About Us
Prevention of CVD, Hypertension, Smoking, Diabetes and High Cholesterol
Prevention of Cardio-Vascular disease (CVD)
Prevention of Cardio-Vascular disease (CVD)
CVD is a major public health problem. CVD
prevention can help keep people’s hearts healthy
and prevent strokes. The best way to prevent
cardiovascular disease is for people to eat better
and be more active.
“ An estimated 2.8 million men and 2.8 million
women in the UK are living with CVD. The
British Heart Foundation estimates that around
111,000 people have a stroke for the first time
every year.”
CVD includes coronary heart disease (CHD),
stroke and peripheral arterial disease. These
conditions are frequently brought about by the
development of blockages in the arteries. They are
also linked to conditions such as heart failure,
chronic kidney disease and dementia.
Cardiovascular disease (CVD) is generally due to
reduced blood flow to the heart, brain or body. It is
increasingly common after the age of 60, but rare
below the age of 30.
Some countries have much more cardiovascular
disease than others and, unfortunately, the UK sits
at the top of the table – just like the average
cholesterol levels.
In England in 2007, CVD led to nearly 159,000
deaths (accounting for nearly 34% of all deaths in
England). Most premature deaths from CVD – that
is, among people aged less than 75 – are
preventable.
An estimated 2.8 million men and 2.8 million
women in the UK are living with CVD. The
British Heart Foundation estimates that around
111,000 people have a stroke for the first time
every year.
Despite recent improvements, death rates in the
UK from CVD are relatively high compared with
other developed countries (only Ireland and
Finland have higher rates).
Stop smoking, eat healthier foods, increase aerobic
physical activity, and achieve optimal weight and
weight distribution are central to CVD prevention.
Modifiable Risk Factors
In more than 90% of cases, the risk of a first heart
attack is related to nine potentially modifiable risk
factors (Yusuf et al. 2004):
• Smoking/tobacco use
• Poor diet
• High blood cholesterol
• High blood pressure
• Insufficient physical activity
• Overweight/obesity
• Diabetes
• Psychosocial stress
• Excess alcohol consumption.
Smoking, obesity and a physically inactive
lifestyle are among the top risk factors for
developing Coronary Heart Disease (CHD). In
2007, over 20,000 deaths from cardiovascular
disease in England were related to smoking. That’s
why the NSF has driven forward major
developments in prevention.
Stroke
A stroke is a serious medical condition that occurs
when the blood supply to part of the brain is cut
off. There are two main types of stroke. The most
common type (an ischaemic stroke) is when one of
the blood vessels leading to or in the brain is
blocked. The second type (haemorrhagic stroke) is
when a blood vessel in the brain bursts, causing
bleeding into the brain.
A transient ischaemic attack (TIA), often called a
‘mini- stroke’, happens when the blood supply to
part of the brain is interrupted for a short time. The
symptoms are the same as for a stroke, but they
usually last only a few minutes or hours, and
disappear altogether within 24 hours.
Causes of stroke
Stroke is a largely preventable condition. Many of
the key risk factors such as smoking, high blood
pressure, obesity and high cholesterol levels can be
reduced by making lifestyle changes.
There are some risk factors for stroke that cannot
be changed, including:
• age (higher risk if you are over 65)
• family history
• ethnicity (higher risk in south Asian, African and
Caribbean)
• your medical history (previous stroke, TIA or
heart attack)
Cutting the risk
Strokes can usually be successfully treated and
also prevented. Eating a healthy diet, taking
regular exercise, drinking alcohol in moderation
and not smoking will dramatically reduce your risk
of having a stroke. Lowering high blood pressure
and cholesterol levels with medication also lowers
the risk of stroke substantially. Reducing the risks
can rapidly reduce the likelihood of developing
CVD.
Diet
A poor diet is a major risk factor for a stroke.
High-fat foods can lead to the build-up of fatty
plaques in your arteries and being overweight can
lead to high blood pressure.
A low-fat, high-fibre diet is recommended,
including plenty of fresh fruit and vegetables (five
portions a day)and whole grains. Salt intake is a
major determinant of CVD in the UK, mainly due
to its effect on blood pressure. On average,
70%–90% of people’s intake comes from salt
added during the manufacturing process; only
10–30% comes from adding it during cooking or at
the table. You should limit the amount of salt that
you eat to no more than 6g (0.2oz) a day because
too much salt will increase your blood pressure.
