Heart, strokes and statins

29 August 2013

BMI Healthcare's Dr Robin Northcote answered your heart, stroke and statins questions.

AXA PPP healthcare: Good afternoon and welcome to this afternoon's live chats. Dr Robin Northcote is here to answer you heart, stroke & statin questions.

RichardLondon asked: Hi Dr Northcote, a recent report claimed that up to four million people have been wrongly placed on statins, putting them at risk of side effects with little chance they will benefit from the drugs. What is your view on this and how do you know, if prescribed by your GP, statins are the right medication for you?

Dr Robin Northcote answered: Richard. The evidence surrounding statins and their potential health benefits has been explored over many years (>30!!). No one doubts their efficacy or safety any more. However, there are always those for whom a statin is unhelpful and potentially harmful. They are certainly the safest, most effective method of controlling a high blood cholesterol level.

Becs asked: I watched a TV program about good ways to keep your heart healthy and it suggested bursts of exercise rather than prolonged. IS that ok for the heart?

Dr Robin Northcote answered: Becs. You are quite correct. Many years ago the Canadian Airforce introduced a series of short exercises to result in a cardiovascular training effect, and these were used in cardiac patients with great benefit. There is now good evidence that short bursts of intense exercise can provide benefit for the heart and also prevent heart disease. All exercise is good for the heart and blood vessels - but like everything else, there is always the exception to the rule!

Chris asked: My brother's wife has recently had a stroke. He is struggling in dealing with this and supporting her and their children. How I can I be there for him, in terms of advice and support? Thanks, Chris.

Dr Robin Northcote answered: Chris. I understand the difficult situation that your brother and yourself will find yourselves in. While there are professional organisations such as the Chest Heart and Stroke Association to ask for advice, much of the support she will need will rest with the family. If the stroke is very recent, there is a good chance that continued physiotherapy and speech therapy can result in improvement. A frien of mine had a stroke ten years ago in his 50's - initially he was v disabled, but now has been able to adapt his life to cope with his disability. As a result he can now drive a car and play golf regularly (and still beat me!!!).

Abby asked: I find regular exercise difficult as I have knee pains when I run. But was told that exercise is the best way to minimise heart disease (which I have a family history of). How else can I minimise the risk?

Dr Robin Northcote answered: Abby. Exercise would still not be out of the question. Although you have knee problems with running (and many people do!), have you considered alternatives such as cycling or swimming. These exercises will support your joints.
Other than this, the best ways to avoid cardiac disease are to stop smoking (I don't know if you do), make sure your Blood Pressure is well controlled and that you don't have a high cholesterol level, keep your weight under control to help avert the onset of Diabetes and eat a diet low in saturated fats. You cannot do anything about your inherited genetics - but that may change in the future!!!

Abby commented: Thanks a lot, I don't smoke but will look into adding more saturated fats into my diet and trying to get swimming when I can. Thanks again.

Dr Robin Northcote answered: Don't add saturated fats - minimise them eg dairy produce, full fat milk etc.

Abby commented: Sorry... that is what I meant!

Dr Robin Northcote answered: There is some evidence that essential fish oils eg those found in oily fish such as herring or mackerel are helpful in preventing heart disease - also a useful source of fat soluble vitamins - A D E and K

Emily asked: Who is most at risk to suffer from a stroke?

Dr Robin Northcote answered: There are a number of recognised risk factors for stroke. A risk factor is simply a characteristic which identifies someone with a higher than average risk. For example, key risk factors include High Blood Pressure (for every 10mmHg over 135mmHg increment in BP there is a 20% higher risk of stroke), Diabetes, Smoking, Excessive alcohol consumption, obesity, lack of exercise and several cardiac causes such as a 'hole in the heart' or heart rhythm abnormality such as Atrial Fibrillation.

Gemma1 asked: What pattern of family history increases your likelihood of developing heart disease?  I.e. Are you more likely to get it if it's common on your father's side? 

Dr Robin Northcote answered: Gemma There is no particular pattern favouring your mother or fathers side of the family. basically, when Doctors refer to 'Family History', they refer to a first degree relative (ie mother, father or brother/sister) suffering from a heart attack before they get to 55years of age. There is very little evidence that heart disease in an uncle at the age of 82yrs will have any bearing on your own risk of a heart attack. In summary, if there is a first degree relative who has suffered a heart attack before reaching 55 years, then you have a risk factor and should ensure you have your BP and cholesterol checked - make sure you never smoke, and make up for the risk factor by taking life long exercise!

Gemma1 commented: Are there any supplements you would recommend to reduce your risk of heart disease?

Dr Robin Northcote answered: I don't think there are any supplements that have been proved to actually work! There has been speculation that Vit B6 and Folic Acid are beneficial - but no conclusive proof. Also, essential fish oils can be helpful eg those found in herring and mackerel. It is probably more important to avoid certain foods eg saturated fats and sugar than it is to supplement the diet.

Gemma1 commented: OK great.  Thanks for your advice.

Elizabeth asked: Dr Northcote,would you advise a fit  58 trolls man with a family history of ischemic heart disease & hypertension to take a statin.?

Dr Robin Northcote commented: If the family history applied to a first degree relative, and if the patient himself had hypertension I would. However, I would want to know more about his circumstances eg his diet, whether he had elevated cholesterol (remember, there is 'good cholesterol' - HD- Cholesterol and as well as bad - LDL -Cholesterol), and whether he was diabetic or smoked. If he was healthy otherwise, with a normal cholesterol and took a lot of exercise and ate a healthy diet, he might not need a statin!

Elizabeth commented: Thank you,there is no personal history of hypertension ,strong first degree family history of IHD.

Elizabeth commented: What are the main side effects of statins?

Dr Robin Northcote answered: Statins are very safe drugs. They have been used in countless millions of patient years since first introduced in 1978. A few people experience side effects. for example, painful muscles and joints : this is called a myopathy and will settle if the drug is stopped. Women are more prone to this side effect. headaches, facial flushing and nausea are other less serious side effects. Many people experience a change in their digestive system - this may be simple flatulence or more marked change in bowel habit. Less common problems are related to upset in the liver biochemistry - so people with liver problems or those who drink excessively should avoid statins. A few people report skin rashes and there is recent evidence to indicate that mild memory loss can occur infrequently - this reverses when the drug is stopped!

Dr Robin Northcote answered: Hope you got my answer to this question - it was fairly lengthy! , but does not seem to have appeared in the stream!!

AXA PPP healthcare asked:We've had a question come through from Aaron on Facebook: "My Dad is soon to undergo an angioplasty for a blockage in his heart, what is recovery like for this, and how can he best aid himself in his recovery?"

Dr Robin Northcote answered:Aaron Angioplasty is a very common day case procedure.  He should be able to leave the hospital a few hours afterwards (if the procedure is performed via the artery in the wrist, called the radial artery), or the following day, if it is performed through the artery at the top of the leg (femoral artery). He should be able to walk out of hospital and return to his normal activities within 24 hours. I would normally advise against driving for two weeks, and tend to advise patients to take a few days off work. One of my patients had triple coronary angioplasty with 4 stents deployed and two days later was attending the Open Golf Championship at Muirfield. I hope he does well and gets a good result from the procedure!

AXA PPP healthcare: Today's live chat is now over. Thank you for all your questions, and thank you to Dr Northcote for his brilliant answers.We hope they have helped.