing medicines are also available over the counter and we don’t know whether these were also consumed

by people taking part in the study.However, we do know that consuming

too much sodium is linked to high blood pressure, which raises your risk of heart attackD and stroke. The researchers found that taking the maximum daily dose of some medicines would on its own exceed the UK recommended daily sodium limits. It’s recommended that we stick to 2.4g or less of sodium a day (equivalent to 6g salt) to help keep our hearts healthy.

Dr Mike Knapton, our Associate Medical Director, said: “To give us an idea of whether these risks translate for medicines bought over the counter, we would need to see further research focusing on non-prescription medication.

“Our advice is to avoid effervescent preparations, which may contain salt. If you’re in doubt about what’s in your meds, have a look at the label. All medicines that contain at least 23mg of sodium in each dose are required to declare on their labelling that the product contains sodium. Medicines that contain less than 23mg are considered to have a very low level of sodium and are not a risk to health.

“The most important thing is that you don’t panic and stop taking your prescribed meds. If you’re at all worried about what’s in your meds, have a chat to your pharmacist or book an appointment with your GP.”

THE BHF’S VIEW

20 December 2013

Dr Gale acknowledges that some people will have concerns. “We need to reassure the public that this data will not be mishandled. Just as laboratory scientists have rules and regulations to abide by for human tissue samples, health science researchers also have regulations about how to handle clinical data.

“There is no need to identify specific patients – our research summarises overall effects. My belief is this is the way forward in applied health research.”

Addressing questionsIf you want to register an objection, you can say no to your identifiable information leaving your GP practice, or you can allow it to go to the HSCIC but not to be used outside the HSCIC. However, it would be more difficult to invite you to take part in clinical trials or relevant research studies. Tell your GP if you have concerns.

Professor Peter Weissberg, our Medical Director, said: “With the right safeguards in place to protect confidentiality, this new system will be of enormous benefit to patients and help reduce the burden of heart disease in future.

“Patients can choose whether or not to share their information. That’s why it’s important to raise awareness of the benefits access to patient records can bring so everyone can make the right choice. Personally, I will be allowing my own data to be shared.” n

For more information about the scheme, answers to common questions and useful links, visit bhf.org.uk/HMdata.

More online

“Soluble painkillers used by millions of people in Britain could pose a health risk because they are high in salt, UK researchers are warning.”

27 November 2013

20 January 2014HARD TO SWALLOW? THE TRUTH ABOUT SALT AND MEDICINES

NameGenderAddressNHS number, postcode, date of birth*

Codes in your medical record (which record diagnosis, test result, prescription or referral)

Notes in your medical record (for example, your occupation or how you told your doctor you were feeling)

Any sensitive information (such as sexually transmitted infections, pregnancy termination, convictions or abuse)

What information about me will be used?

*(These will just be used to link your record to a new, anonymous record and will then be deleted.)

Imag

e: iS

tock

phot

o

LETTERS DAY IN THE LIFE

98

Vanessa Moores works as a volunteer in the BHF shop in Hornchurch, Essex. She tells Sarah Kidner why the role is important to her, and to us

Q Why did you become a BHF volunteer?A I work as a self-employed balloon

artist and florist, and noticed a pattern that means I have some spare time at the beginning of the week. In February 2009, my dad died of a heart problem and we got information from the BHF, so it seemed natural to volunteer for you. I went into my local store in Hornchurch to ask if they needed any help and, of course, they said ‘yes please’.

Q What’s a typical day like?A I volunteer on Mondays and

Tuesdays. Typically on Monday morning, I concentrate on tagging Gift Aid donations, steaming and putting items out in the shop. In the afternoon, I operate the till, help and chat to customers, and make sure the shop is tidy and the rails and shelves are kept full. On Tuesdays, I collect people’s donations in the morning and work on the till again in the afternoon.

Q So, you pick up donations. How does that work?

A As I’m in the shop on a Monday, I check the collection docket book and take the addresses of donors that the team have arranged to pick up from on Tuesday. My mum also volunteers on a Tuesday,

so she comes with me in my car to help. We collect some lovely clothes, bric-a-brac and books. We also collect from our donation bins, which are in the local sports centre. Some days, I have to go back to the shop and drop off donations before I can finish the collections because the car is full.

Q What’s the best thing about volunteering for us?

A I enjoy doing the pick-ups because people are grateful we can come and collect things. Often I go back to see the same people, have a little chat and make sure they are OK. There is one lady I have been

to several times over the past 18 months or so. Sadly, her husband died of a heart attack and she wanted to clear out some of his things. Then I saw her again when she was clearing her house to move to be closer to her daughter, and now I see her in her new house and it’s nice to see her happy and settled. I enjoy working in the Hornchurch shop, as it is a great, lively team and we help and support each other. Plus, for me, it’s very rewarding and I feel

like I’m giving a little back to the BHF.

Q What’s challenging about your role?

A I work in one of the busiest shops for donations in our area,

so some days it can be non-stop with donations coming in. But Jo, our manager, is always enthusiastic and encouraging and helps us keep

going until the end of the day. Also steaming can be a little

hot on the occasional sunny days that we have.

When you work with a lovely management and volunteer team like at the Hornchurch shop, it most certainly is worth helping the BHF with the life-saving work that it does. n

YOUR LETTERSWe love to read your emails and letters so keep writing: [email protected] or Heart Matters, British Heart Foundation, Greater London House, 180 Hampstead Road, London NW1 7AW

Heart Matters bhf.org.uk

Call 0844 334 1414 or visit bhf.org.uk/collection. Call 0800 915 3000 to find your nearest shop and call 0800 138 6556 or visit bhf.org.uk/volunteer to enquire about volunteering.

Get involved

I enjoy doing the pick-ups. Often I go back to see the same people, have a chat and make sure they are OK”

To read more of your letters online, visit bhf.org.uk/HMmarchletters

Day in the life BHF VOLUNTEER

The winner of our star letter will receive a British Heart Foundation water bottle

Sharing personal experiences of your condition or treatment, or of how you’ve used BHF services can be a big help to others. If you’d like to be on a list of people willing to share their stories with Heart Matters, send details of your experience of a heart condition or how BHF resources have helped you to [email protected] with ‘Share my story’ in the subject line. Or write to Sarah Brealey, Heart Matters, British Heart Foundation, Greater London House, 180 Hampstead Road, London NW1 7AW.

Share your story

STAR LETTERI would like to thank you for Heart Matters magazine, which is always a good read.

About two years ago (Feb/Mar 2012), I read an article in the magazine that suggested that people with osteoarthritis might try aqua aerobics as a means of exercise for the heart. On investigation, I found that my local leisure centre ran convenient sessions twice a week, each lasting 45 minutes, so I signed up. When I can, I have attended the sessions and also cycled to the leisure centre.

I am amazed at the lack of men trying this wonderful exercise. Having said that, perhaps I should be pleased that I am the only man among 50 women!

This is no easy workout, the way I do it – as it is up to the user how they push themselves using the resistance of the water to work on the muscles without impact on the joints.

I would like to thank you for suggesting it.Dennis Wilkinson, Frimley Green, Surrey

Our physical activity specialist Lisa Purcell replies: It’s great to hear Dennis has been inspired by Heart Matters. Remember, if you have a heart condition, check with your GP before taking up a new exercise. Start at a pace you feel comfortable with, and build up slowly as you become more confident and improve your fitness. You can order back issues by calling 0870 600 6566.

Dementia treatment hopeI read Blood pressure drug could help with dementia (Jan/Feb 2014, page 4) with interest.

My late mother Margaret suffered from this condition. I have taken dementia training to help others and I am a dementia ambassador in Hull, speaking to people who suffer from the condition and their families and carers.

If this drug works for vascular dementia, it would bring a better quality of life to many who have the condition and to their carers. As your report says, amlodipine is low cost, safe to use and already licensed.

This could be a breakthrough and open a new world to sufferers and their carers – so I’m happy to hear this research is happening, it’s good news.David Treacher, Hull

Bereavement and cardiac rehabThe star letter in your Sep/Oct issue last year was a similar experience to what I went through. I lost my wife of 56 years to cancer; the loss is unbearable to endure.

Like Ronald Davison, one of the most important things for me was going to cardiac rehabilitation exercise classes. They were a great help to me after my surgery and since then. I would encourage everyone who gets the opportunity to go to them. Yours gratefully,Bill Adams, Glasgow

Editor Sarah Kidner replies: We’re very sorry to hear about the loss of your wife. You may like to read Sandra’s experience of coping with bereavement on pages 38–41. You’ll also find some practical support on what to do when you lose a loved one.

4

Heart Matters

Thanks to your support, a 4p per day

drug for high blood pressure could

become the fi rst-ever treatment for

one of the most common forms of

dementia within a decade.

The BHF and the Alzheimer’s Society

are funding a groundbreaking £2.25m

clinical trial at Queen’s University Belfast

to test amlodipine in nearly 600 people

with vascular dementia.

Vascular dementia is caused by

problems with the blood supply to the

brain and aff ects more than 150,000

people in the UK. Those with high

blood pressure, coronary heart diseaseD,

high cholesterol and diabetesD are

especially at risk.

Researchers, led by Professor Peter

Passmore, hope to show that 10mg a day

of amlodipine can signifi cantly improve

memory and cognitive health. They

think it may work by protecting brain

cells from damage when blood supply

to the brain is poor.

As amlodipine is already licensed and

known to be safe, the treatment – which

costs the NHS just £1.07 a month per

patient – could be in use within fi ve to

ten years, as opposed to decades if a

new drug were to be developed.

Amlodipine belongs to a class of

drugs known as calcium channel

blockers, which are widely used to

treat high blood pressure.

Professor Peter Weissberg, BHF Medical

Director, said: “If positive, the study will

soon pave the way for an aff ordable

treatment for vascular dementia.”

NEWS

Imag

es: S

cien

ce P

hoto

Lib

rary

, iSt

ockp

hoto

18 January Registration for the London

to Brighton Bike Ride opens at 10am.

You’ll have to be quick if you want to

join 28,000 people for the largest charity

bike ride in Europe. In its 39-year history,

the event, supported by Santander, has

seen more than 750,000 people pedal

54 miles, raising more than £60m to fi ght

heart disease. Visit bhf.org.uk/L2Bday.

7 February Ramp up the Red! See right

for more details.

16 February Valentine Walk, Blackpool

– a three- or six-mile circular walk

around the stunning parkland and lake

estate of Herons’ Reach, De Vere Hotel,

Blackpool. Contact Barbara Dunn on

01772 641870 or [email protected].

8 March International Women’s Day –

we’re profi ling some of the women who

play important roles in improving the

UK’s heart health. Vote for your favourite

at bhf.org.uk/womenwithheart.

12 March No Smoking Day – see page

38 for more information.

15 March Everest Base Camp Trek –

enjoy breathtaking Himalayan scenery

on this epic 16-day challenge. Visit

bhf.org.uk/everest or call 0844 847 2788.

16 March Wyre Forest Jog – run 5km

or 10km on undulating, leafy paths. Visit

bhf.org.uk/wyre or call 0845 130 8663.

23 March London to Reading Bike

Ride – visit bhf.org.uk/londontoreading

or call 0845 130 8663 to fi nd out more

about this 40-mile challenge.

23 March Warwick Half Marathon –

run through gorgeous Warwickshire

countryside on traffi c-free roads. Visit

bhf.org.uk/warwick or call 0845 130 8663.

Dates for your diary

BLOODPRESSUREDRUGcould helpwith dementia

In season in Januaryand February Clementines, kale, Jerusalem

artichokes, parsnips and swede


ASK

THE

EXPE

RTS

If you have a heart health concern, the Heart Matters panel of experts is here to help

Call the Heart Matters Helpline on 0300 330 3300 for more information. To suggest a question, email [email protected].

Have a question for the team?

MEDICAL MEDICAL

Travelling with a pacemaker

is a registered dietitian. She has worked for the NHS on programmes to prevent cardiovascular diseaseD. She advises on diet and nutrition.

Victoria Taylor

Q I have a pacemaker D and I am going on holiday shortly. What do I have to consider when travelling?

A Pacemakers are small electrical devices implanted in patients, either to control the rhythm of the heart or improve the pumping of the heart. Because they are electrical, there is an understandable concern among many patients about the effect of airport security systems on the pacemaker.

I would advise that you show your device identification card, which should have been given to you when your pacemaker was implanted, to the airport staff. It is safe to pass through the security system at a normal walking pace, as modern pacemakers and other implantable devices such as ICDsD are well shielded against outside interference. It is worth remembering though, that the metal casing of the pacemaker may trigger the security alarm. Under these circumstances, you may be searched with a hand-held metal detector. This is also safe, but it should not be placed directly over the device for longer than necessary.

In short, pacemakers are very effective and a safe treatment for some patients with heart problems, and shouldn’t prevent you from travelling.

page 32A journey through grief and heart disease

page 24How the UK is tackling the obesity crisis

THE BIG INTERVIEW

NutritionalVALUES

Dr Susan Jebb OBE is a nutrition scientist and obesity expert with more than

20 years’ experience. She

talks to Sarah Kidner about

the obesity crisis and how

the UK is helping to tackle it

24

Heart Matters

Reading Dr Susan Jebb’s CV, it’s easy to

see why she’s one of the UK’s leading

obesity experts. Until recently she

was Head of Diet and Population Health

at the Medical Research Council Human

Nutrition Research unit in Cambridge,

she is a member of the Public Health

England Obesity Programme Board and

chairs the Department of Health Public

Health Responsibility Deal food network

(brokering voluntary agreements with

the food industry). Currently, she is

Professor of Diet and Population Health

in the Department of Primary Care Health

Sciences at the University of Oxford.

After training as a dietitian, Dr Jebb

has spent years studying large groups of

people, getting them to change their diet

and testing the outcomes of these changes

with a view to reducing health risks.

“The quality of your diet matters but

the single most important thing in terms

of diet is to control your weight,” she says.

“Overweight people who lose just 5kg of

weight show a measurable improvement in

their blood lipidsD and their blood pressure,

and a reduced risk of developing diabetesD.”

Obesity crisisThe focus is important in the face of a

genuine obesity crisis. Today, 25 per cent

of the adult population is obese – a body

mass index (BMI) equal to, or greater than,

30kg/m2 – compared with 6 per cent of the

adult population in the 1980s.

“The scale [of obesity] is worrying but

more worrying is the enormous plethora

of ill-health that comes with it. Obesity is

the canary in the coal mine,” says Dr Jebb.

“It’s very visible and while in itself it may

not be the most important issue, if you

are overweight or obese your chance of

developing heart disease and diabetes

increases dramatically.

“Obesity is blighting people’s lives

and it clearly adds a huge burden to the

healthcare system at a time when we are

all getting older and we all need more

complex health and social care.”

Understanding the causes of the crisis

isn’t easy. “This isn’t a national collapse of

willpower; there’s something else going on.

One of the reasons why we think obesity has

bhf.org.uk

THE BIG INTERVIEW

We o� er resources and tools that can help you to maintain

a healthy weight, or to achieve sustained weight loss. Order

or download information from bhf.org.uk/HMpublications

including Eating well, Cut down on salt and So you want to lose

weight… for good. You can also order our Cut the saturated fat

wall chart (M4). See page 50 for a full list of booklets and codes.

Visit bhf.org.uk/eatwellplate to � nd out about balanced

diets. Check your BMI using our online calculator at

bhf.org.uk/bmi or use the tape measure from your

membership pack. Search for healthy recipes

at bhf.org.uk/recipe� nder.

Support from the BHF

become so much more common is that we

are surrounded by food everywhere we go.

Our biology is set up to encourage us to eat

food when it’s available. Combine this with

an environment where food is everywhere,

and you have got a catastrophic mix.”

Other factors are behavioural. “If

somebody comes into the o� ce today

with a birthday cake, I would probably

have a piece before I have really thought

about the extra calories.

“The things we think of as decisions

about food are usually not re� ective

decisions; they are impulsive actions that

are stimulated by the environment, whether

that’s the micro-environment at home or at

work, but also the wider food environment

in supermarkets and on the high street.”

Tackling the crisis, togetherTackling obesity will depend on individuals,

the health service, government and the

food industry working together.

Dr Jebb says the health service needs

to provide more support through the GP

system and by referring people to weight

loss programmes.

“I think we have got to embed weight

management services into the health

service in the way that we have with

smoking cessation services. With so many

people su� ering from obesity we need to

look at the delivery of care and how we can

help people who are overweight to access

support services,” she adds.

In addition, everyone could bene� t from

changes in the food supply and Dr Jebb

is convinced that working with the food

industry is a necessary part of the solution.

Through the Public Health Responsibility

Deals (voluntary agreements with the food

industry), manufacturers have reduced the

amount of salt, saturated fats and calories

in some foods but there is, says Dr Jebb,

still a long way to go.

