Tag: heart attack

One drink a day shortens your life

Ah, alcohol.

Some people don’t touch it for religious reasons.

Some people drink in moderation.

Some to excess.

Alcoholic drinks are classified by how many units of alcohol they contain. A recent study suggested that drinkers who consumed over 12.5 units (100g) of alcohol were more likely to die sooner than those who did not breach this amount.

If we follow current UK guidelines, this means that we should not drink more than 6 pints of average strength beer at 4%, or these might have serious repercussions for our health.

6 pints! Some people exceed that in a single day or two!

The limits established by the UK seem lower compared to those in the other countries, but nevertheless, each country sets its own guidelines based on lifestyle and economic factors.

The crux of this research was that adults over the age of 40 would lose between one or two years of their life is they exceeded the UK guidelines.

The somewhat irony of this research was that drinking alcohol was linked with higher incidences of cardiovascular symptoms, except for heart attacks, where it was lower.

How can these be so? How can drinking lead you to develop health problems, yet not cause you heart attacks?

This is where the “blind spot” of the research falls. It may not just be the drinking that is difficult to measure empirically.

You may argue that is not so much the level of alcohol that is the problem, but the lifestyle factors associated with the level of alcohol.

For example, those who exceed the UK threshold for alcohol consumption regularly may have lifestyle concerns or health worries that cause stress on the heart. Think of someone who is depressed and drowning himelf in sorrows. It is not necessarily the alcohol that he keeps swigging down, but more the stress that the depression is taking on him.

You may also argue that those who don’t exceed this limit have less stressful lifestyles. Or perhaps they have other outlets for stress, such as sport and exercise, and hence do not feel the need to drink as much.

It is like analysing football fans. You might find that the ardent supporters are more likely to have suffered the stresses, the highs and lows of their football team. They are also likelier to be older fans. Those who have not followed football teams as passionately or for as long are likely to be younger individuals. But you cannot say the number of football games watched cuts your life expectancy.

Why do drinking limits differ from place to place? I mentioned earlier that in some countries, this is due to economic interference. But how is this so? Imagine a country like, say, Spain, which produces various kinds of wines. As a higher percentage of the country’s economy depends on sales of alcohol, it is likely that Spain will have higher recommended guidelines. And Spain does. While UK men are told not to drink above 14 units of alcohol, this limit is 35 units in Spain. A staggering 2.5 times higher than in Britain!

The UK limit is also lower than Ireland (21.2). What does Ireland export? Guinness. It has been calculated that every day 10 million glasses of Guinness are sold all across the world and 1.8 billion points of Guinness are sold.

It is difficult to measure the health effect beyond the recommended threshold because it would be unethical to make someoe drink above that limit for a long time. But the results of the study suggest that consumption for many people is best reduced and monitored.

 

Obese children now from lower-income households

In bygone times having large children were prized. It was a sign that you were rich, had the wealth to feed your children and that they ate well. Unlike those skinny people who had no food to eat. Larger children were a mark of status, coming from higher income households where there was more disposale wealth.

This trend appears to be reversing. A study of obese children in England found that many of them were of poorer socio-economic backgrounds.

How has this happened? It is easy to point the finger at an abundance of high fat, high calorie, cheap food. In short, fast food.

Take a walk down your high street. Start by counting how many chip shops you can see, or shops selling fried chicken. You would probably see a fair few. And see what happens when the kids are dismissed after school. You will see many crowding around these shops, getting their fill of fried chicken and chips.

To top that all off: to quench their thirst after consuming the oily, high sodium food, many opt for sugary fizzy drinks.

The high fat, high calorie, high sugar diet is repeated over many days and weeks. We may talk of the social responsibility in allowing fast food places to target school children but that is what happens because fast food shops know where the bulk of their clients lie. To make matters worse, some children assume that eating fried chicken gives them protein to grow big, which is what they want. Chicken is a source of protein, but when fried it is high in fat and the combination of caloric drinks does not help either.

The consumption of such a high fat diet is a ticking time bomb for the NHS. In two or three decades from now many people will increasingly be obese, and there will be a higher population of middle-aged obese that threatens to burden the NHS.

