Cholesterol NEWSNEWS :: CAMPAIGNING :: FUNDRAISING :: RESEARCH :: MAILBAG

MPs back our Heart Hotspots campaign

Heart attacks:The signs, symptoms and treatment

CholesterolNEWSFEBRUARY 2013

Guide to healthyeating this spring

2 :: February 2013 / CEO’s REPORT

‘Carry On Campaigning’ to get the message across and change policy

Website: www.heartuk.org.ukAddress: HEART UK, 7 North Road, Maidenhead, Berkshire SL6 1PE

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Editor: Michael Crozier croziermj@aol.comDesigned & produced: Crozier Associates Ltd, crozierassociates.com© 2012 HEART UK ISSN 2050-4411 Charity Registration No: 1003904 Company limited by guarantee No: 2631049

No. 126 Volume 27 February 2013

Ithink it’s too late to say Happy New Year, but I hope your year has started well. Of course, this is the time of

year when most of us promise many things to ourselves, including eating more healthily and getting fit.

I did exactly that and the plan is working so far, generally I eat reasonably healthily, so only small adjustments are needed. The fitness, however, needs a little more focus. I usually enjoy exercising using a DVD at home and the frequency of this has been stepped up. I also decided to start walking to the station, instead of driving. The walk is around 35 minutes and I am really enjoying it.

If you promised similar things to yourself, I hope they are going well too and you feel encouraged to continue with them.

For HEART UK the focus remains on fundraising this coming year. We have a new development manager who has some exciting plans which she talks about in this edition (see pages 3-4). I

would encourage you to get involved, in any way you can, to help us. Maybe even break out the sponsorship forms and turn your New Year resolutions into fundraising activities to keep that motivation going even further.

On the campaigning side, we are waiting for the Government’s Cardiovascular Outcomes Strategy to be published. We hear that familial hypercholesterolaemia (FH) should

be featured, but time will tell. If FH is featured in the way we have recommended in the consultation, the next challenge will be how it is funded. We continue to campaign for a nationally-funded FH cascade screening programme across the UK, but I fear any services for FH will remain locally funded (if at all), which means we still have a postcode lottery.

You can find further details of our campaigning activities on pages 4-5. Rest assured this remains high in our priorities for 2013.

Finally, if you or anyone you know can offer advice, help, support or contribute to the charity in anyway, we would love to hear from you. We always need help with fundraising, but there are lots of other ways you can help such as volunteering to be a case study, introducing us to your employer, helping us recruit celebrity ambassadors. Look out for more opportunities on Charlotte Hoare’s section (pages 3-4).

Jules Payne Chief executive

heart of the matter

CONTENTS: CEO’s report, this page; fundraising update and events, p3-4; campaigning successes and update, p5-6; Guardian news story and healthy eating guide, p6-7; all you need to know about heart attacks, p8-9; diary and mailbag, p10-11; the Ultimate Cholesterol Lowering Plan and LDLP news, p12

Cholesterol NEWS

Family. Friends. HEART UK. Is there a place for us in your will? Leaving a legacy is a wonderful gift to future generations, helping us prevent early deaths caused by high cholesterol.

For more information on providing the gift of a lifetime to support HEART UK, please contact us on 01628 777046 or email: development@heartuk.org.uk

If you have any queries, questions, concerns or just would like a chat related to heart health, cholesterol, diet or medication, call our friendly helpline where you can speak to one of our dietetic or nurse advisors Monday to Friday, from 10am to 3pm. Advice is also available in Urdu, Punjabi and Hindi every Friday. Call us on:0845 450 5988Or you can email your questions to:ask@heartuk.org.uk

You can also join our ever increasing on line community group at HealthUnlocked to chat with others who have an interest in raised cholesterol and heart conditions. We now have more than 800 members and more are joining every day. To ask questions, share experiences, offer advice and support to other members, post your own blogs or generally keep in touch with like minded people sign up at: http://heartuk.org.uk/healthunlocked

Leave us a legacyNeed advice?

Cover photo: The Rt. Hon Hazel Blears, MP for Salford, w

ith Jules Payne

FundRaising / February 2013 :: 3

Cholesterol NEWS

Time has flown since I joined HEART UK in December and I have been busy getting to grips with the job and trying to speak to as many of you as possible. From my short time here I realise that HEART UK is a fantastic charity, full of very committed staff, volunteers, members and supporters.