“We’ve seen real improvements

in individual products and a greater

choice of healthier options, but the food

industry also shapes our choices through

advertising and marketing. What’s on

promotion, what do you have a discount

voucher for, where is food positioned in

the shop. I would like to see the food

industry producers, manufacturers and

retailers actively steer people towards

the healthier choices.”

Importantly, these changes will help

everyone reduce their risk of obesity, but

they will also bring wider bene� ts. “Let’s

not forget, eating less saturated fat and salt

together with more fruit and vegetables

is going to reduce your risk of heart disease

– whatever your weight,” she says. ■

25

Retailers have a responsibility to promote

healthier options

Phot

ogra

phy:

Joha

nna

War

d; Im

age:

Get

ty

32

MY STORY

The person who has passed on would want you to carry on and live life to the full”

33

MY STORY

Phot

ogra

phy:

Tom

Jack

son

Eric Pemberton had a heart attackD and bypass

surgeryD while he was dealing with his daughter’s

terminal illness. He was so distraught over his

daughter that he hardly cared about himself.

But he survived and, despite the loss of his daughter,

aged 21, and then his wife, plus his own serious health

problems, he manages to keep a positive attitude to life.

He says: “I feel young at heart and delighted

I survived. I am 83 but I feel about 53.”

Dealing with lossEric’s youngest daughter Gayle was in her second year

at univ ersity when she came home feeling unwell.

When she was diagnosed with acute leukaemia, she

was told she might only live for a few days. In fact she

carried on for 18 months and Eric, who had been made

redundant from his job as a television engineer, nursed

her during that time.

He says: “My daughter’s death was the biggest

tragedy ever. She was so alive. She was a determined

young lady, she had three jobs and was doing well at

university. She could have done so much and it is a loss

to society that she is gone.

“I still suff er from Gayle’s death. I still shed tears for

her. I don’t think I will ever really get over it, but you

have to put it behind you. You have to understand

that the person who has passed on would want you

to carry on and live life to the full, because they loved

you so much.” It was during Gayle’s illness that Eric had his heart

attack, in 1994. He said: “At fi rst, I didn’t really know

what was going on. When I was told what had

happened, I wasn’t scared. I just thought ‘this is life’.

THE STORMEric Pemberton has battled the loss of a daughter and a wife,

as well as serious heart problems. He tells Sarah Brealey how

he has stayed strong

“I was in hospital after my heart attack when my

daughter was extremely poorly. She visited me

when she herself was too ill to walk up the stairs.

The terrible thing is that I survived and she did not.

“I would gladly have given up my life if it would

have meant that she survived.”

Gayle died in 1996, and in 1997 Eric was told he

needed bypass surgery. He says: “I was still shattered

from the loss of Gayle and I didn’t care whether I lived

or died. But I survived and I went home to my wife.

“I just focused on following the instructions the

doctors gave me. I tried to put everything that

happened behind me and live my life.”

A decade later, Eric’s wife Trish died, after 48 years

of marriage. He says: “She was a fantastic wife. I am so

sad that we didn’t make it to 50 years. She was very ill

at the end. One of the last things she did for me was

buy a card for our anniversary, and she wrote in it

‘I love you immensely’. That meant a lot to me.”

Eric mourned his wife, but he says the loss of Trish,

72, was easier to deal with than that of his daughter

at such a young age, because at least Trish had

enjoyed a full life and seen her children grow up.

Living life to the fullEric believes in making the most of what life has

to off er, especially if you have a heart condition.

To him, that means enjoying hobbies and interests,

and having new experiences.

“I think sometimes people who have heart

problems just sit by the fi re and wait to die,” he

says. “You have to not give up, but go out and do

things. If you want to go on holiday abroad or

Weathering

bhf.org.ukbhf.org.uk

49


a narrowed artery.




bypass graft.































































around the body.



a human donor.










is abnormally low.


















































MEDICAL DICTIONARY


B

A

C

D

L

H

P

S

See p44

See p16

O

I

MEDICAL TERMS




Medical dictionary Medical words, identified by a small symbol D, are explained in plain English in our dictionary on page 49

Imag

es: G

etty

Smoothing the wayQ I always thought that pure fruit

juices and smoothies were a healthy drinks choice but when I looked at the traffic light labels recently I noticed that they are high in sugar. Are they any better than fizzy drinks?

A Drinks such as fruit juice and smoothies that contain naturally occurring sugars have the advantage that they tend to contain additional nutrients, such as vitamins and minerals. They can also help you towards your 5-a-day. A 150ml glass of juice counts as one portion once a day, while smoothies

can contain up to two portions per day (based on them containing 150ml of pure juice plus 80g of whole fruit/vegetable pulp, or two 80g portions of fruit pulp from two different fruits/

vegetables). Drinks with added sugar, on the other hand,

tend to only provide us with energy (calories)

and few other nutrients, if any.

But it’s important to note that you can’t get more than one

is the BHF Associate Medical Director (Prevention and Care). He oversees the work the BHF does to help people reduce their risk of heart disease.

Dr Mike Knaptonof your 5-a-day from juice, or two from smoothies, however much you drink. One of the reasons for this is the amount of energy that these drinks provide. A glass of cola has a similar amount of energy to an equal-sized glass of juice and a smoothie can have even more. Too much energy, from any source, will lead to weight gain.

As well as naturally occurring sugars, watch out for added sugars too. Fruit nectars and ‘juice drinks’ often contain added sugars, especially the more exotic fruit juices such as peach, mango or lychee juice. Smoothies also often come with additional sweetness in the form of honey, syrups or nectars – whichever name is used, it is still added sugar.

So if the choice is between a sugary fizzy drink and a fruit juice/smoothie, then pure fruit juices and smoothies can be a more nutritious choice. These are fine as a once-a-day addition to your diet, but it’s better to drink water and other sugar-free drinks on a more frequent basis.

In terms of traffic light labels, you might notice a change on your fruit juices and smoothies as some of the amber colours for sugars might have turned red. This isn’t because the amount of sugar has increased, but simply that the new labelling format means that all sugars are now treated equally, wherever they come from.

Previously, foods and drinks with only naturally occurring sugar would have only had an amber colour coding, while drinks with the same amount of added sugars would have been red.

≠ For more about the new food labels, visit bhf.org.uk/HMlabels or order our Jan/Feb 2014 issue on 0870 600 6566.

Building strengthQ I’m 55 and I make sure I get at least

150 minutes of moderate-intensity physical activity every week, but I’ve heard that I should also be doing muscle-strengthening activities too. Does this mean I need to join a gym and start lifting weights or are there other options?

A Physical activity is very important for health, and to stay healthy or to improve your health you should do both aerobic and muscle-strengthening activities regularly. Congratulations on getting at least 150 minutes of moderate-intensity physical activity every week; this covers you for aerobic activities.

Muscle-strengthening activities that work all major muscle groups (legs, hips, back, abdomen, chest, shoulders and arms) are also important and can help prevent osteoporosis (thinning of the bones) as well as improve strength, body shape and balance. It’s recommended that you do muscle-strengthening activities on at least two days a week. This is in addition to the recommended minimum of 150 minutes of moderate-intensity physical activity.

Lifting weights is one type of muscle-strengthening activity, but there are many other options to choose from. Others

is a physical activity specialist with more than eight years’ experience working with the BHF. Lisa manages a range of health projects.

Lisa Purcell

page 20Common questions about aspirin answered

20

Heart Matters

MEDICAL

Imag

e: G

etty

Q Why have I been prescribed aspirin?

A Typically, a daily, low dose of aspirin (75mg) is

prescribed for people who have a cardiovascular

diseaseD, such as peripheral arterial diseaseD, or who

have had a heart attackD or certain types of strokeD.

It’s prescribed in this form to reduce the risk of blood

clots forming (we call this thinning the blood). What

we mean by this is that aspirin can inhibit circulating

blood cells known as platelets. One of the most

important protective roles of platelets is to stick

together and block cuts and breaks in blood vessels,

so they are important in normal health. However,

in people at risk of heart attacks and some kinds of

stroke, platelets can stick together inside blood vessels

causing a clot and stop blood � owing to the heart or

brain. Aspirin reduces the chances of this happening,

which makes it useful for patients at risk.

Q How does it work? A The way in which aspirin works was discovered

by the British researcher Sir John Vane about

40 years ago. He showed that aspirin blocks an enzyme

called cyclooxygenase. Cyclooxygenase produces

a range of hormones known as prostanoids. In the

blood, these prostanoids cause platelets to stick

together, so blocking cyclooxygenase with aspirin

reduces the formation of blood clots. Prostanoids

also a� ect in� amed areas of the body, such as sprains

and damaged joints. This is why in the past aspirin

was used as a painkiller and anti-in� ammatory drug.

However, much higher doses are needed to inhibit

pain and reduce in� ammation than to reduce the

risk of blood clots, and we now use non-steroidal

anti-in� ammatory drugs such as ibuprofen, which

are better at this.

Q Should we all take daily aspirin to prevent

blood clots?A Current thinking doesn’t recommend this. If you

have a cardiovascular disease, particularly if you have

had a heart attack or stroke, studies have shown that

the bene� ts of taking aspirin far outweigh the risk of

Tim Warner is Professor of Vascular

In� ammation at Barts and The

London School of Medicine and

Dentistry. He has investigated the

mechanism of action of drugs

that are used in cardiovascular

medicine for more than 25 years.

Doireann Maddock is a senior cardiac nurse with more

than ten years’ experience. She has

worked internationally in areas such

as heart and lung transplant and

cardiothoracic surgery.

Q

A

People with cardiovascular disease

may be prescribed a low dose of aspirin

to help prevent blood clots. Doireann

Maddock puts some common questions

about them to Professor Tim Warner

Drug cabinet:ASPIRIN

Fast facts● 75mg – a low dose of aspirin is often

prescribed if you have cardiovascular disease

● British researcher Sir John Vane

discovered how aspirin works 40 years ago

● Bleeding is the most common side effect

21

bhf.org.uk

MEDICAL

Download our free booklet Medicines for the heart at

bhf.org.uk/HMpublications or call 0870 600 6566.

Find out more

side e� ects. But for people without a cardiovascular

disease, the risk of side e� ects outweighs the bene� t

of preventing blood clots.

Q What are the possible side effects?

A The most likely side e� ect is an increased risk

of bleeding because aspirin reduces the risk of

platelets sticking together. Generally, these bleeds

are very minor, but occasionally patients may

experience severe bleeds. These are most commonly

in the stomach or intestines, where they can cause

substantial and occasionally life-threatening blood

loss. They are more likely to happen if you have a

stomach or duodenal ulcer. Symptoms of this type of

severe bleed include upper abdominal pain, passing

blood or black stools, or vomiting blood. If this

happens, seek urgent medical attention.

Severe bleeds may also occur in the brain, leading

to a strokeD. These rare, but potentially very dangerous

and severe, side e� ects explain why aspirin is not

recommended to be taken by otherwise healthy people.

Occasionally, people who have asthma � nd they are

sensitive to aspirin and that it can cause an asthmatic

attack. Anyone who su� ers from asthma should avoid

aspirin and other non-steroidal anti-in� ammatory

drugs such as ibuprofen.

Q Is there a reason why my GP wouldn’t prescribe

me aspirin?A The most likely reason is because you have

previously been found to be sensitive to the asthmatic

e� ects of aspirin or other non-steroidal anti-

in� ammatory drugs. Another reason may be that you

have a medical history of bleeding in the stomach or

intestines. Your doctor would consider the balance of

bene� ts versus risks in situations such as this.

Q What’s the alternative to aspirin?

A People who are advised to take an aspirin by their

doctor but can’t, most commonly because they are

sensitive asthmatics, can sometimes take the drug

clopidogrel. This drug inhibits the blood platelets but

doesn’t a� ect cyclooxygenase.

Q Are there any foods that I should avoid?

A There are no foods that you speci� cally need to

avoid if you are taking aspirin.

Q What if I have a pain and want to take another

type of painkiller? A The general recommendation would be to try

paracetamol � rst of all. Avoid high doses of non-

steroidal anti-in� ammatory drugs such as ibuprofen

without � rst discussing with your doctor, as the

combination with aspirin increases the risk of bleeding.

Q Are there any other medications I should avoid

if I’m taking aspirin?A As with all drugs, it’s vital that you discuss

with your doctor or pharmacist before taking any

additional medication. ■

bhf.org.uk

49

Angioplasty: A treatment to widen a narrowed artery.

Atheroma: Fatty material (plaques) that can build up within the walls of the arteries.

Bypass surgery: See Coronary artery bypass graft.

Cardiac arrest: This is when a person’s heart stops pumping blood around

their body and they stop breathing normally. It is the ultimate medical emergency. Many cardiac arrests in adults happen because the person is having a heart attack. Cardiomyopathy: A disease of the heart muscle in which the heart muscle becomes weakened. The heart muscle may become thickened, enlarged and/or sti� , depending on the type of cardiomyopathy. It a� ects people of all ages and is usually inherited.Cardiovascular disease (CVD): It includes all diseases of the heart and circulation – for example, coronary heart disease (angina and heart attack) and stroke.Coronary artery bypass graft: Sometimes called ‘CABG’ or ‘bypass surgery’, this is an operation to treat coronary heart disease. The arteries from your chest wall or arm, or veins from your leg, are used to bypass the blocked or narrowed coronary arteries. This helps to improve the � ow of blood to your 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 fatty deposits called atheroma. CHD can lead to angina or a heart attack.

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 is

unable to use the insulin that is produced e� ectively, usually because excess fat in organs leads to resistance to the normal e� ects of insulin. Having diabetes increases your risk of developing CVD.

Heart attack: The medical term for a heart attack is a myocardial infarction,

or MI for short. This is when there is a sudden loss of blood � ow to a part of the heart muscle. Most heart attacks are caused

by atherosclerosis, which is the gradual build-up of atheroma (fatty material) within the artery walls. If the atheroma becomes unstable, a piece may break o� and lead to a blood clot forming. This can block a coronary artery, causing a heart attack, which could lead to irreversible damage to the heart muscle. A heart attack is a medical emergency and can lead to a cardiac arrest.

Heart block: When the electrical impulses of the heart are slowed down, delayed or blocked. Some heart blocks can cause

a bradycardia (a slow heart rate).Heart failure: A condition where the heart becomes less e� cient at pumping blood around the body.Heart transplant: An operation to replace a diseased heart with a healthy heart from a human donor.High blood pressure: Also called hypertension, this is when your blood pressure is consistently higher than the recommended level. The higher pressure puts extra strain on your heart and blood vessels and, over time, can increase your risk of having a heart attack or stroke.Hyponatremia: A condition that occurs when the level of sodium in your blood is abnormally low.

ICD: Also known as an implantable cardioverter de� brillator, this is a small

device that is implanted in a person’s chest, just under the skin, and is connected to their heart by one or more wires (leads). The ICD monitors the heart’s rhythm and, if necessary, delivers a controlled electric shock. This is called ‘de� brillation’ and may be needed if a person has a life-threatening abnormal heart rhythm.

Lipids: Also blood lipids. The name given to all fatty substances in the

blood, including LDL cholesterol, HDL cholesterol and triglycerides.

Obese: The term to describe when someone is very overweight, with

too much body fat. Being obese puts you at an increased risk of numerous health problems, including CHD and diabetes.

Pacemaker: A small device that is implanted in a person’s chest, just

under the skin, and is connected to their heart by one or more wires (leads). It is used to monitor the electrical signals within the heart and can stimulate it to contract and produce a heartbeat. A pacemaker can be used to treat numerous di� erent abnormal heart rhythms.Peripheral arterial disease (PAD): Also called peripheral vascular disease (PVD), this is a condition that a� ects the arteries that carry blood to your legs, arms and tummy area. Over time, the arteries may become narrowed due to atherosclerosis – the gradual build-up of atheroma within the artery walls. In most people who have PAD, it is the lower part of the body, such as the legs, that is a� ected.

Statins: A medicine to reduce cholesterol levels in the blood.

Stroke: An interruption of blood � ow to part of the brain, which can damage it. This happens if an artery carrying blood to your brain becomes blocked, or if it bleeds into your brain. A stroke is a medical emergency.Sudden cardiac death (SCD): An unexpected and sudden death, which is thought to be, and usually is, caused by a heart condition.

MEDICAL DICTIONARY


B

A

C

D

L

H

P

S

See p44

See p16

O

I

MEDICAL TERMS



driver changed his lifestyle.

See p32

Medical dictionaryMedical words, identifi ed by a small

symbolD, are explained in plain

English in our dictionary on page 49

If you have a cardiovascular disease, the benefi ts of taking aspirin far outweigh the risks”

include using resistance bands (look out for our feature in May); doing exercises that use your body weight for resistance (such as push-ups and sit-ups); heavy gardening such as digging and shovelling; carrying shopping bags; or doing yoga or Pilates.

If you have high blood pressureD or a heart condition, it is important that you check with your doctor or cardiac rehab team before doing any new type of exercise, in case they are not suitable for you.


