(L+R) Dr Peter Dale, Professor Albert Wiegman, Lorraine Priestly-Barnham, Professor Steve Humphries
Dr Dev Datta - Spire Cardiff Hospital
Professor Albert Wiegman - Professor of Paediatric Medicine, University of Amsterdam,
Professor Bruce Griffin - University of Surrey
Dr Uma Ramaswami - Royal Free London NHS Foundation Trust
Dr Ravinder Sodi - Clinical Biochemistry & Institute of Cardiovascular and Medical Sciences, NHS Lanarkshire & University of Glasgow
Dr Jeanine Roeters van Lennep - Erasmus MC: University Medical Center Rotterdam
Dr Handrean Soran - Central Manchester University Hospitals
Yvonne Dumsday - HEART UK Ambassador
Professor Chris Packard - Institute of Cardiovascular and Medical Sciences, University of Glasgow
Professor Packard called on the audience to 'follow the data and not the herd and we will get there in the end.'
Lorraine Priestly-Barnham - Clinical Nurse Sepcialist in FH and Cascade Testing Royal Brompton and Harfield NHS Trust
Professor Jim Mann - Human Nutrition and Medicine, Dunedin School of Medicine, New Zealand
Marie van Drimmelen - Clinical Lead for the Department of Blood Sciences at NHS Highland
HEART UK 30th Annual Conference ‘Cholesterol –The Evolving Story. A celebration of 30 years of lipidology’
By Jaqui Walker, General Practice Nurse and Medical writer
HEART UK’s 30th Annual Conference, Edinburgh gave a rich and varied perspective of the last 30 years of progress in lipidology.
The first day of the conference focused on hyperlipidemia in children. In the opening address Professor Albert Wiegman presented compelling data on the importance of screening and identifying children with Familial Hypercholesterolemia (FH) so they can be effectively treated and early cardiovascular events prevented.
The impact of circadian rhythms and sleep on diet-related cardiovascular risk?
Professor Bruce Griffin explained how circadian rhythms in our bodies 24 hour clock are influenced by external cues such as meal timing, physical activity and sleep- wake cycles and this is important for the control of the digestion of food, the storage and use of food energy and our overall energy balance. Modern work and social life can disrupt this system causing a mismatch between these cues and our circadian rhythms. This “chronodisruption” may be involved in the development of obesity and may increase cardiovascular risk. The situation can be complicated by an individual’s naturally occurring preference for morning or evening known as 'chronotype', being out of sync with external rhythms.
In order to prevent “chronodisruption” individuals should avoid irregular meals and sleep deprivation which increases appetite and inappropriate dietary choices. The body is better set up for eating food earlier in the day. Intermittent fasting may help with weight loss and with reducing cardiovascular risk. It is possible that some people only get back into their true rhythm at retirement.
A historical perspective
Professor Paul Durrington, provided a fascinating journey, drawing on examples from art and medical literature, to the roots of our cholesterol knowledge. Starting as far back as 474BC, the 1517 Mona Lisa, and journeying through seminal trials such as 4S, WOSCOPS, CARDS, etc. key people, studies, controversies and discoveries were all described and an amazing perspective given. He highlighted the great advances in our understanding of hypercholesterolemia achieved in recent years. He described nutrition as the basis of atherosclerosis. He cautioned that the UK lacked the expert clinicians and scientists required to translate science into medical practice but praised HEART UK describing its work as critical for future development.
The changing face of cardiovascular risk in the UK
Professor Shepherd accredited improved drug therapy and better management of risk factors as the main reasons for the reduction in CVD in the UK. He described statins as essentially universally beneficial and effective in preventing CVD in men and women, at all ages, irrespective of individual risk, in diabetics, people with hypertension, smokers and in all arterial beds, coronary, cerebral and peripheral.
He presented evidence to show how getting cholesterol levels as low as possible with statins makes good clinical sense, as long as this does not generate side effects and it may confer additional health benefits.