Since coming on board I’ve noted the fantastic fundraising efforts our supporters have made to raise funds for HEART UK.

From dress-down days to donating

money instead of buying Christmas cards, we have benefitted from so many of your innovative ways to get involved and raise funds.

One recent donation, which touched all of us, was a cheque from a supporter whose husband suddenly died as a result of undiagnosed high cholesterol.

The amount raised was from a collection in his memory and we were all touched by the generosity of this kind donation.

Charlotte takes over with a fund of ideas to raise much-needed money

UpdateWe’re always looking for ways in which to raise funds and here are a few of our new initiatives to share with you.

Recycle for HEART UKWe’ve joined forces with a special clothes recycling company and from February branded HEART UK collection bags have been distributed on thousands of doorsteps in the UK. This is a great way of not only raising awareness but funds too as we aim to get £1,500 a month from this scheme! So if a bag lands on your doorstep, please fill it!

Old balancesWe have just completed a special mailing to solicitors asking them to consider HEART UK when clearing their old surplus client balances. This is a simple, yet effective, way to fundraise and special thanks to our team of volunteers who helped with this large mailing.

Christmas 2013-14We’re busy applying to WH Smiths, John Lewis, Waitrose, Waterstones and Paperchase as all of these retailers run

schemes to partner with charities on their boxed Christmas cards. If chosen, we receive a percentage of the profits.

VolunteersWe love our volunteers! We really value our wonderful volunteers at our Maidenhead office and thought we should tell you about them!

Arvind helps with database administration, Emma looks after our grant applications, Alison supports Sally

Hall, Jules’ PA, during the holidays and helped with the old balances mailing, Jacqueline supports events and Anna also helps with our mailings. Yasmin who supports Slade Carter with our campaigning has recently accepted an internship with hanover, the public affairs company we work with.

We are delighted that Arvind has secured funding from a scheme run by Vodafone World of Difference and will be joining the staff part-time for four months. Do contact us if you live near Maidenhead and would like to help out in the office.

We are also looking for volunteers to help with our patient and supporters committee. In particular we are looking for people with membership, fundraising, advertising/marketing/social media and campaigning skills. Ideally this means attending three meetings per year, probably in London and also committing some additional time to support the staff in delivering the agreed activities.

Events

Come on Team RedlacesRun to the Beat: Thanks to all the fantastic runners who took part in Run to the Beat last year. The amount raised

● Invaluable help: Arvind Anand, Emma Swiatek and, below, Jacqueline Akakpo, help out whenever possible

● Charlotte Hoare, our new development manager

Continued on next page

Best foot forward to help our cause

4 :: February 2013 / FundRaising / CamPaigning

Cholesterol NEWS

Cardiovascular disease prevention online libraryHEART UK has launched a new CVD prevention and health checks online library. We want to encourage organisations to submit their examples of good practice in CVD prevention and delivery of health checks.

The library is designed to give organisations an opportunity to shine – and to share their experience with others. HEART UK is looking for examples from NHS organisations, clinicians, commissioners, local authorities, academic institutions, patient advocates, community groups, charities/charitable trusts, and private health care providers.

Please follow this link for more information, and to submit your project:

http://heartuk.org.uk/about-us/how-we-make-a-difference/campaigning-activities/cvd-prevention-library

We would be grateful if you could please distribute this link to your networks to help us fill the library with high quality examples.

Talk Health partnershipsTalk Health Partnerships run a series of online clinics on special health topics. HEART UK nurse Tina Dawson and Dr Dermot Neely, co-chair of the FH Guideline Implementation Team, took part in this initiative during December. They were part of a team of clinicians answering the public’s online queries about heart disease.

Patient decision aids (PDA)The Department of Health has commissioned a series of patient

decision aids (PDAs), designed for patients.

HEART UK’s involvement has been sought in the development of the PDA on cholesterol. PDAs provide factual information and are designed to help people think about their own healthcare decisions. HEART UK’s chairman Dr Robert Cramb, and trustee Dr Dermot Neely and Dr Nigel Capps are all providing clinical input for this project.

Your help needed - HEART UK has also been invited to participate in organising a focus group for the cholesterol PDA. We are looking for individuals who have had or are at risk of having a cardiovascular event and for whom lowering their cholesterol level has been strongly recommended by a medical professional.

