A statin a day keeps the doctor away: comparative proverb assessment modelling study. Adam D M Briggs, academic clinical fellow, Anja Mizdrak, researcher, Peter Scarborough, senior researcher. BHF Health Promotion Research Group, Nuffield Department of Population Health, University of Oxford, Headington, Oxford OX3 7. LF, UKCorrespondence to: A D M Briggs adam. The modelling used routinely available UK population datasets; parameters describing the relations between statins, apples, and health were derived from meta- analyses. Main outcome measure Mortality due to vascular disease. Results The estimated annual reduction in deaths from vascular disease of a statin a day, assuming 7. L reduction in low density lipoprotein cholesterol, is 9. The equivalent reduction from an apple a day, modelled using the PRIME model (assuming an apple weighs 1. Conclusions Both nutritional and pharmaceutical approaches to the prevention of vascular disease may have the potential to reduce UK mortality significantly. With similar reductions in mortality, a 1. Introduction“An apple a day keeps the doctor away,” a public health message delivered by parents and teachers since the 1. Victorian health promotion can truly stand the test of time, whereas other Victorian practices—such as the use of leeches in primary care—have fallen away. Today in the United Kingdom, lifestyle changes (such as increasing levels of physical activity or changing diet) are the recommended first step for primary prevention of vascular disease. Increasingly, however, calls are being made for greater use of drugs in primary prevention, perhaps the best known example being Wald and Law proposing the polypill in 2. In the UK, the only drug class recommended for primary prevention at a population level is the hydroxymethyl glutaryl coenzyme A reductase inhibitors, or statins, and this is only for people at 2. Recent meta- analyses have indicated similar relative benefits to patients with a five year risk of a major vascular event of less than 1% to those at greater than 2. This has led to calls to use statins for cardiovascular disease prevention at the population level, particularly for people aged 5. We set out to test how almost 1. Victorian wisdom might compare with the more widespread use of statins in primary prevention. We modelled the effect on vascular mortality of prescribing everybody in the UK over 5. Malus domestica) a day or a statin a day, estimated the number of adverse events, and compared the subsequent drug, or fruit, costs. Methods. Data on the effect on vascular mortality (any stroke, cardiac death, or other vascular death) of the UK population of a statin a day came from the Cholesterol Treatment Trialists’ meta- analysis, which found that reducing cholesterol with a statin reduces the relative risk of vascular mortality by 1. Heart Month 2017: Here. With February declared Heart Month, many countries and organisations around the world. L reduction in low density lipoprotein cholesterol and that on average this is reduced by 1. L over a year of treatment. We applied this annual reduction to age and sex specific vascular mortality rates for the UK population aged 5. Health Survey for England (stratified by sex and five year age categories, with age and sex specific statin uptake for Scotland, Wales, and Northern Ireland assumed to be the same as for England). We assumed 7. 0% compliance on a conservative basis; this was the lower of the two compliance values reported by Taylor et al in their recent Cochrane review (7. We calculated the reduction in deaths from vascular disease as the difference between the number of vascular deaths in the population not taking statins, using current age and sex specific mortality rates, and the number of deaths when assuming the new mortality rates.