Six grams of salt is about one teaspoonful.
Lifestyle targets
1. Do not smoke
2. Maintain ideal body weight for adults (body
mass index 20– 25 kg/m2) and avoid central
obesity (waist circumference in white
Caucasians 102 cm in men and 88 cm in
women, and in Asians 90 cm in men and 80 cm
in women)
3. Keep total dietary intake of fat to 30% of
total energy intake
4. Keep the intake of saturated fats to 10% of
total fat intake
5. Keep the intake of dietary cholesterol to 300
mg/ day
6. Replace saturated fats by an increased intake
of monounsaturated fats
7. Increase the intake of fresh fruit and
vegetables to at least five portions per day
8. Regular intake of fish and other sources of
omega 3 fatty acids (at least two servings of fish
per week)
9. Limit alcohol intake to 21 units per week for
men or 14 units per week for women
10. Limit the intake of salt
11. Regular aerobic physical activity of at least
30 mins per day, most days of the week, should
be taken (for example, fast walking/swimming)
Source Joint British Societies’ Guidelines
Exercise
Combining a healthy diet with regular exercise is
the best way to maintain a healthy weight. Having
a healthy weight reduces your chances of
developing high blood pressure. Regular exercise
will make your heart and blood circulatory system
more efficient. It will also lower your cholesterol
level and keep your blood pressure at a healthy
level. Regular exercise can help you lose weight.
For most people, 30 minutes of vigorous exercise a
day at least five times a week is recommended.
The exercise should be strenuous enough to leave
your heart beating faster, and you should feel
slightly out of breath. Examples of vigorous
exercise are going for a brisk walk or walking up a
hill.
Want to know more?
www.nhs.uk/LiveWell/Fitness/Pages/Fitnesshome.
aspx
Smoking
Smoking doubles your risk of having a stroke. This
is because it narrows your arteries and makes your
blood more likely to clot.
If you stop smoking, you can reduce your risk of
having a stroke by up to half. Not smoking will
also improve your general health and reduce your
risk of developing other serious conditions, such as
lung cancer and heart disease.
The NHS Smoking Helpline can offer advice and
encouragement to help you quit smoking. You can
call on 0800 022 4332, or visit
http://smokefree.nhs.uk
Want to know more?
www.nhs.uk/LiveWell/Smoking/Pages/stopsmokin
gnewhome.aspx
Alcohol
Excessive alcohol consumption can lead to high
blood pressure and an irregular heartbeat (atrial
fibrillation).Both are major risk factors for stroke.
Because alcoholic drinks are rich in energy (high
incalories) they also cause weight gain. Heavy
drinking multiplies the risk of stroke by more than
three times.
Want to know more?
www.nhs.uk/LiveWell/Alcohol/Pages/Alcoholhom
e.aspx
Treatment
Individuals at high cardiovascular risk warrant
intervention with lifestyle changes and
consideration for drug therapy, to reduce their
absolute risk. Whether or not surgery is needed,
anyone with narrowing of the carotid artery should
be given antiplatelet drugs to reduce blood
clotting. They should also be offered advice and/or
medication for controlling blood pressure and
reducing cholesterol (NICE Clinical Guidance 68).
Antiplatelet medicines reduce the risk of clots
forming in the blood. This reduces your risk of
having a stroke or heart attack. Low-dose aspirin
(usually 75mg a day) may be given to you if you
are considered to be at risk of having a heart attack
or stroke. You may be considered to be at risk if
you:
• have high cholesterol
• have high blood pressure
• have diabetes
• smoke
Scottish National Clinical Guidance recommends
asymptomatic individuals without established
atherosclerotic disease but with a calculated
cardiovascular risk of >20% over ten years should
be considered for treatment with aspirin 75 mg
daily.
However, Low-dose aspirin should not be taken if
you have:
• an active (bleeding) peptic ulcer
• haemophilia or any other bleeding disorder
• an allergy to aspirin or to non-steroidal anti-
inflammatory drugs (NSAIDs) such as ibuprofen
or diclofenac
All adults over the age of 40 years who are
assessed as having a ten year risk of having a first
cardiovascular event >20% should be considered
for treatment with simvastatin 40 mg/day
following an informed discussion of risks and
benefits between the individual and responsible
clinician.