We are looking for people with

How HEART UK is influencing key decisions on healthcare strategy

came to more than £5,400 and we are really grateful to those that took part. Louise Abraham and Esther Marlow deserve a special mention as together they raised more than £4,000. What a fantastic achievement!

The Virgin London Marathon 2013The London Marathon is now the world’s largest fundraising event. What a privilege it is to be involved – not only with the event, but with our dedicated team of 35 runners who pound the streets – in all weathers – to ensure they do their best to raise funds for HEART UK.

Katie Austin, one of our runners, ran the Marathon for us last year with a stress fracture in her left foot; she managed to finish although admits she was crying all the way round. That’s what I call dedication!

We hope to raise more than £50,000 from the Marathon this year – so a huge thank you to all our runners! If you live near London and feel like volunteering

on the day – Sunday April 21 – even just to cheer, please do contact me. We would love to see you!

BUPA 10kIf marathons or half-marathons are too much for you but you would still like to run for HEART UK why not consider 10k (just over six miles)? The BUPA 10K in London is on Bank Holiday Monday, 27 May. To take up a place we need

you to guarantee to raise a minimum of £350; registration costs £30.

Calling all cyclistsHow about raising funds for HEART UK by cycling through Jordan? HEART UK is one of the charities behind The Big Heart Bike Ride to Jordan this November. This is an open challenge and is self-funded. More information about the event can be found on this link: http://www.actionforcharity.co.uk/eventdetailsnew2.php/urlsearch/The-Big-Heart-Bike-Ride-in-Jordan Whatever sport you do, please consider raising funds with a sporting challenge. We will support you all the way!

Introducing text givingIf you have enjoyed this issue of Cholesterol News – could you show your support by “text giving”? It’s simple to do – just text HART20 and the amount – £5 or £10 to this number: 70070. Thank you. For further information about any of these fund-raising activities, please email Charlotte at: ch@heartuk.org.uk

Continued from page 3

● Running through the pain: Katie Austin

CamPaigning / February 2013 :: 5

Cholesterol NEWS

How HEART UK is influencing key decisions on healthcare strategylifestyle-related elevated cholesterol, not those with inherited high cholesterol conditions such as familial hypercholesterolaemia (FH).

The forum will take place around March 2013, venue and location TBC. To register an interest, please contact Slade Carter at HEART UK: sc@heartuk.org.uk

Health committee inquiry into NICEThe influential Health Select Committee recently held an inquiry into the work of NICE. HEART UK submitted a response, highlighting the problems around implementing the NICE Guideline on FH.

One of the health committee’s recommendations was “that a clinician or commissioner who decides to depart from NICE guidelines should be expected both to report and explain the departure.” It will be interesting to see whether this impacts on policy and commissioning reporting requirements.

The home page of the report is at: http://www.publications.parliament.uk/pa/cm201213/cmselect/cmhealth/782/78202.htm

Cardiovascular outcomes strategyHEART UK submitted its response to this strategy, which is due for publication in the coming months.

NHS Commissioning Board prescribed servicesThe NHS Commissioning Board recently held a consultation concerning the “prescribed” services that the board will deliver.

HEART UK fed into several parts of the consultation, making use of the evidence presented in the FH Report. HEART UK would like to see the board take oversight for delivering a national FH programme to help ensure greater equity of access for the diagnosis and treatment of FH.

Heart hotspotsOn 15 January 2013, HEART UK and MSD launched the second phase of the Heart Hotspots campaign in the House of Commons. The original campaign was launched in July 2011 at the HEART UK conference.

The Heart Hotspots campaign aims to raise awareness of cardiovascular disease, and share current mortality and life expectancy data. The campaign uses the latest data to highlight geographic inequalities in rates of coronary heart disease (CHD) in England.

The second phase of the campaign looked at CHD exception coding data, whereby patients have not achieved the minimum Quality Outcomes Framework (QOF) targets recommended for their condition. In particular, this campaign is looking at exception reporting as it relates to the QOF target to achieve total cholesterol of 5 mmol/L or less in CHD patients. At the event, HEART UK met a number of MPs from the major political parties, and enjoyed positive discussions about their local CHD and exception reporting rates.

● Focussing on heart hotspots: From left, HEART UK chair, Dr Robert Cram, Andrew Gwynne MP (our MP sponsor), Jules Payne and Dr John Reckless, HEART UK trustee. Below, Jules and Dr Reckless with the Rt Hon John Healey MP

6 :: February 2013 / nEWs / HEaLTHY EaTing guidE

Cholesterol NEWS

Ready meals can be healthier than celebrity dishes!

