    * Around nine in ten Australian adults had at least one risk factor
    * Poor diet and physical inactivity were the most prevalent risk factors
    * Regardless of age, people were most likely to have two risk factors
    * People in the most disadvantaged socioeconomic group were more likely to have three or more risk factors
    * People who had more risk factors were also more likely to report even having had a heart attack, stroke, angina or atherosclerosis – independent of age and sex

Most common sustained cardiac arrhythmia and a major cause of illness and death in our community It is a major cause of hospital admissions. AF significantly increases risk for stroke.

Prevalence: Less than 1% in young adults, but approximately 10% in those aged 80 and above

Butter or Margarine

The National Heart Foundation recommends margarine or other vegetable oil spreads, while national dietary guidelines recommend unsaturated margarines made from canola, sunflower, safflower or olive oil. Even the best dairy blends contain more saturated fat than other spreads. All margarines with the NHF tick have been independently tested to ensure they have a maximum of just one percent of total fat as trans fat.
Buy a low-salt option whenever you can. Whatever you choose, spread it sparingly and use vegetable or olive oil rather than margarine or butter for frying.

Cardiac Resynchronization Therapy (CRT)

is indicated in patients stable on optimal medical therapy that have:

moderate to severe heart failure (NYHA Class III-IV),
QRS >130ms and
LV ejection fraction <35%

CRT in randomized clinical trials has been shown to:

improve quality of life and functional capacity, with persistence through 1 year,
reduce mortality and heart failure and
improve cardiac function and structure

Notes from Dr Bruno Martin, Cabrini Conference, July, 2007

Child obesity

Cholesterol management - Statins

Heart Failure incidence and prevalence

Obstructive Sleep Apnoea (OSA )

Obstructive sleep apnoea (OSA) has been clearly linked to accelerated cardiovascular disease and death. The injurious mechanisms by which OSA leads to accelerated cardiovascular disease and heart failure relate to: increased mechanical work, raised sympathetic activity, hypoxia, coagulability and endothelial dysfunction. These injurious effects of OSA include: hypertension in a dose dependent manner; accelerated ischaemic heart disease, nocturnal and daytime arrhythmias, vascular dysfunction and raised coagulability, and increased incidence of stroke. These are independent of coexisting diabetes, obesity and smoking history
* 17% of all motor vehicle accidents are related to OSA
* 43cm collar size + history of Hypertension = OSA
Notes from Dr Peter Solin’s talk on OSA and it’s relationship with cardiac disease
Cabrini Conference, July 2007

Recommendations for device-based treatment of symptomatic chronic heart failure(CHF)

Biventricular pacing (cardiac resynchronisation therapy - CRT), with or without implantable cardioverter defibrillator, should be considered in patients with CHF who fulfil each of the following criteria:

    * NYHA symptoms class iii-iv on treatment
    * Dilated heart failure with LVEF <35%
    * QRS duration > 120ms
    * Sinus rhythm (1)

Implantable cardioverter defibrillator (ICD) implantation should be considered in patients with CHF who fulfil any of the following criteria:

    * Survived cardiac arrest resulting from ventricular fibrillation or ventricular tachycardiac not due to a transient or reversible cause
    * Spontaneous sustained VT in association with structural coronary heart disease
    * LVEF <30% measured at least 1 month after acute myocardial infarction or 3 months after coronary artery revascularisation surgery
    * Symptomatic CHF (NYHA functional class ii-iii) and LVEF <35% (2)

Reduce cardiac mortality by 27%!!!!

Risk of AMI

The chance of a 45 year old female getting to 75 years of age without an AMI is one in three.

For a 45 year old male, it is one in two!!