MY STORYMY STORY

1312

Inspirational RESEARCH

Understanding inherited heart conditions, preventing suffering or finding a cure for heart failure are all things that motivate

BHF-funded researchers, discovers Sarah Brealey

For more details and images of these researchers’ work, plus how Sam applies his knowledge to his own lifestyle, and how Suwan went from engineer and rugby player to biologist, visit bhf.org.uk/HMresearchers.

More online

Winning the fight against heart and circulatory disease requires dedication, patience and commitment, qualities BHF-funded researchers embody. For many researchers, the fight is personal.

Mike’s storyHypertrophic cardiomyopathyD runs in Mike Dodd’s family. The disease can cause the muscle wall of the heart to become thickened, and can lead to shortness of breath, chest pain and irregular heart rhythms. The severity of the symptoms can vary from one person to another. In a few cases, it can cause sudden cardiac deathD.

The condition is usually inherited, and Mike’s father Ian has it, as do his cousins. It led Mike to become interested in cardiology, and then to what he describes as his “perfect job”, initially researching a PhD and now as a postdoctoral researcher at Oxford University. He works with Dr Damian Tyler and BHF Professor Hugh Watkins, who has led the way in finding the genetic mutations that cause hypertrophic cardiomyopathy.

He says the family connection spurs him on in his daily work: “I think about my dad’s condition and the number of people who suffer from heart conditions.”

Mike and his younger brother do not show any signs of hypertrophic cardiomyopathy, but genetic tests three years ago showed that they carry the gene that causes it. He now has check-ups every two years.

Mike works with magnetic resonance imaging (MRI), which uses powerful magnets to create detailed images of the inside of the body. In particular, he’s looking at the way the heart uses energy, and how this changes after a heart attackD or in conditions such as diabetesD or cardiomyopathy. Understanding this may lead to being able to save parts of the heart muscle after a heart attack.

“I started in Oxford five years ago doing a PhD, funded by the BHF,” he says. “I am now funded as a postdoctoral researcher, and we are part of the BHF-funded Centre

of Research Excellence. That is why I have done the London to Brighton Bike Ride five times and the Blenheim Palace Half Marathon; to give something back.”

Suwan’s storySuwan Jayasinghe was inspired to become a researcher by health problems in his own family. “My grandmother survived six or seven heart attacks and it was on the seventh or eighth that she passed away,” he says. “I was about 15 or 16 when she died and it had a great effect on me.”

Twenty years later, Suwan is a group leader at University College London, working on techniques that could help to repair damaged hearts. He’s so driven that he starts work at 4.30am. He says: “John Fenn, a former colleague who won a share of the Nobel Prize for Chemistry in 2002, said to me ‘Your life on this planet is finite, so if you are thinking about sleeping, wait till you die’.”

Suwan’s research focuses on electrospraying technology, which uses thousands of volts to create living tissue. A needle is filled with human cells and a natural polymer such as collagen, and connected to a power supply, with an electrode beneath it. The electrical charge between the needle and the electrode means the mixture can be sprayed and

placed precisely to build up human tissue. “Not being able to do what you want on

a day-to-day basis because of your health can really hurt. So if I can contribute to removing ill-health or reducing it, then that’s very important to me.

“The icing on the cake for me personally would be to see this technology being used to treat patients in the future. That would be a great result for the efforts of our team and the fundraising efforts of the BHF.”

Sam’s storySam Boateng has seen close members of his family die from heart problems. “My grandmother and cousin suffered from heart failureD, which cost them their lives,” he says. “My mother has heart failure and my dad had a strokeD. I have seen what it is like to have cardiovascular diseaseD and I know the impact that it can have on families, as well as the impact on society and the NHS.”

It’s this that drives Sam’s work, and his family experience and professional knowledge mean he knows the importance of being healthy. He also does outreach work, explaining to people how they can reduce their own risk of heart and circulatory disease.

“If I didn’t have a job doing this then I would still do it as a hobby,” he says. “I am

fortunate that it puts food on the table, but that’s not the reason I do it.”

Sam is studying the causes of heart failure, in particular the effect on the heart if it experiences a high workload, for example if someone has high blood pressure.

He is looking at proteins in the heart, which act like sensors to detect increases in how hard the heart needs to work. “When the heart is put under long periods of stress, those sensors start to behave abnormally and then the heart is no longer able to react to stress in the way it should,” he says. “You then get a downward spiral that leads to heart failure.

“Understanding the mechanism that leads to disease is a step towards both prevention and future cure.”

Sam has been funded by the BHF for his PhD and his current research. He says: “Death rates from cardiovascular disease have gone down in recent decades and that is mainly because of scientific research. The BHF is the biggest funder of cardiovascular research in the UK. So please support them, and help in the fight.” n

Mike Dodd, post-doctoral researcher,

Oxford University

Suwan Jayasinghe, group leader,

University College London

Sam Boateng, Lecturer in Biomedical Science,

University of Reading

I am fortunate my job puts food on the table, but that’s not the reason I do it”

13

15

RESEARCHRESEARCH

Although it’s only a couple of years since Professor Otsu relocated here from Japan to become a BHF Professor of Cardiology, he

already seems at home in the BHF Centre of Research Excellence at King’s College London. He brings with him an international reputation founded on 20 years working at Japan’s Osaka University.

The decision to relocate was, says Professor Otsu, “not very difficult”. This is partly due to the unique way that we fund the Centres of Research Excellence, which are designed to foster new talent, and multidisciplinary research departments.

Professor Otsu explains: “There are many people who come to London from all over the world. I wanted to be able to interact with that international research community, and also educate the international students who come here. The BHF Centre of Research Excellence has a good environment

which means I can communicate with people with various specialties.

“Since I spent a lot of time in the US and Europe, I have many friends there who have become professors. I have good relationships with them and it means we can work together to develop new things. Our team can develop a model for disease and we use that model for cardiovascular research, but it can also be used for other diseases; many people ask to collaborate with us.

“One of the fun parts of science is that we can interact and help each other.”

Making the transitionThe decision to move was made easier thanks to

the support of BHF Professor Ajay Shah, who leads the King’s College Centre, and who approached Professor Otsu during an international conference hosted at the Centre of Research Excellence.

“It gave me a chance to see the faculty and, a couple of weeks later, Ajay asked me whether I wanted to come and work here,” says Professor Otsu.

As well as relocating himself, Professor Otsu has brought with him four Japanese team members. Three of them are former students. “We know each other very well – one of them, Dr Kazuhiko Nishida, was actually my first PhD student.

“We have worked together for over 20 years so it’s fantastic he has decided to come with me. Ajay allowing me to bring my people made the decision to come easier.

“Kaz [Dr Nishida] is the only one who has experience of working abroad but the others seemed excited to work in a different culture, and to come here together.”

A successful start Two months before the move, Professor Otsu came to set up his lab. It was, he says, an exciting day. “I bought everything using the BHF grant. I felt I could start a new laboratory and continue with my work.”

Professor Otsu has made great strides in his work looking at the mechanisms that underlie cell death in heart failureD, a condition that affects more than 750,000 people in the UK. He has discovered a new clue to what that underlying cause may be and, in 2012, he and his team published the results of a study in the international research journal Nature. The study revealed a finding about inflammation (the build-up of immune cells) playing a role in heart failure.”

Their research showed that in mice, this problematic build-up of immune cells may actually be triggered by our own DNA. They found this culprit DNA was from structures in heart cells called mitochondria, which produce the energy the heart needs to pump.

“If we can find the molecule responsible for this inflammation, there’s a chance we can find a therapeutic treatment for heart failure,” says Professor Otsu.

“I appreciate those people who donate to the BHF because that money helped me set up the lab and recruit the right people. I’d like to say ‘thank you’,” he says. “I’m not doing research just for my interest; I’m doing it to help people. My goal is that we will have some new therapeutic treatments to help people living with heart failure within ten to 15 years.” n

A student’s viewTrusha Mistry is a BHF-funded PhD student researching heart failure. She has just started her second year working with Professor Otsu as her supervisor.

She says: “I was really interested in the project because someone very close to me suffered a heart attack and that’s what made me want to work in the field.

“It’s great having Kinya here because he has such vast experience. Even today, I was presenting some data and it’s great to have his opinion directing the possibilities of what I could be doing. You see the quality of the papers that have been published from the Centre of Research Excellence so it’s somewhere that I really wanted to work.”

To find out about Professor Hugh Watkins’ work in our Oxford centre, visit bhf.org.uk/HMwatkins or order our Jan/Feb 2014 issue on 0870 600 6566.

More on Centres of Research Excellence


WORLD-CLASS

Our Centres of Research Excellence attract internationally renowned researchers and are part of a global research community. Sarah Kidner talks to Professor Kinya Otsu who relocated from Japan to London’s King’s College

RESEARCHTALENT

Phot

ogra

phy:

Tom

Jack

son

1716

MEDICAL


MEDICAL

Diabetes increases your risk of coronary heart disease. Doireann Maddock finds out what it’s like to live with, and how to manage the condition

living with DIABETESFocus on...

Lyn Rodney became aware she had type 2 diabetes in 2009. She is one of about three million people in the UK diagnosed with the condition.

Lyn, then 49, had some of the symptoms typically associated with diabetes, as she explains: “I’d lost a lot of weight in a very short space of time and I was drinking a lot of water, I was really thirsty.”

Other signs can include extreme tiredness, slow healing of cuts and wounds, and blurred vision.

At first, Lyn was unaware that what she was experiencing could be a sign of diabetes. A chance conversation with a friend who has the condition prompted the pair to check Lyn’s blood sugar level.

Seeing the results, Lyn’s friend took her to hospital. “The doctor said my blood sugar readings were really high. I was in shock,” says Lyn. “This wasn’t something I was expecting to hear at all. I’d heard of diabetes, but never related it to myself.”

Diabetes is easy to miss. The symptoms can come on gradually and there are thought to be about 850,000 people in the UK with the condition who don’t know they have it.

Type 1 and type 2 explainedLyn has type 2 diabetes, the most common form of diabetes (about 90 per cent of people with diabetes have type 2 compared with 10 per cent who have

people in the UK living with diabetes who don’t know they have it

There are thought to be about

850,000

Diet and diabetesIt’s a common misconception that diabetes is caused by eating too much sugar. Douglas Twenefour is a dietitian and clinical adviser at Diabetes UK. He explains: “Diabetes is a complex condition, so we cannot simply say it is

caused by eating sugar. However, we usually advise people with diabetes, or at risk of developing type 2 diabetes, to follow a healthy diet that is low in saturated fat, sugar and salt, and to increase their physical activity. But in practice specific advice depends on individual circumstances.

“Treats can be an occasional thing; what’s important is that you plan them. People with diabetes would need to be aware of how a particular treat fits in with their individual healthy eating goals. For example, if the goal is weight loss you need to be careful with the calories in that particular treat, the portion sizes and the frequency at which you have it.”

Dietitians can also play a critical role in prevention of type 2 diabetes. “About 80 per cent of type 2 diabetes incidences can be prevented or delayed through lifestyle changes. A dietitian can help support you to make healthy food choices and increase physical activity.”

Here are Douglas’s top tips for managing your diet if you have, or want to prevent, diabetes: 1. Plan regular meals and watch your portion sizes.2. Include more fruits and vegetables.3. Reduce snacks and avoid too much salt and salty foods. 4. Find a physical activity you enjoy and do it regularly.5. Involve friends and family in your healthy eating plans.

Doireann Maddock is a senior cardiac nurse with more than ten years’ experience. She has worked internationally in areas such as heart and lung transplant and cardiothoracic surgery.

Lyn has got her diabetes under control by eatinghealthily and doing regularphysical activity

Phot

ogra

phy:

Kei

th M

eath

erin

gham

1918

MEDICAL

type 1). In type 2 diabetes, your body is initially unable to use the insulin that is produced effectively (insulin resistance), usually because key organs (in particular the liver) are full of fat, which impedes their normal response to insulin.

Naveed Sattar, Professor of Metabolic Medicine at the University of Glasgow, explains: “Insulin is important because it works as a chemical messenger that helps your body use the glucose (sugar) in your blood to give you energy. So if there is a problem with the way your body reacts to it, glucose levels in the blood become too high, causing diabetes.

“Type 2 diabetes often occurs when too much fat is stored around your middle (and in key organs such as the liver) and it’s more common in people over the age of 40, although the numbers of younger people affected are increasing. It’s also more common in people of South Asian and African-Caribbean descent.”

In type 1 diabetes, the body is unable to produce insulin, although why this happens isn’t well understood. It usually develops in childhood and you can’t do anything to reduce the risk.

Risky behavioursA poor lifestyle can, however, increase your risk of type 2 diabetes. Junk food had been a problem for Lyn and her son Daniyel, 10. “Pizza, chips – all those sorts of things became a regular thing,” says Lyn.

I want to do everything within my power to prevent Daniyel from developing it”

“I was about 17 stone, and definitely overweight. People say you should have willpower, but when you are pressured, it’s easier to go for the quickest and simplest option. Junk food is always advertised, it’s always there. Daniyel also started putting on weight because these foods had become part of our lifestyle.”

Being overweight or obeseD is a major risk factor for type 2 diabetes. However, it’s not as simple as saying everyone who carries too much weight has the same risk. Professor Sattar explains: “Men have a higher

risk of diabetes than women because men have a tendency to store fat around their middle, but aside from waist size, risk is also influenced by ethnicity, and having a family history of diabetes. All these factors, in turn, dictate the weight at which your body starts to place excess fat into organs such as the liver, and thus increase your risk of diabetes.”

Living with diabetesLifestyle changes are an essential part of treatment for all people with type 2 diabetes. This can include management of weight, diet and increasing your levels of physical activity. Medication may also be required to help control blood sugar levels.

In Lyn’s case, lifestyle changes and the support of hospital staff were all that were needed to help her get back on track. She says: “I had a lovely diabetes specialist nurse, who told me all about different food types and portion size, and I even started to use smaller plates for my main meal because psychologically that really works. Looking after myself has become a priority and I’ve lost over two and a half stone.”

Lyn also shops for food differently now. “When we go to the supermarket, we look at the nutritional information,” she says. “We are also careful about our portion sizes and make sure we have our five fruit and veg a day. Daniyel has become very aware about eating healthily and has also lost weight.”

Physical activity has become an important part of

life for Lyn, who was advised to walk for at least 20 minutes every day. She says: “That has been really vital. I often go to a local park and Daniyel sometimes comes with me on his bike. We’ve also started to do badminton together and have recently joined a boxercise class. Eating healthily and keeping active is vital in helping me manage my diabetes.”

Matters of the heartHaving diabetes also puts you at risk of long-term complications such as coronary heart diseaseD (CHD). Stephen Wheatcroft, a consultant cardiologist in Leeds explains: “Diabetes is a powerful risk factor for CHD but the links between diabetes and CHD are complex.

“There is a large overlap between diabetes and ‘classical’ risk factors such as obesity and high blood pressureD and cholesterol levels, and changes in the body that happen because of high blood sugar levels can lead to damage in the blood vessels.

“In addition, insulin resistance that underpins type 2 diabetes is associated with important changes in blood vessel structure and function that can predispose you to developing CHD.”

Lyn sometimes worries about the future. Her dad also developed diabetes in adulthood and she doesn’t want that happening to her son. She explains: “The hereditary aspect of diabetes bothers me. Daniyel had a scare the other day but his blood tests came back normal, which was a relief. I want to do everything within my power to prevent him from developing it.” n


Q What is diabetes?A A condition in which glucose (sugar)

levels in the blood are too high. There are two main types of diabetes: type 1 in which your body stops producing insulin; and type 2 in which your body is unable to use the insulin that is produced effectively, usually because excess fat in organs leads to resistance to the normal effects of insulin.

Q Who’s at risk?A There’s nothing anyone can do to

reduce their risk of type 1 diabetes. However, being overweight is a major risk factor for type 2, although it’s not as simple as saying that everyone who carries too much weight has the same risk. Other factors, including your age, ethnicity and family history, can also increase your risk of developing type 2 diabetes.

Q Would I know if I had it?A Undiagnosed diabetes can cause:

• extreme tiredness

• increased thirst

• the need to pass urine more often than usual, especially at night

• unexplained weight loss

• blurred vision

• slow healing of cuts and wounds.If you’re experiencing any of these symptoms, talk to your GP as soon as possible.

Q How is it treated?A Diabetes cannot be cured, but it can

be treated successfully. Type 1 diabetes always needs to be treated with insulin injections. Treatment for type 2 diabetes involves diet, weight control and increasing physical activity. Medication to help control blood sugar levels may be required and reducing blood pressure and cholesterol levels is often also recommended. Your doctor can advise you on the best management plan for you.