Salt mattersStrong evidence links high salt intakes with high blood pressure which in turn is a major risk factor for stroke, heart attacks and heart failure. Almost everyone in the UK eats too much salt. No more than 6g a day is recommended for adults (Guideline Daily Amount or GDA) but on average we eat around 8.6g of salt every day and many people more than this.

The lack of cascade testing for familial hypercholestrolaemia (FH) in England formed the main point of an informative and useful article in The Guardian newspaper on January 22.

Health correspondent Denis Campbell pointed out in the article that cascade testing (where members of a family are offered testing for inherited high cholesterol once one relative has been identified as having the condition) is current practice in Wales, Scotland and Northern Ireland.

The article reported that the British Heart Foundation (BHF) and HEART UK were campaigning for the system to be rolled out all over the nation. The charities stress the urgency of the situation as only one in eight of the estimated 120,000 people with FH in the UK have so far been identified.

The article also quotes Steve Humphries, professor of cardiovascular genetics at University College London, as saying that England’s failure to follow the 2008 recommendation made by the National Institute for Health and Clinical Excellence (NICE) to screen entire families was a “great missed opportunity”.

Guardian story highlights FH discrepancy in England

● How The Guardian covered the story in January

Cooking your favourite celebrity recipe tonight? Then you might be interested in recent research from the north of England. Researchers compared 100 supermarket ready meals with 100 recipes from top selling cookery books written by celebrity chefs. All the recipes and ready meals were main meals rather than desserts, soups or side dishes. Per portion the celebrity recipes contained significantly more energy, protein, fat and saturated fat and significantly less fibre than the supermarket ready meals.

Only a third of meals or recipes met the World Health Organisation’s recommendations for saturated fat and very few met the criteria for salt. When compared with the Food Standards Agency traffic light labelling scheme the ready meals showed more ambers and the recipes more reds but there were similar numbers of greens.

Traffic light rating forthe celebrity recipes and supermarket ready meals (using Food Standard Agency Guidelines)

Recipes Ready Meals Red Amber Green Red Amber Green Sugar 17 0 83 11 0 89Fat 68 17 15 37 39 24Saturated fat 71 1 28 56 1 43Salt* 31 28 41 30 60 10Totals 187 46 167 134 100 166

*The recipe results for salt should be interpreted with caution. Many recipes required salt to be “added to taste” and therefore the unknown amount of salt to be added was excluded from the analysis.

Per portion: An average recipe contained 27.1g (range 16.8-40.4g) fat and 9.2g (range 4.9-15.9g) saturated fat.

An average ready meal contained 17.2g (range 12.3-23.7g) fat and 6.8g (range 3.8-11.6g) saturated fat.

The paper*, which was published in

the British Medical Journal (BMJ) last December, suggested the possible regulation of TV chefs in a similar way to the regulation of advertisements for foods high in fat, sugar and salt.

*BMJ 2012;345:e7607 doi: 10.1136/bmj.e7607 (Published 17 December 2012)

Recommended maximum salt intakes Age Maximum salt intake0-6 months <1g/day6-12 months 1g/day1-3 years 2g/day4-6 years 3g/day7-10 years 5g/day11 years and above 6g/day

nEWs / HEaLTHY EaTing guidE / February 2013 :: 7

Cholesterol NEWS

Ready meals can be healthier than celebrity dishes!

Those with high blood pressure or at high risk of developing it should take extra care to ensure that they keep their salt intake below the recommended maximum of 6g.

Do you know your salt facts? ● Every 1g of salt we cut from our average daily diet would prevent 6,000 fewer deaths from strokes and heart attacks each year ● A child’s blood pressure can influence their blood pressure as they get older, so keeping salt intake down from a young age is important● Three-quarters of the salt we eat is hidden in processed foods ● About a third of our salt intake comes from cereals and cereal products such as bread and breakfast cereals and about a quarter from meat products such as bacon, ham, sausages and canned meat● 19,700 tonnes of salt per year has already been removed from the UK diet since the start of the Government’s salt reduction policy

Salt-busting tips● Cut down on high salt foods and salty snacks● Use herbs, spices, chilli, garlic, pepper, vinegar, lemon juice to add flavour and replace salt ● Beware of high salt flavour enhancers such as stock cubes, gravy browning, soy sauce, ketchup, mustard, pickles and mayonnaise● Take care when buying food outside

the home – takeaways, workplace canteens, service stations, cafés and restaurants ● Buy canned fish in spring water, tomato sauce or heart healthy oils● When buying soups, sauces and ready meals compare the front of pack information and look for ones

that are lower in salt – see our labelling guide below

Salt Awareness Week – 11-17 MarchLook out for coverage during March. This year salt awareness week will be encouraging chefs all over the country to use less salt in cooking.