We calculated 9. 5% credible intervals by applying the 9. Cholesterol Treatment Trialists of 9% to 1. We modelled the effect on vascular mortality (cerebrovascular disease, ischaemic heart disease, heart failure, and abdominal aortic aneurysm) of an apple a day on the entire UK population aged 5. PRIME, a widely published comparative risk assessment model (see web appendix for more details). This uses meta- analyses of studies to parameterise the relation between a wide range of nutritional factors (g/day of fruit, vegetables, salt, and fibre; percentage of total energy derived from total fat, monounsaturated fatty acids, polyunsaturated fatty acids, saturated fatty acids, trans fatty acids, and dietary cholesterol; and total energy intake in kcal/day) and chronic disease mortality. On a conservative basis, we assumed apples to weigh 1. Baseline population diet and the nutritional composition of apples came from the Living Costs and Food Survey 2. We assumed the effect on health of consuming an extra apple a day to be the same irrespective of baseline apple consumption, as described in the underlying meta- analyses describing the relations between fruit and vegetable consumption and cardiovascular disease. We assumed compliance to be 7. We calculated 9. 5% credible intervals by using 5. Monte Carlo analysis to account for the variation in parameters describing the relations between different dietary components and mortality from cerebrovascular disease, ischaemic heart disease, heart failure, and abdominal aortic aneurysm (see web appendix for additional information on PRIME). Table 1 Nutritional composition of 1. We modelled side effects of statins by using the Cholesterol Treatment Trialists’ reports of statins leading to an excess incidence of myopathy of 0. We applied these to the extra population aged over 5. No side effects were modelled for increased apple consumption; aside from the distress caused by a bruised apple, and the theoretical risk of identifying half a worm inside, apple related adverse events are not widely recognised. People with an apple allergy could be prescribed an alternative less allergenic fruit with similar health benefits. We obtained costs of statins from the British National Formulary,1. The cost of an apple came from the Department for Environment, Food and Rural Affairs’ weekly fruit and vegetable prices for the cheapest variety of dessert apple (assuming the NHS would want to purchase at the lowest price) of 4. No costs were estimated for general practice appointments or the management of any side effects. Sensitivity analyses investigated the effect of prescribing statins or apples to everybody over 3. QRISK2- 2. 01. 1 scoring system is validated to predict 1. Results. We estimate that 5. UK, with an extra 1. Assuming 7. 0% compliance, offering statins to 1. MSN Health and Fitness has fitness, nutrition and medical information for men and women that will help you get active, eat right and improve your overall wellbeing. To My Mom On Her Special Day. From the moment I came into this world, you gave to me your heart and soul. You give up all the time you have to yourself just to show. Diet, Serum Cholesterol, and Death from Coronary Heart Disease . Shekelle, Ph.D., Anne MacMillan Shryock, R. Max Factor launches its new super-foundation All Day Flawless 3-in-1 Foundation. Boasting brand new technology it was developed for women who want their. Table 2. Prescribing statins to everyone over the age of 5. The total extra cost of statin treatment from the drug alone is estimated at . The number of adverse events is predicted to double to 2. The cost of statins would be . If compliance with apple prescriptions was 9. Finally, if the apple prescription has no effect on any aspect of the average diet except amount of fruit consumed, annual vascular deaths would reduce by 7. Discussion. Prescribing either an apple a day or a statin a day to everyone over 5. Choosing apples rather than statins may avoid more than a thousand excess cases of myopathy and more than 1. The basic costs of apples are likely to be greater than those of statins; however, NHS prescription prices and convenience may drive people to purchase their apples from a store rather than through a pharmacy, thereby reducing direct NHS costs, or the NHS may be able to negotiate apple price freezes (although defrosted apples may not be so palatable). Strengths and limitations. The strengths of this study lie in the underlying data used to parameterise the population effect of statins and the PRIME model, which came from meta- analyses of trials and prospective cohort studies (see web appendix for further details of the PRIME model). The exact definition of vascular mortality used differs slightly between the Cholesterol Treatment Trialists and the PRIME model. However, the most common causes of vascular death (ischaemic heart disease and stroke) are modelled for both statins and apples, making any remaining differences negligible in their effect size. When estimating adverse events, as the Cholesterol Treatment Trialists note, the reduction in the number of vascular events due to the increased use of statins vastly outweighs the excess incidence of haemorrhagic stroke and diabetes. However, limitations of the Cholesterol Treatment Trialists’ meta- analysis have been suggested, including underestimation of side effects and absence of an effect on all cause