FAQs

bhf.org.uk

49


a narrowed artery.




bypass graft.































































around the body.



a human donor.










is abnormally low.


















































MEDICAL DICTIONARY


B

A

C

D

L

H

P

S

See p44

See p16

O

I

MEDICAL TERMS




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

MEDICAL

As well as controlling blood glucose levels, managing your weight and being physically active are crucial when it comes to managing diabetes. It’s also important to pay attention to the balance of your diet. The BHF has several resources that can help you with this. The eatwell plate shows us the proportions of the different food groups that we should eat to have a healthy diet. Each of the groups is important as they provide us with different nutrients. To get the balance right, eat plenty of fruit and vegetables and starchy carbohydrates, along with some lean meat, fish, eggs or vegetarian alternatives and low-fat dairy products. Avoid too many foods

that are high in fat and sugar. Even if you are trying to lose weight and are cutting down on what you are eating, you should still aim for this balance of foods in your diet to make sure that you get all your vital nutrients. Visit bhf.org.uk/eatwellplate for an interactive version.


You can order our free ‘diabetes pack’, which contains the booklets Diabetes and your heart, Eating well, So you want to lose weight for good and Get active, stay active. Call 0870 600 6566 and quote ‘PK30’ or visit bhf.org.uk/HMpublications.

For more information

Lyn’s son Daniyel is also enjoying a healthier lifestyle


MEDICALMEDICAL

Imag

e: G

etty

Download our free booklet Medicines for the heart at bhf.org.uk/HMpublications or call 0870 600 6566.

Find out more

Q Why have I been prescribed aspirin?A Typically, a daily, low dose of aspirin (75mg) is

prescribed for people who have a cardiovascular diseaseD, such as peripheral arterial diseaseD, or who have had a heart attackD or certain types of strokeD. It’s prescribed in this form to reduce the risk of blood clots forming (we call this thinning the blood). What we mean by this is that aspirin can inhibit circulating blood cells known as platelets. One of the most important protective roles of platelets is to stick together and block cuts and breaks in blood vessels, so they are important in normal health. However, in people at risk of heart attacks and some kinds of stroke, platelets can stick together inside blood vessels causing a clot and stop blood flowing to the heart or brain. Aspirin reduces the chances of this happening, which makes it useful for patients at risk.

Q How does it work? A The way in which aspirin works was discovered

by the British researcher Sir John Vane about

40 years ago. He showed that aspirin blocks an enzyme called cyclooxygenase. Cyclooxygenase produces a range of hormones known as prostanoids. In the blood, these prostanoids cause platelets to stick together, so blocking cyclooxygenase with aspirin reduces the formation of blood clots. Prostanoids also affect inflamed areas of the body, such as sprains and damaged joints. This is why in the past aspirin was used as a painkiller and anti-inflammatory drug. However, much higher doses are needed to inhibit pain and reduce inflammation than to reduce the risk of blood clots, and we now use non-steroidal anti-inflammatory drugs such as ibuprofen, which are better at this. Q Should we all take daily aspirin to prevent

blood clots?A Current thinking doesn’t recommend this. If you

have a cardiovascular disease, particularly if you have had a heart attack or stroke, studies have shown that the benefits of taking aspirin far outweigh the risk of

side effects. But for people without a cardiovascular disease, the risk of side effects outweighs the benefit of preventing blood clots.

Q What are the possible side effects?A The most likely side effect is an increased risk

of bleeding because aspirin reduces the risk of platelets sticking together. Generally, these bleeds are very minor, but occasionally patients may experience severe bleeds. These are most commonly in the stomach or intestines, where they can cause substantial and occasionally life-threatening blood loss. They are more likely to happen if you have a stomach or duodenal ulcer. Symptoms of this type of severe bleed include upper abdominal pain, passing blood or black stools, or vomiting blood. If this happens, seek urgent medical attention.

Severe bleeds may also occur in the brain, leading to a strokeD. These rare, but potentially very dangerous and severe, side effects explain why aspirin is not recommended to be taken by otherwise healthy people.

Occasionally, people who have asthma find they are sensitive to aspirin and that it can cause an asthmatic attack. Anyone who suffers from asthma should avoid aspirin and other non-steroidal anti-inflammatory drugs such as ibuprofen.

Q Is there a reason why my GP wouldn’t prescribe me aspirin?

A The most likely reason is because you have previously been found to be sensitive to the asthmatic effects of aspirin or other non-steroidal anti-inflammatory drugs. Another reason may be that you have a medical history of bleeding in the stomach or intestines. Your doctor would consider the balance of benefits versus risks in situations such as this.

Q What’s the alternative to aspirin?A People who are advised to take an aspirin by their

doctor but can’t, most commonly because they are sensitive asthmatics, can sometimes take the drug clopidogrel. This drug inhibits the blood platelets but doesn’t affect cyclooxygenase.

Q Are there any foods that I should avoid?A There are no foods that you specifically need to

avoid if you are taking aspirin.

Q What if I have a pain and want to take another type of painkiller?

A The general recommendation would be to try paracetamol first of all. Avoid high doses of non-steroidal anti-inflammatory drugs such as ibuprofen without first discussing with your doctor, as the combination with aspirin increases the risk of bleeding.

Q Are there any other medications I should avoid if I’m taking aspirin?

A As with all drugs, it’s vital that you discuss with your doctor or pharmacist before taking any additional medication. n

Tim Warner is Professor of Vascular Inflammation at Barts and The London School of Medicine and Dentistry. He has investigated the mechanism of action of drugs that are used in cardiovascular medicine for more than 25 years.


Q

A

People with cardiovascular disease may be prescribed a low dose of aspirin to help prevent blood clots. Doireann Maddock puts some common questions about them to Professor Tim Warner

Drug cabinet:ASPIRIN

bhf.org.uk

49

Angioplasty: A treatment to widen a narrowed artery.Atheroma: Fatty material (plaques) that can build up within the walls of the arteries.Bypass surgery: See Coronary artery bypass graft.

Cardiac arrest: This is when a person’s heart stops pumping blood around their body and they stop breathing normally. It is the ultimate medical emergency. Many cardiac arrests in adults happen because the person is having a heart attack. Cardiomyopathy: A disease of the heart muscle in which the heart muscle becomes weakened. The heart muscle may become thickened, enlarged and/or sti� , depending on the type of cardiomyopathy. It a� ects people of all ages and is usually inherited.Cardiovascular disease (CVD): It includes all diseases of the heart and circulation – for example, coronary heart disease (angina and heart attack) and stroke.Coronary artery bypass graft: Sometimes called ‘CABG’ or ‘bypass surgery’, this is an operation to treat coronary heart disease. The arteries from your chest wall or arm, or veins from your leg, are used to bypass the blocked or narrowed coronary arteries. This helps to improve the � ow of blood to your 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 fatty deposits called atheroma. CHD can lead to angina or a heart attack.

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 is unable to use the insulin that is produced e� ectively, usually because excess fat in organs leads to resistance to the normal e� ects of insulin. Having diabetes increases your risk of developing CVD.

Heart attack: The medical term for a heart attack is a myocardial infarction, or MI for short. This is when there is a sudden loss of blood � ow to a part of the heart muscle. Most heart attacks are caused by atherosclerosis, which is the gradual build-up of atheroma (fatty material) within the artery walls. If the atheroma becomes unstable, a piece may break o� and lead to a blood clot forming. This can block a coronary artery, causing a heart attack, which could lead to irreversible damage to the heart muscle. A heart attack is a medical emergency and can lead to a cardiac arrest.Heart block: When the electrical impulses of the heart are slowed down, delayed or blocked. Some heart blocks can cause a bradycardia (a slow heart rate).Heart failure: A condition where the heart becomes less e� cient at pumping blood around the body.Heart transplant: An operation to replace a diseased heart with a healthy heart from a human donor.

High blood pressure: Also called hypertension, this is when your blood pressure is consistently higher than the recommended level. The higher pressure puts extra strain on your heart and blood vessels and, over time, can increase your risk of having a heart attack or stroke.Hyponatremia: A condition that occurs when the level of sodium in your blood is abnormally low.

ICD: Also known as an implantable cardioverter de� brillator, this is a small device that is implanted in a person’s chest, just under the skin, and is connected to their heart by one or more wires (leads). The ICD monitors the heart’s rhythm and, if necessary, delivers a controlled electric shock. This is called ‘de� brillation’ and may be needed if a person has a life-threatening abnormal heart rhythm.



Obese: The term to describe when someone is very overweight, with too much body fat. Being obese puts you at an increased risk of numerous health problems, including CHD and diabetes. Pacemaker: A small device that is implanted in a person’s chest, just under the skin, and is connected to their heart by one or more wires (leads). It is used to monitor the electrical signals within the heart and can stimulate it to contract and produce a heartbeat. A pacemaker can be used to treat numerous di� erent abnormal heart rhythms.Peripheral arterial disease (PAD): Also called peripheral vascular disease (PVD), this is a condition that a� ects the arteries that carry blood to your legs, arms and tummy area. Over time, the arteries may become narrowed due to atherosclerosis – the gradual build-up of atheroma within the artery walls. In most people who have PAD, it is the lower part of the body, such as the legs, that is a� ected.

Statins: A medicine to reduce cholesterol levels in the blood.Stroke: An interruption of blood � ow to part of the brain, which can damage it. This happens if an artery carrying blood to your brain becomes blocked, or if it bleeds into your brain. A stroke is a medical emergency.Sudden cardiac death (SCD): An unexpected and sudden death, which is thought to be, and usually is, caused by a heart condition.

MEDICAL DICTIONARY


B

A

C

D

L

H

P

S

See p44

See p16

O

I

MEDICAL TERMS

NEXT ISSUESpecial report on sex and heart disease. Plus how one taxi driver changed

his lifestyle.

See p32 Medical dictionary Medical words, identified by a small symbolD, are explained in plain English in our dictionary on page 49

If you have a cardiovascular disease, the benefits of taking aspirin far outweigh the risks”

Fast facts● 75mg – a low dose of aspirin is often prescribed if you have cardiovascular disease● British researcher Sir John Vane discovered how aspirin works 40 years ago● Bleeding is the most common side effect

BHF-funded research could lead to revolutionary medications that reduce blood clots without the risk of excessive bleeding. Doireann Maddock talks to Dr Andrew Thompson about his work

2322

RESEARCH


Find out more

help to guard against these life-threatening blood clots, but a problematic side effect can be excessive bleeding.

This could range from a simple cut taking longer to stop bleeding or having unexpected nosebleeds, to suffering from a bleed within the stomach or bowel area. This type of bleed is uncommon but, when it happens, it can be life-threatening.

Dr Thompson hopes that by studying P2X1 he can pave the way for medications that reduce the risk of life-threatening blood clots, without the risk of bleeding.

Current antiplatelet medications work to prevent clots in several ways. Some act on platelet production, which reduces the total number that can clump together, while others work on their performance and have the same effect. Unfortunately,

this reduced platelet activity can result in the excessive bleeding that sometimes occurs. Instead, Dr Thompson’s approach will explore whether it is possible to block platelet P2X1 receptors and thereby reduce clotting without altering the normal behaviour of platelets. This is possible because these receptors only become active in conditions where blood vessels narrow due to fatty deposits. In theory, this means that drugs that block these receptors are likely to only work in areas where the danger is greatest (for example, a narrowed coronary artery at risk of causing a heart attack), instead of causing unwanted bleeds, for example from the gut.

Preparing for years in the labIn order to test this theory, Dr Thompson plans to spend three years working in the lab. During this time, he’ll test the impact of 1,200 chemical compounds on P2X1.

“I’m hoping to find different drugs that can block P2X1 receptors,” he explains. “This screening process will use a fragment library, which is essentially

RESEARCH

1,200 different drug-like compounds that have been transferred onto a big plastic tray with lots of dimples in it.

“I’ll dissolve the compounds and carefully transfer them to another plastic tray that contains cells that have the P2X1 receptor. I’ll be able to measure whether there has been a drug effect on these cells by using fluorescent dyes. These dyes are added to the cells and absorbed, and they change their brightness when the P2X1 receptor is affected.”

The fragment library, which took decades to assemble, was generously given to Dr Thompson by a team in Amsterdam. “The fragment library is a tremendous gift,” he says. “It will make the identification of these drugs much easier, so I’m very grateful to have it.

Once I’ve identified new drugs that affect P2X1 receptors, I will then study how they work and modify their properties to make them more effective.”

He will share his findings with Professor Richard Farndale, another BHF-funded researcher, who will use cells from healthy volunteers to assess the ability of the newly found drugs to prevent blood clots in real blood from real people. So what difference will the research make?

Dr Thompson says: “I hope to identify drugs that will initially be used in basic research to help understand the function of P2X1 receptors. In the longer term, I hope that my research will lead to the development of new medications to help prevent blood clotting without the risk of bleeding that is sometimes seen with current medications. A drug like this could have benefits for many people.” n

Dr Andrew Thompson grew up in Scarborough and was educated at Nottingham University. He later worked at Cambridge University for 14 years as a neuroscientist

and currently works in the Department of Chemistry and Biochemistry at Bern University, Switzerland, but will return to Cambridge to pursue his work on blood clotting.

is the name of the receptor that Dr Thompson will be studying

is how long it took a team in Amsterdam to assemble the fragment library

is the amount the BHF has given him for this research

A drug like this could have benefits for many people”

New medications that help prevent blood clotting without the risk of bleeding are what he hopes his research will achieve in the long term

1,200

£224,752

P2X1

is the approximate number of miles the fragment library will travel from Amsterdam to Cambridge

285is the number of years that Dr Thompson spent as a neuroscientist

14

Research can be painstaking, time- consuming and sometimes tedious, something Dr Andrew Thompson

seems unfazed by as he prepares to spend three years in the lab studying a library of 1,200 different chemical compounds.

He’s motivated to do it by the desire to help create potentially life-saving antiplatelet drugs, and has the backing of a £224,752 BHF research grant.

The grant will fund his work exploring the effect of the chemical compounds on a receptor called P2X1, which is important in the formation of blood clots within the body. The receptor is found on the surface of blood cells (platelets). For the blood to

clot, these platelets have to be ‘switched on’, which is where P2X1 comes in. Once switched on, the platelets work together with the liquid part of our blood (plasma) to form blood clots.

Blood clots are essential to the body’s healing process, and save lives by helping to prevent excessive bleeding when a blood vessel becomes injured. However, when clots form inside a blood vessel, such as a coronary artery, or within the brain, they can cause a heart attackD or strokeD.

P2X1: a revolutionary new approachCurrent antiplatelet medications, which include aspirin (page 20) and clopidogrel,

Decades

CLOTStheStopping

is the number of chemical compounds contained within the fragment library

For more on our life-saving work, visit bhf.org.uk/research/our-heart-research.

Imag

e: G

etty

Reading Dr Susan Jebb’s CV, it’s easy to see why she’s one of the UK’s leading obesity experts. Until recently she

was Head of Diet and Population Health at the Medical Research Council Human Nutrition Research unit in Cambridge, she is a member of the Public Health England Obesity Programme Board and chairs the Department of Health Public Health Responsibility Deal food network (brokering voluntary agreements with the food industry). Currently, she is Professor of Diet and Population Health in the Department of Primary Care Health Sciences at the University of Oxford.

After training as a dietitian, Dr Jebb has spent years studying large groups of people, getting them to change their diet and testing the outcomes of these changes with a view to reducing health risks.

“The quality of your diet matters but the single most important thing in terms of diet is to control your weight,” she says. “Overweight people who lose just 5kg of weight show a measurable improvement in their blood lipidsD and their blood pressure, and a reduced risk of developing diabetesD.”

Obesity crisisThe focus is important in the face of a genuine obesity crisis. Today, 25 per cent of the adult population is obese – a body mass index (BMI) equal to, or greater than, 30kg/m2 – compared with 6 per cent of the adult population in the 1980s.

“The scale [of obesity] is worrying but more worrying is the enormous plethora of ill-health that comes with it. Obesity is the canary in the coal mine,” says Dr Jebb. “It’s very visible and while in itself it may not be the most important issue, if you are overweight or obese your chance of developing heart disease and diabetes increases dramatically.

“Obesity is blighting people’s lives and it clearly adds a huge burden to the healthcare system at a time when we are all getting older and we all need more complex health and social care.”

Understanding the causes of the crisis isn’t easy. “This isn’t a national collapse of willpower; there’s something else going on.One of the reasons why we think obesity has

bhf.org.uk

THE BIG INTERVIEWTHE BIG INTERVIEW

Nutritional VALUES

Dr Susan Jebb OBE is a nutrition scientist and obesity expert with more than 20 years’ experience. She talks to Sarah Kidner about the obesity crisis and how the UK is helping to tackle it

We offer resources and tools that can help you to maintain a healthy weight, or to achieve sustained weight loss. Order or download information from bhf.org.uk/HMpublications including Eating well, Cut down on salt and So you want to lose weight… for good. You can also order our Cut the saturated fat wall chart (M4). See page 50 for a full list of booklets and codes.