A traffic light guide to choosing lower salt foods

Your labelling guide to saltRed – foods high in salt contain more than 1.5g salt per 100g or more than 25% of your Guideline Daily Amount (GDA)

Amber – foods with medium salt contain between 0.3 and 1.5g salt per 100g or between 5 and 25% of your GDA

Green – foods low in salt contain less than 0.3g salt per 100g or 5% (or less) of your GDA

Anchovies Olives in brine Salami Bacon and ham Canned meat Sausages Hard cheese, feta Smoked and salt fishSoy sauce Stock cubes/Gravy granulesYeast extract Table sauces Pickles, chutneySavoury rice, noodle snacks Salted/dry roasted nuts Prawns

Crisps BreadBaked beansSome breakfast cerealsCakes and pastriesCooking and pasta saucesMeat piesPizzaPre-prepared meat jointsReady meals SoupSandwichesSome varieties of canned meat, fish, pasta

Plain cottage cheeseCream cheese/plain cheese spreadMozzarella, ricottaSome breakfast cerealsCouscousEggsFresh fish, meat, poultryFresh/frozen/dried/canned* fruit/vegetablesPastaRiceMilkYoghurt, fromage fraisPorridge oatsDried, canned* beans, peas, lentilsSeeds

*canned with no added salt

8 :: February 2013 / adViCE

Cholesterol NEWS

All you need to knowHaving a heart attack, or witnessing one, can be a frightening experience. Here we describe the events that lead up to a heart attack, the symptoms and treatment. While this is a graphic description, and not for the faint-hearted, we hope our explicit narrative might help you cope in the event of one happening to you, a close friend or relative, writes Tina Dawson, HEART UK nurse project manager

Amyocardial infarction, more commonly known as a heart attack, is a serious medical emergency and life-threatening

event. Three times more common in men and more frequent in those aged more than 50, a heart attack is normally caused by coronary artery disease, due to a process known as atherosclerosis.

Atherosclerosis is a gradual degenerative and ageing process which occurs when the lining of an artery is repeatedly damaged. This is more likely to happen where there are existing risk factors such as high blood pressure, smoking, raised cholesterol and diabetes.

Plaques/fatty deposits (rich in cholesterol) build up over time in the artery lining, resulting in the gradual narrowing of the artery itself. If these plaques burst or rupture, the body’s natural response is to form a blood clot over the damaged area to prevent the fatty materials from travelling around the body.

However the blood clot can also block the artery. When this process happens in one of the three coronary arteries that supply the heart muscle, it is called a heart attack or myocardial infarction. If the blood flow cannot be restored the heart muscle beyond the blockage will be starved of blood, oxygen and nutrients and the heart muscle will die. This process can also happen in other arteries around the body, leading to other circulatory

problems such as a stroke.

Heart attacks are classified by a measurement known as the ST segment which is an electrical measurement recorded by a 12-lead electrocardiogram (ECG). They are referred to as either an ST segment elevation (STEMI) heart attack or non-ST segment elevation heart attack (NSTEMI ). A STEMI occurs as a result of the sudden blockage on a ruptured plaque as described above, whereas a NSTEMI is caused by an unstable plaque which has not ruptured but where clots have started to gather.

Symptoms vary from one person to another and not everyone will experience the classic presentation of a heart attack. The level of pain can vary significantly and can range from mild discomfort which makes you feel unwell to a very severe pain in the centre of the chest that some describe as “an elephant sitting on my chest”. Usually of sudden onset, it can also be described as a dull persistent ache, mild discomfort, bad indigestion, heaviness, crushing feeling, and tightness, usually continuous and persistent in nature. Some people, however, may not experience any chest pain at all. There may also be pain radiating to other areas of the body, such as the arms (usually left arm but can affect both), jaw, neck, back, abdomen and stomach.

