Patients with hypertension, or chronic high blood pressure, are often given drugs to lower their risk of heart disease and stroke but the medication could also benefit a wider group of patients.Researchers found that people with prehypertension, where blood pressure is higher than normal but not as severe as in hypertension, had a 22 per cent lower risk of stroke if they took the drugs.

An analysis of 16 studies, covering 70,664 patients, found that treating 169 prehypertensive people with blood pressure-lowering medication for 4.3 years would prevent one stroke from happening.

High blood pressure is the biggest risk factor for stroke, and an estimated 40 per cent of strokes could be prevented if people took steps to control their blood pressure levels.

US data shows that about 10 per cent of Americans have prehypertension, with a blood pressure between 120/80mm Hg and 139/89mm Hg – higher than the upper boundary of “normal” but below the lower limit of hypertension.

Ilke Sipahi of the Harrington-McLaughlin Heart and Vascular Institute in Cleveland, Ohio, who led the study, published in the Stroke journal, said patients would be better off trying to lower their blood pressure through a healthy diet and physical activity than by taking pills.

He said: “We do not think that giving blood pressure medicine instead of implementing the lifestyle changes is the way to go … however, the clear-cut reduction in the risk of stroke with blood pressure pills is important and may be complementary to lifestyle changes.”

Dr Sharlin Ahmed of The Stroke Association said: “Making a few simple lifestyle choices, such as eating a healthy diet low in salt, giving up smoking, and exercising regularly can help to keep your blood pressure under control and can reduce your risk of stroke.

“As highlighted in this study, it may also be beneficial for some people with borderline high blood pressure to take blood pressure lowering medication, however this needs to be discussed with your GP.”

Women who eat a bar of chocolate a week could reduce their chances of having a stroke by 20 per cent, according to a new research.A study of more than 33,000 Swedish women found that those who ate the most chocolate had the lowest chance of stroke.

People who ate 66g per week – about a bar and a half – were 20 per cent less likely to suffer a stroke, while those who consumed 8g a week or less were at the highest risk.

The findings, published in the Journal of the American College of Cardiology, add further weight to previous studies which highlight the health benefits of eating chocolate and cocoa.

Earlier this year Cambridge University experts found that regular doses of chocolate can reduce the risk of heart disease by a third, while a separate study suggested it can be as good for the health as exercise.

Scientists from the Karolinska Institute in Stockholm questioned 33,372 women about their eating habits in 1997 and over the next decade about 1,600 suffered strokes.
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Susanna Larsson, one of three researchers, said: “We followed 33,000 women over the course of 10 years, and we found that those who ate most chocolate had a much lower risk – 20 per cent lower – of suffering a stroke.”

Chocolate was expected to help protect against stroke because it lowers blood pressure, thereby reducing a key risk factor, she added.

The women who took part were not asked whether the chocolate they ate was dark or light, a distinction which would have helped establish a firmer connection between cocoa – the protective agent in chocolate – and stroke risk.

The researchers will now carry out a similar study in men, and expect to find similar results.

From: http://www.telegraph.co.uk/Chocolate-cuts-stroke-risk

Eating lots of fruit and vegetables with white flesh may help to protect against strokes, says a study in the journal Stroke.But Dutch researchers say they do not know why people with a high intake of apples, pears, bananas or cauliflower reduce their risk of stroke by 52%.

The study followed more than 20,000 adults over 10 years.

Stroke experts said people should not be put off eating other colours of fruit and veg.

At the start of the study, carried out in The Netherlands, participants were asked to fill in a detailed questionnaire on diet and lifestyle for the previous year.

By using this information and tracking the health of participants over the next decade, researchers were able to examine the link between the colour of fruit and vegetables consumed and stroke risk.

The study found that a 25g per day increase in white fruits and vegetables was linked to a 9% lower risk of stroke.

Of the white fruit and veg eaten, over half was apples and pears. An average apple weighs 120g.