Also -

"Renal disease = small and large vessel heart disease"

Professor Ian Meredith, Interventional Cardiologist, MMC, Feb 2007

Smoking - Quiting smoking is difficult

Only 5% of smokers contact Quitline whereas 40% of smokers make a quit attempt per year

Time delay to treatment and mortlaity in AMI

For every 30 minute delay in having coronary artery opened up, there is an increase in one year mortality by 7.5%

Ref: De Luca G, Circulation, 2004: 109; 1223 - 25

a) Two types of biological:

* autograft: one taken from another site in the patient (eg saphenous vein graft)
* allograft: one taken from another animal of the same species (also known as homograft)

b) Synthetic: Dacron graft: manufactured from polytetrafluoethylene

Most common problems with vascular grafts:

    * graft occlusion
    * graft infection - rare (1 - 2%)
    * true or false aneurysm at site of anastomosis
    * distal embolism or
    * erosion into adjacent structures eg aortic-enteric fistula

Link: www.surgical.tutor.org.uk

1 Did you know....? Australians with multiple risk factors for cardiovascular disease

    * Around nine in ten Australian adults had at least one risk factor
    * Poor diet and physical inactivity were the most prevalent risk factors
    * Regardless of age, people were most likely to have two risk factors
    * People in the most disadvantaged socioeconomic group were more likely to have three or more risk factors
    * People who had more risk factors were also more likely to report even having had a heart attack, stroke, angina or atherosclerosis –

independent of age and sex

Ref: 2001 National Health Survey

2 Did you know...?Atrial Fibrillation
Most common sustained cardiac arrhythmia and a major cause of illness and death in our community

It is a major cause of hospital admissions.

AF significantly increases risk for stroke

Prevalence: Less than 1% in young adults, but approximately 10% in those aged 80 and above

Identifiable causes of AF:

    * Hypertension
    * Coronary Heart Disease
    * Valvular Heart Disease
    * Cardiomyopathy/CHF
    * Pericarditis
    * Pulmonary Embolism
    * Alcohol excess
    * No identifiable cause - also known as "lone AF": 2 - 30% - ?genetic cause - get a good family history!

Notes from lecture by A/Professor Diane Fatkin, Molecular Cardiology, Victor Chang Cardiac Research Institute, Sydney, NSW

3 Did you know....? Smokefree bars and clubs prompt rise in weekend quitters
In the three months since the July 1 smoking bans, weekend calls to the Victorian Quitline have jumped by almost 20%, compared with the

number of people calling for advice on kicking the habit on the weekends in the three months prior to the bans.

Almost 800 people have called the Quitline on either Saturday or Sunday in the last three months.

Media Release, Quit Victoria, October, 2007

4 Did you know...? Motivating Behaviour Change
Motivation is a state of readiness for change, rather than a personality trait

Motivating Behaviour Change

Helping patients achieve lifestyle change is more difficult than JUST telling them what to do - success will depend on an interaction between

some or all of these factors:

    * Their emotions: confidence, self-efficacy, depression, anxiety, optimism
    * Their previous experiences of trying to change – success or failure
    * Their beliefs, knowledge and attitudes – causes, cures, safety
    * Their skills in change – knowing how to change
    * Their environment – smokefree, opportunity to exercise safely
    * How many other problems they have to face

Motivators = all those forces that encourage patients to change

Notes from Bob Lewin, ACRA Conference, Hobart, August 2007

5 Did you know...? Greying popluation
"80 percent of people over 65 have three or more chronic health conditions"

comments by Tony McBride, Health Issues Centre chief executive

The Age, Nov 9, 2007

Did you know....? Prevention is better than cure
The Australian Institute of Health and Welfare figures show that federal and state governments in 2005-06 spent $1.4 billion on preventative

health (which includes immunisations, education and cancer screening) out of a total government recurrent spending on health of $55.1 billion.

Dr Tony Hobbs, chairman of the Australian General practice Network says "Take for instance, obesity. Between 20 and 25 percent of the

population is obese, and more than half is overweight. If current trends continue, health experts estimate about 80 percent of adults and a

third of children could be overweight or obese by 2020. Yet people who are obese can't get a Medicare-funded referral from a GP to see a

health professional such as a dietitian to help them lose weight. They can only get one if they have another chronic condition, such as diabetes.

The policy means people can't get a Medicare referral to help them lose weight until they have a more complex and expensive medical

problem".

The Age, Nov 9, 2007 page 8
Did you know....? New Targets for Smoking rates
Currently 17.5% of adult Australians smoke - the target is to reduce this rate to 14% by the year 2013

The State Government has announced an extra $5.5 million for tobacco control strategies

Quit Victoria will be doubling their TV advertisements as this medium is clearly the most effective aid in getting people to stop smoking.

