In briefs

Professor D John Betteridge With sadness, we report the death of Professor D John Betteridge, BSc, MB BS, PhD, MD, FRCP, FAHA, Consultant Physician, University College London Hospitals, London; Emeritus … Continue reading In briefs →

Professor D John Betteridge

With sadness, we report the death of Professor D John Betteridge, BSc, MB BS, PhD, MD, FRCP, FAHA, Consultant Physician, University College London Hospitals, London; Emeritus Professor of Endocrinology and Metabolism University College London; and Associate Dean, Royal Society of Medicine (RSM), who passed away on 4th October 2019, aged 71, following a long illness.

John will be remembered with great fondness by his many colleagues and friends. He had a long and distinguished career – he was a BJC editorial board member, a past chair of HEART UK and past President of the Council on Lipids in Clinical Medicine at the RSM. John received many awards including ‘Distinguished Fellow’ of the International Atherosclerosis Society (IAS), Fellow of the American Heart Association and a member of numerous international bodies. He was co-chair of the executive committee of the major primary cardiovascular disease prevention trial CARDS, and Principal Investigator of other major studies, including the secondary prevention trial PROactive. His research related to the role of lipoprotein metabolism in the pathogenesis of atherosclerosis – a subject on which he authored hundreds of research papers and several textbooks.

Socially, John was a thoughtful, kind, bon viveur with a keen wit and a wide circle of friends. His final illness was tackled with characteristic stoicism. He is survived by his wife, Chris, and children, Tom and Sally.

Ian Mason

Electronic cigarettes and effects on health

There is growing evidence that electronic cigarettes have adverse effects on the cardiovascular system, reports a paper published in Cardiovascular Research (doi: 10.1093/cvr/cvz256).

“E-cigarettes contain nicotine, particulate matter, metals, and flavourings, not just harmless water vapour,” said senior author Professor Loren Wold, of The Ohio State University, Columbus, US. “We know from air pollution studies that fine particles (less than 2.5 microns) enter the circulation and have direct effects on the heart. Data for e-cigarettes are pointing in that direction.”
Proof of harmful effects on the heart and blood vessels is accumulating. Nicotine raises blood pressure and heart rate. Particular matter causes stiffening of the arteries and systemic inflammation, which induce effects on the lungs and can cross into the bloodstream.

The paper states: “Current findings support that e-cigarettes are not a harm-free alternative to tobacco smoke. Great caution and hesitation should remain concerning e-cigarette use until its health risk profile is better established”. European Society of Cardiology guidelines advocate for e-cigarettes to be covered by the same marketing restrictions as cigarettes and call for harmonised international legislation to prevent a new tobacco epidemic.

New magnetocardiography study begins in SCD

The role of magnetocardiography in the prediction of ventricular arrhythmias in patients who have been identified at risk of sudden cardiac death (SCD) is being evaluated in a 510-patient study with the University Hospitals of Coventry and Warwickshire (UHCW) NHS Trust and Creavo Medical Technologies, a UK medical device company. Led by Dr Tom Lachlan, Research Fellow in Cardiology, under the supervision of Professor Faizel Osman, Consultant Cardiologist / Electrophysiologist at UHCW, the study will involve performing magnetocardiography scans – which generate a magnetic field map of the heart– on patients who fulfil National Institute for Health and Care Excellence guidelines for receiving an implantable cardioverter-defibrillator.

Link between vitamin D deficiency and mortality

New research presented at this year’s Annual Meeting of the European Association for the Study of Diabetes in Barcelona, Spain, reveals that vitamin D deficiency is strongly linked to increased mortality, especially in younger and middle-aged people, and is particularly associated with diabetes-related deaths.

The research, conducted by Dr Rodrig Marculescu and colleagues at the Medical University of Vienna, Austria, looked at the records of all 78,581 patients (mean age 51.0 years, 31.5% male) who had a vitamin D measurement taken at the Department of Laboratory Medicine, General Hospital of Vienna between 1991 and 2011, which was then matched with the Austrian national register of deaths. Patients were followed for up to 20 years where possible, with a median follow-up of 10.5 years.

