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NHS Health Checks 30 November Richmond and Wandsworth Update Michaela Nuttall RGN MSc Founder, Learn With Nursesutions Clinical Advisor CVD Prevention Progamme OHID Chair, Health Care Committee HEART UK Associate in Nursing, C3 Collaborating for Healthormation Working Party, British and Irish Hypertension Society Trustee, PoTS UK @thisismichaelaNHS Health Check Competencies1. Programme knowledge • What is it for?What are we trying to prevent? Inflammation Genes Risk FactorsWe weren’t designed to live this long….Top 3Why high blood pressure matters • high blood pressure affects more than 1 in 4 adults in England & 1.13 billion people across the world • it is the second biggest risk factor for premature death and disability • high blood pressure, which can often be prevented or controlled through lifestyle changes, accounts for 12% of all visits to GPs in England • people from the most deprived areas are 30% more likely than the least- deprived to have high blood pressure • diseases caused by high blood pressure cost the NHS over £2bn every year https://publichealthmatters.blog.gov.uk/2019/02/14/health-matters-preventing-cardiovascular-disease/ 8What is Blood Pressure? Heart Arteries Arterioles (Cardiac (Blood (Peripheral output) pressure) resistance)• Systolic (the top number) • Diastolic (the bottom number) 120/70mmHgAfterload??? …is the pressure that the heart must work against to eject blood during systole (ventricular contraction)????? The Circulato ry SystemWe weren’t designed to live this long….How is BP maintained…. (easy peasy) Baroreceptors • Help the body to adjust to being upright • Keeping us functioning • Stops gravity from pulling fluid into our legs • Keeps us consciousAutonomic nervous system Copyright ©2001 BMJ Publishing Group Ltd.Autonomic nervous system Copyright ©2001 BMJ Publishing Group Ltd.Autonomic nervous system Increase cardiac output CO =Stroke volume x Heart rate Copyright ©2001 BMJ Publishing Group Ltd.Autonomic nervous system Copyright ©2001 BMJ Publishing Group Ltd.Autonomic nervous system Produce Aldosterone. Hormone helps to maintain the body’s salt and water levels Copyright ©2001 BMJ Publishing Group Ltd.Autonomic nervous sysduce renin Copyright ©2001 BMJ Publishing Group Ltd.Autonomic nervous system Copyright ©2001 BMJ Publishing Group Ltd.Autonomic nervous sysduce renin Copyright ©2001 BMJ Publishing Group Ltd.Autonomic nervous sysduce renin Copyright ©2001 BMJ Publishing Group Ltd.Autonomic nervous system Copyright ©2001 BMJ Publishing Group Ltd.Autonomic nervous sysduce renin Copyright ©2001 BMJ Publishing Group Ltd.http://high-blood-pressure-symptoms.com/page/2https://www.nice.org.uk/guidance/ng136https://www.nice.org.uk/guidance/ng136Autonomic nervous sysduce renin Copyright ©2001 BMJ Publishing Group Ltd.Autonomic nervous sysduce renin Copyright ©2001 BMJ Publishing Group Ltd.https://www.nice.org.uk/guidance/ng136Reduce the amount of calcium entering cells of the heart and arterial walls. - less strong contractions. Reduces afterload. Myocardial oxygen demand decreases. https://www.nice.org.uk/guidance/ng136Autonomic nervous sysduce renin Copyright ©2001 BMJ Publishing Group Ltd.https://www.nice.org.uk/guidance/ng136Autonomic nervous sysduce renin Copyright ©2001 BMJ Publishing Group Ltd.Lifestyle and effects on Blood Pressure Modifications Recommendation Approximate SBP Reduction Reduce weight Maintain normal body 2eight 3-20 mm Hg (BMI of 18.5-24.9 kg/m ) Adopt DASH diet Rich in fruit, vegetables and low-fat dairy; reduced saturated and total fat 8-14 mm Hg content Reduce dietary <100 mmol (2.4g)/day 2-8 mm Hg sodium Increase physical Aerobic activity >30 min/day most 4-9 mmHg activity days of the week Moderate alcohol Men: < 2 drinks/day 2-4 mm Hg consumption Women: < 1 drink/day Chobanian AV et al., JAMA 2003; 289: 2560-2572. Blumenthal JA et al., Arch Intern Med. 2000; 160: 1947-1958Cholesterol and dietWhat about coconut oil? What is cholesterol? substance which is mainly produced by the body itself - Vital to all cells; – building block in cell membranes – starting material for bile acids – starting material for certain hormones and vitamin D High blood cholesterol increases the risk of atherosclerotic cardiovascular disease We need fat in our diet • An important source of food energy (38 kJ/g, 9 Kcal/g) • Provides and enables the absorption of fat soluble vitamins (A, D, E & K) • Provides the essential fatty acids • Palatability – mouth-feel (fat globules) and carries flavours • Structural lipids (58% body weight) – important in cellular membranes (e.g. brain) • Protects and cushions delicate organs • Substrate for hormone and prostaglandin production • Subcutaneous fat reduces loss of body heat (very important in newborns) Saturated fat guidelines • men should not eat more than 30g of saturated fat a day • women should not eat more than 20g of saturated fat a day • children should have less https://www.nhs.uk/live-well/eat-well/different-fats- nutritionImagine 2 small packs of these = 10g sat fat HEARTUK.org.uk 6 cholesterol busting foods! • Foods rich in unsaturated fats • Fruit and veg • Oats and barley • Nuts • Foods with added plant sterols and plant stanols • Soya foodsDifferent types of fatty acids Insoluble vs. soluble fibre Insoluble fibre Soluble fibre • This fibre can