Suzie Stillman, Deputy Director, Quit Victoria, November, 2007
Did you know...? Urban myths in Cardiology
Urban myths in cardiology

by ESC Congress News Correspondent: Janet Fricker

HARDLY a week goes by without a new study linking diet to heart disease. The studies are enormously contradictory – some show

causative effects, others protective, and this creates huge confusion. Here our experts guide you through some of the current urban myths in

cardiology.

Another cup of coffee?

Different studies have associated coffee with both cardiovascular risks and benefits. Coffee contains more than 1000 different biologically

active substances; some (like caffeine) are detrimental to the heart, while others (like antioxidants) are protective.

Study design seems to influence results, explains Ahmed El-Sohemy, Canada Research Chair in Nutrigenomics (University of Toronto,

Canada). Case-control studies have shown that increased coffee consumption was associated with an increased risk of coronary heart

disease (CHD), while prospective cohort studies have shown either no effect or a protective effect for moderate intakes. “Such discrepancies

suggest that coffee may have acute effects on the risk of CHD, which are revealed in case-control studies, but obscured in cohort studies by

the time lag between exposure assessment and outcome,” says El-Sohemy.

The method of coffee preparation appears to be important. Boiled (unfiltered) coffee raises serum cholesterol levels to a greater extent than

filtered coffee. The cholesterolraising factors have been identified as the diterpenes, substances that are extracted by hot water but retained by

filter paper, neatly explaining why filter coffee does not affect cholesterol. Coffee may protect against type 2 diabetes, a risk factor for CHD.

Coffee contains the antioxidant chlorogenic oxide, which can inhibit the glucose-6-phosphatase system and decrease intestinal absorption of

glucose.

The way the body metabolises caffeine may affect CHD risk. In a recent study El-Sohemy and colleagues showed that coffee was associated

with an increased risk of nonfatal MI among individuals with slow caffeine metabolism, but not among fast metabolisers. Caffeine is

metabolised by the polymorphic cytochrome P450 1A2 (CYP1A2) enzyme, and people who are homozygous for the CYP1A2*1A allele

are "rapid" caffeine metabolisers, whereas carriers of the variant CYP1A2*1F are "slow" metabolisers.

Eggs unscrambled

The popular belief is that cholesterol in the diet is automatically translated into cholesterol in the blood, which is then laid down in the coronary

arteries. Since eggs represent the richest source of dietary cholesterol, with a yolk containing between 50 and 250 mg cholesterol, they have

taken much of the rap for the adverse effects of dietary cholesterol. New evidence suggests this reputation is unjustified.

Studies by Henry Ginsberg in the 1990s showed that men who ate up to four eggs a day increased their total serum cholesterol by 0.038

mmol/L per 100 mg of added dietary cholesterol, and that women increased their total serum cholesterol by 0.073 mmol/L per 100 mg of

added dietary cholesterol.

In 1999 researchers from the Harvard School of Public Health found no relationship between egg consumption and cardiovascular disease

when they followed 80,000 women for more than 14 years in the Nurses’ Health Study and almost 38,000 men for eight years in the Health

Professionals Follow-up Study. One egg per day, the authors concluded, had no impact on heart disease risk.

In addition, since eggs are low in calories, yet have a high satiety index, they may offer an effective approach to weight loss.

Many earlier studies showing links between dietary cholesterol and blood cholesterol were confounded by the fact that dietary cholesterol

and saturated fat frequently occur together in the diet, making it difficult to distinguish between their individual effects.

ed wine or white?

Regular consumption of red wine has been suggested as the explanation for the "French paradox", whereby French people have a relatively

low incidence of coronary atherosclerosis compared to other Western populations with identical smoking habits and lifestyles.

A Lancet report by Renaud and De Lorgeril noted that the annual mortality rate per 100,000 population from CHD was 78 in Toulouse,

France, compared to 348 in
Belfast, UK, and 380 in Glasgow, UK, despite similar intakes of saturated fat. Analysing 17 countries, Renaud and De Lorgeril found that

wine was the only foodstuff to show a negative correlation with mortality, indicating a protective effect. When this news appeared on 60

Minutes in the US in 1991, red wine drinking increased by 44% and some wineries began lobbying for the right to label their products “health

food”.