Visit bhf.org.uk/eatwellplate to find out about balanced diets. Check your BMI using our online calculator at bhf.org.uk/bmi or use the tape measure from your membership pack. Search for healthy recipes at bhf.org.uk/recipefinder.


24

become so much more common is that we are surrounded by food everywhere we go. Our biology is set up to encourage us to eat food when it’s available. Combine this with an environment where food is everywhere, and you have got a catastrophic mix.”

Other factors are behavioural. “If somebody comes into the office today with a birthday cake, I would probably have a piece before I have really thought about the extra calories.

“The things we think of as decisions about food are usually not reflective decisions; they are impulsive actions that are stimulated by the environment, whether that’s the micro-environment at home or at work, but also the wider food environment in supermarkets and on the high street.”

Tackling the crisis, togetherTackling obesity will depend on individuals, the health service, government and the food industry working together.

Dr Jebb says the health service needs to provide more support through the GP system and by referring people to weight loss programmes.

“I think we have got to embed weight management services into the health service in the way that we have with smoking cessation services. With so many people suffering from obesity we need to look at the delivery of care and how we can help people who are overweight to access support services,” she adds.

In addition, everyone could benefit from changes in the food supply and Dr Jebb is convinced that working with the food industry is a necessary part of the solution. Through the Public Health Responsibility Deals (voluntary agreements with the food industry), manufacturers have reduced the amount of salt, saturated fats and calories in some foods but there is, says Dr Jebb, still a long way to go.

“We’ve seen real improvements in individual products and a greater choice of healthier options, but the food industry also shapes our choices through advertising and marketing. What’s on promotion, what do you have a discount voucher for, where is food positioned in the shop. I would like to see the food industry producers, manufacturers and retailers actively steer people towards the healthier choices.”

Importantly, these changes will help everyone reduce their risk of obesity, but they will also bring wider benefits. “Let’s not forget, eating less saturated fat and salt together with more fruit and vegetables is going to reduce your risk of heart disease – whatever your weight,” she says. n

25

Retailers have a responsibility to promote healthier options

Phot

ogra

phy:

Joha

nna

War

d; Im

age:

Get

ty

Heart Matters

2726

NUTRITION NUTRITION


Five steps to smarter cooking

1 Plan everythingDon’t underestimate the humble shopping list, based on a meal plan for the week. This ensures you have everything you need and also helps you to avoid temptation in the supermarket.

2 Only cook one mealDon’t get into the habit of catering for a variety of likes

and dislikes. Make one meal for everyone. It costs more to buy the different foods and cook separate dishes.

3 Freeze leftoversCooked too much? Leftover bread? Don’t bin it, freeze it. Enjoy casseroles, soups and curries another day and use up bread as breadcrumbs, toast or chunky baked croutons in soup.

4 Add pulses to stretch out the meatOne of the most expensive items in your basket is meat so learning to make a little stretch a long way is a good idea. Beans and lentils are vegetarian sources of protein and iron, but shouldn’t be exclusive to non-meat eaters. By adding pulses to your dishes in place of some of the meat,

you’ll bulk them up and get plenty of protein, plus the flavour of meat, but it costs you less.

5 Fill your ovenIf you’re putting the oven on, don’t just use it to cook a couple of jacket potatoes. Cook a casserole to freeze for another day and bake some fruit to eat over the next couple of days.

The price of the weekly food shop has been widely discussed recently due to soaring food costs. Martin Caraher, Professor of Food and Health

Policy at City University, says: “[Food] costs have risen by about 20 per cent since 2007 and that’s set to continue. In addition, the cost of fuel has also gone up and so the cost of transporting, storing and cooking food has also been affected.”

These rising costs mean that increasingly we are making compromises when it comes to food. “Food is the elastic item in our budgets unlike rent, mortgages or utility bills, which are fixed,” says Professor Caraher.

For many, that means making tough decisions about what, and how much, food we can afford, but it’s important this isn’t at the cost of eating healthily. A healthy diet helps to prevent problems such as coronary heart diseaseD and obesity (page 24), which are more prevalent in low-income areas.

Balancing budgets, and dietTo explore whether it’s possible to eat healthily on a budget, my editor challenged me to develop a seven-day eating plan (see sample menus, page 28) on a budget of £50 for two people based on the Family Food 2011 average. The Family Food 2011 report gives us UK figures for the amount and types of food and drink we

are buying as well as how much we spend on it.The menus needed to offer a balanced diet, and

to meet reference intakes (RIs) for adults. These are guidelines about the approximate amounts of particular nutrients and energy a healthy diet requires. The daily menus also needed to provide people with their recommended 5-a-day, and include foods such as wholegrains and oily fish.

The prices were compared in three different supermarkets and the cost based on the actual amounts consumed (so, 200g porridge oats from a 500g pack rather than the cost of the whole pack).

It would cost more at the till to buy full packs of everything in the menu, but this should even out over following weeks providing everything is used up.

While we tried to make the exercise as realistic as possible, there’s a huge difference between a trained dietitian planning a week’s worth of meals, and the realities of living on a restricted food budget, which can be stressful and complex.

Professor Caraher says: “You can’t do it in one shop. You need to shop around and you need to have the resources to do that: time, energy, knowledge and the ability to read food labels. It’s possible to live cheaply. I’m not sure how many of us really do or how many of us would want to – those are two different issues.”

In planning the meals, I found I had enough money

My editor challenged me to develop a seven-day eating plan on a budget of £50 for two people”

Victoria Tayloris a registered dietitian. She has worked for the NHS on programmes to prevent cardiovascular diseaseD. She advises on diet and nutrition.

The rising cost of food is becoming a political hot potato. BHF dietitian Victoria Taylor explores the challenges of

healthy eating on a budget, and shares her tips

Read our full week’s sample menus online at bhf.org.uk/HMfoodforthought.

Online extra

28

NUTRITION

Heart Matters

to meet the nutritional requirements but I had to be extremely careful about what foods I was choosing to do this – even down to the type of fruit and vegetables. Mediterranean vegetables such as peppers and aubergines suddenly seemed pricey and snacks such as fresh fruit and nuts needed to be eked out.

Part of the eatwell plate (see page 19) is about having some foods high in fat and sugar but, outside of basics such as cooking oil and spreading fat, there just isn’t scope for extras on this budget. While these foods aren’t essential, they are the foods we enjoy eating and, if our diet is too restrictive, it becomes unappealing. We used an average weekly budget and it was a challenge, but not impossible. See our Budget-stretching tips (opposite) and sample menus (above). To eat healthily on a lower

budget than we have explored, you would have to be really savvy, scouring different shops and local markets rather than the convenient supermarkets to get the best prices.

Planning a budget menuIt’s important to plan meals ahead as it helps to avoid waste and ensure a balanced diet. As a dietitian, I am used to mapping out other people’s eating plans or creating new ones. However, I’m also well aware that this does not necessarily come easily to others and, even if it does, the average person won’t have access to a computer nutritional analysis programme that can be used to check the nutritional adequacy of the diet on a daily and weekly basis.

Last spring, our Hearty Lives programme funded a pilot healthy eating on a budget course in Hull. The team ran six sessions at Winifred Holtby School, each lasting two hours. The focus was on teaching people how to organise and plan meals. Programme Manager Ann Sunderland-Burrows explains: “We were working

bhf.org.uk

It’s important to plan meals ahead as it helps to avoid waste and ensure a balanced diet”

Phot

ogra

phy:

Joha

nna

War

d, W

illiam

Sha

w

£300One woman’s monthly saving by eating healthily on the BHF’s Hearty Lives progamme in the areas that had the highest rate of heart disease. We showed the group how to plan what they were going to eat for the week. A number of them stopped cooking several individual meals but found that the family still ate what was offered when they cooked one meal for everyone.

“One lady saved about £300 a month. The course is being continued at other schools in Hull and the council has commissioned eight more courses.” n

≠ Read our full week’s sample menus online at bhf.org.uk/HMfoodforthought.

NUTRITION

Budget-stretching tips1 Shop smart

Review prices online to find the best bargains. Using supermarket budget ranges for items such as tinned and fresh fruit and vegetables, pasta and rice is a real help too. Don’t overlook market stalls and greengrocers for cheaper fruit and veg.

2 Beware multi-buysThese offers aren’t a great deal if you end up with a mountain of food that you can’t eat before it goes off. Think before you go for a multiple offer such as ‘two for one’ or ‘buy two get one free’.

3 Compare like with likeCompare prices per 100g to make sure you really are getting a deal – use the price tabs on

the supermarket shelves to give you this information so you can compare across different size packs. Larger packs are often better value but only if you are going to use it all.

4 Claim your benefitsMake sure that you are receiving any benefits that you are eligible for and, if you find yourself in an emergency situation, look for food banks in your local area and find out how you can access them.

5 Use seasonal fruit and vegPrices come down when there is a glut of any kind of food and, when it comes to fruit and veg, an extra bonus is that produce tastes much better when it’s in season.

Healthy meals checklistEnsure your diet is balanced and healthy. Here are some pointers to look out for:

• Meals include starchy carbohydrates, fruit and vegetables, and protein (from lean meat, fish, eggs or low-fat dairy).

• Meals are varied across the week.

• Snacks are nutrient dense, not just energy dense; in other words, they provide plenty of vitamins and minerals.

• Starchy carbohydrates include high-fibre and wholegrain options.

• Meat is lean and low in salt.

• The menu includes two portions of fish a week, one of which is oily.

• About two to three portions of milk and dairy are included each day and reduced-fat options are used.

• Added fats (oils and spreads) are unsaturated.

• At least five portions of fruit and vegetables are included each day.

29

Focus on… EGGS Eggs can form part of a balanced

diet despite their perceived ‘bad’ reputation due to their cholesterol

content. Eggs do contain some saturated fat, but the butter on your toast or the bacon that may come with your eggs will probably make a more significant contribution to your overall intake.

A boiled, poached or scrambled egg can be a healthy option – just watch out for what you add to them. Avoid cooking scrambled eggs in butter – use a non-stick

pan and add a little unsaturated oil or spread. Swap butter on your toast for unsaturated spread and if you like ketchup with your eggs, remember it’s high in sugar and salt.

Chocolate eggsChocolate is high in fat and sugar, so keep an eye on your portion sizes. Join in the Easter fun but go for small eggs with a hollow chocolate shell rather than a large egg filled with more chocolate and sweets.

Chicken or chocolate, eggs get a bad press when it comes to a heart-healthy diet but there’s no need to miss out on the Easter fun, says dietitian Victoria Taylor

NUTRITION

1 Egg choiceUse the freshest eggs possible to avoid the white turning into a mass of froth in the pan.

2 Water temperatureThe water needs to be hot enough to cook the egg, but not too hot. Look for the point before the water boils, when big bubbles are forming on the bottom of the pan, before you add the eggs.

3 Cooking techniquePutting the eggs into the water reduces the temperature. Allow the water to return to the big bubble stage, turn the heat down and cook for 3–4 minutes; gently baste the tops of the eggs in surrounding water.

4 Careful removalUse a slotted spoon or spatula to lift your eggs out of the water. Let the excess water drain off the egg before you plate up and tuck in.

Cooking the perfect poached eggWhether you want to use it to go on top of a salad, risotto or a simple piece of toast, the poached egg is worth perfecting

Heart Matters30

0300 330 3300*

When it comes to anything heart related, we’re here to help. Call or email our Helpline for support and information on:

Heart conditions

Healthy eating

Heart medications

Heart Support Groups

Keeping your heart healthy

Lowering your risk factors such as high blood pressure

HEART MATTERS HELPLINE

Call the Heart Matters Helpline or email [email protected]

FIGHTFOR EVERY HEARTBEATbhf.org.uk *Call rates are similar to 01 and 02 numbers. Lines are open 9am–5pm, Monday to Friday

Do you have tips on how to cook the perfect poached egg? Email [email protected].

Get involved

Imag

ery:

Sup

erst

ock,

Stoc

kfoo

d

3332

MY STORYMY STORY

Phot

ogra

phy:

Tom

Jack

son

The person who has passed on would want you to carry on and live life to the full”

Eric Pemberton had a heart attackD and bypass surgeryD while he was dealing with his daughter’s terminal illness. He was so distraught over his

daughter that he hardly cared about himself.But he survived and, despite the loss of his daughter,

aged 21, and then his wife, plus his own serious health problems, he manages to keep a positive attitude to life.

He says: “I feel young at heart and delighted I survived. I am 83 but I feel about 53.”

Dealing with lossEric’s youngest daughter Gayle was in her second year at university when she came home feeling unwell. When she was diagnosed with acute leukaemia, she was told she might only live for a few days. In fact she carried on for 18 months and Eric, who had been made redundant from his job as a television engineer, nursed her during that time.

He says: “My daughter’s death was the biggest tragedy ever. She was so alive. She was a determined young lady, she had three jobs and was doing well at university. She could have done so much and it is a loss to society that she is gone.

“I still suffer from Gayle’s death. I still shed tears for her. I don’t think I will ever really get over it, but you have to put it behind you. You have to understand that the person who has passed on would want you to carry on and live life to the full, because they loved you so much.”

It was during Gayle’s illness that Eric had his heart attack, in 1994. He said: “At first, I didn’t really know what was going on. When I was told what had happened, I wasn’t scared. I just thought ‘this is life’.

THE STORMEric Pemberton has battled the loss of a daughter and a wife, as well as serious heart problems. He tells Sarah Brealey how he has stayed strong

“I was in hospital after my heart attack when my daughter was extremely poorly. She visited me when she herself was too ill to walk up the stairs. The terrible thing is that I survived and she did not.

“I would gladly have given up my life if it would have meant that she survived.”

Gayle died in 1996, and in 1997 Eric was told he needed bypass surgery. He says: “I was still shattered from the loss of Gayle and I didn’t care whether I lived or died. But I survived and I went home to my wife.

“I just focused on following the instructions the doctors gave me. I tried to put everything that happened behind me and live my life.”

A decade later, Eric’s wife Trish died, after 48 years of marriage. He says: “She was a fantastic wife. I am so sad that we didn’t make it to 50 years. She was very ill at the end. One of the last things she did for me was buy a card for our anniversary, and she wrote in it ‘I love you immensely’. That meant a lot to me.”

Eric mourned his wife, but he says the loss of Trish, 72, was easier to deal with than that of his daughter at such a young age, because at least Trish had enjoyed a full life and seen her children grow up.

Living life to the fullEric believes in making the most of what life has to offer, especially if you have a heart condition. To him, that means enjoying hobbies and interests, and having new experiences.

“I think sometimes people who have heart problems just sit by the fire and wait to die,” he says. “You have to not give up, but go out and do things. If you want to go on holiday abroad or

Weathering

bhf.org.uk

34

MY STORY

whatever you want to do, then do it. If you fancy playing football, or sailing (as I do), or flying a microlight (as I also do) then why not?”

Eric learnt to sail in the RAF as a young man, and never forgot how much he enjoyed it. So when he was 50, he borrowed money to buy a boat so he could take it up again. He sold that boat when he lost his job but, after his wife died, he realised he needed another interest. So he bought another one, which he now sails with his son John (pictured right with Eric). “It is a fantastic pastime,” he says. “There is so much freedom when you are out at sea. You can go as fast or as slow as you like, and no one tells you what to do.”

He was in his 70s when he decided to learn to fly a microlight, having been inspired by an airfield near to his new home in Lincolnshire.

Eric also enjoys gentler hobbies, and takes pleasure in small things. “I live ten miles from the coast and I walk along the beach and see the waves come in and out. I take pleasure just in looking out of the window and seeing all the birds. Life is great.”

He’s a firm believer in doing things with other people, and having new experiences. He spent 20 years as a local independent councillor. “It opened up a new world to me,” he says. “I was able to help so many people with their problems. Then in 1994, I became Mayor of Solihull. It felt very daunting, especially because I had my heart problems. I felt like I couldn’t do it, but I decided to put on a mask and play the part of being mayor, and that is how I got through it. I even met the Queen and Prince Philip. It was a great experience.”

Looking ahead Eric’s heart attack left him with heart failureD, and he also suffers from an irregular heartbeat, prostate and thyroid problems, and asthma. But he says he feels “fit as a fiddle” despite all this, and is full of plans for the future.

“There is so much more I want to do. I want to complete my microlight training. There are so many places I haven’t visited in my motorhome. I want to carry on sailing with my son.”

Eric recognises that he’s far from alone in going through difficult times, and is keen to offer

If you fancy playing football, or sailing (as I do), or flying a microlight (as I also do) then why not?”

encouragement to others. He says: “Whether you have a heart attack, bypass surgery or a bereavement, the point is to not give up. I grieve for both my wife and my dear daughter, but neither of them would wish me to live a life of grief and solitude.

“Life is worth living. I see some people who are much worse off than me and it is amazing what they can do. I take hope from that.” n

n Turn to page 38 to read about what to do when someone dies, and where to find bereavement support and information.