Other associated symptoms include nausea, vomiting, feeling cold and clammy, sweating profusely, shortness of breath, coughing, difficulty in breathing,

wheezing, light-headedness or dizziness, or generally feeling unwell. Some people report experiencing an overwhelming feeling of anxiety (like a panic attack). During a heart attack there is also a risk of cardiac arrest, where the heart stops pumping altogether due to disturbances in the heart’s rhythm. Breathing also stops and immediate resuscitation is required.

If you think that you, a friend or relative are having a heart attack, call 999. It is important to receive emergency treatment as soon as possible to restore the blood flow to the affected part of the heart and to limit the amount of permanent damage. If the heart has stopped beating (cardiac arrest) then an electrical shock from a defibrillator administered by a paramedic can restore normal heart rhythm. Chest pain is considered a priority emergency call and if a doctor or paramedic suspects a heart attack, they will either treat you in the ambulance if possible, or get you to hospital within the shortest time frame to receive treatment. Currently just over half of people who have a heart attack die during the first 28 days and of these 75% of deaths occur in the first 24 hours and 30% before they are admitted to hospital. For every minute a person is in cardiac arrest, their survival is reduced by 10%.

Emergency treatment:Primary percutaneous coronary angioplasty is a procedure which reopens a blocked coronary artery and is the preferred treatment and ideally should be performed very soon after symptoms begin.

It involves the insertion of a long thin tube (known as a catheter) into each of the coronary arteries, via the groin or arm, under local anaesthetic. A contrast fluid is injected into the arteries via the catheter and images are produced by x-ray. The consultant cardiologist and team who perform the procedure will then be able find the narrowing/blockage in the coronary artery.

Once the narrowed section has been located, the artery is reopened by inflating a balloon, which is located on the tip of the catheter. This will squash

● Plaque can build up causing atherosclerosis

adViCE / February 2013 :: 9

Cholesterol NEWS

about a heart attack

and flatten the fatty plaque and any blood clot/thrombus against the artery wall. This is usually directly followed by insertion of a metal bridge, known as a stent, which is left in place in the artery wall to keep the artery open afterwards. This procedure will restore the blood supply back to the heart muscle.

Thrombolysis involves injecting medication intravenously to dissolve the clot to restore blood supply. This treatment can be given in an ambulance by a paramedic, but it is not suitable for all heart attacks and there are contra-indications regarding the treatment for some patients. Thrombolytic medications target and destroy fibrin, a protein

that makes up blood clots, and agents such as reteplase and tenecteplase are used. Patients may also receive additional anticoagulant medication such as Clopidogrel, Pragusel, Heparin and Glycoprotein IIb/IIIa inhibitors which work in a different way to the thrombolytic agents. Treatment with these agents needs close monitoring as they can increase risk of bleeding especially when used in combination.

Coronary angioplasty can also be performed as a routine procedure for patients who may have originally received thrombolytic treatment or for those who have narrowed arteries but who have not had a heart attack.

Sometimes an alternative surgical procedure known as coronary artery bypass grafting may have to be considered if an angioplasty is not technically possible due to the difficult anatomy of arteries, or if there is more than one narrowing. This involves taking a vein or blood vessel from another part of the body to replace the narrowed sections of the artery.

Other tests for the heart:Blood samples are taken to test for certain proteins known as troponins which are found in heart cells and released into the blood stream in high levels when the heart muscle is damaged in a heart attack. A troponin test will give an idea of the level of damage to the heart and help to determine how well you are responding to treatment over a period of time.

A chest x-ray will show the size and position of the heart and the lungs, and any complications such as fluid build-up. Other tests include an ultrasound of the heart, known as an echocardiogram, which looks at the structure of the heart, how well it is functioning/pumping, the heart valves and it can identify areas that have been damaged.

Hospital stays following a heart attack normally lasts 5-7 days depending on the individual’s recovery time. During this time, individuals are referred to a cardiac rehabilitation programme and receive advice and information on a combination of lifestyle changes and medications to reduce the risk of having another heart attack. The aim is to aid recovery and to get the person back to a normal life as quickly as possible. Most people will make a full recovery and can return to normal activities within a few months.

The good news is that recent research indicated that the number of people who die from a heart attack has been halved in the last eight years. This is thought to be due to healthier lifestyles, earlier detection and better management of cardiovascular risk factors, and advancements in the treatment and care of those admitted to hospital. However the number of heart attacks is not declining at the same rate.

10 :: February 2013 / YOu asK, WE ansWER

Are my aches and pains down to my statins?