For patients who face many years of risk after
diagnosis of a significant carotid narrowing (with
or without symptoms), early surgery called a
carotid endarterectomy to remove the blockage is
the most important and effective intervention to
reduce still further the risk of stroke.
For more information visit:
Stroke Association, 0845 3033 100,
www.stroke.org.uk
Northern Ireland Chest, Heart and Stroke
Association, 0845 7697 299, www.nichsa.com
Different Strokes, 0845 130 7172,
www.differentstrokes.co.uk
http://www.nhs.uk/NHSEngland/NSF/Pages/Coro
naryheartdisease.aspx
http://guidance.nice.org.uk/CG68
Having an excessively high level of lipids in your blood
(hyperlipidaemia) can have a serious effect on your health as it
increases your risk of having a heart attack or stroke.
Bad Cholesterol (LDL - low density lipoprotein) accounts for 70%
of the cholesterol in our blood and acts to carry cholesterol from
your liver to the cells that need it. If there is too much cholesterol
for the cells to use, this can cause a harmful build-up in your blood.
Good Cholesterol (HDL - high density lipoprotein) carries
cholesterol away from the cells and back to the liver for excretion
from the body via the gastro-intestinal system. There it is either
broken down or passed from the body as a waste product. If your
HDL levels are low and your total cholesterol is normal or
above then your chances of a heart attack are higher.
Your body needs
cholesterol to:
• make up the structure of the
membrane (outer layer) of
every cell in the body
• insulate nerve fibres
• make hormones, such as sex
hormones and steroid
hormones
• make bile acids, which are
needed for the digestion and
absorption of fats
Triglycerides are the fats you use for energy and come from the
fatty foods you eat. There is usually an association between
triglycerides and raised cholesterol. Being overweight and
drinking too much alcohol can push up triglyceride levels.
The optimal total cholesterol target is 4.0 mmol/l and low density
lipoprotein (LDL) cholesterol 2.0 mmol/l, or a 25% reduction in
total cholesterol and a 30% reduction in LDL cholesterol,
whichever gets the person to the lowest absolute value.
The government recommends that minimum standards of
cholesterol levels should be less than 5.0 mmol/l. In the UK, two
out of three adults have a total cholesterol level of 5.0 mmol/l or
above.
Risks of high cholesterol
High cholesterol is not a
disease but increases your risk
of serious conditions such as:
• coronary heart disease,
caused by atherosclerosis
(narrowing of the arteries)
• stroke
• mini-stroke (transient
ischaemic attack or TIA)
“The UK population has one of the highest average cholesterol
concentrations in the world.”
A number of different factors can
contribute to high blood cholesterol,
including:
• Lifestyle factors: unhealthy diet, lack of
exercise or physical activity, obesity and drinking
excessive amounts of alcohol
• Treatable factors: hypertension, diabetes and
underactive thyroid gland
• Fixed factors: family history of early heart
disease, stroke or cholesterol-related condition;
age, ethnic group
Who should be tested?
Anyone can have their blood cholesterol level
tested, but it is particularly important to have it
checked if:
• You have been diagnosed with coronary heart
disease, suffered a stroke/mini-stroke or you have
leg artery disease
• You are over 40
• You have a family history of early
cardiovascular disease (for example, if your
father or brother developed heart disease or had a
heart attack or stroke before the age of 55, or if
your mother or sister had these conditions before
the age of 65)
• A close family member has a cholesterol-related
condition, such as familial hypercholesterolaemia
(inherited high cholesterol)
• You are overweight or obese
• You have high blood pressure or diabetes
• You have another medical condition such as a
kidney condition, an underactive thyroid gland or
an inflamed pancreas (pancreatitis). These
conditions can cause increased levels of
cholesterol or triglycerides
Treating high cholesterol
If you have been diagnosed with high cholesterol,
the first method of treatment will usually involve
making some changes to your diet (adopting a
low-fat diet) and doing plenty of regular exercise.
After a few months, if your cholesterol level has
not dropped, you will usually be advised to take
cholesterol-lowering medication.