A view from General Practice
Dr Bob Finnie a retired GP from Edinburgh explained how general practice including lipid management has changed beyond recognition since 1986. Lipid management in general practice has however not been free from scepticism, confusion and a lack of clear non conflicting guidance. The key for the future is for GPs to discuss with patients how many drugs they are happy to take and how low they aim to get their cholesterol.
A patient’s perspective
Mrs Yvonne Dumsday and Mrs Hazel Gallagher explained how FH had affected them, their families and their lives including the positives such as their work with what is now HEART UK.
Yvonne Dumsday found out about FH by chance when listening to a radio programme and explained how her mission since then had become to make sure that 25 years later everyone knew about FH in the same way they understand MS. She regrets that despite the fact it may affect 1 in 250 people this has not been achieved. Mrs Dumsday stressed the importance of the patient voice being heard and ensuring they have access to meetings such as this HEART UK conference.
Mrs Hazel Gallagher found when she was diagnosed that there was no information available for families with FH. Together with Carolyn Bradbeer she founded the Familial Hypercholesterolaemia Association aka (FHA) which later joined with the BHA to become HEART UK. Mrs Gallagher described not knowing you have FH rather than the condition itself that is bad for you and put this into the context of her uncle who died at 40 with FH and whose sons both developed heart disease in their 30s. Mrs Gallagher and her sons who have FH are healthy, manage their condition and live life to the full.
The Myant Lecture LDL and atherosclerosis
Professor Chris Packard described how a convergence of information has identified LDL cholesterol as having a key role in atherosclerosis. LDL is a causative and essential factor in atherosclerosis as opposed to other factors e.g. raised blood pressure, smoking which are aggravating factors.
Twenty years of follow up from the WOSCOPS clinical trial shows a legacy benefit from the original five years of statin treatment in the active arm of the trial. There was no increase in late-appearing side-effects was detected during the extended follow up, and there was an improvement in survival and a lower incidence of heart failure. Reducing cholesterol as soon as possible therefore appears to be important.
In reviewing the outcome of clinical trials Professor Packard proposed that in order to resolve atherosclerosis LDLc should be reduced to about 1.0mmol/l. This is the level people are born with and in populations with LDLc in this range there is no coronary heart disease.
He called on the audience to; “follow the data and not the herd and we will get there in the end.”
Dietary fats and cholesterol
Professor Bruce Griffin explained how people's perception of dietary guidelines for the prevention of CVD are being strongly influenced by the outcome of recent meta-analyses (combined analyses of different types of study). For most people there is no need to restrict dietary cholesterol, UK, European and USA guidance now supports this. Certain groups however, e.g. those with FH will need to watch dietary cholesterol. What you substitute saturated fat with is important.
It is important to consider the actual foods consumed not just the nutrient category, for example plant and dairy sources of saturated fat appear better for cardiovascular health than refined meat sources. Long chain omega-3 fatty acids have proven benefits in reducing cardio metabolic risk but they should be consumed from whole fish and not supplements.
The Scientific Advisory Committee on Nutrition SACN has formed a Saturated Fat Working party and is due to report its findings in 2017-2018.
Therapeutics- what does the future hold?
Dr Kees Hovingh looked at the options for patients who fail to achieve acceptable LDL-C levels with the currently available lipid lowering drugs. There are now 3 PCSK9 inhibitors in trials which aim to establish their clinical effect in terms of CVD reduction, safety, and the consequences of prolonged exposure to very low levels of LDL-cholesterol.
Other therapies include those that have an effect on triglycerides (antisense therapy) and treatments that reduce inflammation in the artery wall.
100 000 Genome project
Professor William Newman discussed how the 100,000 Genome project was started by the NHS in order to understand new types of genetic technology which will help in diagnosing conditions and planning treatment in the future. There are three main sections to the programme, rare diseases, cancer and infectious diseases. Information can be shared nationally and internationally to help increase understanding.
The project may be useful in helping people with FH who have not been given a genetic diagnosis.
Dr Justin Rochford described the future of obesity management with therapies that can alter appetite, nutrient storage or energy expenditure. The gut flora is an interesting area of investigation and some superfoods such as blueberries are showing promising anti-obesity effects.