QI have been experiencing aches in my arms and legs and think it could be caused by my statin. It’s

the second one that I’ve tried and I just seem to experience the same symptoms each time. Should I stop taking it?

AAll medications can cause potential side-effects so if you are experiencing any

symptoms which could be due to taking medication, it is important that you speak to your doctor. Your doctor can arrange some tests to investigate possible causes. This might include checking your thyroid , liver and renal function, checking for vitamin D deficiency, and considering any potential drug interactions with other medicines you may take.

Calcium channel blockers, for instance, can slow down the rate at which the statin is broken down therefore increasing the levels in the blood. Side-effects may be related to the dose or type of statin you are taking so changing the type of statin or altering the dose may help.

Your doctor can also check for any underlying muscle problems or conditions which might be aggravated by taking a statin.

Many doctors will suggest a statin break, which means stopping the medication for at least two weeks

to see whether symptoms dissipate. This will help confirm whether the symptoms were caused by your statin.

Those who have tried more than one statin and are still experiencing side-effects can be referred to a specialist lipid clinic for assessment and treatment.

Lipid clinics are normally based in the outpatient departments of hospitals and look after people who have difficulty tolerating cholesterol lowering medication, as well as treating those with raised/inherited cholesterol conditions.

There is a system that allows both you and your doctor to report suspected side effects caused by prescription medicines. To find out more visit the Yellow Card Scheme website (http://yellowcard.mhra.gov.uk/), which is run by the Medicines and Healthcare Products Regulatory Agency (MHRA), a government agency which monitors the use of medicines.

You may also be interested in “yourstatin.co.uk”, a patient-based website providing information for people who have been prescribed a statin.

Why is my statin different?

QI was taking Lipitor for my cholesterol but noticed when I recently went to pick up my

prescription it was different and now called atorvastatin. Am I taking a different medication?

ADon’t worry, you are still taking the same medication. Until last year atorvastatin was only

made by one drug company under the brand name Lipitor. Because atorvastatin came off patent last year this means that other drug companies can now produce it. There are at least five other companies who now supply atorvastatin to your pharmacy. If you have any concerns please speak to your GP or pharmacist. A useful website for looking up your medication can be found at the link below: http://www.medicines.org.uk/emc/

How long should I fast before a cholesterol test?

QIs it important to fast before having a cholesterol test and if so for how long?

AFasting has very little effect on total cholesterol levels, but LDL cholesterol (bad cholesterol)

can only be calculated from a fasting sample so it is important to fast if you are having a full lipid profile taken (including triglycerides, HDL cholesterol and total cholesterol).

Fasting tests should be carried out in the morning after a 10-14 hour fast. You may drink water and take your regular medication, although if your medication needs to be taken with food it can usually be delayed and taken after the test. If you are unsure, check with your doctor or hospital before the test.

mailbag You phone or write, our team replies. Our helpline is open Monday-Friday, 10am-3pm Call us on: 0845 450 5988Or you can email your questions to: ask@heartuk.org.uk

Cholesterol NEWS

Diary dates1 March 2013 – Lipoprotein apheresis and novel pharmacotherapies for severe FH Wales Millennium Centre, Cardiff

The programme includes these sessions:Establishing a new apheresis unitScreening strategies for Lp(a) and therapeutic managementNovel therapies in the treatment of severe dyslipidaemia,Lipoprotein apheresis case studies

To reserve a place, please email Suzanne.watkins@wales.nhs.ukInfo: www.cardiffandvaleuhb.wales.nhs.uk/lipidunit

3-5 July 2013 – HEART UK 27th Annual Conference:Familial hypercholesterolaemia (FH) – recognised at last?Exhibition and Conference Centre,University of the West of England (UWE),Frenchay Campus, Filton Road, Bristol, BS34 8QZ HEART UK’s 2013 conference will return to the

theme of familial hypercholesterolaemia (FH)Identification of all patients with homozygous and the more severe forms of heterozygous FH remains a priority and the meeting will focus on children with FH, apheresis and new treatments for high-risk FH patients.

Other topics will include difficult and contentious challenges in lipid management, including the impact of lipid lowering therapies on the progression of pre-diabetes.Info: www.heartuk.org.uk/news-and-events/meetings-conferences/heart_uk_annual_conference

YOu asK, WE ansWER / February 2013 :: 11

Cholesterol NEWS

Which cheese is better to eat for calcium?

