The smoking ban has led to a sharp fall in heart attacks

Major research suggests that the introduction of a smoking ban has resulted in a 40 per cent fall in the number of people suffering from heart attacks as the result of passive smoking.

Major research suggests that the introduction of a smoking ban has resulted in a 40 per cent fall in the number of people suffering from heart attacks as the result of passive smoking
Heart attack rates in the UK have fallen by up to 42 per cent since the 2007 smoking ban, major research suggests.

A review of 77 studies found that reduced exposure to passive smoking has caused a “significant reduction” in heart problems across the population.

Several of the studies found that non smokers and ex-smokers gained most the benefits.

The Cochrane study examined a range of health outcomes in 21 countries, including the UK, which have introduced bans in recent years.

Researchers concluded that there was strong evidence that reduced exposure to passive smoking reduced the number of people suffering from cardiac problems.

The studies examined included a Liverpool study of 57,000 hospital patients. This found admissions for heart attacks fell by 42 per cent among men and 43 per cent among women in the five years since the ban was introduced in 2007.

And US research reviewed found a 14 per cent reduction in strokes in counties which introduced a ban, compared with those which did not.

Some 33 out of the 44 studies reviewed on heart disease found a “significant reduction” following the introduction of smoking bans.

Researchers said the studies took account of other trends over the period – such as a large increase in rates of statin prescribing, to protect against heart disease.

Review author, Professor Cecily Kelleher, from University College, Dublin, said: “The current evidence provides more robust support for the previous conclusions that the introduction of national legislative smoking bans does lead to improved health outcomes through a reduction in second hand smoke exposure for countries and their populations.”

Professor Peter Weissberg, medical director of the British Heart Foundation, said: “This review strengthens previous evidence that banning smoking in public places leads to fewer deaths from heart disease and that this effect is greatest in the non-smoking population.

He said the studies were observational and all had their limitations, but it would be difficult to study the effects of passive smoking in a more robust scientific way.

Researchers said the evidence was less clear about whether the introduction of bans had actually helped people to give up smoking.

Nonetheless, smokers seemed to benefit from some reduction in exposure to passive smoke.

One Scottish study, which found no fall in smoking rates after a ban was introduced in 2006, found a 14 per cent reduction in hospital admissions for heart problems among smokers, and a 21 per cent reduction in admissions among non-smokers.

The research found the impact of the ban on respiratory health, and conditions such as asthma, was less clear cut, though seven of 12 studies on asthma found reduced hospitalisations since the ban.

Younger people having more strokes

There has been a big rise in the number of working age men and women having stroke.

big rise in the number of working age men and women having stroke.In England in 2014 there were 6,221 hospital admissions for men aged 40-54 – a rise of 1,961 on 14 years earlier according to reserach by the Stroke Association.

Experts said unhealthy lifestyles were partly to blame for the rise, though the growing population and changes to hospital practice also played a part.

Researchers say based on their findings strokes should not be considered as a disease of the old.

Strokes are caused by blood clots or bleeds to the brain and can lead to long lasting disability.

The majority occur in people aged over 65, and though rates are decreasing in this group, this report suggests growing numbers of younger people are at risk.

Experts analysed national hospital admission data spanning 2000 to 2014.

These findings highlight the importance of ensuring your blood pressure and cholesterol are under control, as well as having a health check at the age of 40.

Trends for people in their 40s and early 50s appeared to be getting worse. In women aged 40-54, there were an extra 1,075 strokes recorded in 2014, compared with 2000.

Experts said growing obesity levels, sedentary lives and unhealthy diets – which raise the risks of dangerous blood clots – all played a part.

And they argued strokes among this age group had long lasting personal and financial impacts on individuals and their families, as well as on the economy.

Recovering patients can find it difficult to return to work and should have more support from employers, the report suggests.

Jon Barrick, of the Stroke Association, said: “These figures show stroke can no longer be seen as a disease of older people.”

“There is an alarming increase in the numbers of people having a stroke in working age. This comes at a huge cost, not only to the individual, but also to their families and to health and social care services.”

The Stroke Association said that even younger people should be aware of the warning signs such as dizziness, difficulties with speech and changes in the face.