The NHS should encourage exercise, but unfortunately many of the measures – such as to take 10,000 steps a day – are ill conceived. You could do 10,000 steps a day, but if that is done at a slow pace that hardly taxes your heart rate, you are not burning fat. In addition, fat burning only takes place after the body has been active for at least twenty minutes, at a heart rate of at least 60% MHR (Maximal Heart Rate).

The overabundance of cheap fast food has meant that lower income families see it as a cheap affordable way to feed their children. And when their children get obese, they are viewed as being “big” which many think is good for them.

We are at a point of disconnect, but what we have to address is this. Better, nutritional food costs more. And it doesn’t taste as good at the same price. Unless we can introduce subsidies on healthy food, we will only evolve into a society that increasingly consumes junk food. The price we pay for promoting healthy eating through subsidies will go a longer way towards reducing the ticking time bomb of poor social health.

How the dangers of e-cigarettes extend beyond DNA damage

Studies done on laboratory mice suggest that e-cigarettes can be harmful to humans, although to a lesser degree compared to the traditional tobacco they are supposed to replace. This suggests that  cigarette smokers could do themselves some good in switching to e-cigarettes, although those who have yet to pick up the habit should avoid it because it can actually do the body harm – and is not zero-risk smoking as some might view it.

E-cigarettes have been growing in use over the last few years. Because they are aerosol-based, they use compounds to deliver nicotine to the user. This means they avoid the smoke associated with traditional tobacco cigarettes. In the latter, the burning of tobacco releases carcinogens, which cause cell damage and cancer when they are inhaled. The delivery of nicotine by aerosol in e-cigarettes avoids these, although the recent study proposes that this is not enough.

The most recent research into the use of e-cigarettes suggests that they still cause cancer because they damage string DNA and the body’s ability to repair itself.

Laboratory mice were exposed to the vapour of e-cigarettes for a period that simulated normal human consumption. The vapour of e-cigarettes contains both nicotine and solvent, and while the solvent itself had no effect on the mice, the combination of solvent and nicotine had the same impact as nicotine itself.

The limitations of the study were that it was unclear the vapour inhaled by the mice was equal to the amount a human being would, or pro-rated for the difference in mass! Furthermore, the impact on mice may not be comparable to those on humans.

The research does highlight, nevertheless, that there is a potential danger in e-cigarettes. While guidelines in 2016 recommended them as a safer alternative to tobacco, they are not 100% safe. Various groups of people such as the younger generation, for whom smoking is a perceived sign of maturity, think that just because there is no burnt substance, that they are perfectly safe. Unfortunately, the easy availability of these e-cigarettes, just like nicotine gum, means that rather than getting individuals off cigarettes, they may only be building up a lifelong addiction instead.

The real health concern behind energy drinks

Could your regular normal drink give away your age? Possibly. It is conceivable that your pick-me-up in the morning is a general indicator of age. Those who prefer nothing more than a coffee are more likely to be working adults in their mid thirties or older. Those within the younger age brackets prefer to get a caffeine fix from energy drinks, the most popular among them being Red Bull, whose popularity has arguably been enhanced by its ability to be mixed with other drinks. Why is there this disparity in preference? It has been suggested that the older generation are more health conscious of the levels of sugar within the energy drinks and their effect, and hence avoid consuming them, while younger professionals who perhaps lead a more active lifestyle, including going to the gym, are more inclined to think they will somehow burn off the sugar over the course of the day, and they need the sugar to power them through the day, in addition to the caffeine.

Research suggests this kind of thinking pervades the younger generation, even right down to the teenage age group. In a bid to seem more mature, many are adopting the habits of those they see around them. The image of a twenty-something with energy drink in hand along with a sling bag, possibly a cigarette in the other, on the way to work, whatever work may be – perhaps a singer-songwriter? Or something with a socially glamorous title – is seemingly etched on the minds of youngsters as a life of having made it. This, coupled with the media images of celebrities on night outs with energy drinks in hand, to enable them to party the night through, have certainly promoted the rise of the energy drink among teenagers. It is arguable that energy drinks are the stepping stones from which the younger generation obtain their high before they progress to the consumption of alcohol. Research has demonstrated that it is usually within three years of starting energy drinks that a young adult progresses to consuming alcohol in the search of newer buzzes.

