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Winning a place on The Apprentice helped Ruth beat her heart issues

"I feel betterand stronger"

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SURPRISESURPRISE!

Find a hidden gem in your BHF Furniture & Electrical store today. . .

British Heart Foundation 2016, registered charityin England and Wales (225971) and in Scotland (SC039426)

Discover something unique at your local BHF Furniture & Electrical store, where you will fi nd a huge range of pre-owned, vintage and new items at great prices.Find your nearest store: bhf.org.uk/furniture Freephone: 0808 250 0164

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Reading Heart Matters allows me to concentrate on looking after my heart”Kirsty Munn, Derby

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

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

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

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

healthy eating tools and online community. • Ask the experts: call our Helpline

on 0300 330 3300* for heart health information and support.

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

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With Olympic fever upon us, we can all be inspired by the fitness and sheer determination of this summer’s athletes. I caught up with BHF Professor John Deanfield, a former Olympic fencer who applied his sporting drive to a medical career. He’s treated a generation of children

with heart defects and conducted groundbreaking research. He also gives us his thoughts on the Games and their legacy. Read all about it on page 31.

Unlike Professor Deanfield, chemical engineer Dr Geoff Moggridge (pictured) is a relative newcomer to cardiovascular research. He’s equally driven though, and is currently creating better replacement heart valves, thanks to funding from the BHF.

Our cover star, Ruth Whiteley, has determination in spades. After fighting back from her heart condition, she decided to apply for The Apprentice. She says the show helped make her stronger than ever.

Clearly, determination isn’t just for Olympians. We can all do it, as our feature on building willpower reveals (page 37). And eating healthily gets easier if you focus on positive steps, not negative ones, as we explain on page 28.

Feedback from you inspires us to make Heart Matters better and better. Turn to page 6 to find out how to give us your views.

Meet Dr Geoff Moggridge, an engineer whose new heart valve lets blood flow naturally Turn to page 40

Go with the flow

Sarah Brealey, Editor

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SURPRISESURPRISE!

Find a hidden gem in your BHF Furniture & Electrical store today. . .

British Heart Foundation 2016, registered charityin England and Wales (225971) and in Scotland (SC039426)

Discover something unique at your local BHF Furniture & Electrical store, where you will fi nd a huge range of pre-owned, vintage and new items at great prices.Find your nearest store: bhf.org.uk/furniture Freephone: 0808 250 0164

£From95SOFAS

2 Heart Matters

MORE THAN A MAGAZINE

FREE

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

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

• More than 250 mouthwatering recipes, categorised by suitability for special diets or health conditions.

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

Kirsty Munn, Derby

Change of details? Fill in the enclosed form or go online to let us know

And don’t forget, our Heart Matters Helpline can offer help understanding your heart condition, plus healthy lifestyle support on 0300 330 3300 (lines are open 9am–5pm, Monday to Friday; costs are similar to 01 and 02 numbers).

Reading Heart Matters allows me to concentrate on looking after my heart”

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

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With Olympic fever upon us, we can all be inspired by the fitness and sheer determination of this summer’s athletes. I caught up with BHF Professor John Deanfield, a former Olympic fencer who applied his sporting drive to a medical career. He’s treated a generation of children

with heart defects and conducted groundbreaking research. He also gives us his thoughts on the Games and their legacy. Read all about it on page 31.

Unlike Professor Deanfield, chemical engineer Dr Geoff Moggridge (pictured) is a relative newcomer to cardiovascular research. He’s equally driven though, and is currently creating better replacement heart valves, thanks to funding from the BHF.

Our cover star, Ruth Whiteley, has determination in spades. After fighting back from her heart condition, she decided to apply for The Apprentice. She says the show helped make her stronger than ever.

Clearly, determination isn’t just for Olympians. We can all do it, as our feature on building willpower reveals (page 37). And eating healthily gets easier if you focus on positive steps, not negative ones, as we explain on page 28.

Feedback from you inspires us to make Heart Matters better and better. Turn to page 6 to find out how to give us your views.

Meet Dr Geoff Moggridge, an engineer whose new heart valve lets blood flow naturally Turn to page 40

Go with the flow

Sarah Brealey, Editor

bhf.org.uk 3

YOUR BHF4 Your letters6 News

Heart attack genes discovered

8 Spotlight on... Health literacy Increased understanding can benefit your health

24 Fighting fair Our promise to BHF supporters

43 Big interview Claire Henry, from Dying Matters, explains why we should talk about death more

49 Dictionary Medical terms explained

50 Information and support A guide to our free resources

MY STORY10 “I feel better

and stronger” The Apprentice helped Ruth Whiteley bounce back from heart issues

RESEARCH31 Foiling heart disease

Meet an Olympic fencer turned professor

40 Material change Dr Geoff Moggridge talks us through his amazing heart valve

MEDICAL14 Focus on... Multiple

health conditions What you can do about this growing issue

18 Drug cabinet: antiplatelets How these drugs reduce heart attack risk

20 South Asian background How ethnic origin affects heart health

23 Ask the experts Scuba diving and MRI scans

NUTRITION25 Ask the expert

The VB6 diet explained, plus healthier summer salads

26 Ooh, saucy! Healthy tips to spice up summer barbecues

28 Eat upbeat Eating healthily isn’t about deprivation – we share positive tips Plus Recipe cards: Nordic dishes

WELLBEING37 You’ve got the power!

What is willpower and how can you use it to live a healthy life?

46 Let’s talk Discussing illness can be tough. Here’s how to break the ice

ACTIVITY34 An Incan adventure

Cardiac rehab let John fulfil his travel dreams

Inside the magazine of the British Heart FoundationSummer 2016

Online exclusivesbhf.org.uk/heartmattersmag

Our expert team

BHF Associate Medical DirectorDr Mike Knaptonhas been a GP for more than 30 years and is a director at Addenbrooke’s Hospital, Cambridge.

Recipe writerMoyra Fraseris our new resident food writer. She’s a former Telegraph food columnist and author of numerous cookery books.

Senior DietitianVictoria Tayloradvises on nutrition and is a spokesperson for the BHF. She used to work on public health campaigns.

Consultant PhysicianAlbert Ferrois a Professor at King’s College London and Consultant Physician at Guy’s and St Thomas’ hospitals

Senior Cardiac NurseMaureen Talbothas worked in the NHS and the private sector in general and cardiac nursing, for more than 25 years.

Senior Cardiac NurseChristopher Allenhelps manage BHF’s genetic information service and has specialist experience in cardiology and cardiac surgery.

≠ Watch: Our animation about Dr Geoff Moggridge’s amazing new heart valve

≠ Six salad dressings you can make in only three minutes – and they’re all heart-healthy too!

≠ Fun quizzes: How much do you know about sauces? Plus, which Olympic sport should you try?

≠ Six things you need to know about high blood pressure

≠ Top tips for getting a good night’s sleep

≠ Compare: The good and the bad of barbecue meats

≠ A patient’s diary: Heart valve surgery

Heart Matters is published by Wardour on behalf of the British Heart Foundation, Greater London House, 180 Hampstead Road, London NW1 7AW.

The British Heart Foundation 2016 is a registered charity in England and Wales (225971) and in Scotland (SC039426). ISSN 1745-9753

Views expressed in this magazine are not necessarily those of the British Heart Foundation or Wardour. The BHF does not endorse third-party products and services featured in Heart Matters. Information correct at time of going to press. © BHF 2016. Heart Matters is printed on paper from sustainable forests. G204/0716

For BHFEditor: Sarah BrealeyFeatures Editor: Lucy TrevallionProduction Editor: Daniela SchichorProject Coordinator: Ruth PorterPrint: Eclipse Colour Print Ltd

For WardourManaging Editor: Rachael HealyArt Director: Daniel CoupeCreative Director: Ben BarrettProduction Director: John FaulknerProduction Artworker: Jack MorganAccount Director: Georgina BeachManaging Director: Claire Oldfield Chief Executive: Martin MacConnol

4 Heart Matters

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

Successful recoveryIn July 2012 I was told I needed a hip replacement. However, at the pre-op I was found to have a heart murmur. Further tests showed that I needed a new aortic valve.

I had the operation in May 2013 and I was in the Freeman Hospital in Newcastle for eight days and Hexham General Hospital for eight days. When I went home, one of the next-door neighbours looked in each day for a few weeks to make sure I was all right. Another neighbour lit the stove on the morning of my discharge and twice got me some bread before I was allowed to drive.

I know and am thankful for the fact that I have been extremely fortunate. A few years earlier I would have been shaking in my shoes at the

my belief that you should take what you read about health research reported extravagantly in the press with a pinch of salt.

Heart Matters has covered this subject succinctly to my great delight (Spotlight on health stories in the media, Spring 2016). It is my hope that your readers will remember the important explanations to help them counter-balance undue influences of sensational reporting of health studies.

It would be prudent to double-check with reputable sources that have been recommended or indeed read future Heart Matters for critical coverage of the research topics.

Although there shouldn’t be real harm in reading amusing health issues reported in the media, verification should be sought before accepting any headlines as gospel truth.Jo Pate, Hounslow, Middlesex

Stepping forwardI thoroughly enjoy reading Heart Matters and find the information very valuable.

I was pleased to read how important and good for you walking is (Letters, Spring 2016).

I have recently suffered a subarachnoid bleed and high blood pressureD and was told by

In your Autumn issue How to choose a doctor or surgeon. Plus: High blood pressure, saturated fat explained and inspirational walking stories.

STAR LETTER

thought of any operation, let alone a major heart one. Yet I was completely calm, without any anxiety whatsoever. I was warned that the recovery would be horrendous, but there was nothing to be unduly worried about.

I think that the three factors in this result were the skill and expertise of the surgeon and his team, the fact that I

Our cycling range is ideal for your daily commute or a BHF challenge

and has been designed with comfort in mind. Our star letter writer can win a BHF-branded

cycle jersey worth £45. Designs may vary depending on

stock availability

was reasonably fit and healthy (and that I did what I was told), and my faith. We should never underestimate the power of prayer. Robert Parker, Haltwhistle, Northumberland

Unhealthy mediaI have always enjoyed reading Behind the headlines in Heart Matters. It’s in keeping with

I read of Gladys Grimstead’s cycling development (Letters, Spring 2016) with interest.

I rode an original small-wheel Moulton cycle for 50 years but lately, I found myself restricted to just one route as I cycled locally doing the errands. The hills were just too much for me at 86 years old and headwinds were becoming a nuisance rather than a challenge.

So a year ago I bought an electrically assisted cycle and I am besotted with it. The battery-powered motor not only helps when you pedal, but it cancels out hills and headwinds. I am finding longer and longer routes for my errands and the car sits glumly on the drive, quietly rotting (except when it is raining or dark).

My three Moultons have gone to a young enthusiast and I have a new heart-friendly lease of cycling life. Isn’t life great when you can overcome your limitations?Ted Clark, Leamington Spa, Warwickshire

FIND USFacebook “f ” Logo CMYK / .eps Facebook “f ” Logo CMYK / .eps

facebook.com/BHF @TheBHF instagram.com/the_bhf

THE BIG THANK YOU I had a heart attackD on 29 December 2015. I had two arteries unblocked and stentsD fitted. I receive your Heart Matters magazine, which is excellent, as are your booklets and the information from the Heart Matters Helpline. I would have been lost without them. A big thank you to you for everything.Vera Kitchenside, Cheshunt, Hertfordshire

5

If you’d like to share your story with Heart Matters, email [email protected] or write to Sarah Brealey, Heart Matters, British Heart Foundation, Greater London House, 180 Hampstead Road, London NW1 7AW.

Share your story

I had my second aortic valve replacement just over two years ago, with an aortic arch aneurysm repair (first one 13 years earlier). Totally agree that it is harder to get over psychologically but you will get there. One day at a time. Good luck sweetheart. Julie Fraser

I had the same operation as Barbara last October. I’m now on the road to a good recovery thanks to our NHS and everyone who works in it. Support BHF – you never know when you might need it. Peggy Swaffer

We also shared 24-year-old Helen Doyle’s story. In 2012, she was diagnosed with an atrial septal defect. During recovery, her goal was to run the London Marathon, which she did in April. You said:

My sister had an aortic valve replaced two years ago and has run six half marathons! Let’s hear it for heart patients! Janet Hopkins Marty

Thank you for being such an inspiration Helen. I’ve just had quadruple heart bypass surgery and hope to one day run again, having previously done over 100 5K park runs! Nirjay Mahindru

Good luck Helen! Such an inspiration! I just found out this year that I have an atrial septal defect and I have to have surgery for it, but hopefully I’ll be back running in no time too! Chantelle Hewitt

COMMENTS ONLINE Barbara Hardy (Spring 2016) had a heart attack aged 63 and later needed bypass surgery and a new aortic valve. Family and friends helped her through. Here are your thoughts from Facebook:

my GP that walking is the best thing I can do. I am gradually building this up week by week and feel very fortunate, not only to be making a good recovery, but also that the weather is improving so that we are encouraged to go outside and enjoy our beautiful British countryside.

Thank you very much for providing such a wonderful magazine and keep up the good work.Alison Combes, Spalding, Lincolnshire

Heart Matters Editor Sarah Brealey replies: “It’s great to hear that you are enjoying walking and that it’s helping your recovery. Look out for our Autumn issue to read the inspiring stories of two men who found walking helped them after heart problems.”

Warming up I was very interested to read your article Off the bat (Spring 2016) about table tennis, but it failed to cover the important issue of warming up beforehand and cooling down afterwards.

Both my wife and son enjoyed playing league table

tennis for many years, and I have observed that table tennis players don’t always warm up properly. They have a short ‘knock up’ and then play, sometimes working up quite a sweat. At the end of their game, they may sit down and watch the next game with no cool-down period.

Last year I had open heart surgery and part of my recovery was to attend a six-week rehabilitation course. I learned about the need to avoid dehydration when exercising – at my first rehab

session where I consumed a litre of water, this proved insufficient as my blood pressure dropped. I had to drink another half litre in order to get it back to a level that was safe for me to go home.

I also learnt that the heart was a muscle that required moderate regular exercise to strengthen it. However, at every session the experts stressed the importance of a 10-minute warm-up (to raise the heartbeat slowly) and a 10-minute cool-down (to bring the heart rate back to

normal slowly). This is advice we should all remember when exercising.Arthur Williams, Plymouth, Devon

Life goes on after AF I read with interest the article on Andrew McDonald (Spring 2016), who had atrial fibrillation (AF)D.

Three months before my 60th birthday I suffered a strokeD. My afflictions were not permanent, thankfully. However, just prior to my 61st birthday, I was diagnosed with permanent AF. My medication was increased to include a stronger blood pressure tablet and warfarin. I am now 73 and lead a normal life. I was luckier than Andrew as I had no collapse, cardioversionD, pacemakerD or ablationD. He does seem to have been put through the mill, I wish him well.

My wife and I walk for miles and I play football with my grandson, though I followed the advice of my GP to not fall off ladders or out of trees!

By the way, I have been taking statinsD continuously for 15 years without problems. Barrie Gough, Hednesford, Staffordshire

6

NEWS

Heart attack genes discovered

Scientists have discovered two new genes that may affect your risk of developing coronary

heart disease (CHD)D, which increases heart attackD risk. The findings could lead to new treatments to prevent heart attacks.

The researchers – part of an international collaboration involving the BHF – looked at the DNA of more than 190,000 people.

One of the genes which they discovered, ANGPTL4, reduces the body’s ability to remove a type of fat, called triglyceridesD, from the blood stream. The researchers also discovered an inactive form of this gene – people with this type had lower levels of triglycerides in their blood, and had a 53 per cent lower risk of developing CHD. This discovery could pave the way for new medicines to lower the levels of triglycerides

in the blood – similar to how statinsD lower cholesterol levels.

The scientists also found a second gene, called SVEP1. They identified a link between alterations to this gene and increased blood pressure, which is a major risk factor for CHD. More research is needed to explain this link.

CHD is responsible for nearly 70,000 deaths every year, making it the UK’s single biggest killer. Most deaths from CHD are caused by a heart attack.

BHF Professor Sir Nilesh Samani, who was involved in the research, said: “We hope that we will be able to use this new information to develop new therapies to reduce a person’s likelihood of developing coronary heart disease and, ultimately, of having a heart attack.”

≠ Scientists at the University of Edinburgh have found a link between testosterone and heart disease, which may explain why men are at a higher risk

of heart disease than women. The discovery, which was funded in part by the BHF, offers hope of new treatments being developed to reduce that risk.

≠ We’re funding researchers at Dundee and Glasgow universities £290,000 to find out if vitamin K can improve cardiovascular health in people with chronic kidney disease. If successful, this trial could

NEWS BITES

Your magazine. Your views.Tell us how we can make Heart Matters meet your needs better. Take our short survey online, at bhf.org.uk/heartsurvey. If you don’t have internet access, post your comments instead – write to Editor Sarah Brealey at the address on page 4.

Let’s hear your voices Your experience means you understand what heart patients need and want. By working with us and sharing your experiences, you can help ensure the BHF’s work meets these needs.

Heart Voices is a growing network of people affected by heart disease, who want to help shape our work, for example by attending a discussion group to develop a new booklet, or completing surveys.

To join or find out more, visit bhf.org.uk/heartvoices or call 020 7554 0426.

Researchers looked at the DNA of more than190,000 people

reveal new ways to reduce heart attacks and strokeD.

£290,000To see if vitamin K can improve cardiovascular health

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17 July Heart of England Bike Ride. Cycle 12, 18, 30 or 60 miles in Solihull to raise funds for the Mending Broken Hearts Appeal. Register at bhf.org.uk/hoebikeride or call 0845 130 8663.

30–31 July Glasgow to Edinburgh Trek. Help power our research with a 100K walk. Visit bhf.org.uk/g2etrek or call 0845 130 8663.