Subsequent observational studies have shown consistent reductions in all-cause mortality among red wine drinkers. A number of mechanisms

have been suggested - that alcohol increases HDL cholesterol, that alcohol inhibits platelet aggregation, and most recently that polyphenols in

red wine activate a receptor on the surface of platelets, called PECAM-1, which inhibits platelet aggregation and thus prevents further

thrombus growth.

“While observational studies have shown an association, this does not prove cause and
effect,” says Dylan de Lange from the Thrombosis and Haemostasis Laboratory, Utrecht, the Netherlands. The current debate centres on

whether the “French Paradox” is because of components of the wine, or the result of confounding factors, such as the lifestyle of wine

drinkers. Factors other than alcohol or red wine may have an influence on mortality - red wine consumers may buy healthier food products,

while the “sick quitter phenomenon”, where abstainers have a higher all-cause mortality, may include people who stopped drinking because of

health problems. One study showed that 27 out of 30 cardiovascular risk factors were
more prominent in abstainers than in consumers of alcohol.

“What’s needed to resolve the issue is a double-blind placebo controlled trial with solid end-points, such as MI and death,” says de Lange.

“But how do you blind a trial in which people have to drink alcohol? It’s easy to distinguish between a glass of red wine and a glass of grape

juice.” He sees the only way forward as conducting a trial using polyphenols, “but, before we can do this trial, issues need to be resolved

around
bioavailability, and the best combinations of polyphenols.”

Omega-3 fatty acids

Interest in omega-3 fatty acids was first sparked in the 1970s when studies by Bang and Dyerberg showed that the Greenland Inuit, who

consumed a diet rich in oily fish, had an exceptionally low incidence of cardiovascular disease compared to other populations. These basic

observations about omega-3 fatty acids – a specific type of polyunsaturated fat found in fatty fish (such as wild salmon, sardines and

mackerel)and plant food sources (such as flax, walnuts and canola oil) – spawned hundreds of other studies.

The strongest evidence for a beneficial effect comes from the Gruppo Italiano per lo Studio della Sopravvivenza nell’Infarto miocardico

(GISSI)-Prevezione study, in which 5654 patients with coronary artery disease were randomised to either omega-3 fatty acids (850 mg/d) or

usual care. After 3.5 years, those taking the omega-3 fatty acids had experienced a 20% reduction in overall mortality and a 45% decrease in

risk for sudden cardiac death. Subsequent metaanalyses have shown a favourable effect of fish fatty acids on stroke and fatal coronary heart

disease.

Further evidence suggests omega-3 fats have anti-arrhythmic effects (including reventing atrial fibrillation), anti-thrombotic actions, anti-

atherogenic effects, antiinflammatory effects and the ability to lower blood pressure and improve endothelial function.

However, last year doubts were cast after the publication of a systematic review by Lee Hooper and colleagues from the University of East

Anglia (Norwich, UK). The study – which included 48 randomised control trials and 41 cohort studies – found no strong evidence for a

reduction in combined cardiovascular events in patients taking omega-3.

The authors, however, acknowledged that the inclusion of an observational study by Burr and co-workers advising 3000 men with stable

angina to eat oily fish or take fish oil supplements was largely responsible for the net neutral effect.

A number of explanations have been offered as to why the angina study produced conflicting results. “It could be because the very long

follow-up brought out the harmful effects of methylmercury, a fat soluble toxicant found in oily fish that is known to increase risks of MI,”

suggests Marika Massaro, a nutrition researcher from
Institute of Clinical Physiology of the National Council of Research (Italy).

Marianne Geleijnse, a nutritionist and epidemiologist from Wageningen University Netherlands), believes that there may also be a biological

explanation since the study was undertaken in angina patients who may be different from other patients. She said it was significant that the

study suffered from several logistical problems and did not differentiate between fish and fish oil supplements.

To resolve the issue, Geleijnse and colleagues are undertaking a double-blind andomised placebo-controlled trial, where coronary patients

are being randomised to margarine with or without fish oil. In the meantime, people are recommended to eat at least two servings of oily fish

per week.