be partially digested and • through the gut helping other food and waste productst pasmay help to reduce the amount of move through the gut more easily. It helps keep bowels cholesterol in the blood healthy and stop constipation. Foods rich in this sort of fibre are more bulky and so help make us feel full, which means we are less likely to eat too much • fibre include oats and pulses such as beans and lentils. • Wholegrain bread, brown rice, wholegrain breakfast cereals and fruit and vegetables all contain this type of fibre. Indicated cardio- protective effects of fish omega-3 REDUCES TRIGLYCERIDES REDUCES BLOOD PRESSURE INHIBITS PLATELETS IMPROVES ENDOTHELIAL FUNCTION REDUCES PLAQUE ANTI- BLOOD STRUCTURE ARRHYTHMIC CLOTTING Foods proven to lower cholesterol Plant sterols/stanols are the most effective food components proven to lower LDL-cholesterol Plant sterols/stanolsa drink Oat Sunflower oiAlmonds Olive Oily s oil fish -0% -1% -4% -3% -6% -5% - 10% Plant sterols and plant stanols are natural components of the human diet Major sources of plant sterols and plant stanols: 2 • Fat and oils • Cereals • Fruits and vegetables • Nuts Average daily plant sterol and Daily consumption of 2g of plant stanols intake of adults plant sterols/stanols can effectively lower TC and 150 - 400mg/day 1. 2019 ESC/EAS GuidelinLDL-C evee managemy 7 - 10% inpidaemias EuropeanHeart Journal (2020) 41, 111-188 2 .Gylling H, Plat J, Turley S et al; 2014; 232(2): 346–3hu a Soci1,2 Consensus Panel on Phytosterols. Plant sterols and plant stanols in the management of dyslipidaemia and prevention of cardiovascular disease. Atherosclerosis Quantity of regular foods required to provide 2g plant sterols and plant stanols • To get the optimal amount of plant sterols and plant stanols from regular foods would be extremely difficult • Plant sterol and plant stanols enriched foods facilitate the consumption of the recommended intake of 2g of plant sterols/day. Normen L, Bryngelsson S, Johnsson M, Evheden P et al. They phytosterol content of some cereal foods commonly consumed in Sweden and in the Netherlands. J Food Comp Analysis 2002;15(6):693-704. Weihrauch JL, Gardner JM. Sterol content of foods of plant origin. J Am Diet Assoc 1978;73(1):39-47. Plant Stanol Ester - How does it work? •Plant stanols structurally resemble HOW DO THEY WORK? cholesterol, allowing them to interfere with normal cholesterol absorption in the small Plant stanol ester lowers both total cholesterol and LDL-C levels by partly intestine inhibitingthe absorption of both biliary and dietary cholesterol in the small intestine (HDL-C concentrations are not affected) – to allow the plant stanols to work optimally, they should be consumed with a meal. Without plant stanol Plant stanol ester Cholesterol Plant stanol ester ester about a half of rof the cholesterol and the cholesterol lowers the blood total in the digestive and LDL cholesterol tract is absorbed levels. to the body.0 20 % % of the of the cholesterol is cholesterol absorbed is absorbed 50 80 of the cholesterol isof the cholesterol is excreted Plant stanol ester has been shown to lower cholesterol. High cholesterol is a risk factor in the development of coronary heart 22sease. A daily intake of 1.5–2.4g of plant stanols has been shown23o lower cholesterol by 7–10% in 2–3 weeks, and this effect is sustained as long as the recommended intake is achieved daily. The cholesterol-lowering effect of the plant stanols have been demonstrated in over 80 published clinical studies 25.Gylling H et al. EuropeanAtherosclerosis Society CPhytosterols. Atherosclerosis 2014; 232(2): 346–360. 26. Musa-Veloso K et al. Prostaglandins Leukot Essent85(1): 9–28.2011; 24. Gylling H, Plat J, Turley S et al; EuropeanAtherosclerosis Society Consensus Panel on Phytosterols. Plant sterols and plant stanols in the management of dyslipidaemia and prevention of cardiovascular disease. Atherosclerosis 2014; 232(2): 346–360. 57. De Jong A, Plat J, Lütjohann D et al. Effects of long-term plant sterol or stanol ester consumption on lipid and lipoprotein metabolism in subjects on statin treatment. Br J Nutr 2008; 100: 937–941. 65. Blair SN, Capuzzi DM, Gottlieb SO et al. Incremental reduction of serum totalcholesterol and low-density lipoprotein cholesterol with the addition of plant stanol ester-containing spread to statin therapy. Am J Cardiol 2000; 86: 46–52 A dietary portfolio effectively reduces LDL- cholesterol levels Week 0 Week 2 Week 4 0 -5 -10 -8.5% -15 Control diet Control diet + statin -20 Dietary portfolio -25 -29.6%* LDL 3holesterol (% change ) -35 -33.3%* 34 adults 4 week interventions # Dietary portfolio = plant sterols, soya protein, viscous fibre, almonds * Significantly different from control (low saturated fat diet) Jenkins et al. AJCN 2005What about coconut oil? Myth: Its good for heart health Fact: Coconut oil is solid at room temperature so there should be no surprise that it is really high in saturated fat - largely lauric and myristic acids. Both these fats increase your LDL cholesterol. Some have suggested that because lauric acid also raises HDL cholesterol it might have health benefits. However, the small increase in HDL-cholesterol is far outweighed by the negative increase in LDL cholesterol. https://www.heartuk.org.uk/news/latest/post/16-heart-uk-says-bbc-coconut-oil-claim-not-to-be-trusted