Smoking kills two thirds of smokers

The risk of death from smoking may be much higher than previously thought – tobacco kills up to two in every three smokers not one in every two according to new research.

Smoking kills two thirds of smokersThe study tracked more than 200,000 Australian smokers and non smokers above the age of 45 over six years.

Mortality risk went up with cigarette use, the BMC Medicine reported.

Smoking 10 cigarettes a day doubled the risk, while 20 a day smokers were four to five times more likely to die.

Although someone who smokes could lead a long life, their habit makes this less likely.

Smoking increases the risk of a multitude of health problems- including heart disease and cancer.

Cancer Research UK currently advises that half of all long term smokers eventually die from cancer or other smoking related illnesses- but recent evidence suggests the figure may even be higher.

Newer studies in UK women, British doctors and American Cancer Society volunteers have put the figure at up to 67%, says Prof Emily Banks, lead author of the Australian study.

“We knew smoking was bad, but we now have direct independent evidence that confirms the disturbing findings that have been emerging internationally.

“Even with the very low rates of smoking that we have in Australia, we found that smokers have around threefold the risk of premature death of those who have never smoked. We also found smokers will die an estimated 10 years earlier than non-smokers,” she said.

George Butterworth, tobacco policy manager at Cancer Research UK, said: “It’s a real concern that the devastation caused by smoking may be even greater than we previously thought.”

“Earlier research has shown, as a conservative estimate, one in two long term smokers die from smoking related diseases in the UK, but these new Australian figures show a higher risk.”

“Smoking habits differ between Australia and the UK in terms of how much people smoke and the age they start, so we can’t conclude that the two-in-three figure necessarily applies to the UK.”

In Australia, about 13% of adults smoke. In the UK, the figure is about 20%.

Health Direct points out that stopping smoking can bring a person’s health risks back down.

Ten years after quitting, risk of lung cancer falls to half that of a smoker and risk of heart attack falls to the same as someone who has never smoked, according to NHS Smokefree.

Dementia is biggest killer of women in UK

Dementia is the biggest cause of death for women in England and Wales official figures show.

Dementia is biggest killer of women in UKThe disease now kills more than three times as many women as breast cancer and thousands more than either heart attacks or stroke.

Analysts say the rising numbers may be because doctors are becoming more aware of the disease and recording it on death certificates more frequently.

Coronary heart disease remains the leading cause of death in men. For males, dementia is the third most common cause of death.

The gradual wasting away of the brain in dementia cuts lives short. The condition can be recorded as the sole cause of death, but is frequently found as an underlying condition. Many people with dementia ultimately die from pneumonia- due to physical inactivity.

The data, published by the Office for National Statistics (ONS) showed more than half a million people died in England and Wales in 2013

Cancer is the leading killer when all subtypes of cancer are combined across both genders. Nearly one in three deaths last year was from some form of cancer.

The latest data confirms a dramatic shift in the causes of death in the past decade.

Between 2003 and 2013 the percentage of deaths from coronary heart disease, which includes heart attacks, fell to 16% of male deaths from 22%. In women the figure fell to 10% from 15%.

Improved care means people are more likely to survive heart attacks and more people take statins to prevent them in the first place.

Meanwhile, dementia rose to 6% of male deaths from 2% and to 12% of female deaths from 5%.

The latest data is the second consecutive year that dementia has been recorded as the leading cause of death for women.

The ONS report said: “Some of the rise over the last few decades may also be attributable to a better understanding of dementia. This means that doctors may be more likely to record dementia as the underlying cause of death.”

Heart disease warnings missed by most adults

Many adults in the UK are unaware of the risk factors for heart disease, according to new research.

Heart disease warnings missed by most adultsWhile a third of people are worried about getting dementia or cancer, only 2% are afraid of coronary heart disease, a survey by the British Heart Foundation has found and one in ten adults confessed to not knowing how to look after their hearts.

Coronary heart disease (CHD) is responsible for about 74,000 deaths in the UK each year and roughly one in five men and one in eight women die from the condition.