There are the obvious problems of over consumption of alcohol and it is of increasing concern that the copious amounts of energy drinks among young people prime them to reach for higher volumes of alcohol once they make the transition. Simply put, if a young person has habitually consumed three or four cans of Red Bull every day, and then progresses to try alcohol – usually the drink with the highest alcohol percentage, usually vodka for the same reason of the perception of being socially prestigious – then a starting point appears to be three or four shots of the alcoholic drink.

And one of the drinks that helps bridge the divide between energy drinks and alcohol?

Red Bull mixed with vodka.

Ever seen the videos of young adults knocking down shots of vodka or whisky like a fun game?

It seems that imprinted in the social subconscious is the idea that part of maturity and social status is the ability to knock down many shots of high strength alcohol. These has implications for the health of the future generation.

But it is not just the alcohol time bomb that is worrying. Over consumption of energy drinks causes tooth decay and a high level of caffeine and side effects within the body now.

A study of over 200 Canadian teenagers found that consumption of energy drinks caused incidences of sleeplessness and increased heart rate. They also reported other symptoms such as nausea and headaches.

But while the tabloids, in their usual way, exaggerated the links in the way that tabloids do, claiming that energy drinks can cause heart attacks and trigger underlying stress-related conditions, only one in five hundred suffered seizures, but even these cannot be traced directly to the energy drinks.

Energy drinks not only have implications on health, through the impact of sugar and caffeine, but they are subtly dangerous because they blur the lines between non-alcoholic drinks and alcoholic ones, and make the latter more trendy and accessible. In a way, they are similar to vaping. Both are supposedly healthier imitations of what they are supposed to replace. Apparently vaping has no significant effect on the compared to smoking; energy drinks are non-alcoholic ways of obtaining a high or rush.

The problem, however, is that once users have had their fill of these – the so-called healthier options – these options actually compel the individuals to move on to the less healthier option. And when they embark on the more health impacting lifestyle choices – either alcohol or smoking – the patterns of dependency have already long been established.

So the dangers of energy drinks are not so much they cause sleeplessness and increased heart rates.

It is actually that they propel individuals towards alcohol dependency. The main research question that should be asked, is, “Have you been tempted to try alcoholic drinks mixed with energy drinks such as Red Bull?”

Beta blockers and their impact on heart attack sufferers

 

Recent research suggests that the prescription of beta blockers for heart attack patients may not have the benefit ascribed to them.

In the UK, the prescription of beta blockers is routine for patients who have had a heart attack. There are two categories of patients – those who have had a heart attack, and those who have had a heart attack with heart failure, the latter of which is the more severe case. A heart attack involving heart failure is a complication in which the heart muscle has experienced damage and where proper function is compromised.

Beta blockers work by reducing the activity of the heart and lower blood pressure. In essence, the pressure on the heart is lessened by a reduced demand on it.

Current guidelines recommend that the first group of patients are prescribed beta blockers, while for those in the second group, who have experienced heart failure, beta blockers are mandatory.

The research investigated the effect of beta blockers on the first group, for whom beta blockers are recommended but not compulsory. The findings suggested that 95% of patients in the first group did not experience a significantly longer life span and beta blockers did not have any significant impact. There was no statistical difference in death rates within a year large enough to attribute to any positive impact of the beta blockers.

As the data involved tracking a very large sample size of 179,810 people, the results could be deemed to be fairly accurate.

So what the ramifications of this research?

The first is that the vast majority of the first group of heart attack patients are being over-prescribed beta blockers. Beta blockers, while reducing the workload of the heart, can induce side effects such as drowsiness and fatigue as a result of lower blood pressure. Patients may be experiencing these burdens on their health unnecessarily.

The second issue is that over-prescription causes an unnecessary burden on the NHS if it is prescribing drugs unnecessarily. Imagine a patient who has just had a heart operation. While he or she is recuperating in hospital, beta blockers are prescribed as part of the medication. Multiply that by over 100,000, and the result is an unnecessary annual cost to the NHS if the drugs that are needless and have no impact.

Furthermore, the use of drugs with no apparent benefit can, in the long run, only weaken the body’s immunity.

The findings of the survey, however, do not reflect on the impact of beta blockers on the second group of patients – those who have had a heart attack involving heart failure. Another outcome of the findings was the suggestion that treatment be more personalised in order to locate and target patients in the first group who would benefit from the prescription of beta blockers for heart attacks which did not involve heart failure.