3–5 September London to Paris On-Road Bike Ride. An unforgettable 400km ride through English and French countryside. Visit bhf.org.uk/londontoparis or call 0845 130 8663.

11 September Great North Run. Join 54,000 runners in Newcastle upon Tyne for the world’s biggest half marathon. Email [email protected] or call 0844 477 1181.

18 September Pete Hayes 10K Fun Run in Handsworth, Birmingham. Register at bhf.org.uk/handsworth10K or call 0300 330 3322.

24 September London to Brighton Off-Road Bike Ride. Take on a testing 75 miles of single-track, cycle and forest paths to get from capital to coast. Visit bhf.org.uk/L2Boffroad or call 0845 130 8663.

24–25 September Manchester to Blackpool Night Ride. Cycle through the night to the Blackpool illuminations. Visit bhf.org.uk/M2B or call 0845 130 8663.

Autumn Bag it. Beat it. Donate unwanted clothes, books, music and DVDs to a BHF shop. Visit your nearest shop for more details, call 0800 915 1111 or visit bagit.bhf.org.uk.

2 October Blenheim Palace 10K and Fun Run. Choose from a half marathon, 10K or 2K fun run. Visit bhf.org.uk/Blenheim or call 0845 130 8663.

9 October Royal Parks Foundation Half Marathon. Email [email protected] or call 0844 477 1181.

17–28 February 2017 Big Heart Bike Ride Vietnam and Cambodia. A 450km cycling adventure. Visit bhf.org.uk/V2C or call 0844 847 2788.

Dates for your diary

bhf.org.uk

Love hillwalking? Test yourself with our new 8 Peaks Challenge. It takes place on 3 September in the dramatic landscape of the Lake District.

The demanding trek involves walking for around 12 hours in one day, and climbing more than 1,600m during the 14-mile route.

The route tackles some of the UK’s toughest mountains, including the highest

mountain in England, Scafell Pike (978m), along with Broad Crag (934m), and Ill Crag (930m).

Join us and you’ll trek through the heart of some of the most majestic scenery in the country, pushing yourself to your limits in the fight against heart disease.

For more information or to sign up, visit bhf.org.uk/8peaks or call 0844 847 2788.

Since teaming up with DFS in 2012, we’ve raised a staggering £10m to help power life saving research.

When DFS customers buy new upholstered furniture they are offered the opportunity to have the BHF take away their old, unwanted furniture and sell it in one of 175 Furniture & Electrical stores

≠ There is a link between loneliness and heart disease, according to a new study from the University of York, published in the journal Heart. Loneliness and

social isolation were associated with a 29 per cent higher risk of developing coronary heart disease and a 32 per cent increased risk of stroke.

≠ Short-term daily statins before and after heart surgery do not prevent complications, says a University of Oxford trial we funded. This may alter post-surgery guidelines on preventing atrial fibrillationD.

Reaching great heights

Sofa so good for DFS partnership across the country. More than 70,000 items of furniture that could have gone to waste have been given a new lease of life, providing homes with affordable pre-loved sofas and armchairs.≠ Book a free collection for your unwanted furniture at bhf.org.uk/dfs or call 0808 250 0030.

Walk all over heart disease

Just Walk is your chance to raise money and fight heart disease the way you

want. Taking part is as easy as putting one foot in front of the other – simply pick your own route, choose your own date, and just walk.

Every three minutes in the UK, another family loses a loved one to heart and circulatory disease. With every step you take and every pound you raise, you’ll help bring our research closer to that next life saving breakthrough. So tell heart disease to take a hike – and Just Walk!

Get your free Just Walk kit today when you sign up to fundraise for us at bhf.org.uk/justwalk or by calling 0300 330 3322.

8 Heart Matters

Spotlight on…

NEWS

Health literacy

Interpreting health information isn’t always easy. Whether it’s getting to grips with a

condition, the effects of your medication or just reading Heart Matters, health literacy is more important than you might think. Lack of understanding is linked to a greater risk of hospitalisation, depression and death, and a reduced ability to manage your own and your family’s health.

A 2015 study found more than two in five people in England are not health literate. The figure rose to more than three in five when ability to understand numbers was assessed.

A BHF-funded study published in the BMJ in 2012 found a strong association between health literacy (demonstrated by the ability to understand written instructions for aspirin tablets) and death rates. Those with the lowest health literacy scores were more likely to die within five years than those with the highest scores.

And an American study published in the BMJ last year showed heart attackD patients were more likely to be readmitted to hospital within 30 days if they had lower health literacy.

Collaborative approachThe NHS is encouraging patients to take on a greater role in their own care. Health literacy is vital to this.

Dr Jonathan Berry, NHS England’s health literacy expert, said: “Patient empowerment with self-care needs to be underpinned by good health literacy. Healthcare professionals need good awareness of the challenges faced by people with limited health literacy.”

Over the last five years, regional bodies, community networks and charities have carried out health education programmes. NHS England aims to bring these under a national framework. Dr Berry said: “We will be looking at examples where existing health literacy activities are funded by statutory services and sharing these learnings with other organisations, such as charities, who might want to ask their local authority or health and wellbeing board to consider a similar funding model in their area.

“The challenge is going to be how we can support the continuation and expansion of this on a population scale, with the shortfall in NHS funding.”

Many people have trouble understanding health information. We explain how this could damage your health and what you can do about it

Sarah Briggs is a specialist heart failureD nurse in Rotherham. She says: “Health literacy is vital to creating a confident, expert patient who can self-monitor and self-care. We believe promoting expertise among our patients increases understanding of heart failure and early, effective treatment, which improves symptoms, enhances quality of life and reduces hospital admissions.”

Her team is working to improve health literacy, including with a 12-week educational programme for heart failure patients. Patients and carers can also attend a half-day course on heart failure and treatment options, before

they start taking medications. Sarah says the course reduces anxiety, so more people take their medication as prescribed. “We had comments like ‘I didn’t know what heart failure is until today’,” she says. “One patient said he had heart failure for seven years but never really understood it.”

≠ Turn to page 50 for details of our free booklets about heart health, conditions and treatments, including the easy-to-read 10 minutes series on lifestyle changes and Quick guides to heart conditions. ≠ Find out about how your heart works at bhf.org.uk/knowyourheart.

Peter’s storyPeter Allen, 83, was diagnosed with atrial fibrillationD, heart failure and had a pacemakerD fitted 15 years ago. With the help of his GP surgery, he monitors and adjusts his anticoagulantD medication, so he only needs six clinic visits per year.

Peter volunteers for Anticoagulation Europe. Anyone with coagulation issues in his area can contact him. Peter said:

“I’m one of those people who likes to know what’s going on with my health. Heart Matters’ Drug Cabinet section is really useful because it explains the different medications, and the interactions between them.

“I found Heart Matters by chance lying in my doctor’s waiting room. The important thing is that everyone gets

access to these sources of information, but often people don’t know where to find it.”

Nurse Sarah Briggs runseducation programmesfor heart failure patients

What is health literacy?Your ability to find health information and act on it. Health information includes spoken and written communication from health practitioners and information on medicine bottles.

9bhf.org.uk

The BHF says: This study shows that decreasing your intake of saturated fat can help lower cholesterol. However, more research and longer studies are needed to assess whether or not people who eat less saturated fat reduce their risk of cardiovascular-related death.

“Ditching butter for veg oil may not be better for heart”Eating ‘healthy’ spreads rather than butter may not reduce the risk of heart disease after all, a major review has concluded.

We have long been told butter is full of ‘bad’ saturated fat and that we should instead eat sunflower and vegetable oil spreads, which are linked to a lower risk of heart attackD.

“Being overweight may be less unhealthy”Being overweight may not be as unhealthy as it was 40 years ago, Danish research suggests. The study found the ‘moderately’ overweight now have lower rates of early death than those who were normal weight, underweight or obese.

The BHF says: Although this study suggests that people with a higher BMI are surviving longer than 30 years ago, it does not mean we need to reconsider the parameters of a healthy BMI. The results highlight the progress we have made in treatments for people with obesity and cardiovascular conditions, which has led to lower death rates.

as 12g of ethanol, which is equivalent to a small glass of wine (1.5 units) and less than a pint of medium-strength beer (2 units).

The BHF would always recommend that if you drink alcohol it is important to keep within the guidelines: men and women should not drink more than 14 units of alcohol each week and you should have several alcohol-free days each week. These guidelines apply whether you drink regularly or only occasionally.

Drinking more than the recommended amount can have harmful effects on your health, such as increasing the risk of some cancers. There are safer and healthier ways to protect your heart, such as not smoking, being active and eating a healthy balanced diet.

“Couple of alcoholic drinks a day could protect heart, say scientists”

Does alcohol boost your heart health?

Daily Mail 13 April 2016The Telegraph 11 May 2016

BBC News 10 May 2016

BEHIND THE HEADLINES

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Having one or two extra alcoholic drinks a day could lead to a higher risk of breast cancer but a lower risk of coronary heart diseaseD, according to a study published in the BMJ.

The study looked at 22,000 women over a five-year period, although only 1,955 of those increased their intake by seven or more alcoholic drinks a week. The study also only looked at postmenopausal women aged 50–64, so its findings cannot be applied to the whole population.

Similarly, the drinking patterns of these women were not taken into account. This is important, as studies have shown that binge drinking can worsen coronary heart disease and can lead to an increased risk of death.

The researchers, who are from the University of Southern Denmark, suggested that alcohol could bring down the risk of heart disease by raising levels of ‘good’ cholesterol.

June Davison, Senior Cardiac Nurse at the British Heart Foundation, said: “Although previous research has identified that low to moderate intake of alcohol is associated with decreased risk of coronary heart disease, the benefits of drinking alcohol can be outweighed by an increased risk of other health problems.”

The story was covered in the UK by The Telegraph and Daily Mail. A flaw in the media coverage was that it mentioned that a glass or two of wine could be good for you, but didn’t explain that this means a small rather than standard-sized glass.

One unit of alcohol contains 8g of ethanol. However, the study classed a drink

There are safer and healthier ways to protect your heart than drinking alcohol”

10

COVER STORY

Taking on Lord Sugar and his boardroom challenge was the goal Ruth Whiteley needed to get through her health issues, as she tells Sarah Brealey

Ruth Whiteley has always been “an all or nothing kind of gal”. She liked to work hard, train hard and ski fast. But developing a heart rhythm problem aged 44 made her question her body. Her goal through her recovery was to become a

contestant on reality TV show The Apprentice. She felt that if she was able to appear on the programme, then she would know her health was back to normal.

Ruth had just finished a gym session with a personal trainer in late 2011 when she collapsed. An ambulance was called and she was taken to hospital.

“All I knew was that I didn’t feel in control of myself,” says Ruth, who runs a sales training business in Harrogate. “I was incredibly dizzy and couldn’t stand up. I had an overwhelming feeling of my heart banging in my chest – I thought it was going to explode. The medics calmed me down and said there was a chance it could be a one-off. Unfortunately it continued to happen, often for no reason that I could tell. I could be asleep and wake up with my heart going at nearly 200 beats per minute.”

Out of rhythmRuth had an electrocardiogram (ECG)D in hospital and was sent home with a wearable ECG to give doctors a fuller picture of her heart rhythm.

She was told she had supraventricular tachycardia (SVT), an abnormal heart rhythm in which the heart suddenly starts racing. Ruth was given medication to help, but was keen to deal with the source of the issue.

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“I was in a tricky middle-age situation,” she explains. “I was having problems with my periods, I ended up not being able to have the operation I needed [a hysterectomy] because they couldn’t stabilise my heart rhythm. I was always going to the doctor. Physically, I was tired and very emotional, and personally I felt like my life was a mess.”

Ruth’s health problems affected her whole life. “I had always felt my body was my ally and suddenly it wasn’t any more,” she says. “What your heart is doing affects everything you do. When your heart doesn’t do what it is supposed to, it makes you question everything.”

Because her condition was so unpredictable, Ruth felt she couldn’t plan ahead. She started turning down social invitations. “I didn’t want to let people down, but I would worry about whether my heart would start racing,” she says. “I wasn’t very good at coping with it. There was one occasion when I did go to the opera with a friend and I got a tachycardia midway through the first half. I told my friend I was going to the loo. I was in there trying to control my heart rate, as I’d been taught to do by my doctor, and I was there for ages. My friend came out to see how I was, then she got flustered, and it was all a lot to cope with.”

Life-changing procedure Eighteen months after the problems started, Ruth had an ablationD. Within days she felt back to normal and was able to plan the hysterectomy she needed. But two weeks after the hysterectomy, a significant tachycardia episode sent Ruth back to hospital.

Heart Matters


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Winning a place on theboardroom show helped

Ruth regain her confidence

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Some people row the Atlantic... but as a businesswoman who’s watched The Apprentice, that’s what I wanted to aim for”

12 Heart Matters

“They had warned me that there was a danger of the arrhythmia coming back,” she says. “At first I thought I was imagining it.”

The return of her heart problems felt like “a big hurdle”. But fortunately, a second ablation, six months after the first, was successful, and she’s been fine since.

Ruth had both ablations at Leeds General Infirmary, carried out by Dr Lee Graham, Consultant in Cardiology and Cardiac Electrophysiology.

“It felt strange having an ablation, because you are conscious,” Ruth says. “It felt like being part of a magician’s show. It’s fantastic. For him it was just a job. For me it was a completely life-changing moment. I am in awe of him. He was totally and utterly brilliant. The whole process was life-changing, so I thought: ‘I can’t just let this go. I have got to do something I never thought I would be able to do.’”

While watching box sets of The Apprentice during her recovery, Ruth decided to apply. She saw it as a way of proving to herself that her health problems were in the past.

“I know for some people that would mean climbing a mountain or rowing the Atlantic,” she says. “But as a businesswoman who’s watched The Apprentice for 11 years, that’s what I wanted to aim for.”

Boardroom challengeRuth applied to be on the show and was selected for the 2015 series, broadcast last autumn.

“It was a very overwhelming experience,” she says. “It does take over your life. But I knew that before I

I wanted to feel normal, that I was truly over my heart problems”

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≠ Order one of our free booklets, such as Heart attack – your free guide or Having heart surgery, at bhf.org.uk/HMpublications or call 0879 600 6566.≠ Discover more inspiring stories about rebuilding confidence after a heart event and find tips from experts at bhf.org.uk/confidence.

Free BHF support

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Abnormal heart rhythms and ablation

went on, which is why I thought: ‘If I can stand that, I am cured.’

“The boardroom tasks are very stressful. You have to be totally on the ball. You don’t know what you’re going to be asked. They take your pen and paper away before you go in – that was difficult for me, because my list is my life.”

Lord Alan Sugar fired Ruth in the fourth week. She says: “I think it is right that I left when I did. Although I would have liked to stay on, it was incredibly stressful.

“It was stretching in all ways – emotionally, physically, maritally. The media attention was hard on my family, who have been amazing. Without my husband I wouldn’t have been able to do it. My daughter Gabriella – she was 11 at the time – has been exceptional. She never cried or moaned.

“So it was challenging, but I wanted to feel normal, that I was truly over my heart problems. I know I am now better and stronger as a result.”

Back to normalRuth, now 48, is focusing on her business (delivering training in sales), public speaking engagements, and spending time with her family.

She’s given up alcohol, as she found it had a negative effect on her heart rhythm.

“I wasn’t a big drinker anyway,” she explains. “It’s just easier and less stressful if I don’t drink.”

She feels better, though it’s made her realise how central alcohol is to many social occasions. “My friendship groups have changed, as I’m no longer

There are many kinds of abnormal heart rhythm. They are usually caused by a problem with the heart’s electrical system.

Supraventricular tachycardia (which Ruth had) means the heart beats much faster than normal (at more than 100 beats per minute). It can be accompanied

by chest pain, dizziness, light-headedness or breathlessness. In some people, it results from an extra electrical connection in the heart present from birth, as in Wolff-Parkinson-White syndrome, but can occur in hearts that are otherwise normal. Alcohol, caffeine and stress can also affect your heart rhythm.

Ablation (or catheter ablation), is a treatment to control or correct certain types of abnormally fast heart rhythms, including atrial fibrillation (AF) and SVT. A thin, hollow, flexible tube (cardiac catheterD) is passed into your heart through an artery in your groin or wrist. Your doctor pinpoints tissue where the abnormal signal

originates and destroys it with radiofrequency waves (radiofrequency ablation) or by freezing (cryoablation), as in Ruth’s case.

It may take eight to 10 weeks until it is clear whether an ablation has worked. Sometimes, the procedure has to be repeated before the problem is resolved.

someone that goes out Friday night drinking, or that a girlfriend can sit up late with over a bottle of prosecco. Sometimes that seems to cause other people a bigger problem than it causes me.”

Ruth tries to eat healthily, with lots of vegetables, fruit, oily fish and nuts. Life is back to normal, although she’s still frightened to exercise. “I don’t do any exercise at all,” she says. “I know it’s all in my head, and it’s because I first collapsed in the gym. I have gone skiing twice, but only very slowly. I worry that the exercise is going to set my heart off again, but I realise the problem is more mental than actual.”

Most of the time, Ruth doesn’t think about her health. “I have got out of the habit of feeling for my pulse,” she says. “It became a real habit for me. You can become quite fixated on your heart.

“I got so used to noticing it, that after my ablations I had a few panicky moments because I couldn’t feel my heartbeat. Then I realised – that’s normal.”

Heart Matters

MEDICAL

14

The number of people living with multiple long-term conditions is increasing. We need to re-think healthcare to ensure everyone can live life to the full

Focus on…Multiple healthconditions

Jack Chisnall takes 21 tablets a day, plus injections for his diabetesD and an inhaler for his asthma. Despite having reduced mobility, he has frequent medical appointments – between five and 15 a month. Jack, 65, from Lincolnshire, also has arthritis, an

underactive thyroid, issues with his gallbladder, and carpal tunnel syndrome.