A healthy diet includes foods from all of the
different food groups:
• Carbohydrates (cereals, wholegrain bread,
potatoes, rice and pasta)
• Proteins (lean meat, beans and fish)
• Unsaturated fats
• Fruit and vegetables (at least five portions a
day)
You should try to avoid or cut down on the
following foods, which are rich in saturated
fat:
• Fatty cuts of meat and meat products, such as
sausages and pies
• Butter, ghee and lard
• Cream, soured cream, creme fraiche and ice
cream
• Cheese, particularly hard cheese
• Cakes and biscuits
• Chocolate
• Coconut oil, coconut cream and palm oil
Switching saturated fats to mono-unsaturated fats
such as olive oil can actually lower total
cholesterol whilst preserving the important HDL
cholesterol. We also know that the vitamin Niacin
can help toreduce cholesterol. It is virtually
impossible to develop coronary heart disease if
your cholesterol level is below 3.8 mmol/l.
Studies overwhelmingly show that it is perfectly
possible to stop and even to reverse the build up
of fatty deposits within artery walls. You can help
prevent getting high blood cholesterol by eating a
healthy, balanced diet that is low in saturated fat.
For more information visit:
www.nhs.uk/conditions/Cholesterol/Pages/Introductio
n.aspx
www.nhs.uk/LiveWell/healthy-
eating/Pages/Healthyeating.aspx
www.nhs.uk/LiveWell/Loseweight/Pages/Loseweight
home.aspx
Hypertension (High blood Pressure)
High blood pressure is usually defined as having
a sustained blood pressure of 140/90mmHg or
above. As hypertension often causes no
symptoms, or immediate problems, it is known
as the ‘silent killer’. However, it is a major
primary risk factor in the development of
coronary heart disease, stroke and kidney
failure. The only way to find out whether you
have high blood pressure is to have it checked
regularly.
“High blood pressure is a common
condition, affecting around one in three
adults in England. The risk of
developing high blood pressure increases
with age. Half of people over 75 years
have the condition.”
If you have high blood pressure, your heart has
to work harder to pump blood around your
body. Over time, this can weaken it. The
increased pressure can also damage the walls of
your arteries, resulting in a blockage or causing
the artery to split (haemorrhage). Both of these
situations can cause a stroke.
High blood pressure is a common condition,
affecting around one in three adults in England.
It is estimated that 18% of adult men and 13%
of adult women have high blood pressure but
are not getting treatment for it.
The risk of developing high blood pressure
increases with age. Half of people over 75 years
have the condition.
There are two types of high blood
pressure:
Primary high blood pressure (90-95% of
cases), there is no identifiable cause for this type
of high blood pressure. A number of risk factors
increase your chances of developing the
condition including:
• age - the risk of developing high blood
pressure increases as you get older
• a family history of high blood pressure – the
condition seems to run in families
• being of Afro-Caribbean origin
• high-fat diet
• high amount of salt in your diet
• lack of exercise
• being overweight
• smoking
• excessive alcohol consumption
• stress
All available evidence shows that lifestyle plays
a significant role in regulating your blood
pressure.
Secondary high blood pressure (between 5
and 10%), where high blood pressure is caused
by an underlying cause, such as kidney disease,
or a particular type of medication that you are
taking.
High blood pressure can be treated or prevented
by making changes to your lifestyle, such as
eating a healthier diet, exercising more
regularly, and reducing the amount of alcohol
you drink.
Blood pressure is measured using two figures.
One figure represents the pressure of the heart
as it contracts to pumps blood around the body.
This is known as the systolic pressure. The
second figure represents the pressure of the
heart as it expands and fills with blood, while
waiting for the next contraction. This is known
as the diastolic pressure.
“All available evidence shows that lifestyle
plays a significant role in regulating your
blood pressure.”
It is important to recognise that blood pressure
will vary dependent upon many situational
factors. Physical activity, emotion, hydration,
smoking, caffeine and time of day are just some
of the factors that can significantly impact blood
pressure immediately.
For most people, a healthy blood pressure is a
systolic pressure of 90-120 millimeters of
mercury (mmHg) and a diastolic pressure of 60-
80mmHg. Or, as blood pressure is normally
expressed, a level between 90/60mmHg and
120/80mmHg.
Checking your blood pressure
Having one high blood pressure reading does
not necessarily mean that you have high blood
pressure. Your blood pressure can fluctuate
throughout the day. Therefore, your GP will
need to take several readings over a set period
of time, usually every month, to see whether
your blood pressure level is consistently high.
“Having one high blood pressure reading
does not necessarily mean that you have
high blood pressure.”
Before having your blood pressure taken, you
should rest for at least five minutes and empty
your bladder. To get an accurate blood pressure
reading, you should be sitting down and not
talking when the reading is taken.