One of Eric’s favourite pastimes is sailing with his son John

Heart Matters

Eric’s tips for happiness• We cannot avoid loss, but remember our loved ones would not wish us to continue to grieve throughout our lives.

• Do things you take pleasure in, and try to have fun.

• It is so much better to share experiences with someone else, to do things together. Even if you don’t have a partner, do things with a friend. Try joining a club or society where you will meet people with the same interests.

• Accept what is happening to you, but live your life to the full as much as you can. Do as much as you can, when you can.

• Don’t look at heart problems as the end of your life – maybe this is just the beginning.

35bhf.org.uk

Many of us have a habit or two that we’d like to change. The good news is that it’s never too late to do things differently.

Research shows that making healthy changes even in later life still brings benefits. If you’re doing no exercise at the moment, becoming moderately active can be what makes the biggest difference to your health. Changing habits isn’t always easy, but going about it the right way can really help your chances of success.

Understand your habitsFirst, think about your behaviour and what you’d like to adjust. Bas Verplanken, Professor of Social Psychology at the University of Bath, says: “Habits

Break the HABITSof a lifetime

are something we do frequently – and that makes them important in terms of health. Eating junk food occasionally is not a problem, but doing it regularly is.

“A habit is usually an automatic behaviour rather than a choice that we have thought through – grabbing a chocolate bar without thinking about it, for example. There may also be a lack of control, and this particularly applies when there is an element of addiction, such as with smoking.”

Because habits are something we may do without fully thinking about it, it’s helpful to start by thinking about when and how they happen, and what triggers them. For example, you may automatically have a couple of biscuits with your morning cup of tea, or open a bottle of wine to have with your dinner.

It’s never too late to change your habits for the better. Sarah Brealey explains how to do it

Imag

e: S

tock

food

WELLBEING

3736 Heart Matters

WELLBEING

n We’re here to help you make healthy changes. Our free Heart Matters motivational emails offer support with healthy eating, stopping smoking, getting active or mental wellbeing. Sign up at bhf.org.uk/HMemails. n Check out the previous issue of Heart Matters (Jan/Feb 2014) for more tips on changing your lifestyle, including how to take up exercise (bhf.org.uk/HMhero) and to read Emma Luck’s

inspiring story of how she lost weight for good (bhf.org.uk/HMemma). Order a back issue by calling 0870 600 6566.n To order our free ‘Changing habits pack’, which includes the booklets Put your heart into walking, Eating well, Stop smoking and Coping with stress, call 0870 600 6566 and quote ‘PK31’ or visit bhf.org.uk/HMpublications. Turn to page 50 for a full list of BHF booklets and codes.


Keeping a diary of your habits can offer insight into them. A weekly activity diary is good if you’re trying to increase the amount you do – you can also use it to chart your progress. If you want to change your eating habits, keep a food diary of everything you eat for a week.

Our Senior Dietitian, Victoria Taylor, says: “Once you get a true view of when and why you eat unhealthily, you can think how you’ll deal with challenging situations, such as eating out with friends or being

short of time to prepare meals. For instance, if you’re eating out, you could check out menus in advance to find the healthiest option and rehearse how you’ll respond if someone suggests some extra garlic bread or a creamy dessert that you don’t want to eat.”

It’s also useful to think about other reasons behind your behaviours. Often we make unhealthy choices for emotional reasons, to cheer ourselves up, or as a reward. If you recognise this, then you can look for other, healthier ways to achieve the same effect – such as listening to your favourite song or taking a walk to lift your spirits or treating yourself to a book or magazine instead.

Set specific goals Once you’ve committed to making a change, make a detailed plan. Professor Verplanken says: “You need to plan exactly when and where to do what. We call these ‘implementation intentions’.

“Losing weight is an example. The way we put that into practice is the implementation intention – in other words, what precisely you need to do to achieve your goal.

“For instance, when you go shopping, you could look at the fat content of all the foods you buy and choose lower-fat alternatives. Or at mealtimes, resist going for seconds or try using a smaller plate.”

Or if your goal is to be more active, decide exactly what that means you’ll do and when you plan to do it – whether it’s walking to work every day or going jogging three times a week. Our physical activity specialist, Lisa Purcell, says: “Put the times you plan to be more active in your diary and put reminders where you’ll see them. It’s important to do something that you enjoy – it could be anything from aqua aerobics to dance, football or judo.”

Making changes isn’t always easy, but remember that you can do it. If your plans go wrong one day, don’t be disheartened or give up – just start again the next day. n

Joao Bocas, 39, from Brighton, quit after smoking for 14 years. “I stopped smoking and drinking at the same time because I wanted to focus on my fitness,” he says.

“It took me a few attempts but, on the third time, I stayed with it and I haven’t smoked for eight years.

“I used nicotine patches to help me quit. At first, I avoided social situations until I felt more confident about being with people who were smoking and drinking. I bought a lot of

fruit instead of cigarettes and alcohol, because I wanted to be good to myself. I tried to do healthy activities to replace the ones I had been doing, so I went to the gym a lot.

“I went on to do a sports degree as a mature student. I now run a wellbeing consultancy business and I do a lot of sports coaching, fitness training and work with young people, so not smoking fits in better with that. And I feel like I have much more energy, I can taste things better and I can smell the fresh air.

“I have a baby boy as well as a 14-year-old stepson, so it is good for them that I don’t smoke. Hopefully I will live a bit longer too.”

1 Work out what triggers the habits you want to change.

2 Make specific plans for how you will change your habits – what, when and where.

3 Get support from people around you. If they can make healthy changes along with you, it will make things easier.

4 Don’t be afraid to ask for professional support, perhaps from a stop-smoking adviser or your GP.

5 Make changes whenever you want, but it may be easier when starting a new routine. A holiday, retirement, new job or moving house are all good times to take stock.

6 Include something you enjoy in your lifestyle changes, or you won’t stick to them.

7 If you feel your good intentions fading, visualise the better, healthier future you will have if you change your lifestyle, and compare that with the future you will have if you don’t.

Seven steps to success

No Smoking Day: V for VictoryLast year, our No Smoking Day campaign encouraged a million people to attempt to stop smoking. This year’s campaign has a V for Victory theme, which is set to inspire just as many people – if not more – to win the battle against cigarettes by giving them up for good on 12 March.

The campaign will help smokers along the road to victory, providing information, support and encouragement to put

together a personal battle plan so that they are in the best possible position to make a successful quit attempt on the day.

About 10 million people in the UK smoke but about two-thirds say they want to give up.

More than 100,000 smokers in the UK die from smoking-related causes each year, including about 22,000 from heart and circulatory diseases and 45,000 from cancer.

Smoking is a major risk factor for developing furring and hardening of the arteries, which can lead to a heart attackD or strokeD.

So if you’re a smoker who wants to quit, join in and give it a go on 12 March.

n For more information and support, visit nosmokingday.org.uk.n To join the conversation on Twitter, use the hashtag #NoSmokingDay.

Check out menus in advance to find the healthiest option”

WELLBEING

bhf.org.uk

39

WELLBEINGWELLBEING

Copingwith a deathDealing with the death of a loved one is one of the hardest things any of us have to face. Sarah Brealey talks to Sandra Cohen about the death of her beloved husband, and presents tips for coping

You can get what I call a plate-glass moment, when you walk into a memory and the shock of it is so painful”

A ll you can do “is put one foot in front of another,” says Sandra Cohen, about losing Aubrey, her husband of 19 years (right).

She still misses him “every second of every day”, but she has learnt that things do eventually get easier. “You don’t want to hear it at the time, but you will get through it.”

Sandra, 70, from Leicester, cared for her husband for the last eight years of his life, after he was left disabled by a strokeD and heart attackD. The final years were hard but, she says, not as hard as living without him.

At the time, she felt she didn’t know how to cope, but three years on she’s able to share her advice for others going through a similar loss.

“If people offer help, let them; they may not ask again,” says Sandra. “You probably don’t care whether you eat or not, so for someone to bring you a hot bowl of soup is a real help.”

She says that talking about your loved one is one of the most comforting things you can do. “It’s important to reach out to people – not to melt over them but to talk about the person that you’ve lost. People won’t bring up the subject with you because they don’t know how or they feel embarrassed, but it really helps.

“Touch means a lot too. A hug, or someone holding my hand for a minute, is very comforting.”

Keeping goingFor most people, the emotional impact of bereavement is the hardest thing to deal with. Our bereavement adviser, Diane Mix, says: “Often the most difficult time is later on, perhaps after the funeral is out of the way. This can be when the realisation of what’s happened really kicks in, but it’s also when people may

have stopped calling, and family members may have gone back to work.

“Look after yourself, get fresh air, eat small nutritious meals and get plenty of rest. If you feel like you are really struggling, ask for help from your GP, or a counsellor.”

Sandra agrees that things can get harder once the initial tasks have subsided. “You can wake up and feel like you don’t have a purpose. In my case, my husband and I had been together day and night. I’d stopped work; I didn’t have dependent children or pets. It’s vital to find a purpose. To me, that was doing voluntary work in the community.

“It might be a cliché, but bereavement is a journey and you go through so many things – grief, guilt and anger.”

Sandra sought help from a bereavement counsellor, which she found very useful, as well as spending time with friends. She says: “Don’t think that your friends don’t want to know you any more. Try not to feel like you are abnormal.”Ph

otog

raph

y: K

eith

Mea

ther

ingh

am


Sandra cared for her late husband Aubrey for the final eight years of his life

4140

She also recommends preparing yourself mentally for moments of extra grief. “Try to find something to do on the days that you know are going to hurt – birthdays and anniversaries.

“Be prepared for shocks you are not expecting. You can be fine for a while and then you get what I call a plate-glass moment, when you walk into a memory and the shock of it is so painful.

“There will be times when you can go out and have a lovely time, like I did a few weeks ago – then I came home and howled, because I didn’t have anyone to talk to about it.

“One thing I always do is leave a light on when I go out. That way at least the house doesn’t feel so dark and alone when I come back.”

Sandra’s message of hope is that, no matter how dark things seem, you will come out the other side. “Eventually you learn to live again. You don’t get over the loss of a loved one, but you learn to live differently.” n

Practical considerationsInform a doctorBefore anything else, tell a doctor and any next of kin. If the death was expected, their GP will give you a medical certificate showing the cause of death; if it wasn’t, or if the deceased hadn’t seen their GP in the last 14 days (28 days in Northern Ireland), the death has to be reported to the coroner.

Register the deathYou need to register the death with the Registrar of Births, Marriages and Deaths in the district where it happened, within five days (eight days in Scotland). Time limits don’t apply if there’s going to be a post-mortem. Take the medical certificate with you.

Pets and practicalitiesIf the house is empty, make sure it’s secure, cancel any newspaper or milk deliveries, and consider turning the water off. Make arrangements for any pets.

InsuranceHome insurance won’t be valid if it was only in the deceased’s name. If you are a named driver on the deceased’s car insurance, it may be invalid. Contact the insurer.

Joint accountsIf you held a joint account with the deceased, you must notify the bank about the death, but this may lead to the account being frozen. Ask if this is going to happen, and explain if it causes you problems.

Funeral arrangementsFind out if there’s a funeral plan in place to cover costs – this, along with the will, may give guidance about funeral wishes. Funeral directors’ prices vary so shop around if you feel up to it. Don’t be

pressured into buying the most expensive options.

If you receive certain means-tested benefits, you may be eligible for help with funeral costs. Contact the Department for Work and Pensions Bereavement Service on 0845 606 0265.

Financial concernsClaim on a life insurance plan if there is one.

If there’s a will, it usually names one or two people as executors. If there’s no will, the rules of intestacy set out who is entitled to administer the estate and who the beneficiaries will be (these may not be who you would expect, which is why it is important to make a will). This person will need to gain a grant of probate (confirmation in Scotland) so they can legally deal with your estate.

Any inheritance tax (IHT) must be paid within six months. If it’s on property, you can pay in instalments. Spouses, civil partners and charities can inherit without paying IHT.

Debts or mortgages have to be paid, but only if there’s money left in the estate – debts don’t pass on to relatives. If the debt was in joint names, though, it becomes the responsibility of the survivor.

Tell othersInform the deceased’s bank(s), pension provider, mortgage provider or landlord as well as utility providers, government departments and the local council. In most areas of England, Scotland and Wales there is a Tell Us Once service so you can inform the council and government departments in one go, either when you register the death or later. Enquire when you book your appointment to register the death.

Our booklet Losing someone to heart disease offers help and support. Call 0870 600 6566 to order this, or our ‘Small Creature pack’ for bereaved young children. Turn to page 50 for a full list of booklets and publication codes. For support from our bereavement adviser, call our Heart Matters Helpline on 0300 330 3300. We’ve also got more detail in our online magazine at bhf.org.uk/HMcoping.

The Government produces a booklet called What to do after someone dies. You can get a copy when you register a death, or from Jobcentre Plus offices, many funeral homes, Citizens Advice, or at www.gov.uk/after-a-death. In Scotland, see the Scottish Government’s booklet What to do after a death in Scotland, from scotland.gov.uk or call 0131 244 3581.

Age UK has a When someone dies booklet. Visit ageuk.org.uk or call 0800 169 6565.

Support and information

WELLBEING

We’ve produced a free booklet about leaving a gift in your will, which includes guidance on making a will, things to think about before your solicitor appointment and a jargon buster. Email [email protected] or call 0300 330 3322 for a copy.

This March, the BHF and other charities have come together for Free Wills Month. This means that anyone over 55 in a participating area can have a simple will written or amended for free. You don’t

have to leave a gift to the BHF, but we would be extremely grateful if you chose to. The areas are Basingstoke, Blackpool, Chesterfield, Chichester and Worthing, Coventry, Darlington, Eastbourne, Harrogate, Hastings, Liverpool, Middlesbrough, Newcastle-upon-Tyne, Northampton, Peterborough, Sheffield, Slough, Sunderland, Wolverhampton, the Wirral and York. Call 0845 020 4309 or visit freewillsmonth.org.uk to make an appointment.

Alan’s storyAlan Gilchrist, 79, from Hull, says: “I had a sudden and unexpected heart attackD in 2009, which was followed by a quadruple bypass operation and an implantable cardioverter defibrillator being fitted.

“I received a very high standard of care. I know that treatment has improved and will continue to improve due to research. The BHF has played a major role in funding that research. At a time of economic cutbacks, it is vital that research doesn’t suffer and that necessary equipment is available.

“Following my heart attack, I found the BHF information booklets invaluable.

“I was able to understand what had happened to me and it showed me the light at the end of a very dark tunnel. This is why I want to leave a legacy to the BHF, so they can continue their important work into heart disease and continue to support others like me.”

Leave a BRIGHTER FUTUREGifts in wills are hugely important in funding our life-saving research – they account for nearly half our income. We understand that loved ones come first, but once you’ve taken care of them in your will, please consider helping us create a better future for everyone affected by heart disease

I want the BHF to be able to continue their important work into heart disease and continue to support others like me”

Help with making a will



MY STORY

They say you never forget how to ride a bike, but what if you never learnt? That was the situation facing

49-year-old Heart Matters member Simon Clark, who was put off cycling after crashing into a wall as a child. “I didn’t get on a bike again for 40-odd years,” says Simon, from Market Harborough in Leicestershire.

“There were many occasions when my children were small and they wanted to go out on a bike ride and I couldn’t participate,” he says. “I felt a bit low about that, a bit depressed.”

It’s never too late to learnEverything changed when Simon, an IT consultant, read the letters page of our May/June 2013 issue of Heart Matters. The writer of our star letter that month was asking for advice about where adults can go to learn to ride a bike. Our response included a link to the Government’s Bikeability website (tinyurl.com/bikeabilityadults). Branded as ‘Cycling Proficiency for the 21st century’, it has a section on cycling skills for adults. “I didn’t realise that there were people out there giving lessons,” says Simon. “I read the

4342

“

Learn to cycle Contact your local council to find out if they run cycling courses for adults, which may be subsidised or even free. In London, you can also book through the cycling area of tfl.gov.uk. If not, visit tinyurl.com/bikeabilityadults to find an instructor near you.

If you’re in Northern Ireland, you can visit cycleni.com/useful-info/cycling-training or call 07775 737324; in Scotland, visit cyclingscotland.org or call 0141 229 5350;

and in Wales, visit bikeabilitywales.org.uk or call 07968 109145.

The cost of any training will vary according to the instructor and whether it’s subsidised, how many sessions you need and if they’re group sessions or one to one.

Having a mobility problem doesn’t have to be a barrier either. To get support with cycling with a disability, visit ctc.org.uk/ride/inclusive-cycling.

letter and thought it was something I could do.”

Simon went through the Bikeability website to arrange a one-to-one lesson in June with part-time Bikeability-certified instructor Rob Williams. He says: “Rob and I had a chat on the phone, then he took me out to a car park on the edge of Rutland Water reservoir, and off we went.