He’s not unusual. More than a third of the UK adult population (about 18 million people) live with a long-term condition, such as heart disease, diabetes or cancer, and it’s estimated that as many as half of them live with more than one. The number of people with multiple long-term conditions is predicted to keep growing, adding billions to health and social care costs.

This is common partly because many conditions have the same risk factors, such as obesity and smoking. Having one condition can also increase your risk of developing another. For example, diabetes, rheumatoid arthritis or kidney disease can raise your risk of heart disease. Rising life expectancy also means more elderly people are living with multiple conditions. Everyone will need the right support to manage conditions well.

Dr Alf Collins, NHS England Lead Commissioner for long-term health conditions, describes the

rising number of multiple conditions as “a massive quandary”, which he says is “only set to get worse”.

Silo workingFor Jack, disjointed healthcare adds to his health challenges. “Thankfully, I’m retired. I don’t know how you’d manage all these appointments and a job,” he says. “I’m a stoic person and I try to get on with it, but it would be lovely if there was one person who could take an overview.”

Jack has had diabetes since his 20s. His carpal tunnel syndrome limits his hand movements. An enlarged prostate gives him bladder-control issues, and surgery for bowel cancer means he uses a colostomy bag. He says: “I find that healthcare works in silos. There’s no point in talking to someone in oncology about the carpal tunnel in my hands – they just wouldn’t know what to do.”

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As well as the problem of multiple uncoordinated appointments, Jack feels that doctors don’t always pay enough attention to things that affect his quality of life. “Doctors tend to go on about the asthma and diabetes and the bowel cancer, but these aren’t the things that have the most effect on my life,” he says. “It’s the lack of mobility, bladder control, and you wouldn’t believe the amount of glassware and crockery I go through, because of the problems with my hands.”

Dr Mike Knapton, a GP and BHF Associate Medical Director, says: “Dealing with long-term or multiple health conditions requires a lot of time talking to patients to diagnose the problem, making sure they understand it, then explaining treatment options and the side effects of the various drugs.

“Many patients take multiple drugs, and it’s the responsibility of the doctor to know how these will interact, and to manage the risks and side effects.”

Jack appreciates the fact that his doctor discusses medications with him and allows him to have some control over this. Jack knows, for example, that grass sets off his asthma in summer and that dust can be a problem too, so he anticipates his reaction and self-medicates accordingly. He also looks after his own health by exercising and stretching for around 40 minutes every day.

tips for living with multiple conditions8

1Talk to your GP about services available in your

area for people with multiple conditions, including community support.

2 Try to schedule medical appointments for the

same day to reduce visits and travel time.

3Write down questions you would like to ask,

especially if you’re worried you might forget them.

4 Ask your GP if there is an Expert Patient course

in your area – this can help

you learn about coping with chronic conditions and dealing with pain.

5 Request a free Medicines Use Review. This is an

appointment with your local pharmacist to talk about how you’re getting on with your medications. It is useful if you regularly take several prescription medicines or have a long-term illness. If you’re prescribed a new medication for high blood pressureD, type 2 diabetes, asthma, chronic obstructive pulmonary disease (COPD), or to thin your blood (such as warfarin or

clopidogrel) you can ask for extra help from your pharmacist via the New Medicines Service (England only).

6Get support from people around you. Friends and

family can play an active role in the care of their loved ones. Group activities such as walking or exercise classes are great physical activity and have been shown to help with psychological issues, such as loneliness and depression. Joining a support group can also help. Visit bhf.org.uk/heartsupport or call 0300 330 3300 to find your nearest Heart

Support Group in England and Wales. In Scotland, call Chest Heart and Stroke Scotland on 0808 801 0899.

7 Being informed about your condition can help

you feel in control. Find out more at bhf.org.uk or in our publications (see page 50). Visit NHS Choices (nhs.uk), or other charity websites for different conditions, such as diabetes.org.uk.

8Call the BHF’s Heart Helpline on 0300 330 3300

to get answers about heart disease and related conditions.

Overcoming hurdlesIn March 2016, the National Institute for Health and Care Excellence (NICE) published the first draft guidelines on treating people with multiple conditions. The final guidelines are due in September. The draft guidelines say GPs should identify people with two or more long-term conditions who may benefit from a ‘tailored approach’ to their care. This

would particularly include those who are frail, or take many prescribed medications, or have long-term mental and physical health problems.

A tailored approach should include finding out the patient’s priorities, involving loved ones if the patient wants to, coordinating different medical appointments, reviewing the benefits of medications and investigating non-drug treatments as alternatives.

Previously, the Five Year Forward View, launched in 2014 by NHS England, Public Health England and the Department of Health, set out a vision for the NHS. This includes the need to take “decisive steps to break down the barriers in how care is provided between

I take eight tablets first thing in the morning, seven more after breakfast, two after dinner and four last thing at night”

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16 Heart Matters

family doctors and hospitals, between physical and mental health, between health and social care.”

The report suggests specialist centres should provide for people with multiple health conditions. More healthcare professionals should be trained to support this.

“If, for example, you live with five long-term conditions, is it right that you see five different specialists?” asks Dr Collins. “Wouldn’t it be better if you had one doctor, who could integrate the views, ideas and knowledge of those five different services?”

There are also plans to integrate health and social care by 2020. However, the challenge is increased by social care funding shortfalls – demand is rising,

while budgets are being cut. Integration will be a “big, big challenge,” says Dr Collins. “Social care is means-tested and the NHS isn’t, so there are huge hurdles to overcome before we can integrate them. It’ll happen, but it’s not going to be straightforward.”

Meanwhile Jack, who walks with a stick and can only sit for short periods of time because of his arthritis, continues to live a full life. He gets support from friends and enjoys his hobbies, including studying dog breeding.

“I live alone in an old stone cottage, but it’s single storey, so I can get about, and with planning I can go out for food with friends,” Jack says. “I went to America recently with the help of friends to give a lecture on canine genetics and nutrition.”

The BHF funded nine integrated care pilot schemes in England, Scotland and Wales between 2012 and 2015. Most of these focused on integrating primary and secondary care for heart conditions.

In East Cheshire, the project extended the cardiac nurse role, crossing traditional boundaries of hospital, community, and primary and social care. The team provides joint training and assessment

with colleagues specialising in diabetes, respiratory disease, pain management and palliative care. This is better for patients and has reduced hospital stays, saving the local health trust £1,195,000 in two years. After this successful pilot, the NHS has provided long-term funding to sustain this model in East Cheshire. ≠ Read more at bhf.org.uk/integratedcare.

How we’re joining up care

We’ve invested £1m into our House of Care pilot

projects. This new model is based on person-centred care, where healthcare professionals and patients come together as equal partners to develop a care and support plan. This starts with what matters to the patient and identifies best treatments, the right care and support, and actions patients can take. It considers emotional wellbeing alongside medical issues.

There is evidence that care and support planning leads to improvements in physical and mental health, and enables people to better manage conditions. It’s also in line with the NHS Five Year Forward View.

Previously, House of Care has mostly been applied to long-term conditions other than heart and circulatory disease.

Our House of Care programme is being trialled in Gateshead,

Glasgow, Hardwick (Derbyshire), Lothian and Tayside. The approach has three parts:≠ Implement routine care and support planning in primary care.≠ Redesign services for people with heart and circulatory disease, driven by care and support planning.≠ Develop community support for self-management in areas of health inequalities, high deprivation, and high prevalence of heart and circulatory disease.

Dr Sana Zakaria, Service Innovation and Evaluation Portfolio Officer at the BHF, says:

“By empowering people with knowledge and the infrastructure to support behaviour change, they will be able to not only take ownership of their health, but also drive it forward as equal partners with healthcare professionals.

“It is important for people to feel that something is being done ‘with’ them rather than ‘to’ them.”

Building a House of Care

18mNumber of people in the UK who have a long-term condition

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MEDICAL

Our panel of experts answer your health questions

ASK THE EXPERTS

Potassium and pacemakersQ I had surgery recently and

was prescribed potassium supplements. Why is this?

Senior Cardiac Nurse Christopher Allen says:Potassium is an

important mineral that helps your body, particularly nerves and muscles, function normally.

Your heart is a muscle and is controlled by your nervous system, so potassium levels that are too high or too low can affect the way it works. This could lead to abnormal heart rhythms such as atrial fibrillation (AF)D, which you’re already at an increased risk

of having following surgery on your heart or chest. This is because the surgery can disrupt the electrical pathways that make your heart beat normally.

Research suggests that having your potassium at a certain level within the ‘normal’ range helps prevent AF after surgery, so you’ve probably been prescribed the supplements because your potassium is below the normal or target range.

You would normally only take this medication for a short time after surgery, unless your potassium levels are consistently too low.

As with any medication there may be some side effects, most

commonly diarrhoea, nausea and stomach pain or wind.

Q I have a pacemaker and heard I can’t have an MRI scan. Is this true?

A An MRI scanner uses strong magnetic fields to create a detailed image of the inside of your body. The magnets may affect any metal implants in your body – including pacemakersD and their wires, but also implantable cardioverter defibrillators (ICDs)D, metal heart valves, brain aneurysm clips, artificial joints and dental fillings. In some cases, an MRI may still be OK, but always tell medical staff beforehand if any of the above applies to you. An MRI

Need more information? Go online to bhf.org.uk/experts for more of your questions answered.

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

How to get in touch

Under pressureQ I would like to take up

scuba diving but I have high blood pressure. Is this something that I can do?

Dr Mike Knapton says: Scuba diving can be a great way to keep fit and provide a workout for your heart. However, diving can have significant effects on the body, including increasing blood pressure.

There are a number of medical conditions that could put you at risk

when diving. As you have high blood pressureD, it’s a

good idea to get checked out by your doctor before you go diving.

The British Sub-Aqua Club is the governing body for sub-aqua

diving and snorkelling in the UK. It has a useful website (bsac.com) with all the information you will need to take up scuba diving. This includes a self-declaration form – a short questionnaire asking about any specific

medical conditions. If you

have any of the conditions you will need a medical reference and potentially a medical examination. Conditions include diseases of the heart and circulation, including anginaD, chest pains, diabetesD, high blood pressure, palpitations and strokeD.

You should also have a medical if you are currently

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A Ablation A procedure to correct or control certain types of

abnormal heart rhythms. It involves using radiofrequency waves to destroy the abnormal electrical pathways. Angina An uncomfortable feeling, tightness or pain in your chest that may also be felt in your arms, neck, jaw, back or stomach. The symptoms of angina are usually caused by coronary heart disease.Angiogram X-ray pictures that show whether the arteries are narrowed and if so, how narrow they have become. A coronary angiogram examines the coronary arteries.Angioplasty A procedure used to widen a narrow artery. It involves temporarily inserting a catheter and infl ating a tiny balloon at the narrowing to widen it and improve the blood fl ow.Anticoagulant Medicine to prevent harmful blood clots from forming, by making your blood take longer to clot. Anticoagulants can reduce the risk of a stroke, and are also

used to treat blood clots that have already formed.Arrhythmia An abnormal heart rhythmAtrial fi brillation (AF) An abnormal heart rhythm in which the atria (upper chambers of the heart) beat in an irregular pattern. People with AF have an irregular, and sometimes fast, pulse.

B Bypass See coronary artery bypass surgery.

C Cardiac arrest The ultimate medical emergency, when

a person’s heart stops pumping blood round their body and they stop breathing normally. Cardiac arrests in adults can be caused by a heart attack.

Cardiac rehabilitation Also called ‘cardiac rehab’, this is an education and exercise programme to help you recover from a cardiac event and get back to as full a life as possible.Cardioversion A treatment to help restore a normal heart rhythm. It can be done using medicines (chemical cardioversion), or by giving the heart a controlled electric shock with a defi brillator (electrical cardioversion).Cardiac catheter A fi ne, fl exible, hollow tube which can be passed through a blood vessel in the wrist or groin into the heart for a diagnostic examination.Coronary artery bypass surgery An operation to treat coronary heart disease. Arteries from your chest wall and arm, or veins from your leg, are used to bypass the blocked or narrowed coronary arteries, improving blood fl ow to the heart muscle.Coronary heart disease (CHD) When the walls of the coronary arteries (the arteries that supply blood to the heart muscle) become narrowed due to a gradual build-up of atheroma (sometimes called ‘plaques’).

DDiabetes A condition in which glucose (sugar) levels in the

blood are too high. There are two main types of diabetes: type 1, where your body stops producing insulin, and type 2, where your body can’t use the insulin it produces, usually because excess fat in organs prevents the insulin from working eff ectively. Diabetes increases your risk of developing cardiovascular disease.

EElectrocardiogram (ECG) A simple, painless test to record

the heart’s electrical activity. Small sticky patches (electrodes) are put onto your arms, legs and chest. These are connected to a machine that picks up and records the electrical signals of your heartbeat.

FFree sugars A free sugar is any sugar that is added to

foods by the manufacturer, plus that naturally present in honey, syrups and fruit juices. It does not include sugar naturally present in milk or whole fruit and vegetables. These are called intrinsic sugars and are contained within the cellular structure of foods (primarily fruits and vegetables).

HHeart attack Known medically as a ‘myocardial infarction’,

or ‘MI’. This describes a sudden loss of blood fl ow to part of the heart muscle. Most heart attacks are caused by atherosclerosis, the build-up of atheroma (plaque) within artery walls. If the atheroma becomes unstable, a piece may break off and lead to a blood clot. This can block a coronary artery, causing a heart attack and irreversible heart muscle damage. It is a medical emergency and can lead to a cardiac arrestHeart failure Condition where the heart becomes less effi cient at pumping blood around the body. High blood pressure Also called ‘hypertension’. High blood pressure is when the pressure required to pump blood is consistently higher than the recommended level. This puts extra strain on your heart and blood vessels, and over time

MEDICAL TERMS EXPLAINED

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

can increase your risk of having a heart attack or stroke.

I Implantable cardioverter defi brillator (ICD) A small device implanted under the skin on your chest,

connected to your heart by one or more wires (leads). It monitors your heart rhythm and can deliver a controlled electric shock if you have a life-threatening abnormal heart rhythm.

P Pacemaker A small device implanted under the skin

on the chest, connected to your heart by one or more wires (leads). Monitors the heart’s electric signals and can stimulate heart to contract and produce a heartbeat if required.

S Statins A medicine to reduce cholesterol levels in the

blood and stabilise any fatty plaques (atheroma) against the artery wall. Stent A short tube of expandable stainless-steel mesh that is inserted into an artery to hold it open after an angioplasty, improving the fl ow of blood through the artery. Stroke An interruption of blood fl ow to part of the brain, causing brain cells to die or become damaged. This happens if an artery carrying blood to your brain becomes blocked, or if an artery bleeds into your brain. A stroke is a medical emergency.

T Triglycerides A type of fatty substance found in the

blood and stored in fat cells that consists of three individual fatty acids in each molecule. Its level is measured as part of a blood cholesterol test.

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

Dictionary

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taking any medication (other than the oral contraceptive pill). Subject to a satisfactory medical – which can be undertaken by your GP, but will incur a private fee – you should be able to dive safely.

Get checked out by your doctor before you go diving”

can also affect the settings of your device.

The alternative is usually a CT scan, as this uses radiation and won’t affect your pacemaker. This scan involves lying on a bed, which passes through a doughnut-shaped opening in a CT scanner to create an image of your heart.

In recent years ‘MRI-safe’ pacemakers and leads have been developed. These can be implanted into new pacemaker patients who we know will need MRIs in the future.

≠ More on MRI scans, including a short film at bhf.org.uk/MRI.≠ Learn about CT scans at bhf.org.uk/CTscan.

Q What are antiplatelet drugs and why might they be prescribed?

A Antiplatelet drugs are given to someone who has had a heart attackD, to reduce the chances of them having another. You might also be given antiplatelets if you have had a stentD fitted to a narrowed artery, if you’ve had a strokeD or if you’ve been diagnosed with peripheral vascular disease. The most common antiplatelet drug used in preventing further heart attacks is aspirin. Others include clopidogrel, prasugrel and ticagrelor.

Platelets are cells that circulate around your body in the bloodstream. They are

responsible for blood clotting, which is normally a very useful function; for example, when you cut yourself, it stops you from bleeding excessively. However, for people with coronary heart diseaseD they can cause problems.

A heart attack happens after fatty plaque (atheroma) builds up in the arteries that supply

Heart Matters18

Antiplatelet medications

DRUG CABINET

MEDICAL

Antiplatelet medications, such as aspirin and clopidogrel, are commonly used to reduce the risk of heart attack. Senior Cardiac Nurse Christopher Allen finds out more from Professor Albert Ferro

blood to your heart. If this plaque ruptures, the body’s natural response is to clot around the rupture, so platelets are activated to form a clot. Unfortunately, this blocks the artery and prevents blood reaching part of your heart muscle. Starved of oxygen, the cells in the heart muscle start to die. In some cases this can lead to heart failureD.

CV Professor Albert Ferro ≠ Consultant Physician at Guy’s

and St Thomas’ hospitals ≠ Professor of Cardiovascular Clinical

Pharmacology at King’s College London≠ Chair of Royal College of Physicians Joint Specialty

Committee on Clinical Pharmacology and Therapeutics

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abnormal heart rhythms. It involves using radiofrequency waves to destroy the abnormal electrical pathways. Angina An uncomfortable feeling, tightness or pain in your chest that may also be felt in your arms, neck, jaw, back or stomach. The symptoms of angina are usually caused by coronary heart disease.Angiogram X-ray pictures that show whether the arteries are narrowed and if so, how narrow they have become. A coronary angiogram examines the coronary arteries.Angioplasty A procedure used to widen a narrow artery. It involves temporarily inserting a catheter and infl ating a tiny balloon at the narrowing to widen it and improve the blood fl ow.Anticoagulant Medicine to prevent harmful blood clots from forming, by making your blood take longer to clot. Anticoagulants can reduce the risk of a stroke, and are also

used to treat blood clots that have already formed.Arrhythmia An abnormal heart rhythmAtrial fi brillation (AF) An abnormal heart rhythm in which the atria (upper chambers of the heart) beat in an irregular pattern. People with AF have an irregular, and sometimes fast, pulse.