Dr Mike Knapton, associate medical director at the British Heart Foundation, said: “Your heart is the most vital organ in the body, but all too often we take it for granted. Despite being a largely preventable condition, coronary heart disease is still the UK’s single biggest killer, causing unnecessary heartache for thousands of families.”

As well as chest pain, the main symptoms of CHD are heart attacks and heart failure. However, not everyone has the same symptoms and some people may not have any before CHD is diagnosed.

The British Heart Foundation has issued 10 tips to prevent heart disease:

  • Give up smoking
  • If you’re over 40, take up your free NHS health check
  • Maintain a healthy weight
  • Lead an active lifestyle
  • Ditch the salt
  • Eat your “five a day” of fruit and vegetables
  • Cut down on saturated fat
  • Read food labels to find out if something is healthy for you
  • Don’t drink too much alcohol
  • Watch food portion sizes.

The poll was conducted by YouGov and included 1,010 men and 1,089 women.

Meanwhile the World Health Organization (WHO) is calling on countries to take action on salt to cut deaths from heart disease. It wants governments to sign up to reducing global salt intake.

“If the target to reduce salt by 30% globally by 2025 is achieved, millions of lives can be saved from heart disease, stroke and related conditions,” said director Dr Oleg Chestnov.

Higher stroke and heart attack risk linked to faulty gene

Researchers have identified a gene that may put people at greater risk of strokes and heart attacks.

Higher stroke and heart attack risk linked to faulty gene Published in PLOS ONE The PlA1/A2 Polymorphism of Glycoprotein IIIa as a Risk Factor for Myocardial Infarction: A Meta-Analysis they say the gene fault may encourage the formation of blood clots – the ultimate cause of most heart attacks and strokes.

Scientists hope gene tests may help doctors one day to pinpoint individuals more likely to suffer these conditions, but experts say lifestyle factors such as smoking and exercise have the greatest influence on risk.

Around one in 10 people in the Caucasian population carries this variation of the gene, named PIA2.

And researchers from King’s College London reviewed more than 80 studies involving about 50,000 people – the largest analysis of this genetic fault to date.

They found individuals with PIA2 were more likely to have a stroke – caused by a blood clot blocking blood supply to the brain – than those without the gene.

Scientists calculate the gene increases a person’s risk of having a stroke by 10-15%.

But how significant this increase is depends on an individual’s baseline risk – influenced by factors such as smoking, diet, weight and exercise, the scientists say.

For people with two copies of the gene the risk rises by up to 70% from this baseline.

In a second study published in the same journal, the scientists show PIA2 is also linked to an increased risk of heart attacks in people under 45.

More research is needed to see whether this holds true for the whole population, they say.

About 150,000 people have a stroke in the UK each year and more than 100,000 heart attacks are recorded annually.

Both thrombotic strokes (the most common kind) and heart attacks are caused by blockage of blood vessels in the heart and brain – ultimately through the formation of clots.

The faulty gene appears to affect a protein called glycoprotein IIIa – present on platelets, natural clotting cells in the blood.

Platelets help trigger the formation of clots to stop bleeding after injury. But scientists say carrying the gene may render them overactive.  They caution that overall the genes play a smaller role in risk than more established factors, such as high blood pressure and obesity.

But developing a genetic test could help predict people at highest risk, allowing doctors to suggest more potent medication or lifestyle changes, they say.

Prof Albert Ferro, of King’s College London, who led the research said: “We would now need to validate this test and see how useful it is in the clinical world.

Leonardo da Vinci still teaching us about the heart

After Leonardo da Vinci dissected the heart of a man he produced the first known description of coronary artery disease.

Leonardo da Vinci still teaching us about the heartMore than 500 years later, coronary artery disease is one of the most common causes of death in the western world.

“He had a great mind, and he was willing to really look and see,” says Mr Francis Wells, a consultant cardiothoracic surgeon at Papworth Hospital in Cambridge, who has spent years studying Leonardo da Vinci’s anatomical drawings, which form part of the Royal Collection in Windsor.

His diagrams and sketches of the skull, skeleton, muscles and major organs fill countless notebooks while his theories on how they function fill many more pages.

But it was the heart that appeared to particularly fire his interest, from 1507 onwards, when he had reached his 50s.