The optimal BP target is 140 mm Hg systolic
and 85 mm Hg diastolic higher risk people
(established atherosclerotic disease, diabetes,
and chronic renal failure) a lower BP target of
130 mm Hg and 80 mm Hg.
The best way of preventing high blood pressure
and the associated risks of cardiovascular
disease, is to eat a healthy diet, maintain a
healthy weight, exercise regularly, drink alcohol
in moderation and avoid smoking.
Treating high blood pressure
Treatment for high blood pressure will depend
on your blood pressure levels and your
associated risk of developing a cardiovascular
disease, such as a heart attack or stroke.
Slightly High blood Pressure
If your blood pressure is slightly higher than the
ideal level (120/80mmHg), and your GP feels
that the risks of cardiovascular disease are low,
you should be able to lower your blood pressure
by making simple lifestyle changes, such as
improving your diet and taking regular exercise.
moderately High blood Pressure
If your blood pressure is moderately high
(140/90mmHg or higher), or your GP feels that
your risk of developing cardiovascular disease
in the next 10 years is more than one in five,
you will be prescribed medication and advised
about changing your lifestyle.
Very High blood Pressure
If your blood pressure is very high (180/110
mmHg or above) you will be referred to a
hypertension specialist (a doctor who specialises
in treating high blood pressure).
For more information visit:
www.nhs.uk/conditions/Blood-pressure-
(high)/Pages/Introduction.aspx
http://guidance.nice.org.uk/CG127
HIGH CHOLESTEROL
Having an excessively high level of lipids in your blood
(hyperlipidaemia) can have a serious effect on your health as it
increases your risk of having a heart attack or stroke.
Bad Cholesterol (LDL - low density lipoprotein) accounts for 70%
of the cholesterol in our blood and acts to carry cholesterol from
your liver to the cells that need it. If there is too much cholesterol
for the cells to use, this can cause a harmful build-up in your blood.
Good Cholesterol (HDL - high density lipoprotein) carries
cholesterol away from the cells and back to the liver for excretion
from the body via the gastro-intestinal system. There it is either
broken down or passed from the body as a waste product. If your
HDL levels are low and your total cholesterol is normal or
above then your chances of a heart attack are higher.
Your body needs
cholesterol to:
• make up the structure of the
membrane (outer layer) of
every cell in the body
• insulate nerve fibres
• make hormones, such as sex
hormones and steroid
hormones
• make bile acids, which are
needed for the digestion and
absorption of fats
Triglycerides are the fats you use for energy and come from the
fatty foods you eat. There is usually an association between
triglycerides and raised cholesterol. Being overweight and
drinking too much alcohol can push up triglyceride levels.
The optimal total cholesterol target is 4.0 mmol/l and low density
lipoprotein (LDL) cholesterol 2.0 mmol/l, or a 25% reduction in
total cholesterol and a 30% reduction in LDL cholesterol,
whichever gets the person to the lowest absolute value.
The government recommends that minimum standards of
cholesterol levels should be less than 5.0 mmol/l. In the UK, two
out of three adults have a total cholesterol level of 5.0 mmol/l or
above.
Risks of high cholesterol
High cholesterol is not a
disease but increases your risk
of serious conditions such as:
• coronary heart disease,
caused by atherosclerosis
(narrowing of the arteries)
• stroke
• mini-stroke (transient
ischaemic attack or TIA)
“The UK population has one of the highest average cholesterol
concentrations in the world.”
A number of different factors can
contribute to high blood cholesterol,
including:
• Lifestyle factors: unhealthy diet, lack of
exercise or physical activity, obesity and drinking
excessive amounts of alcohol
• Treatable factors: hypertension, diabetes and
underactive thyroid gland
• Fixed factors: family history of early heart
disease, stroke or cholesterol-related condition;
age, ethnic group
Who should be tested?
Anyone can have their blood cholesterol level
tested, but it is particularly important to have it
checked if:
• You have been diagnosed with coronary heart
disease, suffered a stroke/mini-stroke or you have
leg artery disease
• You are over 40
• You have a family history of early
cardiovascular disease (for example, if your
father or brother developed heart disease or had a
heart attack or stroke before the age of 55, or if
your mother or sister had these conditions before
the age of 65)
• A close family member has a cholesterol-related
condition, such as familial hypercholesterolaemia
(inherited high cholesterol)
• You are overweight or obese
• You have high blood pressure or diabetes
• You have another medical condition such as a
kidney condition, an underactive thyroid gland or
an inflamed pancreas (pancreatitis). These
conditions can cause increased levels of
cholesterol or triglycerides
Treating high cholesterol
If you have been diagnosed with high cholesterol,
the first method of treatment will usually involve
making some changes to your diet (adopting a
low-fat diet) and doing plenty of regular exercise.
