Well that’s 2024 drawing to a close! Traditionally we reflect back on our year and how it’s been, and I’m no different. Clearly for a great many in the world, 2024 has been a terribly difficult year and my heart goes out to them. For me it’s certainly had its challenges, but overall has been pretty good. 2022 was utterly dreadful as my daughter was incredibly ill losing 40 centiles in body weight, hospitalised, and ultimately diagnosed with coeliac disease. 2023 was all about recovery (and she made a full one) so frankly 2024 in comparison was a breeze. I am also optimistic for 2025 (having said that, I’m optimistic in pretty much every situation!)
I wanted to start by saying a huge thank you for being a Coastal Cardiology member. It was a bit of a step into the unknown developing this into a subscription-based platform, I had never done anything like it before. It takes a good few hours each week researching, planning, writing and recording, and I do hope you’ve enjoyed it, and perhaps incorporated some of the education into your daily life. Around 95% of members renewed after the first year so I guess I must be doing something right, and I really hope people are inspired to make lifestyle changes off the back of this, and feel better for it.
For today’s blog, I thought I would re-visit my favourite research videos of the year, and give you the highlights. You can, of course, see them again in full on the site.
In no particular order…
Diet
The UK Biobank is a huge data repository, linking various genetic and environmental factors of enormous numbers of people, and uses computer modelling to see how these things interact. This makes it ripe for research studies.
One of these investigated effect of diet and salt. We know that type 2 diabetes is on the rise, and that central body fat plays a role. This study was performed over 13.5 years, in 170,000 people, 40% male, average age mid 50s. They used a dietary survey, regarding pro-inflammatory diets or not. This is mostly common sense – processed foods, fatty foods, red meat, simple carbohydrates vs green leafy vegetables, olive oil, fruits and so on. They also assessed salt consumption.
6000 patients developed T2DM (4%), but the risk was 18% higher in people who followed pro-inflammatory diet. If people sometimes added salt to their food – 10% higher t2dm risk. If they usually add salt, 14% higher. If always add salt – 30% increased risk! If pro-inflammatory diet and always add salt – 60% increased risk! This was an observational not a randomised controlled trial, but nevertheless those numbers are quite frightening.
Cholesterol
Check out my cholesterol video to get a better understanding of this topic, it’s one of the most watched in the members area. In particular, I debunk the idea of ‘good’ and ‘bad’ cholesterol. I often get asked by patients that if they have a high HDL level, is that not a good thing that prevents heart attacks and strokes?
This study involved 18,000 patients who had had a heart attack (ie high risk patients) and a medication that raised HDL. There were no difference in clinical outcomes however. This mirrors other trials showing that a high HDL level per se confers no benefit. It’s all about LDL management.
Another interesting trial I presented this year was about a new therapy to improve lipids. Only last week I saw a tragic case of a man in his 50s with no conventional risk factors for heart disease, who had a big heart attack and tragically died. In the debrief with my junior doctors, I told them that one thing that always crosses my mind in this scenario is lipoprotein (a). This is a genetically inherited marker of risk, with raised levels being seen in some families who have premature coronary disease. Several studies are underway in this space, and this year reports of trials demonstrating new drugs can safely lower lipoprotein (a) levels came in. We are still some years off a licenced drug with good outcome measures, but it’s a step in the right direction.
Blood pressure
Presented at the American College of Cardiology meeting was a trial of 100 patients with high BP. This was a randomised, and all patients were already treated with tablets. The hypothesis was whether a spiritual based intervention could be of benefit. I am not talking about organised religion or belief system here, but more about how people chose to think or organise their lives. Whatsapp messaging interventions were given daily in one of four areas – forgiveness, gratitude, purpose of life, optimism, with prompts for example to reach out to someone who they felt needed forgiveness, or they were grateful to, or maybe a specific task for that person to reflect on in their life. The control group were just left to their own devices.
Measures of blood vessel function were taken which is an important part of blood pressure. The interventions lasted for 12 weeks. There was a statistically significant lowering of BP by 7mmHg. That is about the same reduction as you could get with a good amount of weight loss!
I’m a big fan of meditation and reflective practice. I came to it myself several years ago when I was having a tough time and wanted to explore other options to ‘feel well’. Although initially very sceptical, a daily meditation practice has literally changed my life and I am very grateful for it. To be clear, one doesn’t need to be religious to do this. When I finish a meditation, even a short one, I always feel calmer and better afterwards. Whilst I don’t check my BP before and after, I could well believe it is lower, and this study backs that up.
Regular strategies to improve mental health are so important in many areas of health and happiness, I simply can’t recommend this enough. They are particularly relevant in dementia, and having just spent time over Christmas with my Mum whose dementia is getting so bad now I think a dementia nursing home is on the cards in the near future, this is front and centre in my mind. She didn’t recognise her own grandchildren which is just so very sad.
Also in the blood pressure space, the new European Society of Cardiology guidelines updated the recommendations for BP management. The main takeaways are:
The target BP is 120/80, and figures up to 139/89 are now classified as ‘elevated blood pressure’. I have long argued that it makes no sense to take ‘hard’ cut-offs with risk. It makes no biological sense that risk increases linearly with rising blood pressure. It is actually log-linear, meaning the risk increases at a much higher rate as the BP rises. Why wait until someone has a BP of 160 before starting to try and get it down?
This means that there are many ‘at risk’ people wandering around thinking that because they do not meet the criteria for hypertension they are ‘ok’. These new guidelines challenge that assumption, and agree with what I’ve been saying for years! Now I’m definitely not saying these people all need medication, far from it, but I do believe lifestyle measures should be there for all (see the meditation section above!). For the rest of the recommendations, do see the video from 8thSeptember.
The final group of trials I wanted to write about were concerning the ‘weight-loss wonder drugs’ or GLP-1 agonists, such as Ozempic and Wegovy. However, I’ve written an awful lot already, and this is such a big topic, I figured I’ll do a whole section on it next week.
Thanks again for taking the time to read my posts each week and watch my videos, it means a lot. Wishing you a happy and successful new year.