Cardiac rehabilitation Also called ‘cardiac rehab’, this is an education and exercise programme to help you recover from a cardiac event and get back to as full a life as possible.Cardioversion A treatment to help restore a normal heart rhythm. It can be done using medicines (chemical cardioversion), or by giving the heart a controlled electric shock with a defi brillator (electrical cardioversion).Cardiac catheter A fi ne, fl exible, hollow tube which can be passed through a blood vessel in the wrist or groin into the heart for a diagnostic examination.Coronary artery bypass surgery An operation to treat coronary heart disease. Arteries from your chest wall and arm, or veins from your leg, are used to bypass the blocked or narrowed coronary arteries, improving blood fl ow to the heart muscle.Coronary heart disease (CHD) When the walls of the coronary arteries (the arteries that supply blood to the heart muscle) become narrowed due to a gradual build-up of atheroma (sometimes called ‘plaques’).


blood are too high. There are two main types of diabetes: type 1, where your body stops producing insulin, and type 2, where your body can’t use the insulin it produces, usually because excess fat in organs prevents the insulin from working eff ectively. Diabetes increases your risk of developing cardiovascular disease.






or ‘MI’. This describes a sudden loss of blood fl ow to part of the heart muscle. Most heart attacks are caused by atherosclerosis, the build-up of atheroma (plaque) within artery walls. If the atheroma becomes unstable, a piece may break off and lead to a blood clot. This can block a coronary artery, causing a heart attack and irreversible heart muscle damage. It is a medical emergency and can lead to a cardiac arrestHeart failure Condition where the heart becomes less effi cient at pumping blood around the body. High blood pressure Also called ‘hypertension’. High blood pressure is when the pressure required to pump blood is consistently higher than the recommended level. This puts extra strain on your heart and blood vessels, and over time




I Implantable cardioverter defi brillator (ICD) A small device implanted under the skin on your chest,

connected to your heart by one or more wires (leads). It monitors your heart rhythm and can deliver a controlled electric shock if you have a life-threatening abnormal heart rhythm.




blood and stabilise any fatty plaques (atheroma) against the artery wall. Stent A short tube of expandable stainless-steel mesh that is inserted into an artery to hold it open after an angioplasty, improving the fl ow of blood through the artery. Stroke An interruption of blood fl ow to part of the brain, causing brain cells to die or become damaged. This happens if an artery carrying blood to your brain becomes blocked, or if an artery bleeds into your brain. A stroke is a medical emergency.



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

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been diagnosed with coronary heart disease to help reduce their risk of having a heart attack. It acts directly on the platelets.

Warfarin is an anticoagulantD rather than an antiplatelet. It acts on a different part of the clotting process – it reduces the liver’s ability to use vitamin K to make blood-clotting proteins. It may be prescribed if you have atrial fibrillation (AF)D or a metal heart valve, to reduce the risk of having a stroke due to a blood clot forming.

Taking aspirin will not reduce your risk of having a stroke if you have AF or a metal heart valve, and similarly, taking warfarin will not reduce your risk of having a heart attack.

Q Any issues with other drug interactions?

A If you’re taking antiplatelets you should avoid taking ibuprofen or other painkillers in the same family, as they can increase your risk of bleeding if taken together.

The Medicines and Healthcare products Regulatory Agency says taking the antiplatelet drug clopidogrel with omeprazole or esomeprazole (drugs that suppress stomach acid, known as PPIs) “is to be discouraged unless considered essential”. Other PPIs should be considered instead. There is some evidence that omeprazole or esomeprazole may prevent

Antiplatelet drugs can reduce the chance of a heart attack by telling platelets not to stick together and form a blood clot.

Q How long would I take them for?

A Following a heart attack, you will most commonly be given aspirin for life, plus another antiplatelet drug to be taken for one year. This is especially important if you have had a stent fitted, as the chances of a blood clot forming inside the stent are much higher in the first year after insertion.

Each drug works in a slightly different way to stop platelets forming blood clots, meaning two can work effectively together. If you’re intolerant of aspirin, you may take one of the other antiplatelet drugs for life instead. Most commonly this would be clopidogrel, which works at least as well as aspirin. Aspirin is preferred as a first-line drug because it’s been around for longer, so we have the most experience of its use.

Q Why am I taking aspirin and warfarin, don’t they do the same thing?

A Aspirin and warfarin are sometimes prescribed together. This is because they not only work differently, but also help to manage different conditions.

Aspirin is most commonly prescribed for those who have

Antiplatelet drugs... tell platelets not to stick together and form a blood clot”

clopidogrel from working as effectively, leading to more heart attacks among people who took both drugs. This evidence is limited, though. If you have concerns, speak to your doctor.

Q Why have I been told to stop taking my medication?

A If you’re taking two antiplatelet drugs – usually because you’ve had a stent fitted – you’ll probably be advised to stop taking one of the drugs after a year. You will only need one antiplatelet drug for life, as the risk of a clot forming is much lower after the first year.

Q Are there side effects? A Antiplatelets can irritate the

lining of the stomach, so there

is a risk of gastrointestinal side effects such as indigestion and stomach aches. It’s important to tell your GP about any side effects you’re having, but keep taking your medication in the meantime. Some people develop a gastric (stomach) ulcer and will need to start taking PPIs to protect the stomach lining.

Because antiplatelet drugs reduce the ability of the blood to clot, you may be more prone to nosebleeds and bruising, or you may bleed for longer than usual if you get cut. This is completely normal and is considered an acceptable side effect because of the significant reduction in your risk of heart attack.

FREE

Summer 2016

Ooh, saucy!Healthy tips to

spice up your summer barbecue

Material change

How we're creating

better heart valves


PULL OUT

AND KEEP

RECIPECARDS

NORDIC DISHES


10

Winning a place on

The Apprentice helped

Ruth beat her heart issues


Enjoyed this article?≠ Visit bhf.org.uk/drugcabinet.≠ Read about aspirin at bhf.org.uk/aspirin, or order our Mar/Apr 2014 issue on 0870 600 6566. ≠ Learn about PPIs at bhf.org.uk/PPI, or order our Spring 2016 issue on 0870 600 6566.

Heart Matters

MEDICAL

20

Your ethnic origin can increase your risk of heart and circulatory disease and diabetes. Senior Cardiac Nurse Christopher Allen talks to Sandy Gupta

Focus on…South Asian background and heart health

CA Does South Asian background affect heart risk?SG We’ve known for more than 50 years that the risk of coronary heart disease (CHD)D is up to 50 per cent higher in first-generation South Asians than in the white European population in the UK. The sad thing is, it’s still a problem, despite us knowing this for so long.

CA What do we mean by South Asian background?SG We’re talking about people of the Indian subcontinent (India, Pakistan, Bangladesh and Sri Lanka), living in the UK. Even within the South Asian group, there are differences in risk. Those at highest risk are the Bangladeshi population, followed by Pakistanis, Indians and Sri Lankans – but even Sri Lankans may be at higher risk than white Caucasians.

CA What is the reason for this increase in risk?SG It is partly to do with body shape and diabetesD. South Asians mainly develop central obesity (fat around the middle). Extra fat, particularly on the middle, increases insulin resistance (meaning you must produce more insulin to stabilise blood sugar, among other processes) and therefore risk of developing type 2 diabetes. For this reason, the waist circumference indicating increased risk is lower for a South Asian person than a white European.

Diabetes increases your risk of CHD and of having a heart attackD. It is also linked to high levels of triglyceridesD and low levels of HDL (‘good’) cholesterol.

South Asians are diagnosed with type 2 diabetes at a much younger age, and at higher rates (rates are at least twice as high in South Asian communities as in the general population). It’s often a silent condition, so a diagnosis may come years after onset, when blood glucose levels have been unstable for some time and have already caused harm to the body.

Lifestyle factors may play a role, but part of it is genetic. A school playground study showed that children of South Asian background aged 10–14 had early markers of insulin resistance – a precursor to type 2 diabetes. Environmental factors such as a poor diet or smoking increase this genetic risk.

CV Dr Sandy GuptaConsultant Cardiologist at Whipps Cross and Barts Health NHS Trust, London

≠ Special interest in raising awareness of heart disease, particularly in South Asian communities

≠ Former Chairman of the BHF Strategy Group on Cardiovascular Health and Ethnicity

≠ Former member of BHF Prevention and Care Committee

≠ Past holder of BHF fellowship, exploring relationship between inflammation and heart disease

21bhf.org.uk

“There is a very strong history of heart disease and strokeD in my family. I was first diagnosed with diabetesD when I was pregnant with my son in 2005, but the day he was born, doctors said my blood sugar was back to normal and that my GP should follow up within two years.

“This didn’t happen. In late 2012, I started sweating profusely at night and using the toilet a lot. I was always thirsty, couldn’t control my hunger and started to have dizzy spells. The GP thought it might be early menopause, but blood tests showed my blood sugar was very high. I was diagnosed with type 2 diabetes – I felt very sad.”

Making changes“I try to live well and control the condition. I want to be healthy and live long for my son. I try my best to do exercises, and I take my medications on time and control the food I eat. I’m really a very happy person. I tell myself that today is a beautiful day and I love to spend time with my son. The reason I need to feel better every day is because of him. He’s very clever – he’s been there a few times when my blood sugar is very low and called for help. I worry that my health can affect him too.

“I take a lot of medications every day, including a statinD [to reduce cholesterol and heart attack risk] and an ACE inhibitor [for blood pressure]. I’ve reduced my weight and I do a lot of walking. I encourage my son to have a healthy diet with lots of fruit and salads. He tells me he will study very hard, but he’ll also look after his body because one day he might be a Bollywood actor!

“I talk a lot in my temple and my local community about healthy living. I use the BHF booklet Healthy living, healthy heart. I find it very useful. A lot of families use a lot of oil, sugar and salt in their cooking and I try directing them to services that can help them make changes.” (See box on page 22.)

Soma Biswas, 48, from Middlesex, has been diagnosed with diabetes, high blood pressure, an irregular heart rate and high cholesterol

Soma’s story

22 Heart Matters

CA Does a traditional South Asian diet increase risk?SG The components of a South Asian diet are healthy, such as lentils, vegetables and oily fish. But traditionally, many foods are fried. This means they’re higher in energy [calories], which can contribute to weight gain. Traditional fats such as ghee are high in saturated fat, which is linked to raised LDL cholesterol levels. Salt is also a big issue and, over time, a high-salt diet is associated with high blood pressureD.

Some typically South Asian snacks, such as samosas (made with deep-fried pastry), are very unhealthy. In South Asian culture, there are often large gatherings and family functions, where exposure to these foods is frequent and it’s easy to graze and not realise how many calories you’re eating. Culturally, it may also be seen as rude to turn down food someone has prepared for you.

It’s important, however, not to ‘ban’ any foods. Recognise what is a ‘luxury’ item that should be eaten rarely, and what is a healthy item that can be enjoyed regularly. Dietary changes shouldn’t be viewed as a punishment, but be conscious of portion sizes and preparation methods.

CA What about exercise?SG Studies suggest South Asians, especially women, do less physical activity. Many factors influence this. Some South Asian women may be reluctant to attend a mixed-sex gym or go swimming because of religious beliefs. They should be supported in finding activities they feel comfortable taking part in, such as walking, group dancing or single-sex exercise classes.

It’s not just the South Asian population though – many people in the UK miss targets for physical activity. It’s important to build activity into your daily routine, for example getting off the bus a stop earlier or going for a

walk at lunchtime. Breaking activities into manageable chunks (of 10 minutes or more) can make it much easier to achieve your target of at least 150 minutes a week.

CA Are there other factors?SG Many South Asian communities are in areas of deprivation. This can increase risk of developing CHD, for many complex reasons. For example, in deprived areas people are often on lower incomes and may have less access to healthier foods. The highest death rates occur in Bangladeshi communities in east London, which has many pockets of deprivation. Compared with the white British population, Bangladeshi populations in the UK are more likely to report poor oral health, work part-time, suffer infant mortality, and live in overcrowded households.

Rates of cigarette smoking and tobacco chewing are also higher in Bangladeshi communities. Shisha smoking is popular among some South Asian groups. Flavoured shisha can be misleading for younger people who don’t realise it is often tobacco-based.

CA Does this increased risk apply to people of South Asian background born in the UK?SG Yes, evidence shows risk factors in young South Asians are often more prevalent than in young white Europeans. Even among children born and raised in the UK, South Asian heritage not only genetically means they’re at higher risk of CHD, but family surroundings also play a major role in influencing lifestyle habits.

CA Do people of mixed ethnic origin have raised risk?SG At present, not enough time has passed for studies of these groups to answer this question with certainty.

In South Asian culture, there are often family functions where it’s easy to graze”

≠ Order one of our free guides, including: Healthy living, healthy heart, Taste of South Asia and Diabetes and your heart. Call 0870 600 6566 or visit bhf.org.uk/HMpublications.≠ Explore hundreds of healthy recipes at bhf.org.uk/recipefinder.≠ Look out for our Autumn issue to learn about African-Caribbean heritage and your heart health.

Free BHF support

*Heart Matters Helpline open 9am-5pm Monday-Friday. Similar cost to 01 and 02 numbers.

How do I follow a heart-healthy diet?

What does this diagnosis mean for me?

Why have I been prescribed this medication?

Why do I need this test?

Call the Heart Matters Helpline on 0300 333 2333* or email [email protected]

Questions about your heart condition?

24

JOIN THE FIGHT

Fighting fair

The past year has been a difficult one for charity fundraising. Media

coverage following the death of Olive Cooke, the poppy seller who was described as being “hounded” by charities, led to the government commissioning a report into charity fundraising from Sir Stuart Etherington, Chief Executive of the National Council for Voluntary Organisations.

Since then, charities, including the BHF, have been looking at the best ways to manage their relationships with their supporters who generously make all of our work possible.

The Etherington report was published in September 2015 and made recommendations to improve the experience for charity supporters. All of the recommendations were accepted by the government. These included:

it should be. We’ve also volunteered to be part of a task force, investigating how we can improve the experiences of charity supporters.

Our promiseWe have been working hard to make sure our policies and procedures are as rigorous as they should be.

As part of this, we have developed a Supporter Promise, which outlines our commitment to four

Inspired to raise funds? To help us fund more crucial research, call 0300 330 3322 or go online to bhf.org.uk/fundraise.

We will put supporters at the heart of what we do”

We couldn’t do our life saving work without your donations. That’s why we promise to treat our supporters as they deserve – with honesty and respect

key principles. Following these will help to ensure our supporters’ experience is as positive and rewarding as it can be.

≠ The creation of a new single regulator to create a more effective sanctions regime. ≠ The Fundraising Regulator will be funded by charities.≠ A new Fundraising Preference Service where individuals can register if they no longer wish to be contacted by charities for fundraising purposes.

We welcome these initiatives – they aim to make sure giving to charity is the great experience we believe

Our principles≠ Be honest and transparent about where donations go and why we need funds. ≠ Keep our supporters’ personal details safe. This means we will never sell or share supporters’ data with any third-party organisations. ≠ Be respectful – and we will continue to be sensitive when engaging with vulnerable people. Our Vulnerable Supporter Policy and practices reflect this. ≠ Be accountable – this includes everyone we work with. We will also make it easy for people to get in touch with us.

≠ Read our Supporter Promise in full at: bhf.org.uk/about-us/supporter-promise.≠ If you have comments or questions, or would like to review the way we contact you, get in touch with our Supporter Services team. Email [email protected] or call 0300 330 3322.

Find out more

We treat our supporters with respect and never sell or share your data

Heart Matters

25

NUTRITION

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

How to get in touch

bhf.org.uk

Our Senior Dietitian Victoria Taylor shares nutrition advice

ASK THE EXPERT

Super saladsQ During the summer I eat a

lot of salads. Do you have any advice on healthy dressings I can have with them? Also, is a salad a good option to order in a restaurant?

Victoria Taylor says: Salads are often seen as a low-calorie choice, and therefore ideal for those trying to lose weight. But ingredients like cheese, bacon and croutons can dramatically increase the saturated fat and salt content.

Dressings, too, can be high in calories, fat and salt. An average two-tablespoon serving of

Caesar salad dressing contains around 140kcal and 14g of fat.

At home, choose lighter versions of ready-made dressings. Light Caesar salad dressing contains just 10kcal and less than 0.5g of fat per tablespoon and a fat-free French dressing would save you around 63kcal and 7.4g of fat per tablespoon, compared with a standard version.

It’s not just about the calories though – try making your own salad dressing so you know exactly what’s in it. Vinaigrette-style dressings are easy to make by mixing vinegar (such

Enjoyed this article? Find all of our nutrition information at bhf.org.uk/nutrition.

as balsamic, white or red wine vinegars) with oil.

Switching from saturated fats to unsaturated fats like vegetable oils (including olive or rapeseed oils) can help lower cholesterol levels when consumed as part of a balanced diet. Avoid salad dressing

Daytime dietingQ I recently heard of a

diet called ‘vegan before six’. Will this help me lose weight?

Victoria Taylor says: The ‘vegan before six’ or VB6 diet involves following a vegan diet before 6pm. This means that any animal products such as meat, fish, shellfish, dairy, eggs and honey should be avoided before 6pm, but after this time you are free to eat whatever you want, though you’re advised to limit processed foods.

Like many other diet plans, VB6 involves

limiting your intake of key food groups. This can lead to weight loss, mainly because

for most of us it means cutting out foods like fatty meat, cheese, and many cakes and biscuits, which are high in fat

and sugar and therefore high in energy. The difference is, however, that these foods are only

restricted at certain times. So if you just save up these

foods and eat them after 6pm, you won’t necessarily lose any weight.