After a few months, if your cholesterol level has
not dropped, you will usually be advised to take
cholesterol-lowering medication.
A healthy diet includes foods from all of the
different food groups:
• Carbohydrates (cereals, wholegrain bread,
potatoes, rice and pasta)
• Proteins (lean meat, beans and fish)
• Unsaturated fats
• Fruit and vegetables (at least five portions a
day)
You should try to avoid or cut down on the
following foods, which are rich in saturated
fat:
• Fatty cuts of meat and meat products, such as
sausages and pies
• Butter, ghee and lard
• Cream, soured cream, creme fraiche and ice
cream
• Cheese, particularly hard cheese
• Cakes and biscuits
• Chocolate
• Coconut oil, coconut cream and palm oil
Switching saturated fats to mono-unsaturated fats
such as olive oil can actually lower total
cholesterol whilst preserving the important HDL
cholesterol. We also know that the vitamin Niacin
can help toreduce cholesterol. It is virtually
impossible to develop coronary heart disease if
your cholesterol level is below 3.8 mmol/l.
Studies overwhelmingly show that it is perfectly
possible to stop and even to reverse the build up
of fatty deposits within artery walls. You can help
prevent getting high blood cholesterol by eating a
healthy, balanced diet that is low in saturated fat.
For more information visit:
www.nhs.uk/conditions/Cholesterol/Pages/Introductio
n.aspx
www.nhs.uk/LiveWell/healthy-
eating/Pages/Healthyeating.aspx
www.nhs.uk/LiveWell/Loseweight/Pages/Loseweight
home.aspx
Smoking
If you smoke, giving up is probably the greatest
single step you can take to improve your health.
Stopping smoking can be followed by a rapid
decline in the risk of CHD.
Smoking’s impact on public health is huge.
Smoking is responsible for one in every five
deaths in adults aged over 35 in England, and
half of all long-term smokers will die
prematurely due to a smoking-related disease.
Smoking and Stroke
In asymptomatic people, up to 10 years are
needed to reach the risk level of those people
who have never smoked. Smoking doubles your
risk of having a stroke.This is because it
narrows your arteries and makes your blood
more likely to clot.
Approximately 100,000 people die from
smoking- related diseases in the UK every
year. Tobacco accounts for approximately
29% of deaths from cancer, 13% of
cardiovascular deaths and 30% of deaths
from respiratory disease.
Tobacco smoke contains nicotine, which is
highly addictive. As well as nicotine, each
cigarette contains more than 4,000 different
chemicals, many of which are toxic (harmful to
the body). More than 60 of them cause cancer
(are carcinogenic).
Some of the most harmful conditions that
smoking can cause are:
1. Premature death
2. Cancer
3. Respiratory diseases
4. Cardiovascular and cerebrovascular diseases
5. Osteoporosis, stomach ulcers and infertility
Risks to others
When you smoke, it is not just your health that
is at risk, but the health of anyone who breathes
in cigarette smoke (including those around you).
The smoker only inhales about 15% of the
smoke from a cigarette. The other 85% is
absorbed into the atmosphere or inhaled by
other people who are passive smokers.
“Stopping smoking can be followed by a
rapid decline in the risk of CHD.”
Around 65% of smokers say they want to stop
smoking, but most believe they are unable to.
However, around half of all smokers eventually
manage to give up. When you stop smoking, the
benefits to your health begin straight away.
It is generally a good idea to fix a quit date,
rather than gradually reduce your smoking. Tell
people around you that you are going to stop,
and try to get others at home or work to stop
with you. This support network makes it easier
when temptation arises!
Be prepared to fail and try again
Please don’t despair if you fail on your first
attempt! You won’t be the first or last smoker
that this has happened to. Regroup, work out
what went wrong - was it peer pressure, alcohol,
stress, etc? Don’t be ashamed and it is very
important at this stage to maintain your nicotine
replacement therapy, family and group support.