In Italy, says Massaro, the results of GISSI are thought so convincing that omega-3 is
now prescribed as secondary prevention treatment for patients who have suffered an MI.

Did you know...? Maintaining successful weight loss
Personal contact is best strategy for maintaining successful weight loss

Regular personal contact with a health care professional, even by phone, is more effective than other approaches to long-term maintenance of

a stable body weight after successful weight loss.

Source: Svetkey, L. et al. JAMA 2008; 299: 1139-1148.
Did you know...? Acute Management of Chest Pain
Acute management of chest pain

· People experiencing symptoms of an Acute Coronary Syndrome (ACS) should seek help promptly and activate emergency medical

services.

· The most important initial need is access to a defibrillator to avoid early cardiac death resulting from reversible arrhythmias.

· Aspirin should be given early (ie, by emergency or ambulance personnel) unless already taken or contraindicated.

· Oxygen should be given, as well as glyceryl trinitrate and intravenous morphine as required.

· As a minimum, medical facilities receiving patients should be given warning of incoming patients in whom there is a high suspicion of an

ACS — particularly ST-segment-elevation myocardial infarction (STEMI) — or whose condition is unstable.

· Where appropriate, a 12-lead electrocardiogram (ECG) should be taken en route and transmitted to a medical facility.

· Where formal protocols are in place, prehospital treatment (including fibrinolysis in appropriate cases) should be facilitated.

Ref: Guidelines for the management of acute coronary syndromes, 2006, National Heart Foundation and The Cardiac Society of Australia

and New Zealand

Did you know...? Exercise and CHD.
Exercise can reduce the risk of CHD posed by elevated BMI, but not eliminate it

Researchers have shown that the risk of coronary heart disease (CHD) associated with elevated body mass index (BMI) can be reduced

considerably with the inclusion of regular physical activity; however, the risk cannot be eliminated completely, even with high levels of activity.

It is now well established that obesity and physical inactivity independently increase the risk of CHD; however, little is known about the

combined effect of physical activity and body weight on morbidity and mortality. Weinstein et al. conducted a prospective cohort study

among a cohort of women to investigate the relationship of physical activity and BMI to determine if physical activity can reverse the

deleterious effects of elevated BMI.

A total of 38,987 women aged =45 years, who were free of cardiovascular disease, cancer and diabetes at baseline were included into the

study. Normal weight was defined as BMI <25, a BMI of 25–29 was deemed overweight, and BMI =30 was defined as obese. Women

who expended in excess of 1000 kilocalories by way of recreational activities in a given week were defined as ‘physically active’. Six

combined body weight–physical activity categories were established for analysis. The main outcome measure was the occurrence of incident

CHD during the follow-up period (mean follow-up of 10.9 years). Incident CHD referred to a cardiovascular event including nonfatal

myocardial infarction, coronary artery bypass graft, percutaneous luminal coronary angioplasty, or CHD-related death.

During follow-up 948 cases of incident CHD occurred. As expected, raised BMI and reduced levels of physical activity were found to

independently increase the risk of CHD.

Importantly, the results showed that physical activity did attenuate the risk of CHD. The results strongly supported the current guidelines

which recommend at least 30 minutes of moderate activity per day. Furthermore, the study results suggested that more than 30 minutes of

physical activity per day could further reduce the risk of CHD. However, even extremely high levels of exercise could not completely

eliminate the excess risk of CHD among overweight or obese women without concurrent weight loss.

The authors concluded that the risk of CHD associated with BMI in CHD is significantly reduced by the inclusion of physical activity.

“Regardless of body weight, these data highlight the importance of counselling all women to participate in increasing amounts of regular

physical activity and maintaining a healthy weight to reduce the risk of CHD,” they stated.

Reference

Weinstein, A. Sesso, H. et al. 2008, ‘The joint effects of physical activity and body mass index on coronary heart disease risk in women’

Arch Intern Med; 168: 884–890.

Did you know...? Fish Oils
About five years ago, the American Heart Association Nutrition Committee issued its position statement that all patients with CHD ought to

have the equivalent of 1 g of combined EPA and DHA, i.e. a fish-oil supplement. The National Heart Foundation of Australia will later this

year be disseminating detailed recommendations and a literature review supporting a similar statement.