The VB6 diet is good if it leads to eating more fruits,

vegetables and wholegrains, and less meat and processed

foods. But remember, there are plenty of unhealthy vegan foods, such as chips and sugary drinks, and you’re unlikely to lose weight if you have too many of these. Many people do maintain a healthy vegan diet, but they need careful planning to ensure they are nutritionally balanced.

So, while there may be benefits to this way of eating, it needs to be a pattern you

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ingredients that are high in saturated fat, like sour cream, melted butter and blue cheese. But even unsaturated oils are still high in calories, so watch how much you use.

When eating out, ask for salad dressing on the side so you can control how much to add. Even better, use balsamic vinegar or a squeeze of lemon instead.

≠ Find six healthy salad dressings you can make in three minutes at bhf.org.uk/dressings.≠ See our summer salad with four different toppings at bhf.org.uk/summersalad.

can stick to in the long term if you are going to keep off any weight that you lose. Losing weight steadily and gradually is the safest way, and there are no quick fixes. So before making dramatic changes, try making simple adjustments to your physical activity levels and your diet, such as reducing your portion sizes or choosing low fat, salt and sugar varieties of the foods you normally eat.

≠ Check out our booklet Facts not fads – Your simple guide to healthy weight loss. Turn to page 50 for more details.≠ Go online for our comprehensive guide to diets. Visit bhf.org.uk/weight.

Remember, there are plenty of unhealthy vegan foods”

NUTRITION

From ketchup to brown sauce, soy sauce to pesto, we love adding flavour to our food. But there can be hidden health hazards, as Dr Hannah Forster explains

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Heart Matters26

If you love food that’s full of flavour, you may find yourself adding condiments or sauces to give meals an extra kick. But ready-made sauces can contain

a surprising amount of fat, sugar and salt. Over time, consuming too much of these can damage your health. Checking out the nutrition label will reveal the truth about your favourite sauce – but don’t fear, there are healthier options available.

Tomato ketchupThere’s 0.3g of salt and 4.1g (one teaspoon) of sugar in a tablespoon of ketchup. The recommended daily maximum of free sugarsD is 30g (about seven teaspoons), so go for reduced-sugar versions, which contain up to 50 per cent less. Or make a salsa with chopped tomatoes, onion, coriander, lime juice and chilli – delicious with a barbecue or in a sandwich. See three easy salsa recipes at bhf.org.uk/salsa.

MayonnaiseEach tablespoon of mayonnaise contains around 104kcal and 11.3g of fat – a significant chunk of the recommended daily intake of 70g. Swapping to one of the reduced-fat options available would save you 61kcal and 7.1g of fat. Or make your own lighter version by mixing a small amount of mayonnaise with some low-fat yoghurt. For many dishes, like potato salad or coleslaw, low-fat yoghurt on its own or mixed with lemon juice and chopped herbs works just as well as mayonnaise.

Soy sauceThere’s a lot of salt in soy sauce – around 2.75g per tablespoon, which is almost half the recommended 6g daily maximum. Even reduced-salt versions can contain more than 2g of salt per tablespoon so should be used sparingly. Consuming too much salt over time is linked to high blood pressureD, so measure out the amount you use with a spoon rather than splashing it straight from the bottle.

27bhf.org.uk

Ooh, saucy!

Go online ≠ Test your knowledge of sauces with our fun quiz. Visit bhf.org.uk/saucequiz.

Brown sauceThere is around 3.5g (nearly a teaspoon) of sugar and 0.2g of salt in each tablespoon of brown sauce. A reduced-salt and reduced-sugar version is a healthier choice, containing around 2.3g of sugar and 0.1g of salt per tablespoon.

MustardThis is one of the healthier sauces, as it’s relatively low in fat and sugar, although not always low in salt. Mustard powder made up with water is the lowest-salt option – a 2g portion is virtually salt-free. Ready-mixed versions contain more salt – one teaspoon of English mustard from a jar contains 0.43g of salt. One teaspoon of wholegrain mustard contains 0.26g of salt. While these are high in salt, their strong flavour means you’re likely to use less of them than other table sauces. Check nutrition labels, as some brands contain more salt than others.

Sweet chilli sauceAs its name implies, sweet chilli sauce is packed with sugar – around two teaspoons per tablespoon of sauce. Make your own by blending together a deseeded red chilli, two chopped red peppers, 1cm fresh grated ginger, four dates (stones removed), the juice of one lime and a generous pinch of black pepper. For loads of flavour without the sugar, try hot chilli sauce instead.

Cooking saucesReady-made sauces come in infinite varieties for curries, pasta, stir-fries and more. Whatever the dish, tomato-based sauces are healthier than creamy ones, as they’re usually lower in saturated fat and calories. Instead of a creamy korma, go for a balti or jalfrezi. With pasta, choose arrabbiata or bolognese instead of carbonara or cheese-based sauces. Swapping a 75g portion of carbonara sauce for a tomato-based sauce will save around 63kcal, 7g of fat and 4.8g of saturated fat.

Always check the labels of ready-made sauces, as brands vary. Reduced-fat options are not always lower in salt or sugar.

Don’t feel restricted by instructions on the jar – adding extra vegetables or pulses will help towards your 5-a-day. Add a tin of chopped tomatoes to a jar of tomato-based sauce to make it go further and dilute the salt content.

The best option is to make your own sauces so you can control what goes into them. Try using chopped tomatoes, garlic and herbs to make your own pasta sauce. Cook a big batch of a tomato-based sauce and freeze in portions to save time and money. For creamy sauces, use low-fat yoghurt or half-fat crème fraiche – add it at the end of cooking for best results.

PestoOne tablespoon of pesto contains around 103kcal and 9.5g of fat. Reduced-fat versions are a better choice where available. Or combine fresh chopped basil leaves with olive oil to get the flavour of pesto. It will still be high in fat, but lower in saturated fat and salt.

NUTRITION

Heart Matters28

You don’t have to deprive yourself to eat well. Dr Hannah Forster shows us how to focus on positive changes instead

upbeatEAT

Hannah Forsteris an associate nutritionist with a degree in nutrition and a PhD in the field of personalised nutrition

29bhf.org.uk

2portions of fish per week can help protect your heart

Food should be a pleasure, and that’s still true even if you’re trying to eat healthily.

Although some diet plans focus on negatives, implying you have to cut out everything

you like, that doesn’t have to be the case. In fact, completely cutting out foods or even whole food groups isn’t necessarily a good idea. Not only is it potentially unbalanced, it can lead to a sense of failure if you can’t resist something on the ‘banned’ list – making it more likely you’ll give up altogether. In any case, a diet regime that feels like a chore will be difficult to stick to in the long term.

Eating healthily by focusing on positive steps rather than negative ones is much easier – and often more effective, too.

More of the right thingsEating more may seem strange if you’re trying to lose weight, but eating at regular intervals (three nutritious meals a day, plus snacks if needed) and eating more of the right things can help.

Don’t focus on what you can’t have, focus on what you can have – fruits and vegetables, white and oily fish, wholegrain and high-fibre starchy carbohydrates. This will leave less room for foods like fatty or processed meats, and salty or sugary snacks and drinks.

Doing this will help balance your diet, which should mean you get all the nutrients, vitamins and minerals needed for good health and the right amount of energy, making it easier to maintain a healthy weight.

Fill up on fruit and veg Having at least five portions of fruits and vegetables each day can help protect your heart and reduce your risk of dying from a

heart attackD or strokeD. What’s more, the fibre content will fill you up and reduce temptation from unhealthy foods.

Eating more fruit and vegetables is easy. Add stewed fruit, sliced banana or berries to yoghurt or porridge for breakfast. Put extra veg in soups, stews and sauces, or just have an extra portion or two alongside your main meal. Fruit is an obvious snack, but don’t overlook

vegetables – cut sweet peppers, carrots, celery or cucumber into batons so they’re ready when hunger strikes, or simply wash cherry tomatoes and radishes. Adding pomegranate seeds, grapes or apples to salads can make them look and taste more exciting.≠ Read about healthy salads on page 25.≠ Watch our easy 5-a-day swaps video at bhf.org.uk/5aday.

Whole lot of grainsWholegrain foods such as bread, brown rice and wholemeal pasta are a source of fibre, so choose them over white varieties to keep your digestive system healthy. Other wholegrains like oats also provide soluble fibre that can help lower cholesterol levels. You could have porridge or a wholegrain bagel for breakfast, wholemeal pasta salad for

You don’t need to completely cut out treats, but it’s worth thinking about the treats we give ourselves. Why not reward yourself in ways that aren’t related to food? You could watch a favourite TV programme, go to the cinema or buy yourself a magazine. Exercise may not seem like a treat but it can help to reduce stress. Do things that make you feel good, like taking a walk with a friend, spending a day playing games with children or grandchildren, doing a bit of

gardening, or booking yourself in to a new exercise class.

If you’re really longing for something sweet, treat yourself with exotic fresh fruit, such as dragon fruit (above) or a luxury mix of dried fruit and nuts. Or, for something refreshingly different, how about our summer fruit soup (see recipes pullout, centre)?

We’ve also got lots of ideas for sweet and savoury treats at bhf.org.uk/treats, and healthy baking recipes on our Recipe Finder at bhf.org.uk/recipefinder.

Treat yourself

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lunch and grilled chicken and brown rice salad for dinner. Wholegrain rice cakes topped with banana are an easy snack.

Go for fishAim to have two portions of fish a week and make one of these an oily fish such as salmon, mackerel, trout or fresh tuna (not tinned). Oily fish is a source of protein and provides omega-3 fatty acids, associated with reducing your risk of heart and circulatory disease. Adding fish to your diet can help reduce your meat intake and the saturated fat and salt that can come with it.

Buy more foodBeing prepared and buying more of the right foods makes it easier to follow a

healthy diet and means you’re less likely to eat out or order takeaway food.

Planning meals in advance and going to the supermarket with a shopping list for the week ahead will help you stay on track. Be realistic about how much you will cook and eat in a week, so you don’t waste food.

Cooking your own meals can help you eat healthily by allowing you to control the amount of fat, salt and sugar you add.

If cooking from scratch seems difficult, start small with a plan to cook once or twice a week, or cook one thing you can eat over a couple of days at the weekend and build up from there. If time is an issue, make the most of your weekend and batch cook and freeze meals for during the week. ≠ Read 15 thrifty ways to use your leftovers at bhf.org.uk/leftovers.

Colour it inMaking meals colourful increases their appeal. Add a variety of coloured vegetables such as tomatoes, spinach,

Enjoyed this? ≠ Turn to page 37 to learn how to increase your willpower. ≠ Check out our centre pullout recipes for tasty, heart-healthy cooking ideas.

20Minutes it takes to feel full after eating

Pink and white straws create an illusion of sweetness, making green smoothies more palatable”

yellow peppers, beetroot, carrots and sweetcorn to make your meals look great on the plate, and more nutritious too. It’s also good from a nutrition perspective to eat a range of colours, as different fruits and vegetables have varying nutritional benefits.

There’s even evidence that using coloured plates (or cups or straws) can influence your perception of foods. Pink and white striped straws create an illusion of sweetness, making vegetable-based smoothies more palatable. Likewise, eating leafy green vegetables like spinach or broccoli can be more pleasant from a red plate. ≠ Read more about colourful foods at bhf.org.uk/rainbow.

Enjoy your foodThere’s no point eating food you don’t enjoy. Try out different foods to find ones you love. Find hundreds of heart-healthy recipe ideas at bhf.org.uk/recipefinder. We’ve also got healthy versions of your favourite takeaway dishes, such as chicken and green bean curry, dry masala prawns, and red onion, courgette and pepper pizza.

It takes around 20 minutes to feel full once you’ve finished eating. Slowing down as you eat and taking time to enjoy your food can help you resist a second helping or dessert.

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John Deanfield’s healthy lifestyle helped him succeed first as an Olympian,

and then as a professor. He tells Sarah Brealey why we should all invest in a healthier future

FOILING

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Professor John Deanfield has his own entry on Wikipedia, the crowd-sourced online encyclopaedia. But it doesn’t cover his achievements as one of the UK’s most eminent

cardiologists, with hundreds of research papers to his name. Instead, the brief entry describes his participation as a fencer in the 1972 and 1976 Olympics. The cardiologist smiles ruefully and says: “It shows you people’s priorities, I suppose.”

There can’t be many leading cardiologists who are also former Olympians. The BHF Professor of Cardiology says: “That was a fantastic experience for me. It taught me about the importance of a healthy lifestyle.”

Reducing heart and circulatory disease risk is a theme that runs through Professor Deanfield’s work. Early in his career, he worked at Great Ormond Street Hospital, where treatments for children born with heart defects were being pioneered. “I fell in love with the children, and I have

Fencing taught me the importance of a healthy lifestyle”

HEARTDISEASE

spent a lot of time treating children with congenital heart disease,” he says. “Treating them as they grew older made me aware that even teenagers (whether they have congenital disease or not) can have the signs of adult heart disease, and I became interested in how that can be prevented.”

When Professor Deanfield’s career started, children were beginning to survive who previously would have died in infancy. He’s helped create a new specialism – looking after teenagers and young adults with congenital heart disease. Now, for the first time, this group of children can be studied

John, far right, with his fellow Olympic fencers

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32

Clinical trials of a similar tool showed it resulted in people reducing their risk factors for heart disease. “If I tell my patients their heart age is 10 years older than they are, they will say: ‘What can I do to get it down?’” says Professor Deanfield. “Then we can talk about smoking, losing weight or reducing blood pressure or cholesterol levels.”

Understanding atherosclerosis Taking actions like this works because it reduces your risk of atherosclerosis – a condition in which your arteries become clogged by fatty substances known as

Heart Matters

in later life. “We are now in a new phase,” he explains, “looking at what happens to them as they grow older and encounter risk factors for coronary heart diseaseD, when they may still have underlying structural defects in their hearts. It’s what I call Star Trek medicine – we are boldly going where no one has gone before.”

Invest in your arteriesWhat Professor Deanfield learned from studying children and teenagers is relevant to everyone. He wants us all to “invest in our arteries”, starting as early in life as possible.

He is particularly proud of the difference he’s made in changing attitudes to the lifetime management of heart and circulatory disease. “Doctors traditionally wait for people to get sick and treat them quite late in the development of the disease,” he says. “We should start thinking about this much earlier in your life. It is like financial planning – you wouldn’t start saving for retirement when you’re 64. It’s about convincing people their heart health really matters and if they take action early in life and sustain that, they will get a huge lifetime benefit in reducing their risk of heart disease.”

How old is your heart?With this in mind, Professor Deanfield has played a key role in the development of the Heart Age Tool. Launched in February last year in collaboration with the BHF, more than two million people have already used it to get an estimate of their ‘heart age’. This estimates the age at which you might have a heart attackD or strokeD and offers guidance on how to reduce your risk.

Professor Deanfield says: “The Heart Age Tool takes the end results of years of research and translates this into messages that we can all apply to our heart health. If people get that message, it’s a powerful promoter of lifestyle change, as well as promoting treatment in the right people.”

plaques or atheroma. This condition lies behind heart attacks, stroke, peripheral arterial disease and most cases of anginaD.

Alongside his work as a cardiologist, Professor Deanfield has studied atherosclerosis for more than 30 years. In the early 1980s, researchers realised that the endothelium – a single layer of cells on the inside surface of blood vessels – played a key role in the early stages of atherosclerosis. But existing tests were invasive and unsuitable for use on children.

Professor Deanfield and his colleagues developed a technique, using a simple

We are boldly going where no one has gone before”

RESEARCH

33

device similar to a blood pressure cuff. By inflating and deflating the cuff, blood flow can be changed. How the blood vessel reacts to these changes can be measured non-invasively using ultrasound. The results of the study were published in the Lancet in 1992. “In a sense, that is the paper I am most proud of,” says Professor Deanfield. “It has changed the way people study endothelial function in a clinical setting. It took it out of the lab and into general use.”

The study demonstrated reduced functioning of the arteries in smokers and also in children as young as 10 who had familial hypercholesterolaemia (FH) – a genetic condition that leads to very high cholesterol levels. This was the first evidence that high cholesterol can affect the arteries in the first 10 years of life.

Healthy endothelial cells produce nitric oxide, a gas that allows the blood vessels to function normally, including dilating in response to increased blood flow. Professor Deanfield showed that changes in the endothelium – in particular, reduced production of nitric oxide – can

bhf.org.uk

be detected before there is any visible evidence of atherosclerosis, and predict later development of the disease.

Building on this work, Professor Deanfield later showed that inflammation in the body – such as gum disease – is linked to atherosclerosis and endothelial function, and that effective treatment of gum disease improves endothelial function. “Since then, we have shown that if you sort out gum disease in people with diabetesD, it leads to improvements in measures like kidney function and control of your blood sugars,” he says. “That is exciting new research that we have just completed, which has public health implications and also helps us understand arterial disease.”

Olympic hopesThis August, Professor Deanfield will be following the Rio Olympics with interest. He no longer fences (“I don’t like to do things worse than I could do them before”) but retains “wonderful memories” and keeps in touch with his former fencing colleagues.

He says it’s too early to say whether the London 2012 Olympics will have any long-term effect on public health. “There is certainly more interest in the different types of sports, but how that translates

to the health of people is unclear,” he says. “Many people are not doing the recommended 150 minutes a week of exercise, and that applies to many other countries too, not just the UK. That is what I am trying to change, in a small way, through our research.”

Professor Deanfield is 64 and has “no intention of stopping work”. The links between heart and circulatory disease and inflammation remain a focus of his research. He’s also looking at other health issues, particularly dementia, including Alzheimer’s disease and vascular dementia.

“We are spending a lot of time looking for a cure for dementia, but perhaps we’re not looking at the huge role that risk factors for heart disease have on cognitive function,”

he says. “If you reduce your risk factors for heart disease, you can have a huge impact on mental decline. The evidence is out there; we just haven’t grasped it yet.