But no link was found between stroke incidence and green (dark leafy vegetables, cabbages and lettuces) orange/yellow (mostly citrus fruits) or red/purple fruits and vegetables.

Linda Oude Griep, lead author of the study and postdoctoral fellow in human nutrition at Wageningen University in The Netherlands, said more research was needed to find out why white flesh was important.

“It is difficult to say which nutrients are responsible in white fruits and vegetables. We know that apples and pears are high in dietary fibre, but there may be other explanations.”

She said it might be useful to consume considerable amounts of white-flesh fruit and veg to prevent strokes.

“Eating one apple a day is an easy way to increase white fruits and vegetable intake.”

Dr Sharlin Ahmed from The Stroke Association said the findings should not deter people from eating other colours of fruit and vegetables.

“All fruit and vegetables have health benefits and remain an important part of a stable diet. A lot more research is needed before the colour of our groceries alone is used to determine what health benefits they may have.”

“Everyone can reduce their risk of stroke by eating a healthy balanced diet that is low in saturated fat and salt, exercising regularly and ensuring that your blood pressure is checked and kept under control.”

From: http://www.bbc.co.uk/news/health-14931634

With fast food outlets piling on the calories a new initiative was launched this week for food retailers to label the amount of calories that they are selling.The government wants us all to think more carefully about what we eat, to stem rising obesity rates.

It is asking fast food and other restaurant chains to put calorie and other nutrition information on menus.

McDonald’s is on board and has installing calorie content displays for every item of food and drink that it sells in all of its 1,200 restaurants. Starbucks has also signed up to the government’s responsibility deal.

Dietitian Helen Bond says the figures might come as a surprise to some: “People don’t necessarily realise what they are consuming. Without clear calorie labelling, it is easy to see how someone might consume – without any guilt – an entire day’s calories in just one sitting.”

Calories are a measure of energy, so the number of calories tells you how much energy is in the food. Although most people say calories the actual measure is kilocalories, shortened to kcals
Men = 2,500 kcal
Women = 2,000 kcal
Children aged 5-10 = 1,800 kcal

The trick to keeping within the daily limits, she says, is knowing what choices to make.

The average adult male should consume no more than 2,500 calories a day, and women no more than 2,000 calories a day, according to guidelines.

So, if you go to Starbucks for a coffee and pick an Americano, which contains 17 calories, you will still have lots of your daily calorie allowance left for meals.

But pick a Starbucks’ Signature Grande Hot Chocolate loaded with whipped cream and 556 calories and you’ll wipe out up to a quarter of your allowance.

If you are feeling peckish at the same time and decide to buy a Fairtrade chocolate chunk shortbread to go with your hot chocolate, you’ll hit half of your quota for the day as a woman. Even a skinny muffin will add 344 calories to the total.

Yet a fruit salad from Starbucks will only set you back 95 calories.

Similarly, go to McDonald’s and buy a large cappuccino and a grilled chicken and bacon salad for your lunch and the calorie count will be 285. But opt for a Big Mac with large fries and a milkshake and you’ll have consumed 1,450 calories.

Comparison of Recommended daily intake and fast food items:

Starbucks Grande Caffe Americano = 17 kcal;
Starbucks Grande Latte (with whole milk) = 223 kcal;
Starbucks Signature Grande Hot Chocolate (with whole milk and topped with whipped cream) = 556 kcal;
Starbucks fruit salad = 95 kcal;
Starbucks skinny peach and raspberry muffin = 344 kcal;
Starbucks chocolate chunk shortbread fairtrade = 508 kcal;

McDonald’s Large Cappuccino = 120 kcal;
McDonalds Large Coca-cola = 210 kcal;
McDonald’s Large chocolate milkshake = 500 kcal;
McDonald’s Grilled Chicken and Bacon salad = 165 kcal;
McDonald’s large french fries = 460 kcal;
McDonald’s Big Mac = 490 kcal

Ms Bond says: “You can see how things can quickly top up. If someone was to eat 500 extra calories a day above the recommended amount every day for a week, they would put on about a pound of weight.”