“It wasn’t scary, as Rob explained exactly what would happen. We went through brakes and how to slow down, so I knew I was in control.”

Simon started on a bike with no pedals so that he could focus on getting his balance right. “Rob held the back of the bike and ran with me. Then he let go,” he says. Once Simon had mastered coasting on his own, they put pedals on and Rob showed him how to launch off. Simon says: “I was quite elated.”

Rob, an instructor for ten years, adds: “Simon listened and built his confidence up and, in one session, we were able to get him balancing properly, riding around in circles and doing figures of eight. It’s really rewarding to watch.”

Practice makes perfect Feeling confident that he could balance, start, stop and ride around corners, Simon went out solo to practise. “I had lots of false starts, but haven’t fallen off yet,” he says.

Now the Clarks go out every few weeks, cycling eight to ten miles at a time. “I still have the wobbles when I start,” says Simon, “but I can keep up with my wife and sons, no problem.”

Cycling is a fantastic way to get your recommended minimum of 150 minutes a week of moderate-intensity physical activity, and Simon says he feels much fitter

Inspired by Heart Matters, Simon Clark has learnt to ride a bike at the age of 49. He talks to Ruth Ganthony about how it has enabled him to enjoy being active with his family

As easy as RIDING A BIKE

Read our feature Free wheeling for cost-saving bike maintenance tips. Visit bhf.org.uk/HMfreewheeling or call 0870 600 6566 to order the Mar/Apr 2013 issue. If you’re looking for a challenge, visit bhf.org.uk/heartrides for a list of BHF cycling events.

Visit bhf.org.uk/HMlearntoride to read more about Rob’s work and his advice for getting on your bike.

Feeling inspired?

MY STORY

You can make a million excuses why you can’t do something. I never thought I’d be able to ride a bike”

since taking it up. “About five years ago, I had a pulmonary embolism from a blood clot in my left leg, which is why I wanted to do something,” he explains. “I’d been sitting at a desk all day and not moving, so it was about upping my overall exercise levels.” Simon is also a cricket umpire and enjoys walking in the countryside with his wife Susan and sons Gareth, 24, and Daniel, 19.

Rob adds: “As long as Simon carries on doing it, he’s going to see benefits – even if it’s just an hour a week. Try to increase the mileage and just keep spinning!”

New goalsSimon has been a member of Heart Matters for five years, after picking up a copy of the magazine at his GP’s surgery. He also supports the BHF shop in Market Harborough and recycles ink cartridges to help raise funds (therecyclingfactory.com/bhf).

Simon’s ultimate challenge is to take part in a sponsored bike ride. “I’d like to raise money for the BHF, but I need to improve my road safety skills and up my fitness level first.”

Looking back at his achievement, Simon says he feels over the moon and encourages others to get active, too. “You can make a million excuses why you can’t do something,” he says. “I never thought I’d be able to ride a bike.” nPh

otog

raph

y: D

anie

l Cla

rk

44 45

ACTIVITY

Just over a year after being fitted with a pacemaker, Kitty Buchanan-Gregory, 39, ran the London Marathon. It was, she says, something she needed to do because she

felt she had “fallen out” with her body. Kitty completed the marathon in four hours in 2010.

Kitty is just one of thousands of people who have run the London Marathon over its 33-year history, raising vital funds for the BHF. In 2013, 500 runners generously raised a total of £775,000 for us – enough to fund 3,375 days of life-saving research.

This year, we’re humbled to have 600 people running the marathon for us. Many, like Kitty, are inspired to run because, like hundreds of thousands of others, they suffer from diseases of the heart and circulation. Others, such as Steven Taylor (see opposite) run because they’ve lost a loved one, while many BHF staff (see Jane Coltman’s story overleaf ) also take part.

Fighting backIn 2009, Kitty from London was fitted with a life-saving pacemaker to correct her complete heart blockD. As she had previously been a fit and healthy young woman, it came as a huge shock to Kitty’s friends and family when she received the diagnosis. Kitty, by contrast, was relieved to find out the reason she’d been feeling so unwell. However, having to stop rowing – she was training to be in a crew for the Henley Regatta

ACTIVITY

Heart Matters

Developing a heart condition, losing relatives to heart disease or working for the BHF are all things that have inspired people to raise life-saving funds for us by running the London Marathon, as Zoë Slater found out

GOING THE EXTRA MILE

at the time – was really tough for her. “I tried to row, but I was concerned it might risk

damaging my pacemaker,” she says. “I felt so frustrated that I had to stop rowing because of something that I couldn’t control.”

Having always been athletic, Kitty didn’t want to risk becoming inactive, so with rowing no longer an option, she decided to concentrate on running. When she was given the opportunity to run the London Marathon for the BHF, she couldn’t resist.

“I needed something to focus on,” she says, “so when I was offered the chance to run the marathon for the BHF, I jumped at it because I needed to prove to myself that I was still an athlete capable of achieving at a high level. Everyone said ‘don’t do it’ but I needed to.

“I’d fallen out with my body, as I was so angry with it for letting me down and I needed to get some control back.

Kitty Buchanan-GregoryAge: 39Ran the London Marathon: 2010Money raised for the BHF: £2,000Funding our lifeline: Kitty’s sponsorship could pay for over 14 days’ worth of specialist support from our Heart Matters Helpline

“It takes your body a while to get used to having a lump of metal with wires in it, but I trusted myself not to do anything silly and know my limits. I think it’s all too easy to sit back and relax and wrap yourself in cotton wool, but your body has to realise that nothing’s going to change and you just have to get used to it.”

Kitty followed a structured training programme and found it really helpful that she could see how much she was progressing over time, although she says it was sometimes hard to get motivated when it was so wet and cold. However, all her hard work and perseverance paid off. “Marathon day was absolutely amazing,” she says. “You have the whole of London cheering your name and giving you a whole load of love. It’s euphoric.”

Kitty raised £2,000 for the BHF and has since taken part in other sporting challenges. This year, she is raising money for the BHF again by taking part in the London to Brighton Bike Ride.

Remembering lost loved onesSteven Taylor, 32, ran the London Marathon in 2012 – three years to the day after his uncle died from a heart attackD aged 48. But Steven didn’t just decide to run the London Marathon in his uncle’s memory; he committed to running 12 after a friend suggested it would be a good challenge. “If someone dares me to do something, I’ll do it,” he says. “Doing the marathons gave the family something to focus on. My grandma

Steven TaylorAge: 32Marathons run to date: 12Money raised for the BHF: £3,000Funding life-saving work: Steven’s sponsorship could pay for 120 hours of life-saving research

bhf.org.uk

ACTIVITY

46 Heart Matters

ACTIVITY

Taking your first steps

Medical Director of the London Marathon Professor Sanjay Sharma, who is a specialist sports cardiologist, has

the following tips:

• Do not even try to run a marathon if you are getting symptoms of heart disease, such as chest pain, breathlessness and palpitations, and you haven’t been diagnosed.

• Think twice if you have multiple risk factors for coronary heart diseaseD, such as high blood pressure, high cholesterol and diabetesD, unless you’re planning to walk it.

• If you’ve had a previous cardiac treatment (eg, a bypassD or angioplastyD), check with your cardiologist before embarking on training.

• Do not run a marathon if you’ve had a bad cold or chest infection the week before.

• Do not run on an injury, as it will only make it worse.

• Do not take any performance-enhancing agents, such as steroids and stimulants.

• You should be able to run at least 18 miles before completing a marathon.

• When running, don’t drink too much or too little. About 100ml per mile is right.

• Be wary of anti-inflammatory drugs, such as ibuprofen when running, as they can cause hyponatremiaD, heat stroke and gastrointestinal problems. Use paracetamol for any pain relief instead.

• If it’s a hot day, don’t wear too many layers or aim for a personal best.

n Go onlineTo read an interview with Professor Sharma about how he oversees the welfare of 40,000 runners at the London Marathon, visit bhf.org.uk/HMmarathon.

If you are thinking of running a marathon, you must seek medical advice before embarking on a training programme.

kept tabs on me. She liked ringing up and finding out when I was running next.”

Steven, who ran 11 of his marathons in the UK, plus the Berlin Marathon, says he can’t get enough. Asked what it is about marathon running that attracts him, he says: “It’s just that feeling you get at the end – it’s amazing.”

Steven raised £3,000 for the BHF by running the 12 marathons and he has already run another two since he completed his challenge in September 2013. He now has his heart set on running all the major marathons and becoming part of the 100 Marathon Club. However, he hasn’t always been this active. “I only started running five or six years ago,” he says. “I was quite overweight and I just wanted to run one marathon. I’ve now run more than 20 and I’d say that, as long as you’re safe to do so, anyone can give it a go.”

Working it outJane Coltman, 50, like thousands of others, has lost close family members to heart disease. As the Manager of the BHF shop in High Wycombe, Buckinghamshire, she knows how important it is to raise funds so that research into heart and circulatory disease can continue.

“Working day in day out, constantly trying to hit targets to raise money for the BHF, I’m really aware of the research we do,” she says. “Knowing how much things have progressed, I think my grandparents and uncle might have survived if they’d been ill today.”

Jane, who used to run regularly but hadn’t for a few years before she decided to do the marathon, is following the BHF’s training programme (bhf.org.uk/training) and she believes she’s on target. “I would say I’m up to speed,” she says, “but speed isn’t the key word for me!”

Jane previously walked the London Marathon in 2008 with a friend who had had a stroke. “It took 19 hours and 15 minutes and it was very tiring, but the atmosphere was great. I’m really looking forward to experiencing that again this year.” n

n Do it your wayIf Kitty, Steven and Jane have inspired you to take on a challenge, visit bhf.org.uk/heartevents to find out about the range of BHF fundraising events for all abilities.

n Don’t forget to do your 150Not everyone is capable of running a marathon, but we should all aim to do a minimum of 150 minutes of moderate-intensity physical activity each week. To find out more, visit bhf.org.uk/stayingactive.

n Congratulations!Congratulations to our Director of Fundraising Louise Parkes, who ran the London Marathon in four hours and 40 minutes last year, raising more than £3,000 for the BHF.

n Good luckThe very best of luck to our Chief Executive Simon Gillespie and the other 599 people running the marathon for us this year.

Jane ColtmanAge: 50Running the marathon: April 2014Fundraising target: £2,000Funding vital skills: Jane’s sponsorship could support the professional development of two BHF nurses for a year, improving the care of heart patients

47

When Anne Hicks’ alarm clock went off on a June morning, she switched it off as usual. A few minutes later she collapsed and died in her bedroom, where her 14-year-old daughter Emily found her.

It is thought that Anne, 40, died of a problem with her heart rhythm that caused a cardiac arrestD. Her death devastated her family, including her sister, Sharon Spence, from Bathgate, West Lothian.

Afterwards, Sharon got information from the BHF website and called our Genetics Helpline (0300 456 8383). She and her relatives hope to be tested for the condition.

So when Sharon’s boss at Matalan in Livingston was looking for a charity to support, Sharon suggested BHF Scotland. The store held collections and donated the proceeds from its car park, raising more than £3,000.

Sharon and her friend Emily Brown took part in the BHF’s Edinburgh Winter Warmer and raised more than £800. “The feeling crossing the finish line was incredible.

“I’m raising money for BHF Scotland in the hope that it will in some way help stop other people from having to go through the terrible heartbreak of losing someone.”

Fighting heartbreak

Steve Syer knows he could have died 30 years ago if it hadn’t been for a heart transplantD. With it, he’s seen his children turn into adults, and held

six grandchildren and two great-grandchildren who he would otherwise never have met.

For 28 years he and his wife Chris have raised money for the BHF. They’re a core part of the Cheltenham fundraising branch, and organised the 40-mile Cotswolds Bike Ride for 22 years. In that time they’ve been instrumental in raising £1.2m, nearly £700,000 of which has come from the bike ride.

Steve, 71, a retired engineer, says: “Supporting the BHF is really our way of putting something back into the system. Without a lot of the research that’s been done, I would probably never have had my transplant.”

Steve needed a transplant because he suddenly developed cardiomyopathyD. He was seriously ill and was in hospital for six weeks before receiving his transplant in February 1984. The surgeon who carried out his transplant was Magdi Yacoub, who later became a BHF Professor for more than 20 years.

Steve says: “I was really lucky. Apparently I was hours away from the coffin at that time. Since then, I’ve been able to live life as normal, I do whatever I want to do.

“That’s an extra 30 years that I’ve had so far. I wouldn’t have even seen my children finish school.”

Steve is often asked by the National Blood Service to present awards to long-serving blood donors (including his wife), as donated blood helped him to survive.

Steve also collects donations for the BHF at every opportunity. He says: “Please just give all you can, so that more people can have an extra chance like I’ve had.” n

≠ To find out more about this year’s Cotswolds Bike Ride on Sunday 18 May, call 0845 130 8663 or visit bhf.org.uk/cotswoldsbikeride.

We meet a man who has raised money for our life-saving work for almost 30 years after a heart transplant allowed him to watch his children grow into adults

STEVE’S STORY

Supporting the BHF is really our way of putting something back into the system”

bhf.org.uk

FUNDRAISING

If you’d like to do your own fundraising, call us on 0300 330 3322 or visit bhf.org.uk/fundraise.

Inspired to raise funds?

A life-saving transplant allows Steve to live a healthy life

Sharon Spence and Emily Brown raised more than£800 for BHF Scotland

JOIN

THE

FIGH

T

Imag

e: G

louc

este

rshi

re E

cho

48 Heart Matters bhf.org.uk 49

The Mullion Cove Hotel on Cornwall’s Lizard Peninsula has stunning views from its cliff-top position and is

surrounded by unspoilt National Trust land and sparkling blue sea. We’ve got a luxury break there for two to give away to a lucky Heart Matters reader.

The hotel overlooks Mullion’s harbour and fishing cove. With direct access to the South West Coast Path, it’s perfect for a walking holiday. You can also stroll along the secluded beaches of the Lizard – the most southerly point in mainland Britain. Most of the 30 comfortable non-smoking en-suite bedrooms have sea views and the facilities include flat-screen digital television, wi-fi access, tea and coffee-making facilities, hairdryer, individual heating and complimentary toiletries.

Dining options include the AA-rosette Atlantic View Restaurant or the more informal Glenbervie Bar. Fresh fish and seafood, including oysters from the Helford River, always feature on the varied menu.

If a trip to the coast isn’t complete without being able to walk your dog, don’t worry – the Mullion Cove Hotel offers dog-friendly accommodation, a free welcome

pack for dogs, outdoor washing facilities and a sea-view lounge where your pet is welcome too. Dogs are allowed all year round on the beach at Mullion Cove.

Our lucky winner will get: • three nights’ luxury accommodation for two people in a sea-view room

• daily full English breakfast

• daily three-course dinner

• Cornish cream tea on the first afternoon

• a bottle of champagne in the room on arrival

• tickets to the award-winning Trebah Garden

in Mawnan Smith, near Falmouth, a sub-tropical

paradise with more than four miles of footpath to explore.

How to enterTo be in with a chance, simply send your name, address and telephone number to Heart Matters/Mullion Cove prize draw, Freepost RTCH-BXUB-XCTV, 2A Halifax Road, Melksham SN12 6YY or [email protected] by

We’re giving away a relaxing luxury break in one of the most beautiful parts of the UK

Terms and conditions: All entries must be received by midnight on 30 April 2014. The promoter is the Mullion Cove Hotel. Entrants must be aged 18 or over and UK residents. Only one entry per person. All BHF and Mullion Cove employees, associates and direct suppliers are ineligible to enter. Only the winners will be notified. Breaks must be taken by 30 November 2014, excluding 26 May, 23 August and 25 August, and are subject to availability. The prize is non-transferable, non-refundable and there is no cash alternative. The promoter reserves the right to change the prize or cancel the draw at any time. Entry denotes acceptance of these terms and conditions.

30 April 2014. For further hotel information, visit mullion-cove.co.uk.

Reader offerIf you’re not our lucky winner, you can still save 15 per cent on a stay at the Mullion Cove Hotel with our special offer, paying from £119 per room per night for bed and breakfast. You can upgrade to a superior room for a supplement (details available on request). The offer is based on two people sharing a double/twin partial sea-view room and is valid until 31 May 2014, excluding Easter and bank holidays, and is subject to availability.

≠ For more details or to book, call 01326 240328, quoting Heart Matters magazine.

The winners of the relaxing break in Dorset (Nov/Dec 2013 prize draw) are May Hamilton from Southend-on-Sea and Jonathan Gordon from Aberdeen.

PRIZE DRAW

WIN!a luxury coastal break in Cornwall

Angioplasty: A treatment to widen a narrowed artery.

Atheroma: Fatty material (plaques) that can build up within the walls of the arteries.

Bypass surgery: See Coronary artery bypass graft.

