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??