Beta-blockers are prescription-only medicines, commonly referred to as POMS, which means they cannot be obtained over the counter. They must be prescribed by a GP or pharmacist. They work by blocking the action of hormones like adrenaline in order to reduce the activity of the heart.

Examples of commonly used beta-blockers include:

  • atenolol (Tenormin)
  • bisoprolol (Cardicor, Emcor)
  • carvedilol metoprolol (Betaloc, Lopresor)
  • nebivolol (Nebilet)
  • propranolol (Inderal)

The generic name which contains the active ingredient is named first, the brand name is in parentheses.

There are many types of beta-blockers and they may be used to treat symptoms such as angina, heart failure, atrial fibrillation (irregular heartbeat), heart attack or high blood pressure. Those are the more common uses of beta-blockers, also they can also be used for migraine or to treat an overactive thyroid (hyperthyroidism), anxiety, tremor, anxiety conditions or even glaucoma.

Beta-blockers, including beta-blocker eye drops, can interact with other medicines, and in doing so alter the effects of one of the medicines. Some of the more common medicines that can cause interference through interaction with beta-blockers include medicines such as anti-arrhythmics (used to control irregular heartbeats), antihypertensives (medicines for lowering blood pressure), antipsychotics, and clonidine, which is commonly used to treat high blood pressure and migraine.

While the most common side-effects of beta-blockers are dizziness and tiredness, other arising side-effects can include blurred vision, cold hands and feet, and slow heartbeat.

Less common symptoms may include sleep disturbance (insomnia), depression, impotence or libido.

The majority of beta-blockers are to be taken once a day, with the exception of certain beta-blockers that are used during pregnancy and the beta-blocker Sotalol, which is administered two or three times a day. The NHS estimates the annual cost of Sotalol per patient to be 77.09 a year.

On the face of it, the results of the research are pretty straightforward. But are they as almost too straightfoward, to warrant the question of why such research needed to be conducted in the first place?
One cannot blame the cynics for questioning what outcomes the research is meant to arrive at.

Let’s consider the matter in a different light. It is estimated that heart attack survivors have a higher risk of recurrent heart attacks or cardiac death, and 10% of heart attack sufferers die within two years. Only 50% of initial survivors are alive at 10 years.

It is not unreasonable to surmise that those who suffer initial heart attacks either experience mortality between the first and second year or develop recurrent attacks which push them to a compulsory prescription of beta-blockers.

Critics to the research point out that a fairer assessment on the effects of beta-blockers should have examined an extended time period of two years rather than one year. They also point out that the research should have focussed on how many heart attack sufferers, who did not have heart failure, and who then did not use beta-blockers, went on to develop recurrent heart attacks, or heart attacks that included heart failure, as it would be more indicative of the effectiveness of beta blockers.

So why did the findings choose to use the timeframe of a year?

The NHS makes baseline assessments on the cost effectiveness of medicines and treatments according to a scale of quality-adjusted life years, or QALYs. It weighs the cost of treatment against the number of years of significant benefit to the patient gained from the treatment. According to the NHS, a figure of twenty thousand pounds per QALY represents treatment that is value for money. In other words, if a treatment can extend and improve a patient’s life for a year, and costs under 20,000, it is worth it.

The NHS’s Regional Drug and Therapeutic Centre, based in Newcastle, gives the cost of beta blockers as between 10 and 512 pounds annually, depending on the type of beta-blocker required. While this falls well within the QALY threshold of 20,000 pounds, using the research findings that beta blockers have no significant impact on health within the first year allows it to scrap the cost of funding this treatment because beta-blockers supposedly offer no significant benefit. The research has focussed on a time period that cannot significantly examine the effectiveness of beta blockers.

Cynics suggest that the research is merely an attempt to reframe the data regarding beta-blockers in order to minimise the cost of healthcare in an NHS which is lacking in resources.

Medical research, is unfortunately often subservient to economics and often the research appears to be carried out to arrive at a pre-planned conclusion. Wasn’t it long ago, when the economic crisis was looming and the government was looking to raise tax on alcohol, that we were told a glass of red wine a day had health benefits? Yet when the NHS struggled years later and was overburdened by drunken citizens dialling emergency services the evidence peddled about red wine was to the contrary.