News

As written by The Daily Mail

Advice by Dr Iqbal Malik

New Research by Barts NHS Trust and University College London

New research led by Barts NHS Trust and University College London found that running a marathon for the first time could have several health benefits including reducing blood pressure and arterial stiffness.

OneWelbeck Consultant Cardiologist Dr Charlotte Manisty who was part of this study said: “As clinicians are meeting with patients in the new year, making a goal-oriented exercise training recommendation—such as signing up for a marathon or fun-run—may be a good motivator for our patients to keep active. Our study highlights the importance of lifestyle modifications to slow the risks associated with aging, especially as it appears to never be too late as evidenced by our older, slower runners.”

To read the full article, please go to:

https://www.bartshealth.nhs.uk/news/first-time-marathon-runners-reduce-their-blood-pressure-and-arterial-stiffness-7113

Written By Dr Iqbal Malik, Consultant Cardiologist

Cardiovascular risk reduction

NICE’s clinical guideline ‘Cardiovascular disease: risk assessment and reduction, including lipid modification’ (CG181 published 2014, last updated September 2016) includes:

Omega-3 fatty acid compounds for preventing CVD

1.3.48  Do not offer omega-3 fatty acid compounds for the prevention of CVD to any of the following:

• people who are being treated for primary prevention
• people who are being treated for secondary prevention
• people with CKD
• people with type 1 diabetes
• people with type 2 diabetes.

1.3.49 Tell people that there is no evidence that omega-3 fatty acid compounds help to prevent CVD.

Combination therapy for preventing CVD

1.3.50 Do not offer the combination of a bile acid sequestrant (anion exchange resin), fibrate, nicotinic acid or omega-3 fatty acid compound with a statin for the primary or secondary prevention of CVD.

A Cochrane review ‘Omega-3 fatty acids for the primary and secondary prevention of cardiovascular disease ’https://doi.org/10.1002/14651858.CD003177.pub4 (version published 30 November 2018) concludes: “Moderate‐ and high‐quality evidence suggests that increasing EPA and DHA has little or no effect on mortality or cardiovascular health (evidence mainly from supplement trials). Previous suggestions of benefits from EPA and DHA supplements appear to spring from trials with higher risk of bias.”

REDUCE-IT trial

If icosapent ethyl, a highly purified eicosapentaenoic acid ethyl ester is licensed in the UK, the REDUCE-IT trial suggests it may have a role in cardiovascular risk reduction. Is it cost effective? The data is from one trial and not yet main stream in the UK.

In REDUCE-IT,  2g twice a day of  2g of icosapent ethyl was compared to placebo.

• The risk of the primary composite end point of cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, coronary revascularization, or unstable angina (THAT IS  A LOT OF ENDPOINTS – some of which are hard to be certain about), lower, by 25%,(4.8% lower,  number needed to treat of 21)
• The risk of the key secondary composite end point of cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke was also significantly lower, by 26%, ( absolute between-group difference of 3.6 percentage points in the rate of the end point and a number needed to treat of 28)
• AF rates were higher in the treatment group however
• Cardiovascular death was reduced, but not total mortality.

Written by Dr Iqbal Malik

Original source: The New England Journal of Medicine

Dr Malik says “alcohol is a potent driver for atrial fibrillation (AF) and cutting back reduces the risk of it coming back. This article in the NEJM provides more evidence for this”.

Excessive alcohol consumption is associated with atrial fibrillation. Patients with paroxysmal or persistent atrial fibrillation who were in sinus rhythm and who were consuming 10 or more standard drinks per week were randomly assigned to either abstinence from alcohol or continued drinking for 6 months. Recurrence of atrial fibrillation was less common in the abstinence group.

Dr Iqbal Malik. Consultant Cardiologist

Written By Dr Boon Lim. Consultant Cardiologist and Electrophysiologist

The field of Atrial Fibrillation (AF) is moving at a rapid pace, and at the same time, it’s moving right back to basics. The paradigm for AF ablation is pulmonary vein isolation, where the pulmonary veins, which drain blood back from the lungs into the left atrial chamber, are electrically isolated and therefore ectopic firing beats from the pulmonary veins can no longer trigger and sustain AF. Pulmonary veins can be isolated using either radio frequency energy, generating heat, or cryoablation, where tissue is frozen to create a line of scar around the pulmonary veins which isolates them.

Therapeutic strategies beyond pulmonary vein isolation, have been studied extensively, but as of mid-2020, there is no accepted “conventional” strategy across different centres beyond pulmonary vein isolation.

