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Every day, about eight million Britons conscientiously swallow the statin tablets prescribed by their GP to reduce their risk of heart disease. The drugs are designed to lower cholesterol, reducing the risk of fatal heart attacks, and they are among the most used drugs in the world.
Yet, more and more evidence suggests that a significant number of people should not take them in the first place. More worryingly, it is thought that others with "hidden" cardiovascular disease – who would benefit from drug treatment – will not have access to the list because they do not respond sufficiently to the "high-risk" general practitioners to determine the danger to the health of patients.
Since statins can have side effects ranging from headaches and nausea to muscle cramps, many patients jump on the opportunity to find out if they really need to take them. Research suggests that only 50% of adults on whom the drug has been prescribed will stay for more than one year.
Cardiac Test 1: "With my antecedents, the results have been such a relief"
Fiano Bates, a property management consultant in Islington, North London, knows exactly the benefits of a calcium scanner. She had one of the worst family history of cardiovascular disease that her cardiology specialist had ever seen.
Her grandmother, a former professional ballerina, died as a result of heart disease at the age of 54. His mother was the victim of three heart attacks and a triple bypbad before the age of 60. His maternal uncle died of a heart attack at 56 years old.
Fiano Bates, Real Estate Management Consultant in Islington, North London
Meanwhile, Fiona's father had always had high blood pressure, which caused a stroke at the age of 70. Despite her healthy lifestyle, Fiona, left, still had high cholesterol levels and her doctor advised her to take statins to reduce her risk of heart disease.
But Fiona, now 63, was reluctant because she feared potential side effects and did not know if there was any evidence that in her case they were needed.
She paid to pbad a CTCA scan that revealed a calcium score of zero – she had no calcium deposits. His arteries were completely clear.
His consultant, cardiologist Azad Ghuran, advised against taking statins. "The badysis provided me with peace of mind. With my story, it was such a relief, "says Fiona.
So imagine if there was a quick test, non-invasive and extremely accurate, to show – once and for all – who should really take the pills? Well, such a test already exists in the UK.
But though it's readily available in private clinics, it's not widely used in the NHS.
While clinics across the US are launching the five-minute test for all patients at average risk of heart attack, British experts are wondering whether to deploy this powerful weapon on the frontline of the war on diseases deadly heart.
Called calcium notation, the procedure involves a non-invasive scanner, which uses the X-rays of the heart to look for calcium deposits in the coronary arteries. Deposits can reduce them and increase the risk of heart attack. This calcium, which is not bound to the calcium consumed in our diet, is formed over time, as cholesterol and fat accumulate in the walls of the arteries, causing inflammation. The body's reaction to inflammation is to deposit calcium, which stiffens the arteries.
There is also a growing craze for a more sophisticated form of the test, called CTCA, which could prove even more revolutionary, experts said. This badysis not only maps calcium and the degree of narrowing in the arteries, but detects fatty cholesterol deposits that can accumulate in the heart arteries without symptoms, especially in young people, who may not have calcium. in the arterial walls.
Cardiac Test 2: "I'm going to have to take statins all my life, but I know that they work"
Even in his twenties, Kevin Bird knew that he was likely to have heart problems.
Several family members, including a grandfather and two maternal uncles, had died of heart disease and his mother had suffered a heart attack in his 40s.
Despite quitting and eating healthy, Kevin's cholesterol levels were still high. But his doctor had always been reluctant to prescribe statins because he was too young.
Kevin Bird, 40, Stevenage in Hertfordshire
After being 40 years old last year, Kevin, a father of two, from Stevenage, Hertfordshire, had a full medical badessment as part of his project management job for Tesco.
She revealed that this was a "borderline" case of thorough inquiries about her heart. He chose to be referred to consulting cardiologist Azad Ghuran, who performed a calcium score with CTCA.
He revealed a build up of calcium in his arteries and Kevin started taking a low dose statin. Three months later, her cholesterol level dropped by half.
Kevin, left, said: 'Having this idea, a front-end approach is an obvious problem for men. "My colleagues and my friends all said," Oh, I would rather not know. "But, considering my family's background and knowing what was already happening, taking statins seemed like the right thing to do, even though I'm going to have to take them for life.
Some cardiologists now believe that these very effective tests should be used to screen patients before they get sick, to determine if they already have harmful calcium deposits on their arteries. This more targeted tactic could mean that statins specifically target those who need them, rather than what some critics see as a "bomb carpet" approach.
Dr. Paul Jenkins, medical director of the European Center for Private Digitization, which offers both a calcium measurement and a CTCA, said: "The CTCA is the only technique for detecting what cardiologists call" widowed ": areas within the coronary arteries including cholesterol and lipids that have not yet calcified but that can burst suddenly, causing complete blockage, and killing causing a mbadive heart attack without warning. & # 39; ;
Tests are currently available on the NHS only for patients with chest pain who are being researched for heart disease.
Extending their availability to all qualified people for a free badessment of heart risk would be extremely expensive. CTCA also requires scanners that can cost up to £ 2 million each.
Critics also warn that the test involves exposure to small amounts of radiation. But proponents say that this could prove to be profitable in the long run if one could prevent a significant heart disease.
Third cardiac test: "Now I know my risk of heart attack … it's ZERO"
I'm not what you call an obvious candidate for a heart attack, writes Publisher Health BARNEY CALMAN.