If this pattern continues for weeks or months on end, it is easy to see how someone starting at a healthy weight could become overweight or obese.

But it’s not just the number calories that we should be concerned about, it’s also how much salt, fat and sugar is in the food that is important.

“It’s true that calories are calories regardless of where they come from, but you are more likely to pile on the weight if you eat energy dense food – stuff that’s high in fat,” she explains.

If you eat a gram of carbohydrate, this equates to four calories. But a gram of fat equals nine calories.

“So if you eat 100g (3.5oz) of chips, that would be about 190 calories, which is twice as much as 100g of boiled potatoes.”

Ms Bond says it is possible to still enjoy fast food and stay healthy. One way is to make sure you keep track of what you have consumed and compensate if you need to by having a lean salad in the evening instead of a calorie-rich meal.

“Having calories displayed in restaurants and on food packaging will make a difference to those who want it to. It empowers people to make choices and take control of their own health. And it might make some people reconsider what they are eating.”

Adapted from http://www.bbc.co.uk/news/health-14786547

A new 10p a day ‘polypill’ containing aspirin and statins halves the risk of heart disease and stroke, according to the world’s first international trial of the drug.
Researchers found “sizeable reductions” in blood pressure and levels of ‘bad’ cholesterol among those who took the polypill over a 12 week period. Separate pills are already prescribed to millions of people worldwide to lower their chances of heart attack and stroke.

But scientists have been looking at the prospect of a combined pill, which they believe will encourage more people to take the medications more reliably.

Eight years ago Prof Sir Nichlas Wald, who demonstrated that passive smoking causes cancer, proposed the polypill in an article in the British Medical Journal.

He wrote that such an easy-to-take pill could significantly reduce the burden of cardiovascular disease, which is Britain’s biggest killer, accounting for almost 200,000 deaths a year.

Taking such a preventive pill should be as automatic as “brushing your teeth”, he later suggested.

Now the first international polypill study, published and part funded by the Wellcome Trust, has suggested it could be extremely effective.

The researchers examined data from 378 people with a raised risk of cardiovascular disease. Half were given the polypill and half the placebo. About a third of the participants were British, a third Dutch and a third Indian.

Specifically, systolic blood pressure was reduced from a pre-trial average of 134 mmHg to 124; while ‘bad’ LDL cholesterol came down from 3.7 mmol/L to 2.9.

Doctors use mmHg as a standard unit for measuring blood pressure, while mmol/L – millimoles per litre – is used as a measurement unit for very low concentrations of substances in blood.

Cardiologists know that having high blood pressure and cholesterol raises the chances of cardiovascular events, and are able to estimate how much reducing these factors decreases that risk.

The researchers calculated that the polypill would roughly halve the incidence of major cardiovascular events in people with similar risk profiles to the participants.

Writing in the journal Public Library of Science One, they concluded that the benefits to those at a high risk would be even greater: “Overall about one in four high risk people would be predicted to avoid a major event over five years.”

Prof Anthony Rodgers of the George Institute for Global Health in Australia, who led the study, said: “The results show a halving in heart disease and stroke can be expected for people taking this polypill long-term. We are really excited about this – it is a step closer to providing the polypill to patients.”

It has long been known that taking aspirin and statins separately reduces the risk of cardiovascular disease, but this is one of the first studies examining taking them in a combined pill.

It contains 75mg aspirin, 20mg simvastatin, 10mg lisinopril and 12.5mg hydrochlorothiazide. Aspirin prevents blood getting too ‘sticky’, which can lead to clots that cause heart attacks; statins lower cholesterol; while the latter two drugs lower blood pressure.

There were fears that the drugs could react in a pill while being stored, and cancel each other out, but the trial proved these were unfounded.

All four drugs are off patent, meaning any drugs company can manufacture them.

Prof Simon Thom, of Imperial College London, said the Indian pharmaceutical firm Dr Reddys had committed to make the polypill “as dirt cheaply as possible”.