The study found that vitamin D levels of 10 nmol/L or less were associated with a two-to-three-fold increase in risk of death, with the largest effect being observed in patients aged 45 to 60 years (2.9 times increased risk). Levels of 90 nmol/L or greater were associated with a reduction in all-cause mortality of 30-40%, again with the largest effect being found in the 45 to 60-years-old age group (a 40% reduction in risk). No statistically significant associations between vitamin D levels and mortality were observed in patients over the age of 75 years.

The results revealed the largest effect of vitamin D for diabetes deaths, with a 4.4 times higher risk of death from diabetes in the vitamin D deficient group (50 nmol/L or below) than for study participants whose serum vitamin D was above 50 nmol/L. The risk of death from infectious diseases was also doubled in the vitamin D deficient group.

World’s first non-invasive treatment of calcific aortic stenosis

A therapeutic device using high-intensity ultrasound may be able to eliminate the need for invasive treatment of calcific aortic stenosis. The Valvosoft therapeutic device has been used to successfully treat 10 patients with the condition, according to Cardiawave, the French company who developed the device. The patients were treated at the Georges Pompidou European Hospital in Paris, France, and the Amphia Hospital in Breda, The Netherlands, using this new technology, which widens the opening of the aortic valve by delivering short sequences of high-intensity ultrasounds, focused directly onto the valve from outside the body, thus eliminating the need for invasive treatment.

Analysis of the post-operative echocardiographic data, performed by an independent centralised laboratory, and of the clinical results at 30 days, suggests that the primary objectives, which were to assess safety and feasibility of this procedure, have been met.

United cardiology

The BJC believes it is important those of us working in the field of cardiovascular medicine continue to show a united front, as Brexit approaches, and has therefore invited the major cardiological societies of the British Isles to provide regular news and information on their events. These include the British Cardiovascular Society, The Irish Cardiac Society, the Scottish Cardiac Society and the Welsh Cardiovascular Society. We hope that this will further encourage cardiological communication across our borders in spite of any geopolitical divide. Contact [email protected] for more information.

Be cardiomyopathy aware

Cardiomyopathy UK has launched a campaign to draw awareness to the fact that the winter flu season masks the symptoms of cardiomyopathy and myocarditis. It is calling on general practitioners to continue to make patients aware that ongoing flu symptoms could indicate a heart condition and to encourage them to return within four to six weeks if symptoms persist.

According to the charity, a recent survey has shown 95% of people are unaware that persistent-flu like symptoms can be a sign of these two conditions, with 59% less likely to visit their GP in the winter with lingering flu-like symptoms compared to the summer. Reasons given for not visiting the GP in the winter included 42% ‘assuming symptoms would go away’, 27% ‘feeling guilty for using a doctor’s time’, and 28% preferring ‘to grin and bear it’.

“There is a degree of cross-over between cardiac and flu-like symptoms including breathlessness, chest pain, palpitations or dizziness. While these symptoms can linger during the winter months, if a patient is experiencing persistent symptoms, it is important to consider the potential underlying cardiac causes,” said Dr Jim Moore, President of the Primary Care Cardiovascular Society.

AI could help increase AF detection rate

Routine use of artificial intelligence- (AI) based machine learning algorithms could help increase detection rates of people with undiagnosed atrial fibrillation (AF), compared to other risk-prediction models. With up to 300,000 people estimated to be living with undiagnosed AF in the UK, it is hoped that the algorithm will increase the rate at which the condition is picked up helping to prevent complications such as stroke and heart disease.

The machine learning algorithm is potentially more precise than routine practice because it not only looks for risk factors, but also changes and can spot complex relationships between ‘risk predictors’, that cannot be readily identified by humans, such as subtle changes in blood pressure before diagnosis or frequency of GP visits.

The machine learning algorithms now have to be validated in clinical practice. The study is published in Plos One (doi: 10.1371/journal.pone.0224582).