“What is good for the heart is good for the brain. It’s important to communicate that to the public and create a way to predict brain decline – a brain age tool, perhaps. This is something I am working on, supported by the BHF. It could be very exciting.”

The Heart Age Tool is a powerful promoter of lifestyle change”

CV Professor John Deanfield ≠ BHF Vandervell Professor of Cardiology,

University College Hospital, London≠ Consultant Cardiologist at Barts Heart

Centre, London, and previously at Great Ormond Street Hospital, London

≠ Director of the National Centre for Cardiovascular Disease Prevention and Outcomes at UCL

≠ Member of international advisory boards and on editorial boards of several major cardiovascular journals

1Assess your risk of developing heart and circulatory disease (including

blood pressure and cholesterol checks). In England, get a free NHS health check.

2Use the Heart Age Tool at bhf.org.uk/heartage and follow its advice.

3Take inspiration from the Olympics and try a new sport or one you

used to enjoy. Even walking is an Olympic sport! Find more fitness ideas at bhf.org.uk/activity.

How to invest in your arteries

More online ≠ Discover your ideal Olympic sport at bhf.org.uk/olympicquiz.≠ Meet Olympian and BHF Ambassador Roger Black at bhf.org.uk/rogerblack.

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34 Heart Matters

ACTIVITY

The cardiac rehab sessions helped us feel we were on the way to recovery”

John feels healthier than ever and hiked to Machu Picchu, Peru(above right) with his wife Lucette

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“We used to go skiing every year,” says John McGhee, 66. “On a New Year holiday [in 2013], while walking up the hill to get the cable car, I had to keep stopping because there was a sharp pain in my chest.”

John, a retired technical trainer from Swindon, has asthma and put his symptoms down to this. But at the end of the holiday, the pains followed him home. “When I walked fast, I had to stop in the middle of the street,” he explains. “It was a bit embarrassing – I’d get my phone out and check it until I got my breath back.”

John’s wife, Lucette, persuaded him to visit his GP, who suspected John had anginaD. He was referred to Great Western Hospital in Swindon for an angiogramD and was told he might need a stentD, or even surgery.

Soon after the angiogram, John’s consultant broke the news – he needed a quadruple heart bypassD. “They explained immediately what they would do,” says John. “You think: ‘Oh dear, this is worse than I thought’. But then you just want to have it done and get over it.”

John was sent home and told to continue as normal until the hospital set a date for the operation. “The worst bit was not being able to plan ahead,” says John. “I’ve got two daughters who live abroad, in Canada and Germany, and I couldn’t plan holidays to see them.

“You have to tell everybody: ‘I might not be able to make it’. Then they want to know why. It’s OK explaining to family, but you don’t really want to tell everyone.”

Rehab recoveryIn November 2013, John’s operation finally happened. “The surgeon was absolutely terrific,” he says. “The scar

Cardiac rehab set John McGhee on the path to surgery recovery and before long, he was exploring South America, as he tells Rachael Healy

was minimal and I could get out of bed the following day; it was my 38th wedding anniversary, so I wanted to get up and see my wife.”

John was soon back at home, but wondered what should happen next. He’d heard about cardiac rehabilitationD and thought it would be helpful. “Three months after my operation I went to rehab and it was great,” explains John. “There were all these people who had also had heart ops and we were all doing our exercises and chatting away.

“The sessions were excellent. They had us jumping up and down and walking around. It helped us feel that we were on the way to recovery.”

John was pleased to meet people who had been through a similar experience. “We all felt the same,” he explains. “We would chat about how good it felt to be able to walk without getting pain any more. You feel you’re just one of loads of people – of all ages and walks of life – who have been through the same thing.”

The sessions offered practical advice for the future, too. “Each week at the rehab, they had a specialist who came in and gave a talk on food, diet, lifestyle advice and stress – all sorts of things,” says John. “They even told us we could have an occasional glass of wine.”

Bright futureLess than two years later, John was enjoying his favourite Chilean wine fresh from the source in South America.

Spurred on by his cardiac rehab experience, and with his ruby wedding anniversary approaching, John decided to challenge himself with an adventurous holiday. He and Lucette had always talked about visiting Rio de Janeiro, Brazil – 2015 would be the year this dream came true.

ADVENTUREAn Incan

36 Heart Matters

Download or order our free booklet Cardiac rehabilitation, or our free leaflet Cardiac rehabilitation – your quick guide from bhf.org.uk/HMpublications or call 0870 600 6566.

Free BHF support

“After the heart op, it was coming up to our 40th wedding anniversary, so we decided we’d aim for that,” says John. “When I was feeling OK again, we booked a holiday to tour South America.

“We went to Chile, where I had my red wine in Santiago; we went to Buenos Aires in Argentina; then we went to Iguazu Falls on the border of Brazil and Argentina. That involved loads of walking, in and out of rainbows and mountain passes. It was spectacular.

“Then we went to Rio and visited Copacabana Beach and all of the usual things. Then it was off to Peru, where we went to Machu Picchu and the Sacred Valley of the Incas. In the mountains, you get to a vantage point at 11,500ft – if you can walk up that far. I made it to the top; I was so pleased. I felt really fit.

“It was amazing. I couldn’t have done it a couple of years before. At the top of the highest bit, I thought: ‘The surgery allowed me to do this – to get to this high an altitude and walk up hundreds of steep steps’. If I’d seen the surgeon again, I would’ve bought him a bottle of champagne, I tell you.”

John adjusted his eating habits and thinks this has helped him feel fitter. “I absolutely loved cheese – with biscuits, on pasta, with everything,” he explains. “I don’t have that any more, but I have more vegetables and fruit and I’ve grown to like them more than I did before.” He does allow himself the odd treat, but keeps everything in moderation.

What is it?Cardiac rehab is a programme to help you get back to as full a life as possible after a heart event. Programmes vary, but can include physical activity, lifestyle and medication advice, relaxation and psychological support. You should be invited to do cardiac rehab if you’ve had a heart attackD, an angioplastyD, heart surgery or an ICDD inserted, or if you have angina or stable heart failureD.

Research shows cardiac rehab reduces your risk of dying from heart problems and improves quality of life. Yet only 47 per cent of patients admitted to hospital for heart attack, angioplasty or bypass in England, Wales and Northern Ireland attended rehab in 2013–14, with women more likely to miss out.

When will it start?When you’re back home and have fully recovered – usually four to eight weeks after leaving hospital. If you haven’t received an invitation by then, ask your GP. You can still benefit from a programme months after your heart event. Some rehab

teams offer support before the programme begins. This could be a home visit, phone call or helpline.

What happens while I’m there?You’ll be invited to a local hospital, or community or leisure centre, along with others who’ve had a heart event. You may be taken through some suitable exercises, have your heart rate monitored and learn more about healthy eating, alcohol, smoking, physical activity and dealing with stress.

Why should I do it?Our research shows cardiac rehab leads to a 30 per cent increase in the proportion of patients doing the advised 150 minutes of physical activity per week. We also saw a seven per cent decrease in patients suffering from anxiety.

Most patients felt their quality of life increased. There was a big change in fitness – patients who said they felt physically fit increased by 32 per cent.

≠ Find 10 reasons to do cardiac rehab at bhf.org.uk/rehabreasons.

Your guide to cardiac rehab

John says he feels healthier than ever. “I keep active,” he says. “I go swimming. The only downside is that I used to have a sauna at the end and I got told I can’t do that anymore. But I still go and do lengths of the pool.

“I walk every day as well. In the summer, we go to Spain and cycle around. Last winter, we went to Canada to visit our daughter Melissa, in Montreal. We were walking around frozen lakes and up and down hills – it’s amazing that I can do that.”

John enjoys manyhobbies, from skiing to daily walking

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37

WELLBEING

Self-control is an essential part of a healthy lifestyle. Miranda Fitzgerald explains how we can all become willpower superheroes

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Imagine there’s a big slice of cake in front of you. It looks delicious. You can’t resist the temptation. You give in and gobble it down. But as you brush the last crumbs from your lips, you’re already regretting your lack of willpower.

Willpower is essential for avoiding unhealthy habits (like smoking or eating certain foods) and adopting healthy habits, such as regular physical activity and eating more fruit and vegetables. Changes like these can help reduce your risk of a heart event if you have heart and circulatory disease, or reduce your risk of developing

POWER!

heart disease in the first place. But don’t despair if your self-control is lacking – understanding how willpower works can help strengthen it.

What is willpower? Professor Walter Mischel, based at Columbia University, New York, was one of the first psychologists to study willpower. He defines it as “just a matter of learning how to control your attention and thoughts”. In other words, your rational brain can overcome your impulsive, emotional brain. Both are

38 Heart Matters

1 Reward the effortResisting crisps or chocolate with your lunch all week demands a lot of willpower, which can make it frustrating if

tips to boost your willpower

you don’t lose weight. Feel proud of your effort – remember, it has strengthened your willpower.

2 Believe in yourselfSelf-confidence is key. If you believe you can finish a five-mile run and you can imagine yourself on the podium with a medal, then you’re less likely to give up.

3 Clarify your goals Work out what you want to achieve and how you’re going to get there – otherwise it’s like searching for treasure without a map. Planning in advance can help you focus, and there are plenty of apps to help monitor your progress.

10

involved in decision-making, but the strength of our willpower determines our actions. For example, when you crave sugary foods, you might try to resist by concentrating on the negative effects on your teeth and your waistline – or by focusing on positive motivations, like being able to fit into your favourite jeans. If you don’t eat the biscuits, your rational brain has triumphed.

There are three steps to making the right decision, according to Dr Roy Baumeister, Professor of Psychology at Florida State University. These are: setting measurable targets, making them realistic, and having the willpower to follow them through.

The ‘realistic’ part is important for your willpower to succeed. For example, if you decide you’re going to go from couch potato to marathon runner in one month by exercising every day until you drop, your unrealistic goal is likely to fail after the initial burst of enthusiasm.

To increase your chances of success, don’t set goals that are too strict and don’t let one slip-up convince you the whole day is a write-off. Dr Baumeister says: “Dieters may have a fixed target in mind for their maximum daily calories, and when they exceed it for some reason, they may regard their diet as blown for

the day. That day is therefore mentally classified as a failure. Virtue cannot resume until tomorrow. But that doesn’t need to be the case.”

Dr Baumeister believes willpower is related to the energy that is available to the brain. The brain uses 20 per cent of energy produced by the body and if we haven’t eaten enough, our ability to maintain willpower suffers. Planning a regular meal pattern and choosing wholegrain starchy

carbohydrates and other slow-energy-releasing foods as part of a balanced diet will help ensure you have the energy supplies you need. It will also help you avoid getting hungry between meals and making rash, unhealthy choices – one of the reasons many crash diets fail.

Dr Baumeister says: “After making a lot of decisions, your self-control is lower and conversely, after exerting self-control, your capacity for making decisions is lower. As you make a bunch of decisions, you gradually use the energy you have available and subsequent decisions are more passive and tend to go with the default option.”

Fortunately, this energy reduction is only short-term and we can strengthen our willpower, like a

4 Develop a routine If you’re busy, establish a routine to ensure you make the time for exercise, and stock up on healthy meals and snacks ahead of time, rather than grabbing a takeaway.

5 Build up slowly Overdoing it erodes willpower and sets you up to fail. You could call this ‘the tortoise and the hare syndrome’. Take gradual small steps to change your diet or build up your fitness regime.

6 Choose the right time Willpower is a limited resource, so if you’re expending lots of energy moving house or studying, you might be setting yourself up to

fail if you try to give up smoking at the same time. However, it can be easier to change habits when you’re out of your old routine, so if you’ve just moved house it could be a good time to start an exercise regime or healthy diet.

7 Be kind to yourself If you’re trying to quit smoking, it’s likely you’ll have one or two cigarettes before you succeed, but don’t go crazy blaming yourself – be kind to yourself.

8 Treat yourself If you’re eating out in January, it’s hard to motivate yourself by thinking about looking good on your summer holiday, because it’s

Dr Frank Ryan ≠ Honorary

Clinical Senior Lecturer, Imperial College London

≠ Clinical psychologist, cognitive therapist at Camden and Islington NHS Foundation Trust

≠ Author of Willpower for Dummies

Dr Roy Baumeister ≠ Psychology

Professor, Florida State University

≠ Research interests include: self-control, choice and decision-making

39

muscle, by using it more. A study published in the British Journal of Psychology in 2006 showed that just two months of regular exercise can improve concentration, focus, impulse control and self-awareness – all aspects of willpower.

The study authors suggested that the self-control needed to keep exercising regularly helped improve self-control in other areas. In addition, improving your health – physical or mental – boosts your ability to say no.

Willpower after a heart eventA heart attackD or heart diagnosis often prompts people to make lifestyle changes. After a heart event, cardiac rehabilitationD courses provide information on healthy eating and lifestyle, including regular exercise, so this can be a good way to forge new habits. Many cardiac rehab programmes also teach

bhf.org.uk 39

ways to deal with stress. (Turn to page 35 to discover how cardiac rehab helped John McGhee.)

“What stress really does is deplete willpower, which diminishes your ability to control those emotions,” warns Dr Baumeister. This is why you’re more likely to open a bottle of wine after a tough day at work.

So if you’re trying to make healthy lifestyle changes, try to deal with sources of stress. The aftermath of a heart event can be a very stressful time – find handy tips in our Coping with stress booklet (see box, below).

One in three of us don’t get enough sleep, according to the NHS, which can have consequences for your health and your willpower. Try to get a regular eight hours a night (or the amount that is right for you) and go online to find our tips for sleeping better.

“You might think that people with really strong self-control struggle through this grim existence, forcing themselves constantly to do the right thing,” says Dr Baumeister. “But that’s not correct. What it seems is that people with good self-control stay out of trouble and minimise problems.”

so far away. Little rewards along the way – the non-calorific type – can work better.

9 Get support Whether it’s from friends and family, or joining a running club, a bit of cheerleading can be the difference between failure and success. Even saying your goals out loud can make them clearer.

10 Avoid temptation If, like Oscar Wilde, you ‘can resist anything except temptation’, the best tactic is to stay away from it. If you love sticky buns, avoid the bakery. If you crave cigarettes with a drink, cut out pub visits until you’ve beaten the habit.

People with good self-control stay out of trouble”

FREE

Summer 2016

Ooh, saucy!Healthy tips to

spice up your summer barbecue

Material change

How we're creating

better heart valves


PULL OUT

AND KEEP

RECIPECARDS

NORDIC DISHES


10

Winning a place on

The Apprentice helped

Ruth beat her heart issues


Enjoyed this article?≠ Missing out on sleep can harm your willpower, so get 10 tips for a good night’s sleep at bhf.org.uk/sleep.≠ Download our free booklet Coping with stress from bhf.org.uk/HMpublications or call 0870 600 6566.≠ Watch our short video on SMART goals at bhf.org.uk/smart.

RESEARCH

40 Heart Matters

Material CHANGE

A BHF-funded chemical engineer is perfecting a material to tackle heart valve disease. He tells Sarah Brealey how it could change patients’ lives

£1,264,288Total BHF funding for Dr Moggridge and his team for heart valve research

41bhf.org.uk

CV Dr Geoff Moggridge≠ 2011–present Reader, Chemical Product

Design, Department of Chemical Engineering and Biotechnology, Cambridge University; Fellow of King’s College, Cambridge

≠ 2013–14 Leverhulme Trust Senior Research Fellowship, Royal Academy of Engineering

≠ 2002–07 Frank Morton Medal for Teaching in Chemical Engineering, Pilkington Prize and Entec Medal

≠ 1988–91 PhD in Chemistry, King’s College, Cambridge

£1,264,288

What’s the perfect material for a heart valve? It needs to be strong yet flexible, capable of opening and closing 200 million times or more,

compatible with the human body and able to let blood flow easily through it.

Dr Geoff Moggridge thinks he’s found the solution. On his desk in the Cambridge University chemical engineering department is a colourless, semi-transparent sheet. It’s a block copolymer – two kinds of polymer (a large molecule made of many repeated units – nylon, cellulose, wool and DNA are all examples), chemically bonded together.

Dr Moggridge’s copolymer consists of a glassy material, which self-assembles into fibres, bonded to a rubbery material. “It is a bit like fibreglass, but on a very small scale and well controlled,” he says.

The material was invented in the 1970s but only became easy to manufacture recently. Tug it one way, it stretches like a sturdy elastic band: another way, you get only firm resistance. “It is quite striking to have a material that is so different in one direction to another,” says Dr Moggridge. “It has to be strong and flexible. If you make it too strong it won’t open and close properly, which is one of the problems that means people need heart valve replacements in the first place. You couldn’t make a heart valve out of steel, for example.”

The new valve is formed by injection moulding. Material is melted and inserted into a mould, where it cools and sets. “If you can get the fibres in the material lined up so that the direction of greatest strength is in line with the greatest stress on the valve, that would be really useful,” says Dr Moggridge. “That is what is different about what we are doing. A natural valve has that kind of property; we are imitating what a natural material does.”

The end of anticoagulation? A key advantage of the copolymer heart valve over mechanical valves is that patients won’t need lifelong anticoagulantD

medications. Anticoagulants reduce clotting but carry a risk of bleeding and, in the case of warfarin, require regular monitoring and blood tests. Dr Moggridge is “reasonably confident” patients with his valve won’t need the drugs long-term.

Clotting is a risk in existing mechanical valves, which are usually made from carbon or titanium ‘leaflets’ (flaps) attached to a Teflon or polyester ring. “The blood swirls around mechanical valves, because of the way they open,” says Dr Moggridge. “We think it’s this rotation in the blood flow that leads to clotting.”