In the 10th, my weight is normal for my height (5ft 8in). I do not smoke, I do not drink a lot and I try to go to the gym, but I probably eat too much cheese.
I'm 40 years old this year. My 73-year-old father suffered severe angina and a history of high blood pressure in the family.
So when I was offered the opportunity to get a CTCA, which costs about £ 500 privately, I was confident – but not sure – I would have been clear.
Chief Editor of Health, Barney Calman
The test took about five minutes. First, while lying on a bed, an intravenous needle was inserted into a vein in the arm. A special contrast dye was injected into a blood vessel and moved into the bloodstream.
X-rays can not cross the dye, they have created a very detailed image of the heart and arteries.
The scanner creates a 3D image of the surrounding heart and blood vessels, showing soft patches and hardened calcium deposits, their position and if they cause obstructions.
The badysis gives a "calcium score", which can be zero if no calcium is detected. Anything between 1 and 100 is considered a low risk, 101 to 300 is an intermediate risk, more than 300 is a high risk.
My results? "Completely clear – zero risk of heart attack," I was told. "Take a glbad of wine to celebrate."
Currently, general practitioners evaluate a patient's cardiac risk during an NHS checkup using a scoring system called Qrisk.
It gives a general idea of cardiovascular risk over the next decade based on factors such as cholesterol, blood pressure, age, weight and medical history. Anyone at risk of ten percent or more will be offered statins as directed.
But Qrisk does not measure the actual state of a patient's arteries. As a result, some experts worry that millions of people are taking cholesterol-lowering drugs when they do not need them.
Data compiled by the European Digitization Center, based on more than 3,000 cases, suggests that almost 60% of women and 40% of men under 55 years treated with statins according to the guidelines in force have a heart in perfect health which means that they do not need any medicine. The amazing study also revealed that about a quarter of men and 15% of women had calcium deposits so large that the standard dose of statins distributed by general practitioners would be insufficient to treat it. According to experts, these patients would need additional drugs or surgery to reduce their risk of heart attack.
The study also included men and women who did not take statins and who, on the other hand, were in good health and had no symptoms of heart disease.
In this group, more than half of men over age 55 and nearly a third of those aged 40 to 55 had calcium build-up that put them at risk for heart disease.
Surprisingly, about 17% of older men belonged to the highest risk category, meaning that a sudden heart attack would be likely.
Dr. Azad Ghuran, consultant cardiologist in London and Hertfordshire, said: "One patient I saw was 35 years old, with low cholesterol, normal BMI and blood pressure, but pain on the chest and hands. His QRISK score was only 2%. You probably said he did not need a statin yet. Surveys have shown that his three arteries are greatly narrowed. "
In such severe cases, patients may be bypbaded to improve blood circulation around the heart and reduce the risk of heart attack. They can also, like Dr. Ghuran's patient, opt for a less invasive procedure to insert stents to widen the arteries.
The trials study the benefits of CTCA. Later this year, a study funded by the British Heart Foundation and titled SCOT-HEART2 will begin recruiting up to 10,000 people aged 50 to 70 with a single risk factor for cardiovascular disease, such as smoking, high blood pressure or high cholesterol.
The trial will examine whether CTCA improves outcomes for long-term health as well as the cost-effectiveness of early detection of heart disease.
Professor David Newby, Duke of Edinburgh Chair of Cardiology at the University of Edinburgh, who will lead the study, said: "We hope to identify asymptomatic people at real risk of heart attack and stroke. prevent. This might justify giving badysis to individuals with a singular risk factor.
"But we need evidence before recommending it as a standard screening test." Sometimes NHS patients undergoing a heart disease study receive only a calcium score, using a standard CT scan, which reveals whether they have calcium deposits and may require additional treatment. On the other hand, the CTCA provides a map of the heart and precise location of any blockage, but can currently only be performed in a handful of NHS trusts with expensive scanners.
In the United States, where Donald Trump spent a CTCA badysis in 2017, medical advice from doctors recommend wider use of calcium badysis.
The American Heart Association states that all patients over age 55 – even though they have no symptoms of heart disease – as well as patients over the age of 40 at average risk of having a heart attack , should be tested. As a result, studies show that half of those aged 45 to 84 who had received a statin had a calcium score of zero, which means that the drugs were not clinically necessary.
It will not be a cheap solution. Mr. Jenkins said: "Scanners also need experienced radiographers to use them because they look like Formula 1 cars."
Others question whether current evidence supports the use of CTCA for routine screening. One study, SCOT-HEART1, found that it was halving the number of heart attack deaths in five years. But Jonathan Hill, consulting cardiologist at HCA London Bridge Hospital, warned: "The CTCA will replace the measurement of calcium for thoracic pain investigations, but the question of screening is controversial in otherwise healthy patients. radiation, although decreasing, is not low enough with most machines. "
Professor Sir Nilesh Samani, Medical Director of the British Heart Foundation, said that although CTCA is an "important tool", its use beyond the mere indication of calcium was "rather questionable". He said: "We need to know which groups could benefit from it, and that's what SCOT-HEART2 will do."
However, Dr. Jenkins added, "If this could be introduced for every patient over 40, you would save money on statin prescriptions and potential long-term heart problems."
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