mortality for patients at low risk. This would suggest that our estimates of side effects from statins are conservative and that an added benefit of apples over statins may exist in terms of all cause mortality. Our estimates of costs apply only to the basic cost of the intervention. We make no estimate of the cost to the health service of either accessing prescriptions or managing side effects. The predicted effects of a change in national policy to provide statins to everybody aged over 5. Although a conservative estimate, treatment compliance may be less than 7. However, the shock effect of the policy may stimulate more people who are eligible for treatment but are not accessing it to seek medical care. Furthermore, compliance may reduce over time, meaning our results could overestimate future benefits and future adverse events. We also apply the same treatment effect on vascular mortality to people of all ages, sexes, and cardiovascular risk profiles, and in reality these may differ. We assume that the age and sex distribution of the population taking of statins in the UK is the same as that found in the Health Survey for England. The estimate of population compliance with an apple a day is less evidence based. Although apples are of course both delicious and nutritious, this view is not consistently shared across the population; as much as 6. UK adults do not meet the recommendation of five portions of fruit and vegetables a day. Heart Surgery and Soup Diet. One fad diet claims to have medical experts' stamp of approval. Badly- typed, copied multiple times, passed on from one person to the other and found in numerous incarnations on the Internet, the Sacred Heart Diet has the reputation of being a soup diet given to overweight patients prior to heart surgery. However, medical institutions associated with this fad diet have gone out of their way to disclaim their association with it. The soup diet that's purportedly fed to patients before heart surgery has reached urban legend status, says the American Heart Association, or AHA, which devoted an entire web page to the diet. The diet goes by many monikers, one of the more common names being the Sacred Heart Memorial Diet. Among the soup diet's many aliases are the Cleveland Clinic Diet, the Sacred Heart Memorial Hospital Diet, the Miami Heart Institute Diet, the Spokane Heart Diet, T. J.’s Miracle Soup Diet, the Cabbage Soup Diet, the Basic Fat Burning Soup Diet and . And here's where things get confusing: The Cabbage Soup Diet, aka the Sacred Heart Diet, is also sometimes referred to as the Mayo Clinic Diet. And the Cleveland Clinic Diet is also called the grapefruit diet. According to Every. Diet. org, the Sacred Heart Hospital in Montreal, Canada formally announced in 2. The Cleveland Clinic, too, indicates on its website that it is not associated with the diet. The AHA – which has been falsely credited with a phony fad diet that has ice cream, hot dogs, eggs and cheese on the menu – also indicates that it had no part in the development of a soup diet for heart surgery patients. A March 1. 99. 6 New York Times article describes this soup diet as the . Elaine Reid, director of food and nutrition at the Sacred Heart Memorial Hospital in Spokane told the Times that she receives hundreds of letters about the diet from all over the country – and even outside of the United States. In 1. 99. 6, Reid told the Times that the diet has been in circulation for around 1. There are many versions of the Sacred Heart Diet; however, Every. Diet. org indicates that one of the more common recipes lists the following ingredients: stewed tomatoes, green onions, nonfat beef broth, a package of chicken noodle soup mix, celery, green beans, carrots and green peppers seasoned with salt, pepper, curry powder and parsley. The ingredients are chopped into pieces, covered with water and cooked. On the Sacred Heart Diet, which lasts for seven days, you can eat as much of the soup as you want per day; however, the diet integrates different food types on each day of the week. On the first day, dieters can have the soup and all the fruit they want, except bananas. Day two on the diet includes the soup and all vegetables, including a baked potato for dinner. You can have soup and all of the fruits and vegetables you like on day three, with the exception of a baked potato. Day four of the diet includes the soup, at least three bananas and as much skim milk as you want. On the fifth day of the soup diet, 1. Day six lets you eat as many beef steaks as you like, unlimited vegetables – leafy greens are suggested – but no baked potato and at least one serving of soup. On the last day of the diet, brown rice, vegetables and unsweetened fruit juice are added to the menu – along with the soup. Soup- based diets often claim you can lose up to 1. However, Every. Diet. Org points out that many of the pounds you shed on such a diet are due to water loss, and you'll likely put them on right after you go off the the diet. The Cleveland Clinic cautions you against diets that restrict your menu and place you on a rigid eating plan that you can't sustain for the rest of your life. The clinic recommends a Mediterranean diet low in dairy and fatty meats and rich in plant- based foods such as vegetables, fruits, whole grains, beans and peas, and unsaturated fats such as olive oil, nuts and seeds.
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