In addition, fish oil is effective in lowering triglycerides with a similar efficacy to fibrates. Fish oil decreases risk of sudden death following a

myocardial infarction and, at high dose, further infarctions.. Sterol-enriched foods and foods high in fibre lower LDL effectively.

Ref: Professor David Colquhoun, Associate Professor of Medicine, University of Queensland, and Cardiologist at Wesley Medical Centre as

published in Complimentary Medicine, March/April 2008 pg 5

Did you know....? Coronary Artery Spasm
Coronary Artery Spasm

    * First description by Prinzmetal et al. in 1959
    * "exaggerated contractile response of epicardial coronary artery smooth muscle to various stimuli"
    * 60% superimposed on fixed coronary lesions

Clinical characteristics:

    * younger age than obstructive CAD
    * Japanese > Caucasian (diffuse and multi-vessel in Japanese v focal in Caucasians)
    * Smoker/cocaine
    * associations: Raynaud's, Migraine, Kawasaki
    * episodes occur at rest and between midnight and early morning
    * exercise and hyperventilation can be precipitants
    * ECG: ST segment elevation characteristic +/- wave changes over days
    * Arrhythmias common (20 - 50%)
          o # LAD - VT,
          o #RCA - heart block

Notes by Dr Andrew Ajani, Cardiologist, Director of CCU, RMH

Did you know...? How to correctly measure a standard drink
The recent National Drug Research Institute study on alcohol consumption revealed that wine drinkers were consuming up to twice as much

alcohol as they thought.

Drinkers were asked to estimate the number of standard drinks they consumed in a week and were then allowed to pour their "normal" drink.

Participants underestimated the measure anywhere from 10% to 100%.

In response, the Federal Government is reportedly introducing mandatory standard drink logos and education.

So, what is a standard drink?

A standard drink contains 10 grams of pure alcohol or ethanol. Depending on the level of alcohol, a standard drink can vary, but for most

table wines a standard drink is somewhere around 100-12 millilitres.

A standard drink, as seen on wine bottles, is calculated on the size of the container and the percentage of alcohol.

A 750-mililitre bottle of wine with 12.5% alcohol is calculated this: 0.75 x 12.5 x 0.789 (specific gravity of ethanol) = 7.39 standard drinks

(or 7.4 when rounded off)
Did you know...? Rates of smoking and education level
Rates of Smoking and education level

Australians >18 years of age who smoke:

    * Finished tertiary education: 11.8%
    * Year 12/some tertiary education: 18.7%
    * Year 11 or less: 21%

Also,

* Smoking is an indicator of, and possible cause of, downward social mobility
* However, those from a low socio-economic status (SES) have not shown a disadvantage in the ability to quit

Smoking causes (in middle age) 1/3 of all death:

* 20% among high SES, and
* ~40% among low SES

Sianpush et al (2006) Vic Health Centre for Tobacco Control

notes from Ron Borland PhD

Vic Heatlh Centre for Tobacco Control

Did you know....? Cultural Diversity in Victoria
Cultural Diversity in Victoria

    * 44% of Victorians were either born overseas or have at least one parent born overseas
    * 20% of Victorians speak a language other than English at home
    * One in four migrants to Australia live in Victoria
    * One in five University students is an international student (in 2006)
    * We speak more than 150 languages and practise more than 100 faiths.

Population Diversity in Local Councils, 2006 Census
Did you know...? ICD - shocks while driving
Very low risk from ICD shocks while driving

Patients with an Implantable Cardioverter Defibrillator (ICD) have a very low risk of receiving a shock while driving and only one in 25,000

chance of a shock in the subsequent hour, according to data from the Triggers of Ventricular Arrhythmias (TOVA) study

Reference: Albert C et al, Journal of the American College of Cardiology, 2007; 50: 2233 – 2240

Did-you-know ... ?