The cost issue is particularly important in poorer and middle income countries, which are facing growing epidemics of ‘lifestyle’ diseases due to changing diets and people getting less exercise.

About 17 million people die of cardiovascular disease every year, 80 per cent of them in developing countries.

Prof Thom said in such countries the cost could be just £1.20 a month, with richer countries which were able to shoulder the economic burden paying more. Even so, the cost in Britain could be as low as £3 a month.

The case for the polypill has been given a powerful boost by British-led research, published in The Lancet last winter, showing that regularly taking low dose aspirin reduces the risk of certain cancers, including bowel cancer, by up to 50 per cent.

Prof Rodgers commented: “These benefits would take several years to ‘kick in’, but of course one of the hopes with a polypill is it helps people take medicines long-term.”

Two years ago Prof Roger Boyle, England’s heart disease ‘czar’, told MPs that he liked the “concept” but there were questions marks over safety. He also said there was a “fine line” between preventive medicine and “medicalising” the population.

Side effects are a big issue. Aspirin is known to aggravate the intestine and can cause internal bleeding, although most cases are minor.

This trial found that about one in 20 people stopped taking the polypill because of side effects, mainly due to such bleeding but also due to light-headedness caused by too low blood pressure.

Prof Rodgers said it was highly unlikely that all middle aged and elderly people would be offered a polypill in the future, but that it could be allocated to those with a higher risk of heart disease, stroke and certain cancers.

That could feasibly be one in five people over 30, perhaps more.

Dr Lorna Layward, from The Stroke Association, said: “Many people with high blood pressure and high cholesterol are required to take multiple pills every day in order to reduce their risk.

“Calculating when each pill needs to be taken can often be confusing and so combining the pills into one could make taking the medication much simpler.

From: http://www.telegraph.co.uk/10p-polypill-halves-heart-disease-and-stroke-risk

Coffee, sex and blowing your nose could increase the risk of a type of stroke, say researchers in the Netherlands.
The study on 250 patients identified eight risk factors linked to bleeding on the brain.

They all increase blood pressure which could result in blood vessels bursting, according to research published in the journal Stroke.

The Stroke Association said more research was needed to see if the triggers caused the rupture.

More than 150,000 people in the UK have a stroke each year with nearly 29,000 due to bleeding on the brain.

Bleeding can happen when a weakened blood vessel, known as a brain aneurysm, bursts. This can result in brain damage or death.

The researchers at the University Medical Center in Utrecht looked at 250 patients for three years to identify what triggers ruptures.
Caffeine danger

They found that coffee was responsible for more than one in 10 burst brain aneurysms.

The percentage of bursts were due to:
Coffee 10.6%
Vigorous exercise 7.9%
Nose blowing 5.4%
Sex 4.3%
Straining to defecate 3.6%
Drinking cola 3.5%
Being startled 2.7%
Being angry 1.3%

While people drinking coffee had only a 1.7 times greater risk, it is more common than other risk factors.

Being startled increased the risk by more than 23 times, but was responsible for just 2.7% of cases.

Dr Monique Vlak, a neurologist and the study’s lead author, said: “All of the triggers induce a sudden and short increase in blood pressure, which seems a possible common cause for aneurysmal rupture.”

The authors said one in 50 people has a brain aneurysm, but only a few rupture.

Dr Vlak advised that: “Reducing caffeine consumption or treating constipated patients with unruptured intracranial (brain) aneurysms with laxatives may lower the risk of subarachnoid haemorrhage.”

The study only looked at the triggers for the burst. High blood pressure weakens blood vessels in the first place and can be caused by being overweight, smoking and a lack of exercise.

Dr Sharlin Ahmed, Research Liaison Officer at The Stroke Association said: “A sudden surge in high blood pressure can increase the likelihood of an aneurysm rupturing. However, it’s very difficult to determine whether the triggers identified in this study are definitely related to the onset of a stroke as they could simply be put down to coincidence.

