Dr Scott W Murray MBChB, BSc, MRCP, MD

Consultant Cardiologist

Clinical Lead for Prevention and

Rehabilitation

Royal Liverpool University Hospital

“I warmly welcome the launch of this 10 year CVD Prevention Strategy for Liverpool. It is a bold and ambitious strategy, and it needs to be!” Dr Matt Kearney National Clinical Director for Cardiovascular Disease Prevention

HEALTHY LIFESTYLE ADVICE AND HOW TO STOP DYING OF A HEART ATTACK!

Life after PCI? - Why Bother?

• Case control study of acute MI in 52 countries

• Nine risk factors account for >90% of the population attributable risk of MI

Yusuf S, et al. Lancet. 2004; 364:937–952.

MI: myocardial infarction

• Abnormal lipids

• Diabetes

• Abdominal

obesity

• Inadequate

consumption

of fruit and

vegetables

• Lack of regular

physical exercise

• Smoking

• Hypertension

• Psychosocial

factors

• Excess alcohol

Modifiable factors

increase the risk of myocardial

infarction (MI)

Why does insulin affect CVD risk?

We know what we should be doing!

Trending #CVD

C.R.A.P

Completely

Refined

And

Processed

Closing the Gap – Liverpool/STP/North West

Family History: Genes + Environment

Getting the message to our kids!

World Health Organization. Guideline: Sugars Intake for Adults and Children. Geneva: World Health Organization, 2015.

Our 2027 Targets

Khkhjkjhgjkhgjlhgljgljkglkjglkjkjkjjkjbkjk;hbkjh;kh;kjh;kjh

**Reduce Sugar and Low Quality Carbohydrate Intake JBS-3**

Our 2027 Targets (cont’d)

UK NICE Target

A report from (NICE) estimated that a UK national programme reducing population CV risk by 1% would prevent 25000 CVD cases and generate savings of £40 million/year.

CAD mortality rates could be halved by only modest risk factor reductions and it has been suggested that eight dietary priorities alone could halve CVD death

NICE Public Health Guidance 25. Prevention of Cardiovascular Disease. http://www. nice.org.uk/guidance/PH25.

• Our future is at least in part in our own hands – let’s take control!

• Why snack at all?

• If it made a big difference could you avoid sugar and turn some of the white stuff green ?

• If diets have always failed for you, could sugar addiction be a cause?

•We have eaten our way into an epidemic of obesity and diabetes, can we eat our way out of it again?

DR DAVID UNWIN – GP IN SOUTHPORT

HbA1c in %

Total Cholesterol

HDL Cholesterol

Cholesterol Ratio

Triglyceride

Start Finish Loss Start Finish Loss Start Finish Loss Start Finish Loss Start Finish Loss

Averages 8.6 6.5 2.1 5.5 5.1 0.4 1.29 1.46 -0.17 4.3 3.8 0.5 2.23 1.64 0.69

HbA1c in mmol/mol

Weight in Kg

Systolic BP in mmHg

Diastolic BP in mmHg

Gamma-G.T Level in U/L

Start Finish Loss Start Finish Loss Start Finish Loss Start Finish Loss Start Finish Loss

Averages 70.2 47.9 22.3 96.5 87.9 8.6 143 134 9 86 78 8 87.1 48.0 39.1

Case series of 125 consented patients helped by a lower carb diet In a primary care setting over an average of 15 months.

It’s not just about Type 2 Diabetes Significant improvements in weight, liver function, lipids and blood pressure.

Latest results for 2017 in random selection of 1,000 patients 250,000+ participants 70% engagement to completion Average 7.5KG weight loss Average 16 Mmol reduction in HbA1c 1/3 reducing tablet based medications for diabetes 60% stopping need for insulin (intensive insulin makes Type 2 outcomes worse) 50% diabetes “remission” rate with HbA1c back in “normal” range Data and publications to follow Other providers in USA starting – Virta REVOLUTION of digital online based health interventions

JBS 3 - Influencing Lifetime Risk

Impact on a patient post ACS

MECC - What can you do in your own practice?

LIFESPAN – HEALTHSPAN = DISEASE-SPAN

QUESTIONS?NS??