Contents:

Australians with multiple risk factors for cardiovascular disease

Butter or Margarine

Cardiac Resynchronization Therapy (CRT)

is indicated in patients stable on optimal medical therapy that have:

Child obesity

Cholesterol management - Statins

Heart Failure incidence and prevalence

Notes from Dr Meroula Richardson’s talk, Cabrini Conference, July 2007

Identifiable causes of AF:

* Hypertension * Coronary Heart Disease * Valvular Heart Disease * Cardiomyopathy/CHF * Pericarditis * Pulmonary Embolism * Alcohol excess * No identifiable cause - also known as "lone AF": 2 - 30% - ?genetic cause - get a good family history!

Notes from lecture by A/Professor Diane Fatkin, Molecular Cardiology, Victor

Chang Cardiac Research Institute, Sydney, NSW

Metabolic Syndrome

A clustering of risk factors (hyperglycaemia, hypertension, hypertriglyceridaemia, low levels of high-density lipoprotein(HDL) cholesterol, and overweight/obesity) identified as 'metabolic syndrome" has gained widespread recognition.

MetS is strongly associated with an increased risk of Type 2 Diabetes and CVD

According to the International Diabetes Federation criteria, 29.1% of Australians over the age of 25 have metabolic syndrome

Ref: Albert KG, Zimmet PZ, Shaw J. Metabolic Syndrome - a new world-wide

definition: A consensus statement from the International Diabetes

Federation, Diabet Med 2006; 23: 469-80

OBESITY

Obstructive Sleep Apnoea (OSA )

Recommendations for device-based treatment of symptomatic chronic heart failure(CHF)

Reduce cardiac mortality by 27%!!!!

Risk of AMI

The chance of a 45 year old female getting to 75 years of age without an AMI is one in three.

For a 45 year old male, it is one in two!!

Also -

"Renal disease = small and large vessel heart disease"

Professor Ian Meredith, Interventional Cardiologist, MMC, Feb 2007

Smoking - Quiting smoking is difficult

Time delay to treatment and mortlaity in AMI

For every 30 minute delay in having coronary artery opened up, there is an increase in one year mortality by 7.5%

Ref: De Luca G, Circulation, 2004: 109; 1223 - 25

a) Two types of biological:

* autograft: one taken from another site in the patient (eg saphenous vein graft) * allograft: one taken from another animal of the same species (also known as homograft)

b) Synthetic: Dacron graft: manufactured from polytetrafluoethylene

Most common problems with vascular grafts:

* graft occlusion * graft infection - rare (1 - 2%) * true or false aneurysm at site of anastomosis * distal embolism or * erosion into adjacent structures eg aortic-enteric fistula

Link: www.surgical.tutor.org.uk

1 Did you know....? Australians with multiple risk factors for cardiovascular disease

independent of age and sex

Ref: 2001 National Health Survey

2 Did you know...?Atrial FibrillationMost common sustained cardiac arrhythmia and a major cause of illness and death in our community

It is a major cause of hospital admissions.

AF significantly increases risk for stroke

Prevalence: Less than 1% in young adults, but approximately 10% in those aged 80 and above

Identifiable causes of AF:

* Hypertension * Coronary Heart Disease * Valvular Heart Disease * Cardiomyopathy/CHF * Pericarditis * Pulmonary Embolism * Alcohol excess * No identifiable cause - also known as "lone AF": 2 - 30% - ?genetic cause - get a good family history!

Notes from lecture by A/Professor Diane Fatkin, Molecular Cardiology, Victor Chang Cardiac Research Institute, Sydney, NSW

3 Did you know....? Smokefree bars and clubs prompt rise in weekend quittersIn the three months since the July 1 smoking bans, weekend calls to the Victorian Quitline have jumped by almost 20%, compared with the

number of people calling for advice on kicking the habit on the weekends in the three months prior to the bans.

Almost 800 people have called the Quitline on either Saturday or Sunday in the last three months.

Media Release, Quit Victoria, October, 2007

4 Did you know...? Motivating Behaviour ChangeMotivation is a state of readiness for change, rather than a personality trait

Motivating Behaviour Change

Helping patients achieve lifestyle change is more difficult than JUST telling them what to do - success will depend on an interaction between

some or all of these factors:

Motivators = all those forces that encourage patients to change

Notes from Bob Lewin, ACRA Conference, Hobart, August 2007

5 Did you know...? Greying popluation"80 percent of people over 65 have three or more chronic health conditions"

comments by Tony McBride, Health Issues Centre chief executive

The Age, Nov 9, 2007

Did you know....? Prevention is better than cureThe Australian Institute of Health and Welfare figures show that federal and state governments in 2005-06 spent $1.4 billion on preventative

health (which includes immunisations, education and cancer screening) out of a total government recurrent spending on health of $55.1 billion.