Cardiac arrest: This is when a person’s heart stops pumping blood around

their body and they stop breathing normally. It is the ultimate medical emergency. Many cardiac arrests in adults happen because the person is having a heart attack. Cardiomyopathy: A disease of the heart muscle in which the heart muscle becomes weakened. The heart muscle may become thickened, enlarged and/or stiff, depending on the type of cardiomyopathy. It affects people of all ages and is usually inherited.Cardiovascular disease (CVD): It includes all diseases of the heart and circulation – for example, coronary heart disease (angina and heart attack) and stroke.Coronary artery bypass graft: Sometimes called ‘CABG’ or ‘bypass surgery’, this is an operation to treat coronary heart disease. The arteries from your chest wall or arm, or veins from your leg, are used to bypass the blocked or narrowed coronary arteries. This helps to improve the flow of blood to your 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 fatty deposits called atheroma. CHD can lead to angina or a heart attack.

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 is

unable to use the insulin that is produced effectively, usually because excess fat in organs leads to resistance to the normal effects of insulin. Having diabetes increases your risk of developing CVD.

Heart attack: The medical term for a heart attack is a myocardial infarction,

or MI for short. This is when there is a sudden loss of blood flow to a part of the heart muscle. Most heart attacks are caused

by atherosclerosis, which is the gradual build-up of atheroma (fatty material) within the artery walls. If the atheroma becomes unstable, a piece may break off and lead to a blood clot forming. This can block a coronary artery, causing a heart attack, which could lead to irreversible damage to the heart muscle. A heart attack is a medical emergency and can lead to a cardiac arrest.

Heart block: When the electrical impulses of the heart are slowed down, delayed or blocked. Some heart blocks can cause

a bradycardia (a slow heart rate).Heart failure: A condition where the heart becomes less efficient at pumping blood around the body.Heart transplant: An operation to replace a diseased heart with a healthy heart from a human donor.High blood pressure: Also called hypertension, this is when your blood pressure is consistently higher than the recommended level. The higher pressure puts extra strain on your heart and blood vessels and, over time, can increase your risk of having a heart attack or stroke.Hyponatremia: A condition that occurs when the level of sodium in your blood is abnormally low.

ICD: Also known as an implantable cardioverter defibrillator, this is a small

device that is implanted in a person’s chest, just under the skin, and is connected to their heart by one or more wires (leads). The ICD monitors the heart’s rhythm and, if necessary, delivers a controlled electric shock. This is called ‘defibrillation’ and may be needed if a person has a life-threatening abnormal heart rhythm.



Obese: The term to describe when someone is very overweight, with

too much body fat. Being obese puts you at an increased risk of numerous health problems, including CHD and diabetes.

Pacemaker: A small device that is implanted in a person’s chest, just

under the skin, and is connected to their heart by one or more wires (leads). It is used to monitor the electrical signals within the heart and can stimulate it to contract and produce a heartbeat. A pacemaker can be used to treat numerous different abnormal heart rhythms.Peripheral arterial disease (PAD): Also called peripheral vascular disease (PVD), this is a condition that affects the arteries that carry blood to your legs, arms and tummy area. Over time, the arteries may become narrowed due to atherosclerosis – the gradual build-up of atheroma within the artery walls. In most people who have PAD, it is the lower part of the body, such as the legs, that is affected.

Statins: A medicine to reduce cholesterol levels in the blood.

Stroke: An interruption of blood flow to part of the brain, which can damage it. This happens if an artery carrying blood to your brain becomes blocked, or if it bleeds into your brain. A stroke is a medical emergency.Sudden cardiac death (SCD): An unexpected and sudden death, which is thought to be, and usually is, caused by a heart condition.

MEDICAL DICTIONARY


B

A

C

D

L

H

P

S

See p44

See p16

O

I

MEDICAL TERMS

WORTH

£1,110



driver changed his lifestyle.

See p32

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

BHF SUPPORT

Healthy eating and lifestyleBe active for life (physical activity information for over-65s) G364Coping with stress G187Cut down on salt G160Eating well G186Get active, stay active G12Guide to food labelling G54Healthy living, healthy heart (information for African Caribbean communities) G532Healthy meals, healthy heart (South Asian recipes) G6Keep your heart healthy HIS25Looking after your heart (information for South Asian communities) G223Put your heart into walking G26NEW Risking it – short films designed to help you tackle risk factors DVD21 or bhf.org.uk/riskingitSalt made simple G508So you want to lose weight… for good M2Stop smoking G118Traditional foods – healthy dishes (African Caribbean recipes) G503We can help you look after your heart (leaflet) G598Women and heart disease M37 Living with a heart conditionAn everyday guide to living with heart failure G275UAngina HIS6Atrial fibrillation HIS24Blood pressure HIS4Cardiac rehabilitation HIS23Caring for someone with a heart condition HIS20Coronary angioplasty HIS10Diabetes and your heart HIS22Having heart surgery HIS12Heart attack HIS7Heart rhythms HIS14Heart transplantation HIS13Heart valve disease HIS11Implantable cardioverter defibrillators (ICDs) HIS19Lifelines: heart surgery and after (DVD) DVD10

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

If you’ve been inspired by some of our features in this issue, you can order a free pack of related guides to get information and support to improve your lifestyle. Remember to use the pack number to order and search online.

Get your free packs

Living with heart failure HIS8Medicines for your heart HIS17My progress record (a manual to keep important information about your medication, test dates and results) M92MOne step at a time – living with heart failure (DVD) DVD5Pacemakers HIS15Peripheral arterial disease HIS16Physical activity and your heart HIS1Primary angioplasty for a heart attack HIS26Reducing your blood cholesterol HIS3Returning to work with a heart condition HIS21Statins (information sheet) IS66Test for heart conditions HIS9NEW The road ahead – your guide to heart tests and treatments DVD30 or bhf.org.uk/videosWarfarin (information sheet) IS67

16

MEDICAL

Heart Matters

Diabetes increases your risk of coronary heart disease. Doireann Maddock fi nds out what it’s like to live with, and how to manage the condition

living with DIABETESFocus on...

Lyn Rodney became aware she had type 2 diabetes in 2009. She is one of about three million people in the UK diagnosed with the condition.

Lyn, then 49, had some of the symptoms typically associated with diabetes, as she explains: “I’d lost a lot of weight in a very short space of time and I was drinking a lot of water, I was really thirsty.”

Other signs can include extreme tiredness, slow healing of cuts and wounds, and blurred vision.

At � rst, Lyn was unaware that what she was experiencing could be a sign of diabetes. A chance conversation with a friend who has the condition prompted the pair to check Lyn’s blood sugar level.

Seeing the results, Lyn’s friend took her to hospital. “The doctor said my blood sugar readings were really high. I was in shock,” says Lyn. “This wasn’t something I was expecting to hear at all. I’d heard of diabetes, but never related it to myself.”

Diabetes is easy to miss. The symptoms can come on gradually and there are thought to be about 850,000 people in the UK with the condition who don’t know they have it.

Type 1 and type 2 explainedLyn has type 2 diabetes, the most common form of diabetes (about 90 per cent of people with diabetes have type 2 compared with 10 per cent who have


Lyn has got her diabetes under control by eatinghealthily and doing regularphysical activity

Phot

ogra

phy:

Kei

th M

eath

erin

gham

35

bhf.org.uk

M any of us have a habit or two that we’d like to change. The good news is that it’s never too late to do things di� erently. Research shows that making healthy changes even in later life still brings bene� ts. If you’re doing no exercise at the moment, becoming moderately active can be what makes the biggest di� erence to your health. Changing habits isn’t always easy, but going about it the right way can really help your chances of success.

Understand your habitsFirst, think about your behaviour and what you’d like to adjust. Bas Verplanken, Professor of Social Psychology at the University of Bath, says: “Habits

Break theHABITSof a lifetime

are something we do frequently – and that makes them important in terms of health. Eating junk food occasionally is not a problem, but doing it regularly is. “A habit is usually an automatic behaviour rather than a choice that we have thought through – grabbing a chocolate bar without thinking about it, for example. There may also be a lack of control, and this particularly applies when there is an element of addiction, such as with smoking.”Because habits are something we may do without fully thinking about it, it’s helpful to start by thinking about when and how they happen, and what triggers them. For example, you may automatically have a couple of biscuits with your morning cup of tea, or open a bottle of wine to have with your dinner.

It’s never too late to change your habits for the better. Sarah Brealey explains how to do it

Imag

e: S

tock

food

WELLBEING

The diabetes pack (see pages 16–19) PK30

Diabetes and your heart HIS22Eating well G186So you want to lose weight… for good M2Get active, stay active G12

The changing habits pack (see pages 35–37) PK31

Put your heart into walking G26Eating well G186Stop smoking G118Coping with stress G187

2 red onions, cut into wedges500g (1lb 2oz) new salad potatoes (such as Charlotte), cut in half lengthways1 red pepper, deseeded and cut into chunks1 yellow pepper, deseeded and cut into chunks1 courgette, thickly sliced8 cloves garlic, left unpeeled5 tsp olive or rapeseed oil8 chicken thighs (about 1kg/2¼lb total weight with skin on and bones in), skin removed1 tsp dried Italian herb seasoningFreshly ground black pepper, to taste4 tomatoes, halved

1 Preheat oven to 2000C/1800C fan/gas mark 6. Arrange red onions, potatoes, peppers, courgette and garlic in a large, non-stick roasting tin. Drizzle over 3 teaspoons of the olive oil; toss to coat vegetables all over. Roast in oven for 15 minutes.

2 Meanwhile, slash each chicken thigh a couple of times with a sharp knife. Place chicken in a bowl, drizzle over remaining oil, add dried herbs and black pepper; toss to coat chicken.

3 Remove roasting tin from oven; nestle chicken thighs between vegetables. Tuck tomato halves, cut-sides up, around vegetables. Return to oven; roast for a further 45 minutes or so until chicken is fully cooked (see Cook’s tips).

4 Serve immediately, squeezing garlic out of the skins as you eat. Serve with a mixed leaf side salad or crusty bread, if you like.

Chicken and vegetable traybakeThis colourful and tasty traybake, which uses chicken thighs for extra flavour, is easy to assemble and perfect for a mid-week budget mealPrep time: 15 minutesCooking time: 1 hourServes: 4

• To check if the chicken is cooked, insert a skewer into a chicken thigh – if juices run clear and there is no pink meat, it is cooked; if not, return to oven and roast for a further 5–10 minutes or until fully cooked.

• Cool any leftovers and refrigerate overnight. Enjoy the next day, reheated until piping hot throughout.

• Substitute dried mixed herbs for the Italian herb seasoning.

COOK'S TIPS

Recipes: Anne Sheasby; food styling: Sara Lewis; prop styling: Tony H

utchinson; photography: William

Shaw

23%

Each portion contains:

Sugars10.3gLow

Energy1467kJ348kcal

Fat7.9gLow

Saturates1.7gLow

Salt0.3gLow5%11% 9%11%17%

% = an adult’s reference intake

Tagliatelle with salmon and courgettesHot pasta, tossed with a tasty flaked salmon and courgette sauce creates this easy meal that won't break the bankPrep time: 20 minutesCooking time: 20 minutes Serves: 4

• Serve with a mixed dark leaf salad.

• Just before serving, try scattering some toasted flaked almonds over the pasta and sauce.

COOK'S TIPS

2 tsp rapeseed oil2 leeks, washed and thinly sliced (about 225g/8oz prepared weight)2 courgettes, thinly sliced (about 225g/8oz prepared weight)1 tsp dried tarragon3 tbsp cornflour550ml (19fl oz) skimmed or semi-skimmed milk418g (14½oz) can (or 2 x 213g/7½oz cans) pink salmon, drained, bones removed and fish flakedDash of hot pepper sauceFreshly ground black pepper, to taste350g (12oz) dried tagliatelle

1 Heat rapeseed oil in a non-stick saucepan. Add leeks and courgettes; cover and cook gently for about 10 minutes or until softened, stirring occasionally. Remove pan from heat; drain off excess liquid. Transfer vegetables to a bowl; stir in tarragon and set aside.

2 Rinse vegetable cooking pan; use it to make white sauce. In a small bowl, mix cornflour with a little of the milk until smooth. Pour remaining milk into saucepan; stir in cornflour mixture. Bring to the boil over a medium heat, stirring continuously, until thickened and smooth. Simmer for 2 minutes, stirring.

3 Stir cooked vegetables, flaked salmon, hot pepper sauce and black pepper into white sauce. Heat gently until sauce is piping hot throughout, stirring occasionally.

4 Meanwhile, cook pasta in a separate pan of boiling water for 12 minutes or until tender. Remove from heat; drain thoroughly.

5 Divide pasta between 4 serving bowls. Spoon sauce over pasta; toss gently to mix. Serve immediately.

Heart Matters March/April 2014If you're not already a member, join for free by calling 0300 330 3300

23%


Sugars13.4gLow

Energy2621kJ621kcal

Fat12.4gLow

Saturates2.1gLow

Salt1.8gLow30%18% 11%15%31%


Chunky vegetable and bean goulashThis hearty vegetable goulash is ideal for a warming and nutritious meal on a budgetPrep time: 15 minutesCooking time: 1 hour 35 minutes Serves: 4

• Cool any leftovers and refrigerate overnight. Reheat the next day in a saucepan until piping hot throughout.

COOK'S TIP

1 onion, chopped2 cloves garlic, crushed1 red pepper, deseeded and cut into small chunks3 carrots, sliced2 sticks celery, chopped or sliced175g (6oz) button mushrooms400g (14oz) can chopped tomatoes150ml (¼ pint) homemade or reduced-salt vegetable stock150ml (¼ pint) medium cider (or extra stock)2 tbsp paprika2 tsp dried herbes de ProvenceFreshly ground black pepper, to taste400g (14oz) can butter beans, drained and rinsed400g (14oz) can cannellini beans, drained and rinsed2 tsp cornflourChopped fresh coriander and 2 tbsp soured cream, to serve (optional)

1 Preheat oven to 1800C/1600C fan/gas mark 4. Put all ingredients, except canned beans, cornflour, coriander and soured cream, into a large, flameproof, ovenproof casserole and stir to mix.

2 Cover and bake in oven for 1 hour. Remove from oven; stir in canned beans. Re-cover and return to oven; bake for a further 30 minutes or until vegetables are tender. Remove from oven.

3 Blend cornflour with 1 tbsp cold water in a small bowl. Stir into vegetable mixture. Heat gently on top of stove, stirring continuously, until mixture comes to the boil and thickens slightly. Simmer gently for 2 minutes, stirring.

4 Sprinkle coriander over top and garnish with a swirl of soured cream, if you like. Serve with cooked brown rice or couscous.

23%


Sugars13.3gLow

Energy1505kJ358kcal

Fat3.3gLow

Saturates0.5gLow

Salt0.8gLow13%5% 3%15%18%


Green vegetable frittataThis green vegetable-packed frittata is quick and easy to make and creates a really tasty, economical meal.Prep time: 10 minutesCooking time: 30 minutes Serves: 4

1 tbsp olive oil1 onion, chopped175g (6oz) small broccoli florets115g (4oz) frozen peas225g (8oz) cold boiled new potatoes, diced100g (3½oz) frozen leaf spinach, defrosted, squeezed dry and shredded (see Cook’s tips)1 tsp dried mixed herbsFreshly ground black pepper, to taste6 medium eggs25g (1oz) reduced-fat mature Cheddar-style cheese, finely grated

1 Heat olive oil in a large, non-stick frying pan; add onion and cook gently for about 8 minutes or until softened, stirring occasionally. Meanwhile, cook broccoli and peas in a pan of boiling water for 4 minutes. Drain well; set aside.

2 Add potatoes to onion in pan; cook for 5 minutes, stirring occasionally. Add broccoli, peas, shredded spinach, herbs and black pepper to frying pan; stir gently to mix.

3 Break eggs into a bowl or jug; lightly beat together. Pour beaten eggs evenly over vegetables in frying pan.

4 Cook over a medium heat for about 7 minutes or until eggs begin to set and frittata is golden underneath. Meanwhile, preheat grill to high. Sprinkle cheese evenly over top of frittata. Place pan under grill; grill until cheese is melted and top is set. Remove from heat; cut frittata into wedges and serve.

• Defrost spinach; gently squeeze out excess water, pat dry on kitchen paper, then shred spinach. Use as directed.

• Cool any leftovers and refrigerate overnight. Enjoy the next day either served cold or reheated until piping hot throughout.

• Serve with a mixed tomato, red pepper and spring onion salad, if you like.

COOK'S TIPS

Heart Matters March/April 2014If you're not already a member, join for free by calling 0300 330 3300

23%


Sugars2.8gLow

Energy1139kJ273kcal

Fat14.9gMed

Saturates4.1gLow

Salt0.5gLow8%21% 21%3%14%


free date of birth home/work phone mobile phone no smoking ... · stopping smoking is the single...

Documents