QI have osteoporosis. My doctor tells me I need to eat foods rich in calcium. I am very fond

of cheese (especially hard cheese) but I worry that it contains too much saturated fat. Can you help?

ADairy foods are very good sources of calcium and provide around two-thirds of the

calcium we eat. As well as being rich in calcium, cheese can be high in saturated fat.

Around two-thirds of the fat in cheese is saturated, so it’s best to keep portions of high-fat cheeses small and limit them to 2-3 times a week. If eaten regularly, cheese can also contribute significantly to salt intakes.

Look out for cheeses that have been

modified to help make them more ”heart healthy”. Manufacturers achieve this either by:● lowering the fat content (e.g. half-fat or light cheeses)● replacing some or all the dairy fat with a healthier fat blend ● lowering the salt content● increasing the levels of plant sterols

If cooking with cheese, a good tip is to choose stronger varieties (for more taste) and use a smaller quantity. Look out for lower-fat cheese. Here is our guide to what to look for in the supermarket

● More than 30g fat per 100g – very high fat cheese● 20g-30g fat per 100g – high fat cheese● 10-20g fat per 100g – moderate fat cheese● Less than 10g fat per 100g – low fat cheese

All cheeses, whatever their fat content are good sources of calcium.

You can increase your calcium intake by including low-fat milk, yogurts and fromage frais, water straight from the tap in hard water areas, dark green leafy vegetables i.e. broccoli, cabbage, okra; fortified soya milk, sesame seeds, small fish such as sardines and pilchards; beans, tofu, nuts, bread and some breakfast cereals.

Calcium supplements can also be taken but should be discussed with your doctor.

A fact sheet on the various types of cheese and saturated fat content can be found in our dietary information sheets on our website at: http://heartuk.org.uk/healthy-living/healthy-living-resources

With thanks to Tina Dawson and the rest of the HEART UK team

Lipoprotein Lipase Deficiency (LPLD), also known as type 1 hyperlipoproteinemia / familial chylomicronemia, is an extremely rare condition, affecting one or two people in a million.

Typically characterized people with LPLD have very high triglyceride levels because of a lack of lipase, the enzyme that clears fat from the blood.

Symptoms include recurrent abdominal pain, fat-filled spots known as ‘eruptive xanthomata’ and attacks of painful acute pancreatitis.

Pregnancy can be difficult for women with the condition, and all patients are at greater risk of developing type 2 diabetes.

Jill Prawer, one of HEART UK’s ambassadors who was diagnosed with the condition in 1964, has set up an

LPLD online community in partnership with the European Organisation for Rare Diseases EURORDIS (www.eurordis.org) and HEART UK (www.heartuk.org.uk).

The RareConnect community gives those with an interest in the condition a chance to connect with each other. It has a discussion area and a learning zone, where articles of interest and resources can be found, and allows for patients to share their stories in order to help others understand what it is like to live with LPLD. The site is human-translated into French, English, Italian, German and Spanish.

For more information on LPLD and to access the site please follow the link below: http://heartuk.org.uk/cholesterol-and-health/triglycerides/lipoprotein-lipase-deficiency-lpld

If you have any questions or articles of interest you would like to add to the LPLD site, please contact the online communities manager, Rob Pleticha at Robert.pleticha@eurodis.org

12 :: February 2013 / aWaRd-Winning PLan / LPLd

During the last few months you have been telling us how delighted you are with our fantastic new Ultimate Cholesterol Lowering Plan (UCLP©) leaflet, pictured right.

It features HEART UK’s very own evidenced-based, step-by-step approach to cholesterol lowering. It’s packed with friendly illustrations, top tips and appetising menu ideas for lowering your cholesterol. And health professionals love it too!

The UCLP© recently won an award at the Nutrition and Health Show for the best nutrition resource of 2012 despite being up against stiff competition.

A great big thank you to Alpro who have supported the development of the UCLP© over the last 18 months. We are looking forward to working together in 2013 to develop the concept even further, so look out for further briefings.

If you don’t have a copy of the UCLP© leaflet yet you can download it from our website, or call or email our helpline and we’ll pop one in the post. If you are a healthcare professional, call the helpline on 0845 450 5988 to find out how to get hold of your very own UCLP© toolkit.

Tip-top, tasty way to lower your cholesterol

● HEART UK ambassador: Jill Prawer

More help for those with very rare LPLD