In those drawings, he used his knowledge of fluids, weights, levers and engineering to try to understand how the heart functions. He also looked closely at the actions of the heart valves and the flow of blood through them.

Mr Wells’ book, ‘The Heart of Leonardo’, explores the artist’s drawings and writings on the organ, and he says his insights are “quite astonishing. The more we look, the more right we realise he was.”

Many of Leonardo’s conclusions, such as the description of how the arterial valves close and open – letting blood flow around the heart – holds true today, but is not widely known.

“Even cardiologists get this wrong now,” Mr Wells says. “Only with the use of MRI technology has knowledge of this subject been revisited.”

Many of Leonardo’s drawings were based on studies of hearts from ox and pigs. It was only later in life that he had access to human organs, and these dissections had to be carried out quickly in winter before the body began to degrade.

Contemporary dissections of the heart show he was correct on many aspects of its functioning. For example, he showed that the heart is a muscle and that it does not warm the blood.

He found that the heart had four chambers and it connected the pulse in the wrist with the contraction of the left ventricle.  He worked out that currents in the blood flow, created in the main aorta artery, help heart valves to close. And he suggested that arteries create a health risk if they fur up over a lifetime.

Mr Wells also believes that Leonardo realised that the blood was in a circulation system and may have influenced William Harvey’s discovery in 1616 that blood was pumped around the body by the heart.

Yet none of Leonardo’s theories or drawing were ever published during his lifetime. In fact, his notes were not rediscovered until the late 18th century – more than 250 years after his death.

With hindsight they may have had the potential to revolutionise surgery.

In the 16th century, for example, there was no treatment for cardiac disease, or many other diseases, and surgeons occupied a low status in society.

If people survived surgery, it was more by luck than judgement. Heart surgery has transformed in the past century, but Leonardo’s insights could have made a huge difference if they had been made public earlier.

Even now, however, there is common consensus that we have barely scratched the surface of what we know about the heart.

According to Mr Wells, Leonardo’s legacy is that we should follow the Renaissance Man’s example and continue to challenge, question and enquire rather than listen to accepted wisdom.

Leeds hospital suspends child heart surgery

Children’s congenital heart surgery at Leeds General Infirmary has been suspended as a review is carried out.Leeds hospital suspends child heart surgeryThere are concerns about the number of deaths at the hospital, which is at the centre of a long dispute over the future of children’s heart services.

The medical director of the NHS, Bruce Keogh, said it was “a highly responsible precautionary step”.

Leeds General Infirmary had been earmarked for closure by the NHS review to concentrate children’s heart surgery in fewer bigger centres.

Stuart Andrew, Conservative MP for Pudsey, who has led a cross-party campaign to keep the unit open, said it was a “very odd” decision coming after the jubilation that greeted the court ruling.

“We have always asked them ‘is it safe at Leeds?’ and the answer always came back ‘yes it is’.

He added he had not received one complaint about care.

Children who would have been treated in Leeds will be sent to other hospitals around England.

Affected families are being contacted directly by the trust and the review is expected to take three weeks.

Anne Keatley-Clarke, chief executive of the Children’s Heart Federation, an umbrella group for different voluntary organisations, said she had raised concerns about surgery outcomes two years ago, and more recently parents had reported difficulties in getting referrals at Leeds to other heart units.

In a statement on the federation website, she said: “My concern is that it appears that managers and clinicians in Leeds, together with the parent support group, have put their own interests ahead of the well-being of critically ill children and their very vulnerable parents.”

The chief executive of Leeds Teaching Hospitals NHS Trust said outside experts would be drafted in to help review “all aspects” of care.

In a statement, Maggie Boyle apologised to parents and families affected but assured them the trust always put the safety of patients first.

The CQC said it supported the trust’s decision and it was in close contact with the trust to ensure effective arrangements were in place to protect the safety and welfare of patients.

Sharon Cheng, from Save Our Surgery – the group which is co-ordinating the fight to keep children’s heart surgery in Leeds – said: “We’re mystified.  We don’t know of anything that could justify this step.”