The Cambridge team has done experiments to mimic blood flow through their valve. It closely resembles the shape of a natural valve, so blood flow is natural too, reducing clotting risk. A microscopic coating

of heparin (an anticoagulant) on the valve reduces this risk even further.

It could also last longer than animal-tissue valves, reducing need for repeat surgery, although more testing is needed. Once the valve is perfected, it should be easier to manufacture and the end result more consistent than animal valves.

Different approachDr Moggridge and his team are working on a second valve, to be used in transcatheter valve surgery. This is where a new valve is delivered through a cardiac catheterD inserted directly into the heart or through a blood vessel in the leg, and positioned on top of the old one.

The project, funded by a further BHF grant worth £248,000, is to make a removable transcatheter valve. Currently, if a transcatheter valve wears out, it can only be removed by open heart surgery. The

9,000 Valve replacements in the UK each year. After bypass, heart valve replacement is the most common heart surgery

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42 Heart Matters

Dr Moggridge didn’t start his career in cardiovascular research, but BHF

funding is allowing his expertise to benefit heart patients. He specialises in the structure and properties of materials. He has also researched the mixing properties of cake batter in food manufacturing, chemicals that kill the zebra mussel (a freshwater mussel that blocks water pipes), and diffusion.

Dr Moggridge says: “The BHF is very good at giving people the opportunity to change direction. The first grant I got was a New Horizons Grant, which is aimed at people who haven’t worked in the area before. In my experience, that is unusual among funders – usually they like to fund people who already work in that area.”

That grant ran for three years until March 2013. Dr Moggridge’s project is now funded by a four-year grant from the BHF worth £755,030. He is working jointly with the Translational Biomedical Research Centre near

Bristol, which the BHF helps fund, and Newcastle University.

Involving the brightest minds from many branches of science is essential if we want to carry out the

best research into heart and circulatory disease. “Material

properties are not something your average medical person is very aware of,” says Dr Moggridge. “So the involvement of a chemical engineer is necessary. But when you get into something like this, you realise there are a lot of things you don’t know about.”

≠ Read a patient’s diary of heart valve surgery at bhf.org.uk/heartdiary.≠ Download our free booklet Heart valve surgery, from bhf.org.uk/HMpublications or call 0870 600 6566. ≠ Read about heart valve surgery and watch our short film at bhf.org.uk/valvesurgery.

Free BHF support

200m Minimum heartbeats that a replacement heart valve must last

New horizons

first removable valve will use animal-tissue leaflets, but future versions could use the block copolymer. “There is some evidence that when you squash a biological valve to deliver it with a catheter it can get damaged,” says Dr Moggridge.

Dr Moggridge is a chemical engineer, not a heart surgeon, so facts like this are relatively new to him. In fact, he was initially turned down for a BHF grant. “They said: ‘Go away and find a medical collaborator to work with you’,” he explains. “So I worked with Suku Nair, who at the time was a surgeon at Papworth Hospital and is now based at Newcastle.”

During ‘traditional’ valve replacement, the surgeon sews the new valve into place. “It was so useful to watch the details of what a surgeon does during the operation and what they were concerned about,” says Dr Moggridge. “Like, how is he going to sew it in, will the needle go through the material, and will it tear?”

Rigorous testingBoth new valves are going through rigorous testing. Replacement heart valves are subject to International Organisation for Standardisation (ISO) standards, just like A4 paper and agricultural machinery. Currently, the ISO standard says: “There is, as yet, no heart valve substitute which can be regarded as ideal.”

It stipulates that a replacement valve must last 200 million heartbeats – about five years. Dr Moggridge is aiming for 400 million, or 10 years, as a minimum. How can you test a heart valve outside the human body?

You can use a homemade pulse duplicator (where water and glycerol flow through the valve to imitate blood) and then a durability tester. Dr Moggridge’s team have a new durability tester, costing £50,000 and funded by a BHF grant. “The tester (pictured above, centre) can go at 30 times normal speed and test six valves at the same time,” he says. “It means we can simulate five years of use in six months.”

If testing is successful, trials in pigs or sheep will start in Bristol next year. Dr Moggridge says it could be “a matter of years rather than decades” until the valve is available for patients.

Aside from his lab work, Dr Moggridge teaches in King’s College, in sight of the world-famous chapel and the 18th-century Gibbs Building, where he used to live. The surroundings are a reminder of regal wealth,

but funding no longer comes from royalty. Dr Moggridge is grateful to the BHF for its support. “The current grant is paying for two post-doctoral scientists, Joanna Stasiak and Marta Serrani, who do most of the work. It will also pay for the animal trials,” he says. “The work wouldn’t have happened at all without BHF funding.”

Watch our animation of how

the new heart valve works

at bhf.org.uk/newvalve

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43bhf.org.uk

Thinking about death can be tough, but Claire Henry, who leads Dying

Matters and the National Council for Palliative Care, believes we’d be better off if we did. Sarah Brealey meets her

THE BIG INTERVIEW

“Iget told: ‘You’re surprisingly jolly for someone who works in end-of-life care’,” says Claire Henry, Chief Executive of the National Council for Palliative Care (NCPC) and the Dying Matters coalition.

“But it is not all doom and gloom – you can have fun discussing, for example, the music for your funeral.”

Certainly, when I meet Claire, she’s full of smiles, but is clearly driven to improve things for people near the end of their lives, and those around them. She says this drive comes from two events early in her career.

“On a personal level, the biggest thing was the death of my grandad, who I was very close to,” she explains. “He died very

CV2014–present Chief Executive, National Council for Palliative Care

2005–13 Director, National End of Life Care Programme, NHS

2001–04 National Associate Director, NHS Modernisation Agency

2000–01 Project Manager, Ovarian and Prostate Cancer, Leicestershire Cancer Services Collaborative

1987–2000 Nursing career, including cancer and palliative care nursing

“ We only have one chance to get it right”

suddenly, of a heart attackD, and that had a big impact on me. I remember seeing members of my family who needed support.

“Then, when I started my nurse training in the early 1980s, I was working on a surgical ward. There was a lady who was immaculately cared for in a physical sense, but no one had told her she was dying. That experience made me think: ‘We can do better.’”

Claire did see better end-of-life care on other wards – the difference was a patient-centred approach. “It’s so important to talk to people, to get to know their values and aspirations and how we can learn from them,” she says.

The NCPC is the charity for all those involved in palliative, end-of-life and hospice care in England, Wales and Northern Ireland (the Scottish equivalent is the Scottish Partnership for Palliative Care).

Talk about itIn 2009, NCPC set up Dying Matters to promote public awareness of dying, death and bereavement. It is a coalition with more than 30,000 members, including the BHF and members of the public, who can join for free.

4% of dying patients had an advance care plan made before they came to hospitalPh

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Heart Matters44

Claire wants to get people talking about these issues. “It’s not about death,” she says. “It’s about care wishes, funerals and digital legacy [see box, below]. It’s like an insurance policy – if you have got these things written down and sorted then you can get on with your life.”

She acknowledges that this isn’t, and shouldn’t be, compulsory. “Some people never want to talk about it and we have to accept that,” she says.

Dying is the last thing on most of our minds, but Claire stresses that’s no reason to put off planning. “When we are well, people think ‘It is not going to happen to me’,” she says, “But it does. I had a friend who died suddenly of a brain aneurysm. She hadn’t expected anything to happen – one minute she was there and then she wasn’t.

“We only have one chance to get it right and if we don’t, that can lead to problems for the people left behind. That can make their bereavement more difficult. People want to know they have done the right thing.”

started in supporting cancer patients. That’s changing now, but… there is room for improvement for people with heart disease, definitely.”

She’s seen this first-hand, including during her work as a Macmillan nurse in Glenfield Hospital, Leicester, in the early 1990s. “I set up the palliative care service there,” she says. “A lot of my time was spent supporting people with heart problems, which I wasn’t supposed to be doing as a Macmillan nurse! I realised they needed our help too.”

The BHF worked jointly with Marie Curie in Glasgow on the Caring Together project to improve end-of-life care for people with heart failure. Claire praises it as “excellent” for its work to give heart failure patients equal access to treatment, more choice about where they are looked after and joined-up services. She also praises Difficult Conversations, a free booklet for healthcare professionals talking to heart failure patients about end of life, created by the BHF and NCPC.

Claire says people waiting for heart transplants need particular support – because of the shortage of donor hearts, they could die before one becomes available.

“I really want to see palliative care and different specialties such as cardiology learn from each other,” she says. “It is about looking at people’s particular needs and thinking how we can work with patients and families to support them.

“We believe that everyone approaching the end of life has the right to the highest quality care and support, wherever they live, and whatever their condition.”

Supportive roleEnd-of-life care isn’t just about the person dying – their loved ones need support too, including after a death. Claire is keen to see more support in the workplace. A 2014 survey from NCPC and Dying Matters found 32 per cent of those bereaved while employed didn’t feel their employer treated them with compassion. Dying Matters offers a support programme for employers. Claire believes all employers should have a

As we do more online, from socialising to banking, what happens after death is a growing issue. Claire says: “Digital legacy is a huge area. People may have online bank accounts with passwords instead of paper statements. There may not be a passbook in the drawer any more. If it is all electronic, how do you find the details after someone has died?

“It’s important to leave a record of what online accounts you have. If you’ve lost a loved one, contact their bank, building society or other institution to let them know – you’ll need to provide a death certificate and your own identification.”

Some people want to shut down the social media accounts of loved ones after they have passed away, but

different companies have different requirements before they will agree to do this. Facebook allows accounts to be ‘memorialised’ so friends can still view them and post messages.

There are also online memorials for loved ones. The BHF’s Gift of Hope allows you to create a personalised fund page with messages, diary and photo album, while making donations in your loved one’s memory to fund our vital research. Visit lastinghope.bhf.org.uk.

Digital legacy

It’s important to leave a record of what online accounts you have”

4%Proportion of heart failure patients formally referred to palliative care

Quality care for allClaire wants to see good services for all terminally ill people, not just those with cancer. A report published last year by Marie Curie shows 88 per cent of those receiving inpatient palliative care in specialist units (mainly hospices) in 2012–13 had cancer, though it only accounted for 29 per cent of deaths in the UK. Heart failureD patients in particular have been identified as more likely to miss out on palliative care, even though they may have similar symptom burdens and care needs to cancer patients.

Claire says: “There are still inequalities, although it’s getting better. Hospice care

45bhf.org.uk

bereavement policy setting out the support employees are entitled to, and is keen for the government to explore the feasibility of statutory bereavement leave.

“A big part is being aware of when someone needs support, and showing flexibility,” says Claire. “Often people don’t want to go off sick, they want to carry on working because that helps them. Some employers are really good and really supportive, while some people say they are lucky if they get a day off for the funeral.”

In December, the National Institute for Health and Care Excellence (NICE) issued new guidance on care for the last days of life. The previous guidance, the Liverpool Care Pathway (LCP), had attracted criticism for, among other things, water and medicines being withdrawn from the dying person, and some people being classed as dying who went on to recover. The NICE report said: “These were not necessarily a direct consequence of following the LCP, but often happened because of poor or indiscriminate implementation and a lack of staff training and supervision.”

Claire says: “The LCP scared a lot of people. Like a lot of things, education and training are the key. Used well, it was individualised care. When it was used badly, it wasn’t.

“The new NICE guidance is very helpful. Key to it is people being assessed as individuals. It is good to have guidance about pain management and food and fluids. The critical part is how you make it local and individualised. We need to make sure staff are supported, and have ongoing training in communication skills.”

Claire believes quality of end-of-life care is “patchy” across the UK and there is still a lot to do. “There is no room for complacency,” she says. “We still have inequalities between age, conditions and geography. This is something we need to get right – if we get it wrong, we can’t go back and correct it.”

There is room for improvement for people with heart disease, definitely”

≠ Discover what’s being done to improve end-of-life care, at bhf.org.uk/endoflife.≠ National Council for Palliative Care (England, Wales, Northern Ireland): ncpc.org.uk or 020 7697 1520.≠ Scottish Partnership for Palliative Care: palliativecarescotland.org.uk or 0131 272 2735.≠ Dying Matters (England): dyingmatters.org or 0800 021 44 66.

≠ Good Life Good Death Good Grief (Scotland): goodlifedeathgrief.org.uk.≠ Byw Nawr (Wales): dyingmatters.org/wales. ≠ Get Difficult Conversations, a booklet for health professionals talking to heart failure patients about end of life, at bhf.org.uk/HMpublications or call 0870 600 6566.≠ Get help writing your will, at bhf.org.uk/legacies or call 020 7554 0330.

Find out more

Royal College of Physicians’ End of Life Care Audit – Dying in Hospital, 2016

Signs of improvement

Carrying out care of the body in the immediate time after a death

Deactivation of ICDsD at end of life (to prevent inappropriate shocks)

Providing relatives or friends with verification and certification of a death

2013

2015

Viewing the body in the immediate time after a death

Designated quiet spaces available for relatives or friends

Referral for pastoral care or chaplaincy

96% 85% 82% 64% 70%75%99% 94% 92% 75% 77%80%

Although having a policy doesn’t always ensure that everything happens as it should, it’s often a good sign. These figures are for the percentage of hospitals in England with policies on the following areas:

46

Starting a conversation about your heart condition or surgery can be difficult. Sharing the news can make it seem too real, or you may struggle to find the right words. Some people are

reluctant to ask for help, while others worry their condition could be seen as a weakness.

It’s also tough on loved ones. Some will worry about upsetting you, while others may not understand how serious your condition is.

Helen Norris, 40, was diagnosed with long QT syndrome after collapsing on a family day out. Long QT is a rare inherited condition affecting electrical impulses in

Discussing health issues, whether yours or a loved one’s, isn’t always easy. Rachael Healy gets advice from an expert and a heart patient who’s been through it

WELLBEING

I’m sorry you’re going through this

I’ve got some news to share with you...

How much do you know about coronary heart disease?

Could you help me with these

tasks?

I’m here when you need meHow can

I help you ?

Let’sTALK

the heart. It can cause blackouts when the heart’s normal rhythm is interrupted. “The condition I have took a lot of explaining,” says Helen. “It was difficult for people to understand. But as soon as I explained to my nearest and dearest what it actually involves, they were much more comfortable with it and happy that they understood.”

Sharing the news Revealing news of a diagnosis or operation can be daunting. “Telling other people brings it out into the open, so naturally there’s a reluctance to do so,” explains Dr Judith Carrier, Senior Lecturer and Director of Postgraduate Studies at the

School of Healthcare Sciences, Cardiff University. “It’s about sharing with your immediate family or loved ones, but making it clear whether you want it shared more widely or not.”

Dr Carrier, who has a special interest in long-term conditions and is a registered nurse herself, suggests trying a technique healthcare professionals use when breaking news to patients. “Start by asking: ‘What do you know about coronary heart diseaseD?’ It’s a good idea to find out what their perceptions are before you get started,” she says. “Direct people to charity websites, like the BHF or Diabetes UK, as well as NHS Choices, because they

47

have really good resources for families and they’re a good way to start going into further detail.”

There are many ways to share your news, if you decide this is the right thing to do. Helen found it was easier to tell people in person. “An email or a letter isn’t a free-flowing conversation, whereas doing it face to face, or even over the phone, you can discuss things,” she says. “Have an open and honest dialogue. Any information is better than none – I think that’s the key thing. If you don’t talk about it, people will jump to worse conclusions.”

If you plan on telling lots of people, it can be useful to come up with a simple way

Asking for helpWhether you’re adjusting to a diagnosis, recovering from surgery or simply having a bad day, everyone needs support sometimes. But it can be difficult to ask for it. Dr Carrier suggests a direct approach. “The best thing to do is be upfront and say: ‘Look, this is really difficult for me, but this is what has happened and I’d like your support,’” she says.

Being clear about how friends, family and colleagues can help will empower them to assist you. At the same time, setting boundaries about where their involvement should end could prevent you feeling patronised or wrapped up in cotton wool.

It’s important that you can share how you feel about your heart condition. However, it doesn’t have to dominate every conversation or inform your answer every time someone asks: ‘How are you?’ Set aside time to speak about your heart condition and share what’s on your mind, then get on with the rest of your day.

“I kept it a little bit to myself to start with, but then I realised that probably wasn’t the best thing to do,” says Helen. “At that point, I realised I needed to speak to somebody. Not necessarily a counsellor, but a friend outside my immediate, very close group.”

What if I’m talking to someone with a health problem?

1Start the conversationIf a colleague or friend has been unwell

for a while, don’t feel you have to launch in with medical questions. Try welcoming them back by saying: ‘It’s great to have you back’ or ‘We missed having you around’.

Ask open questions, such as ‘How does it feel to be back?’ rather than those with a ‘yes’ or ‘no’ answer. This will get your friend or family member talking and allow them to share their feelings.

2Be a good listenerYour intentions may be good, but

interrupting someone, even to offer reassurance, can be off-putting. Helen

to describe what has happened to you. If you’re worried about finding the right words, you could compose a message to send via post, email or social media.

Helen says there’s no reason to avoid discussing heart conditions with children. “I had to have the conversation with my daughter, who has the condition as well,” she says.

“Speaking to her as a four-year-old, it was about not going into detail, but just saying: ‘Sometimes mummy’s heart does this, then this happens.’ She kind of understands it. It’s about picking your words for your audience, but don’t be afraid to talk to children about it.”

Helen found ways to talk todaughter Isobelle about the

heart condition they share

Heart Matters48

explains what she finds helpful when she’s telling someone about her condition. “Just sit back and listen to everything that I’ve got to say, then when you’ve got all of the information, you can ask me questions,” she says. “If you get it all straight away, great, but if you want to go away and think about stuff, that’s great too. Just let me get it all out and don’t start jumping to conclusions halfway through a conversation.”

“[Work on] being able to listen, rather than dipping in and putting your own opinion in,” says Dr Carrier. “Only give your

opinion if it is asked for. Be supportive, and reflect back on what people have said.”