Try Again!
The NHS Smoking Helpline can offer advice
and encouragement to help you quit smoking.
You can call on 0800 022 4332, or visit NHS
Diabetes
It is important to diagnose diabetes as early as
possible so that treatment can be started. In the
presence of diabetic symptoms (thirst, polyuria,
and weight loss) a fasting glucose of > 7 mmol/l
or Random > 11.1 mmol/l on one occasion is
considered diagnostic of diabetes. If there are 2
fasting glucose values > 7.0 mmol/l or 2 random
> 11.1 mmol/l on 2 separate
occasions, the diagnosis of diabetes is made
regardless of symptoms. If your blood glucose
levels are not high enough to diagnose diabetes,
you may need to have an oral glucose tolerance
test (OGTT). You will be given a glucose drink
and then blood tests are taken every half an
hour, for two hours, to see how your body is
dealing with the glucose.
In the UK, diabetes affects approximately 2.8
million people. More than one million people
are thought to have undiagnosed type 2
diabetes.
The main symptoms of undiagnosed
diabetes can include:
• passing urine more often than usual, especially
at night (polyuria)
• increased thirst
• extreme tiredness
• unexplained weight loss
• genital itching or regular episodes of thrush
• slow healing of cuts and wounds
• blurred vision
There are two main types of diabetes:
Type 1 diabetes: symptoms can develop
quickly, over weeks or even days. There is
nothing that you can do to prevent Type 1
diabetes. This type of diabetes is always treated
with insulin injections.
Type 2 diabetes: occurs when not enough
insulin is produced by the body for it to function
properly, or when the body’s cells do not react
to insulin. This is called insulin resistance. Type
2 diabetes is often associated with obesity.
You should ask for a test for diabetes,
if you:
• are white and over 40 years old
• are black, Asian or from a minority ethnic
group and over 25 years old
• have one or more of the following risk factors:
• a close member of your family has Type 2
diabetes (parent or brother or sister).
• you’re overweight or if your waist is 31.5
inches or over for women; 35 inches or over
for Asian men and 37 inches or over for
white and black men.
• you’ve high blood pressure or you’ve had a
heart attack or a stroke.
“ In the UK, diabetes affects
approximately 2.8 million people.
More than one million people are
thought to have undiagnosed type 2
diabetes.”
Risk factors for type 2 diabetes
You are more likely to develop type 2
diabetes if:
• You have a relative with type 2 diabetes.
• You are of South Asian, African-Caribbean
or Middle Eastern descent.
• You are overweight or obese.
• You are over 40.
• you’ve polycystic ovary syndrome and
you are overweight.
• you’ve been told you have impaired
glucose tolerance or impaired fasting
glycaemia.
• if you’re a woman and you’ve had
gestational diabetes.
• you have severe mental health problems.
“If your diabetes is not treated, it can lead
to many different health problems. Large
amounts of glucose can damage blood
vessels, nerves and organs. If you have
diabetes, you are up to five times more
likely to have heart disease and a stroke
than someone without diabetes.”
All people with diabetes mellitus be considered
‘‘high risk’’ and managed to the same lifestyle
and defined risk factor targets as people with
established CVD and others at high total risk of
developing CVD. This recommendation is made
because most people with diabetes have a 10
year CVD risk > 20% and all have a risk greater
than the population without diabetes.
It may not be possible to avoid developing
type 2 diabetes, but by controlling the risk
factors you may be able to reduce your
chances of getting it. For example, you
should:
• Lose weight, if you are overweight or obese
• Keep your waist size under 31.5 inches (80cm)
if you are a woman, 35 inches (90cm) if you are
an Asian man and 37 inches (94cm) if you are a
man who is white or black
• Get at least 30 minutes of exercise every day
• Do not smoke
• Keep your blood pressure and cholesterol
levels
under control
• Only drink alcohol in moderation
This advice can help anyone reduce their risk of
developing type 2 diabetes, but is particularly
important for those who have an increased risk
of developing it.
For more information visit:
www.diabetes.org.uk/
www.nice.org.uk/guidance/CG96
www.nhs.uk/LiveWell/Alcohol/Pages/Alcoholh
ome.aspx
www.nhs.uk/LiveWell/Loseweight/Pages/Lose
weighthome.aspx
www.nhs.uk/LiveWell/Fitness/Pages/Fitnessho
me.aspx