“A lot more research needs to be carried out to assess whether each of the identified triggers could directly cause an aneurysm to rupture.”

Health Direct flippantly suggests that the old adage of having a cigarette after having sex might just complete the hat trick of stroke risk factors.

From: http://www.bbc.co.uk/news/health-13294022

Family doctors are being prevented from prescribing drugs for conditions such as diabetes, heart disease and osteoporosis as NHS managers attempt to make drastic budget cuts, an investigation has found.
Primary care trusts are adding more medicines to their so-called “red lists” which means they can only be prescribed by a hospital consultant and not a GP.

The measure is designed to save money by restricting access to drugs that are often among the more expensive. It also means that many patients find it more difficult to obtain the most effective drugs free on the NHS, even though they have been approved by the medicines rationing watchdog Nice.

Patients’ groups described the disclosure as “outrageous” and “extremely worrying”.

Examples of medications moved to red lists include a class of diabetes drugs called gliptins; treatments for Parkinson’s disease; a drug that helps lower the risk of fractures in osteoporosis sufferers; and certain types of statins for those at greater risk of heart disease.

One health authority has added 32 drugs to its red list in the past year, while another said it intended to fine doctors who wrote letters requesting that such medicines be prescribed.

Last night, the Department of Health suggested that trusts should look to make savings elsewhere before trying to restrict access to drugs.

According to a survey carried out by Pulse, a magazine for GPs, 73 out of 134 primary care trusts which responded to Freedom of Information Act requests said they had put more drugs on red lists, or added new restrictions on GPs prescribing them, in the past year.

Drugs are prescribed using a “traffic lights” system. If a medication is deemed “green” then GPs are free to prescribe it; if it is “amber” they have to discuss prescription with a specialist; if it is “red” then only a specialist can do so.

Dr Bill Beeby, the chairman of the British Medical Association’s clinical and prescribing committee, said the status of drugs should be based solely on clinical grounds.

But he added: “There are lots of people who try to put drugs on these red lists on the basis of cost.”

With trusts under pressure to make savings estimated at £1.9 million each this year, the study suggests that increasing numbers are restricting access to drugs.

NHS Cambridgeshire has added 32 drugs to its red list over the past year, Pulse found, taking the total to more than 100.

NHS Warrington has added 25 “areas” of prescribing to its list, including the statins Crestor (also known as rosuvastatin) and Lipitor (atorvastatin).

The “areas” include drawing to a halt to “routine prescribing for longer than three months for patients who live abroad”.

NHS Derby City estimates that it will save £781,000 by “decommissioning” 13 drugs, including Intanza, a flu vaccine which uses a very short needle for those who dislike jabs, and Grazax, a grass allergy tablet.

Katherine Murphy, chief executive of the Patients Association, described the bans as “a real worry”. “What’s the point of Nice approving medicines if they are not being made available?” she said.

Barbara Young, chief executive of Diabetes UK, said: “People’s health must not be compromised with an attempt to cut costs. This would be a very short-sighted policy as complications of diabetes, such as kidney failure, are hugely expensive.”

Most drugs prescribed by GPs are so-called “generics”, meaning they are cheap versions of drugs that are no longer subject to a monopoly of production. However, there are no alternatives for some newer, more expensive drugs.

Dr Dermot Neely, an expert on statins at the charity Heart UK, said of the increased use of red lists: “It is an extremely indiscriminate and ill-advised policy, if it’s being used by PCTs to constrain costs.”

Studies show that switching from branded statins to generics results in more heart attacks and deaths, he added.

Richard Hoey, the editor of Pulse, said: “Many of the drugs approved by Nice or other national bodies are not only cost-effective, but are likely to recoup some of the price in the long-term by reducing rates of illness.

“These bans on prescribing drugs are therefore not only damaging to the care of patients, but quite possibly a false economy.” Although its budget has been protected, the NHS is committed to making efficiency savings of up to £20?billion a year by 2014.