Try active listening (find out more at bhf.org.uk/listening). Make eye contact, nod and smile to offer reassurance, rather than interrupting. Avoid dismissive statements like: ‘I’m sure it’ll be fine’ or ‘Everything happens for a reason’. Instead, try: ‘I’m so sorry you’re going through this’ or ‘I’m here to help when you need me’.

3 Offer helpDr Carrier suggests asking: ‘What help

would be useful for you?’ or ‘What can I do to support you?’ It’s important to listen carefully to the answer – never assume someone wants more or less support than they’ve asked for.

4 Support their effortsTry to communicate your support day

to day by helping your loved one adjust to lifestyle changes. If you live together, it might help if you both make healthy changes to your diet, exercise regime, or quit smoking if you smoke.

“They don’t need people saying: ‘Oh go on… come out tonight… it’s OK to have a treat,’” says Dr Carrier. “But they do need people around to support them with any changes they make.”

5Give them spaceGive your friend or family member

space when they need it. Allow them to take ownership of their condition, learning how to monitor their own health and take their medications as instructed, so they feel in control as much as possible.

“People can get obsessed with their family member’s health and be constantly monitoring it,” warns Dr Carrier, “but there’s nothing worse than that. It’s about giving them choices, then supporting them to make the best choice.”

6 Educate yourself“It’s common for people to jump to the

worst possible scenario,” says Dr Carrier.Helen experienced this when sharing

her news. “For a lot of friends, the initial response was: ‘Are you going to drop dead in front of us?’” she says. “Then I had to explain, so they understood it wasn’t a death sentence. Knowledge is power. Just ask questions so you can understand it and if you’re still not sure, ask again.”

You may feel more comfortable talking to someone with a heart condition when

WELLBEING

you know more about it. Read up on conditions and procedures at bhf.org.uk.

7 Keep in touch Helen found social visits were a great

support when she returned home from a hospital stay. “My friends rallied round more than I could’ve expected,” she says. “We had visitors, and food brought round.”

If your friend or colleague has recently come out of hospital or is preoccupied with their diagnosis, they may welcome updates on mutual friends, office life or shared interests.

8 Be understanding Stress can make people behave

differently or make snappy comments. Even if you’re the one who’s ill, remember that this is probably stressful for your loved ones too.

It can be helpful for both sides to try to understand why the other person feels the way they do – imagine yourself in their position. Try to separate difficult behaviour from your overall relationship.

What can I do to support you?

≠ Caring Bridge (caringbridge.org) is a website to help you share news of a diagnosis or operation. It’s a free, not-for-profit service, and users can post updates if and when they want to. There is a ‘guestbook’ option where loved ones can leave messages of support. This can make it easier for friends and family to express their feelings. ≠ Turn to page 50 to order our free guides to heart conditions and procedures. ≠ Read more about active listening at bhf.org.uk/listening. ≠ Find tips on conversations about end of life at bhf.org.uk/talkabout.

Free support

Helen with daughters Abigail (left) and Isobelle

49bhf.org.uk


abnormal heart rhythms. It involves using radiofrequency waves to destroy the abnormal electrical pathways. Angina An uncomfortable feeling, tightness or pain in your chest that may also be felt in your arms, neck, jaw, back or stomach. The symptoms of angina are usually caused by coronary heart disease.Angiogram X-ray pictures that show whether the arteries are narrowed and if so, how narrow they have become. A coronary angiogram examines the coronary arteries.Angioplasty A procedure used to widen a narrow artery. It involves temporarily inserting a catheter and inflating a tiny balloon at the narrowing to widen it and improve the blood flow.Anticoagulant Medicine to prevent harmful blood clots from forming, by making your blood take longer to clot. Anticoagulants can reduce the risk of a stroke, and are also used to treat blood clots that have already formed.Arrhythmia An abnormal heart rhythmAtrial fibrillation (AF) An abnormal heart rhythm in which the atria (upper chambers of the heart) beat in an irregular pattern. People with AF have an irregular, and sometimes fast, pulse.




Cardiac rehabilitation Also called ‘cardiac rehab’, this is an education and exercise programme to help you recover from a cardiac event and get back to as full a life as possible.Cardioversion A treatment to help restore a normal heart rhythm. It can be done using medicines (chemical cardioversion), or by giving the heart a controlled electric shock with a defibrillator (electrical cardioversion).Cardiac catheter A fine, flexible, hollow tube which can be passed through a blood vessel in the wrist or groin into the heart for a diagnostic examination.Coronary artery bypass surgery An operation to treat coronary heart disease. Arteries from your chest wall and arm, or veins from your leg, are used to bypass the blocked or narrowed coronary arteries, improving blood flow to the heart muscle.Coronary heart disease (CHD) When the walls of the coronary arteries (the arteries that supply blood to the heart muscle) become narrowed due to a gradual build-up of atheroma (sometimes called ‘plaques’).


blood are too high. There are two main types of diabetes: type 1, where your body stops producing insulin, and type 2, where your body can’t use the insulin it produces, usually because excess fat in organs prevents the insulin from working effectively. Diabetes increases your risk of developing cardiovascular disease.






or ‘MI’. This describes a sudden loss of blood flow to part of the heart muscle. Most heart attacks are caused by atherosclerosis, the build-up of atheroma (plaque) within artery walls. If the atheroma becomes unstable, a piece may break off and lead to a blood clot. This can block a coronary artery, causing a heart attack and irreversible heart muscle damage. It is a medical emergency and can lead to a cardiac arrestHeart failure Condition where the heart becomes less efficient at pumping blood around the body. High blood pressure Also called ‘hypertension’. High blood pressure is when the pressure required to pump blood is consistently higher than the recommended level. This puts extra strain on your heart and blood vessels, and over time




IImplantable cardioverter defibrillator (ICD) A small device implanted

under the skin on your chest, connected to your heart by one or more wires (leads). It monitors your heart rhythm and can deliver a controlled electric shock if you have a life-threatening abnormal heart rhythm.




blood and stabilise any fatty plaques (atheroma) against the artery wall. Stent A short tube of expandable stainless-steel mesh that is inserted into an artery to hold it open after an angioplasty, improving the flow of blood through the artery. Stroke An interruption of blood flow to part of the brain, causing brain cells to die or become damaged. This happens if an artery carrying blood to your brain becomes blocked, or if an artery bleeds into your brain. A stroke is a medical emergency.



DICTIONARY

Order your free guides by calling 0870 600 6566 or visiting bhf.org.uk/HMpublications

Healthy eating and lifestyle10 minutes to change your life – take time out G92610 minutes to change your life – time to eat well G923 Cut the saturated fat M4Eating well G186Healthy eating on a budget (Short films, online-only at bhf.org.uk/budgetfood) Everyday triumphs (for mental health service users) G972Facts not fads – your simple guide to healthy weight loss M2Get active, stay active G12Get up and go (DVD – physical activity for over-65s) DVD32Healthy living, healthy heart (information for African Caribbean communities) G532Healthy living, healthy heart (South Asian communities) G971/EKeep your heart healthy HIS25Risking it – short films designed to help you tackle risk factors bhf.org.uk/riskingit or DVD21Stop smoking G118Taste of South Asia (South Asian recipes) G606Taste of the Caribbean (African Caribbean recipes) G503This label could change your life G54Women and heart disease M37Your heart, our help G598 Living with a heart conditionAn everyday guide to living with heart failure G275UAngina HIS6Atrial fibrillation – your quick guide G963Blood pressure HIS4Cardiac rehabilitation – your quick guide G964Caring for someone with a heart condition HIS20Coronary angioplasty HIS10Diabetes and your heart HIS22Electrocardiogram – your quick guide G965Having heart surgery HIS12Heart attack – your quick guide G966Heart rhythms HIS14Heart to heart: heart disease and your emotional wellbeing G954

Use our booklets, DVDs and information sheets to help you improve your heart health and get support on living with a heart condition. To see the whole range of guides, order the Take heart (G5) catalogue

50 Heart Matters

ORDER YOUR FREE GUIDES

Want to measure your blood pressure at home? Watch our short film on how to do it at bhf.org.uk/

pressure.

Heart transplant HIS13Heart valve disease HIS11Implantable cardioverter defibrillators (ICDs) HIS19Living with heart failure HIS8Medicines for your heart HIS17My progress record (a manual to keep important information about your medication, test dates and results) M92MOne step at a time – living with heart failure (DVD) DVD5Pacemaker – your quick guide G968Peripheral arterial disease HIS16Physical activity and your heart (download only) HIS1Primary angioplasty for a heart attack HIS26Reducing your blood cholesterol HIS3Returning to work HIS21Stroke – your quick guide G969Tests HIS9The road ahead – your guide to heart tests and treatments DVD30

BHF SUPPORT

A new booklet for adults who are going to have, or have just had heart surgery. It explains what happens before your operation and while you’re in hospital. It also tells you what to expect once you return home, how a cardiac rehab programme can help you, and

what you can do to reduce your risk of further heart problems. Order code: HIS12

Printer perfectWe’ve updated our website to make it even easier to print heart health information straight from the web page. Now, when you hit print you’ll get a streamlined version of the page, making it easier than ever to share information with your friends, family or patients. Don’t forget you can also print practically any of our information sheets and booklets at home – go to bhf.org.uk/HMpublications.

Heart surgery

Nordic pickles

Preparation time: 10 minutesCooking time: noneServes: each pickle serves 2 Not suitable for home freezing

Toss together the ingredients for each pickle with one quantity of the seasoned vinegar. Eat straight away or cover and keep chilled until ready to use, then leave out at room temperature for 10 minutes before serving. Best eaten fresh and crunchy on the day of making.

Ingredients

MethodMoyra FraserOur resident food writer Moyra is a former Telegraph food columnist and author of numerous cookery books.

23%

Each portion contains:

Sugars3.7gLow

Energy116kJ28kcal

Fat0.3gLow

Saturates0g

Low

Salt0.51gMed

9%0% 0%4%1%% = an adult’s reference intake

23%


Sugars4.8gLow

Energy139kJ33kcal

Fat0.4gLow

Saturates0.1gLow

Salt0.55gMed


23%


Sugars2.0gLow

Energy77kJ

18kcal

Fat0.4gLow

Saturates0g

Low

Salt0.5gMed


23%


Sugars9.6gMed

Energy243kJ57kcal

Fat0.1gLow

Saturates0g

Low

Salt0.95gMed13%0% 0%11%3%

% = an adult’s reference intake

NORDIC

Seasoned vinegar for each pickle:20ml (4 tsp) cider or white wine vinegar¼ tsp granulated or caster sugar¼ tsp salt

Cabbage and fennel pickle115g (4oz) firm cabbage, thinly shredded55g (2oz) fennel, thinly sliced¼ tsp fennel seeds1 tbsp chopped fresh coriander

Carrot and radish pickle115g (4oz) carrot, thinly pared with a vegetable parer55g (2oz) radish, thinly sliced (about 4 radishes)25g (1oz) red onion, thinly sliced1 tbsp chopped fresh parsley, chives or basil

Beetroot and horseradish pickle225g (8oz) cooked, peeled beetroot, cut into thin sticks (if you are cooking the beetroot yourself, start with about 350g of raw, trimmed beetroot)½ tsp grated fresh horseradish2 tsp chopped fresh dill

Cucumber and dill pickle115g (4oz) cucumber, very thinly sliced1 small shallot, thinly sliced½ tsp mustard seeds1 tbsp chopped fresh dill

IngredientsRecipes and food styling: M

oyra Fraser; prop styling: Kim Sullivan; photography: W

illiam Shaw

25g (1oz) quinoa1 tsp rapeseed or olive oil85g (3oz) whole spring onions, very finely chopped1 tbsp chopped fresh dill (or basil or coriander leaves)

1 Put the quinoa in a small pot and cover with cold water. Bring to the boil, then simmer for 20 minutes until the grains are tender. Drain and leave to cool.

2 Heat oil in a small, non-stick frying pan and fry the spring onions for 3–4 minutes, stirring, until softened. Stir in the dill and lemon zest with a good 10–12 twists of the pepper mill. Cook for a further minute. Leave to cool.

3 Blitz the salmon in a food processor for 3–4 seconds until coarsely chopped. It should look like rough mince.

4 Line a baking sheet with foil. Stir the cold quinoa and spring onion mixture into the salmon with the egg yolk. Shape into 6 burgers. It will feel very soft but don’t worry. Cover with clingfilm and chill overnight (or freeze in a rigid container for up to 2 weeks).

Method

These recipes are from Heart Matters magazine, Summer 2016. If you’d like to receive Heart Matters and you’re not a member, join for free by calling 0300 330 3300 (costs are similar to 01 and 02 numbers) or visit bhf.org.uk/heartmatters.

“The raw burgers need chilling overnight, so make in advance of when you want to eat them.

“If using coriander, try adding half a finely chopped green chilli when frying the onions.”

Cook’s tips

23%


Sugars0.6gLow

Energy764kJ

183kcal

Fat10.8gMed

Saturates1.9gMed

Salt0.13gLow2%15% 10%1%9%


NORDICSalmon burgers with yoghurt dressing

Preparation time: 20 minutes, plus chilling overnightCooking time: 10 minutesMakes: 6Suitable for home freezing

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5 To cook the burgers, wipe or spray the base of a non-stick frying pan with a little oil and put over a medium heat. Slide burgers into the pan off the baking sheet and brown for 1 minute on each side. Cook, turning once, for 3 more minutes.

6 Alternatively, slide the baking sheet under a pre-heated grill. Brown for 1 minute on each side, then cook (turning, as above) for 3 minutes.

7 Serve in toasted wholemeal buns or wholemeal pitta bread with a green salad, squeeze of lemon juice and a dressing of fat-free Greek yoghurt mixed with finely chopped gherkins, chopped parsley and chives.

Finely grated zest of 1 small lemonFreshly ground black pepper500g (1lb 2oz) skinless salmon fillet1 egg yolk

Watch Moyra making these tasty burgers at bhf.org.uk/salmonburgers.

1 Heat the oil in a medium, non-stick saucepan and fry the onion, leek, potatoes and courgette over a medium heat for 3–4 minutes until beginning to soften.

2 Stir in the paprika and flour and cook over the heat for a further 1 minute before adding in the white wine. Bring to the boil, stirring, and bubble for 2–3 minutes or until most of the liquid has evaporated.

3 Add the stock, milk and a good 6–8 grinds of pepper then return to the boil. Reduce the heat and simmer gently for

1½ tsp rapeseed or olive oil1 large onion, finely chopped1 small leek, finely chopped115g (4oz) baby potatoes, diced1 small courgette, diced½ tsp smoked paprika2 tsp plain flour75ml (3fl oz) dry white wineFreshly ground black pepper

300ml (½ pint) homemade or reduced-salt vegetable stock250ml (8fl oz) semi-skimmed milk225g (8oz) fresh cod (or other sustainably caught white fish fillet) loin or fillet, cut into large bite-sized piecesChopped fresh parsley, lemon juice to serve

Ingredients

Methodabout 20 minutes or until the potatoes are tender.

4 Reduce the heat until the soup is barely simmering and add the pieces of fish. Push the fish under the liquid but avoid stirring to keep the chunks intact. Leave to cook for 10 minutes.

5 Serve the stew in deep bowls with plenty of chopped fresh parsley and a good squeeze of lemon juice.

23%


Sugars15.4gLow

Energy1527kJ363kcal

Fat6.6gLow

Saturates2.1gLow

Salt0.66gLow11%9% 11%17%18%


NORDICSmoky cod stew

Preparation time: 10 minutesCooking time: 40 minutesServes 2 (generously)Not suitable for home freezing

Read about recent changes to the Eatwell Guide at bhf.org.uk/eatwellchanges.

“Try a squeeze of fresh orange juice over the soup instead of lemon. The flavour is good with both the paprika and the cod.”

Cook’s tip

See step-by-step pictures to make following this recipe even easier, at bhf.org.uk/codstew.

1 Mix the arrowroot or cornflour to a thin paste with a tablespoon of the juice.

2 Put the remaining fruit juice in a blender with the fresh or frozen berries and blitz until smooth. Sieve into a small saucepan to remove the pips and add the cinnamon stick, and honey or sugar. Bring slowly to a gentle simmer.

3 Stir in the arrowroot or cornflour and bubble the mixture gently for a further 1 minute until lightly thickened then take the pan off the heat.

4 Pour the thickened juice into a non-metallic jug and leave to cool (with the cinnamon stick). Cover and chill when cool.

Ingredients1 tsp arrowroot or cornflour250ml (8fl oz) fresh red fruit juice (not from concentrate) such as cherry or red grape150g (5½ oz) raspberries or blackberries, fresh or frozen 1 cinnamon stick

1 tsp honey or caster sugar115g (4oz) extra fruits to serve, e.g. sliced strawberries, raspberries, blueberries and pomegranate seedsA few fresh lemon thyme or mint leaves (optional)

Method

“The soup base also makes a delicious sorbet. When the thickened juice is semi-frozen, beat the mixture with a fork to break up the ice crystals, then return to the freezer till solid.”

5 When ready to serve, remove the cinnamon stick and pour the chilled soup into flat soup plates. Top with the extra fruits and thyme or mint.

Cook’s tip

23%


Sugars23.2gHigh

Energy541kJ

128kcal

Fat0.3gLow

Saturates0g

Low

Salt0g

Low0%0% 0%26%6%


NORDICSummer berry fruit soup

Preparation time: 10 minutes plus chillingCooking time: 5 minutesServes: 2Suitable for home freezing

Recipes and food styling: Moyra Fraser; prop styling: Kim

Sullivan; photography: William

Shaw

Moyra carefully creates and tests every recipe to make sure the dishes we share with you are both healthy and delicious. For even more meal ideas, visit bhf.org.uk/recipefinder.

Title First name R R C - British Heart Foundation · 2016-09-29 · FREE Summer 2016 Ooh, saucy!...

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