Top 5 Strategies For Getting AF Back Into Sinus Rhythm:

1. Treat AF Early – Which means see your doctor as soon as you detect AF, this is important as “AF begets AF” – which means exactly what is says on the tin – the longer you have AF, the more difficult it is to get you out of it, whatever strategy is chosen? How long is long ? Well, most electrophysiologists feel that beyond 4 years of AF persistence is a threshold beyond which it would be difficult to restore normal (sinus) rhythm (<40% success rate).
2. Stay Healthy- Live well – exercise and diet well. There is a large body of compelling data which now clearly show a link between sleep apnoea, obesity, the “metabolic syndrome” and AF. Staying healthy with lifestyle choices and losing weight is one of the most important ways to prevent and treat AF.
3. Be Mindful Of Obvious Triggers And Avoid Them- Some common triggers for AF are extreme stress, fatigue, strong caffeine or alcohol intake – if there are repeated triggers for AF which are avoidable, its important to recognise what these are and obviously take precautions to avoid these triggers.
4. Treat Medical Conditions Which Can Cause Predispose To AF-These include thyroid function abnormalities, electrolyte abnormalities, diabetes, hypertension, ischaemic heart disease, recurrent infections (typically chest infections), especially in patients with existing lung conditions such as COPD and sleep apnoea.
5. Catheter Ablation With Pulmonary Vein Isolation- This remains a cornerstone and should be the baseline ablative treatment of choice whenever ablation is considered. Choose a cardiologist who has experience in ablation, and ideally in a high volume centre. The cardiac specialists (electrophysiologists) who have an active research profile usually have a good understanding of contemporary research in AF including the latest ablation techniques and use of state of the art technology to treat AF.

Written By Dr Boon Lim

Written By Dr Boon Lim. Consultant Cardiologist and Electrophysiologist

Sleep apnea is now recognized as a significant factor in both triggering and maintaining Atrial Fibrillation. This is because over time, the repeated apnoeic (cessation of for several seconds) episodes that occur repeatedly overnight, may lead to stress on the heart, which is known to trigger AF.

Sleep Apnea Risk Factors:

• heavy snoring
• high blood pressure

Sleep Apnea Symptoms

• morning headaches
• fatigue throughout the day
• inability to get a good “rest” despite many hours of sleep

In this situation, management SOLELY of AF, for example with drugs or even catheter ablation may fail, with the ongoing primary trigger of sleep apnea which continue to drive repeated episodes of AF at night, which eventually lead to persistent symptoms even during the daytime.

There Are Other Problems With Sleep Apnea too:

There is a clear link between sleep apnea and cardiovascular problems. It’s possible that the constant fluctuation in blood oxygen levels caused by sleep apnea may contribute to arterial inflammation, blood flow obstruction, insulin resistance, and, increased hypertension and cardiovascular-related events.

Our team of electrophysiologist specialist will be able to deliver state of the art treatment of patients with both atrial fibrillation(AF) and sleep apnea. Your treatment from the beginning to the end, will comprise of comprehensive holistic approach addressing all risk factors for AF, including:

• Sleep apnea
• Diabetes
• Obesity
• Metabolic Profile
• Coronary artery disease
• Thyroid dysfunction

Sleep Apnea Detection Device

We will be able to fit an easy to use overnight wrist-based sleep apnea detection device (WATCHPAT ™) which will be able to make a diagnosis of obstructive sleep apnea, and to then initiate approach management to get you back to better health.

Sleep Apnea and Atrial Fibrillation

If you need a comprehensive assessment of AF with sleep apnea, and you are worried how to cure sleep apnea, please contact us to make an appointment with one of our cardiologists.

Written By Dr Boon Lim

Written By Dr Boon Lim, Cardiologist and Electrophysiologist

People who faint need to think carefully about what and how much they drink. Think of your body as a water tank with a minimum level needed to feed to brain with blood and oxygen to keep alert and conscious. If the water tank level drops below this minimum level you are “dehydrated”. For people who faint, it is crucially important to keep this tank as full as possible so that even if the level drops (pools due to gravity) into your lower limbs, which can act as large collecting vessels in your legs, there is still enough supply to the brain.

Keeping your tank well filled, or hydrated, means that you need to:

• Drink at least 2L of water or other non-caffeinated drinks a day (avoiding coffee, tea, or energy drinks)
• Maintain clear or light yellow urine – it’s a sign that you are drinking adequately.
• If you suffer with low blood pressure and have no other medical conditions apart from vasovagal syncope, have a little more salt in your diet. This allows the water to stay in the body, and forces you to drink as you normally feel thirsty after taking salt.

Written By Dr Boon Lim

Written by Dr Iqbal Malik, Consultant Cardiologist

The SGLT-2 Inhibitors have been around for a few years (Empagliflozin, Canagliflozin, Dapaglif lozin). The data on cardiovascular benefits are increasing, but as with all powerful drugs, they cant be used in all patients. They are useful in a type 2 Diabetic, with good renal function (eGFR>45 ml/min/kg), but evidence of cardiovascular disease, heart failure, and some albuminuria. Your cardiologist will need to carefully consider if it is worth while in your particular case. Caution is needed as they can cause low blood sugar, ketoacidosis (especially in Type 1 diabetics), dehydration, and genital infections.

How do they work? They block the reabsorption of sugar in the kidney – you pass more sugar and water out.

Written by Dr Iqbal Malik