Dr Tony Hobbs, chairman of the Australian General practice Network says "Take for instance, obesity. Between 20 and 25 percent of the

population is obese, and more than half is overweight. If current trends continue, health experts estimate about 80 percent of adults and a

third of children could be overweight or obese by 2020. Yet people who are obese can't get a Medicare-funded referral from a GP to see a

health professional such as a dietitian to help them lose weight. They can only get one if they have another chronic condition, such as diabetes.

The policy means people can't get a Medicare referral to help them lose weight until they have a more complex and expensive medical

problem".

The Age, Nov 9, 2007 page 8 Did you know....? New Targets for Smoking ratesCurrently 17.5% of adult Australians smoke - the target is to reduce this rate to 14% by the year 2013

The State Government has announced an extra $5.5 million for tobacco control strategies

Quit Victoria will be doubling their TV advertisements as this medium is clearly the most effective aid in getting people to stop smoking.

Suzie Stillman, Deputy Director, Quit Victoria, November, 2007 Did you know...? Urban myths in CardiologyUrban myths in cardiology

by ESC Congress News Correspondent: Janet Fricker

HARDLY a week goes by without a new study linking diet to heart disease. The studies are enormously contradictory – some show

causative effects, others protective, and this creates huge confusion. Here our experts guide you through some of the current urban myths in

cardiology.

* Hypertension
* Coronary Heart Disease
* Valvular Heart Disease
* Cardiomyopathy/CHF
* Pericarditis
* Pulmonary Embolism
* Alcohol excess
* No identifiable cause - also known as "lone AF": 2 - 30% - ?genetic cause - get a good family history!

* autograft: one taken from another site in the patient (eg saphenous vein graft)
* allograft: one taken from another animal of the same species (also known as homograft)

* graft occlusion
* graft infection - rare (1 - 2%)
* true or false aneurysm at site of anastomosis
* distal embolism or
* erosion into adjacent structures eg aortic-enteric fistula

2 Did you know...?Atrial Fibrillation
Most common sustained cardiac arrhythmia and a major cause of illness and death in our community

* Hypertension
* Coronary Heart Disease
* Valvular Heart Disease
* Cardiomyopathy/CHF
* Pericarditis
* Pulmonary Embolism
* Alcohol excess
* No identifiable cause - also known as "lone AF": 2 - 30% - ?genetic cause - get a good family history!

3 Did you know....? Smokefree bars and clubs prompt rise in weekend quitters
In the three months since the July 1 smoking bans, weekend calls to the Victorian Quitline have jumped by almost 20%, compared with the

4 Did you know...? Motivating Behaviour Change
Motivation is a state of readiness for change, rather than a personality trait

5 Did you know...? Greying popluation
"80 percent of people over 65 have three or more chronic health conditions"

Did you know....? Prevention is better than cure
The Australian Institute of Health and Welfare figures show that federal and state governments in 2005-06 spent $1.4 billion on preventative

The Age, Nov 9, 2007 page 8
Did you know....? New Targets for Smoking rates
Currently 17.5% of adult Australians smoke - the target is to reduce this rate to 14% by the year 2013

Suzie Stillman, Deputy Director, Quit Victoria, November, 2007
Did you know...? Urban myths in Cardiology
Urban myths in cardiology

France, compared to 348 in
Belfast, UK, and 380 in Glasgow, UK, despite similar intakes of saturated fat. Analysing 17 countries, Renaud and De Lorgeril found that

“While observational studies have shown an association, this does not prove cause and
effect,” says Dylan de Lange from the Thrombosis and Haemostasis Laboratory, Utrecht, the Netherlands. The current debate centres on

health problems. One study showed that 27 out of 30 cardiovascular risk factors were
more prominent in abstainers than in consumers of alcohol.