Previously, an NHS review said surgery should stop at hospitals in Leeds, Leicester and London to focus care at fewer, larger sites, where medical expertise can be concentrated.

More than 600,000 people signed a petition opposing the closure plans. Many people were unhappy that children from Leeds faced journeys of up to 150 miles for care.

Leeds heart surgery campaigners win legal challenge

Campaigners trying to keep child heart surgery in Leeds have won a key legal challenge to keep the facility open.Leeds heart surgery campaigners win legal challengeThe High Court has ruled the consultation over changes to children’s heart surgery in England and Wales was flawed.

Legal action was brought by campaigners trying to save operations at Leeds General Infirmary but the ruling could affect other units.

The team behind the NHS review said quashing its plans would be unfair.

The High Court judge backed claims by The Save our Surgery group (SOS) that the consultation process was unfair and legally flawed.

The Joint Committee of Primary Care Trusts (JCPCT) decided child heart surgery should also end at Leicester’s Glenfield Hospital and London’s Royal Brompton so care could be concentrated at fewer sites to improve standards.

The High Court ruling could also affect the future of surgery at those units.

The verdict over child heart surgery is just the latest twist in a long-running fight over the future of this complex area of care.

The debate has been raging for over a decade and has already been subject to legal challenges – a perfect illustration of why changing the NHS remains an incredibly tricky task.

The medical profession is united in the belief that expert care needs to be done at fewer sites.

Child heart surgery is the prime example of that – it is one of the most complex procedures undertaken by the NHS.

To provide a uniformly high quality and safe service operations in such fields need to be concentrated, it has been argued. Evidence shows this helps doctors improve skills and share expertise.

But the push for change is not just confined to child heart surgery. Similar debates are going on over everything from A&E units to stroke care as the problem is that change comes at a price: the loss of services from much loved local hospitals.

The strength of feeling in Leeds – and in other places that face losing services for that matter – is testament to that.

These are difficult decisions and with money getting ever tighter in the health service expect more disputes in the future.

UK ranks badly in European health league table

The UK is lagging behind progress by similar countries on many indicators for ill health, research suggests.UK ranks badly in European health league tableHealth data over 20 years was compared with figures from 18 other countries in the research published in the Lancet.

Although average life expectancy has risen by four years since 1990, it says the UK needs to increase its strategies for tackling preventable problems such as heart disease and stroke.

The team of experts from the UK and the University of Washington in Seattle said the UK had a high burden of smoking-related illnesses, and greater priority should be given to reducing lung disease.

There was also a large rise in the number of recorded deaths related to Alzheimer’s Disease.

The big five avoidable killers:

  1.     Heart disease
  2.     Cancer
  3.     Stroke
  4.     Lung disease
  5.     Liver disease

In the 20 years from 1990 to 2010 that The Lancet study examined, average life expectancy increased by 4.2 years in the UK to 79.9 years.

But the premature death rate had hardly changed in the UK for both men and women aged 20-54.

These are linked to avoidable risk factors such as smoking, high blood pressure and obesity, which are still all too common in the UK, say Chris Murray, from the Institute for Health Metrics and Evaluation, University of Washington, USA, and colleagues who carried out the analysis of global data.

But progress is being made on conditions like diabetes, where the UK appears to be ahead of many of its European neighbours and other high-income countries like the US and Canada.

Prof Murray says the UK also faces fresh challenges, like its growing burden of disability from alcohol use and a 137% rise in deaths linked to Alzheimer’s disease.

He and his team also acknowledged that making firm conclusions based on data from different countries was inherently problematic – not all record the same information and each has its own unique issues and policies that made interpretation and comparison difficult.

Recent figures from the Office for National Statistics suggested people in the UK were living in good health for longer.

But the UK still measures up poorly compared with other countries – it ranked 12 out of the 19 countries in the Lancet study.

Britons have 68.6 years of healthy life, whereas people in top-ranked country, Spain, have 70.9 years of healthy life on average.

In an accompanying editorial in The Lancet, Edmund Jessop from the UK Faculty of Public Health in London said the UK had done very well in many areas of public health – it had stronger tobacco control than any other country in Europe, for example – but there was still “plenty of room for bold action by politicians”.