Although the red list is only for guidance, GPs often feel pressured into following the advice because trusts hold the purse strings.

From: http://www.telegraph.co.uk/Patients-are-denied-high-cost-drugs-by-NHS-trusts

Commonly used painkillers increase the risk of heart attacks and strokes when taken at high doses or over the long term, according to research.
Experts analysed more than 30 clinical trials on more than 116,000 patients to examine the effects of painkillers on people’s health.

The fears relate to non-steroidal anti-inflammatory drugs as well as newer anti-inflammatory drugs known as Cox-2 inhibitors.

Doctors regularly prescribe such drugs to treat painful conditions, including osteoarthritis.

They are given at much higher doses than those found in over-the-counter remedies, which are used for occasional headaches, aches and pains.

The study, in the British Medical Journal, found that compared with a dummy drug lumiracoxib increased the risk of heart attacks, while ibuprofen was linked to the highest risk of stroke (more than treble the risk).

Diclofenac almost tripled the risk, while etoricoxib and diclofenac were associated with around a fourfold increased risk of suffering death from cardiovascular causes.

The authors, from the University of Bern in Switzerland, said: “Although uncertainty remains, little evidence exists to suggest that any of the investigated drugs are safe in cardiovascular terms.”

In an accompanying editorial, Prof Wayne Ray, from the department of preventive medicine in Nashville, said: “Naproxen seemed least harmful.

“Cardiovascular risk needs to be taken into account when prescribing any non-steroidal anti-inflammatory drug.”

Overall, the number of heart attacks and strokes reported was low compared to the number of patients.

In 29 of the trials, there were a total of 554 heart attacks and in 26 trials there were 377 strokes. In 28 trials there were 676 deaths.

From: http://www.guardian.co.uk/high-doses-painkillers-stroke-risk

The first trial among the over 50s in the UK of the “polypill”, a daily tablet combining several low-dose drugs that could protect against heart attacks and strokes, is being launched this month.
The idea was proposed by two British professors in 2003. Prof Sir Nicholas Ward and Prof Malcolm Law, from the Wolfson Institute of Preventive Medicine at Queen Mary, University of London, suggested in a paper in the British Medical Journal that a pill combining low doses of several drugs to bring down cholesterol and blood pressure could save lives.

Ward and Law wrote in their paper: “The polypill strategy could largely prevent heart attacks and stroke if taken by everyone aged 55 and older and everyone with existing cardiovascular disease. It would be acceptably safe and with widespread use would have a greater impact on the prevention of disease in the western world than any other single intervention.” Richard Smith, then BMJ editor, said it was possibly “more than 50 years since we published something as important as these papers”.

The idea has gained currency and is being explored by more than one team of researchers. While some scientists are investigating a pill they christened the “red heart”, which they hope will cut heart disease deaths among those already known to be at risk in Asia, the Wolfson researchers continue to focus on the original concept.

They hope the trial, which begins this month, will pave the way for a pill which anybody over 50 in the UK will be able to obtain at low cost from a pharmacy within a couple of years.

One of the researchers conducting the trial at the Wolfson Institute, Dr David Wald, said: “The polypill has the potential to be a daily preventive method against heart attacks and strokes, just as the contraceptive pill is a daily preventive method to avoid an unwanted pregnancy. This trial is a step towards making access to the polypill a reality.”

The pill is being made by the Indian generics company Cipla. All components are out of patent and therefore can be copied and are cheap. It contains simvastatin to lower cholesterol and three drugs at half the standard dose to reduce blood pressure – losartan, hydrochlorthiazide and amlodopine.

Unlike the red heart, which is intended for people who have already suffered heart problems, the polypill does not contain aspirin as originally envisaged by Ward and Law in 2003. Aspirin is known to protect against heart attacks and stroke, and trials recently showed there were more than 20% fewer deaths from certain common cancers in people who took a daily low dose of aspirin.

But the Wolfson team want to minimise potential side-effects to make the pill safe for everyone to take, and aspirin has been shown to sometimes cause stomach bleeding.

Wald said: “By offering the polypill on the basis of age alone, prevention is greatly simplified and the population receiving the polypill are not medicalised, because they do not have to become patients to receive it.”

The trial will include 100 people, selected on the basis of age alone, who will take the pill for 12 weeks and a placebo for 12 weeks, without knowing which one is which. They will be monitored for the effects on their blood pressure and cholesterol levels. At the end of the 24 weeks, all will be given the polypill for a further two years to help assess the long-term benefits.

Because the drugs which make up the polypill are all well-known and are often taken together, even if not in a single tablet, there would not have to be the usual long licensing process to get the polypill on the market.

Within 18 months or two years, the researchers hope it may be universally available, although they still envisage that it may be prescribed by a pharmacist, rather than sold over the counter.

From: http://www.guardian.co.uk/heart-attack-stroke-polypill-trial-begins

The scale of the “postcode lottery” of care that patients can expect across England, and the different amounts of money health authorities spend on problems, has been highlighted for the first time in an NHS survey.
The NHS Atlas of Variation has found that some NHS trusts are failing in key areas including cancer, stroke, and diabetes care.

For the first time geographical differences have been drawn together into a series of 34 maps that the public can view online to see how well their region is performing.

It shows a 14-fold difference in spend on broken hips between best and worst areas; a four-fold variation in the proportion of stroke patients who spend almost all their hospital time in a dedicated stroke unit; and a 38-fold difference in rates of obesity surgery.

Some health authorities spent more than two-and-a-half times as much on mental health services, while there were similar differences in spend on inpatient cancer care.

Lord Howe, the Health Minister, welcomed publication of the atlas, saying: “In order to improve unwarranted variations in services, it is vital to expose existing flaws in the system.”

Charities said the move demonstrated greater openness but warned the variations showed patients were being let down in many areas.

Prof Chris Ham, chief executive of The King’s Fund, a health think-tank, said the atlas “brings into sharp relief variations in the quality and cost of care across the NHS”.

He said: “With the NHS needing to find £20 billion a year in productivity improvements, reducing unwarranted variation is no longer an option – it is a necessity.”

Many of the maps are standardised to take account of differences in age, sex and prevalence of the condition – some of the major reasons typically cited for variations in care.

The report therefore reveals that practices between NHS trusts vary in ways that cannot always be explained by social or patient factors.

The amount spent on broken hips by primary care trusts (PCTs) ranged from little over £500 per 1,000 people to more than £8,000 – even after differences in local population need were taken into account.

Rates of obesity surgery ranged from just 1.1 operation per 100,000 population to 38.9, with higher rates tending to be in poorer areas.

On cancer, some PCTs spent more than £40,000 per 1,000 population on inpatient care while others spent less than £20,000. Devon, Suffolk and Cambridgeshire were among the higher spenders and parts of London towards the lower end.

However, Mike Hobday of Macmillan Cancer Care said this was one area when higher spend was not necessarily a good thing.

He said: “We think spending less money on inpatient cancer care is better, because that means people are being supported more effectively.”

Shorter hospital stays – and hence lower inpatient costs – indicated better cancer therapies and back-up-treatment were being used, he explained.

Regarding variations as a whole, he added: “What this shows is that the NHS still isn’t very good at sharing good practice from one hospital to another.”

However, he welcomed publication, saying it demonstrated greater “openness”.

The percentage of patients receiving nine key checks on their diabetes control – including for kidney damage, cholesterol and weight – varied from 60 to 70 per cent in Norfolk and parts of Yorkshire to zero to around 40 per cent in places like Cornwall, Lincolnshire and Northamptonshire.

Barbara Young, chief executive of Diabetes UK, said the charity was “seriously concerned”.

“This demonstrates that the NHS is failing to provide universally high quality care across the country and shows that diabetes care is still a postcode lottery,” she said.