2. IN THIS ISSUE
2 personalhealthnews.ca MEDIAPLANET
Editors Pick
Learn howyour
pharmacist can help
optimizeyour
heart health.
p08
Cancer and Heart
Disease
Inthefightagainstcancer,
knowledgegapsregarding
thetoxicityoftherapies
ontheheartexist.
p11
Special Thanks
to the Canadian
Cardiovascular Society
The CCS is the national
voice for cardiovascular
physicians and scientists
in Canada.
YOU HAVE YOUR
MOTHER’S EYES.
WHAT ABOUT HER
HEART DISEASE?
The Heart and Stroke Foundation
funds the best medical minds in
genetic research.
But we can’t do it alone. With
your support, we’ll continue to find
answers and create more survivors.
Is your family at risk? Get a free
assessment at heartandstroke.ca
April and Andrew
Kawaguchi share the
same deadly heart defect.
Publisher: Carlo Ammendolia Business Developer: Brandon Cleary Managing Director: Martin Kocandrle Production Manager: Sonja Draskovic Lead Designer: Matthew Senra
Designer: Andres Esis Contributors: Dr. Lyne Cloutier,Dr. Susan Dent, Randi Druzin, Dr. Justin Ezekowitz, Dr. Mark Gelfer, Dr. Michael Hartleib, D.F. McCourt, Ishani Nath,
Dr. Eileen O’Meara, Dr. Robert D. Reid, Dr. Heather Ross, David Sculthorpe, Michele Sponagle Cover Photo: Elif Rey Photography Photo credits: All images are from Getty Images unless otherwise accredited.
Send all inquiries to ca.editorial@mediaplanet.com This section was created by Mediaplanet and did not involve National Post or its Editorial Departments.
Please recycle after readingStay in Touch facebook.com/MediaplanetCA @MediaplanetCA @MediaplanetCA pinterest.com/MediaplanetCA
H
eart disease
and stroke ta-
ke a life every
seven minu-
tes in Cana-
da. This reali-
ty persists de-
spite astonishing research breakt-
hroughs over the past 60 years —
life-saving advances that have im-
proved prevention,diagnosis,treat-
ment and care.
While we can be proud of this
progress, the toll of heart disease
and stroke is still too high. It’s
counted in lives as well as dollars,
as our healthcare system consumes
40 percent or more of provincial and
territorial budgets.
Breakthrough discoveries
Now the 21st century is escalating
newer threats: an aging population,
Innovation Is Our Best Hope
Against A Persistent Adversary
David Sculthorpe
CEO, Heart and Stroke
Foundation of Canada
Dr. Eileen O’Meara
Co-chair of the Canadian
Cardiovascular Society
Heart Failure Guidelines;
Cardiologist at the Montreal
Heart Institute and Associate
Professor of Medicine at the
Université de Montréal
By Dr. Justin Ezekowitz
Co-chair of the Canadian
Cardiovascular Society
Heart Failure Guidelines;
Cardiologist and Director of
the Heart Function Clinic at
the Mazankowski Alberta
Heart Institute in Edmonton
“We must have
innovative public policies
to create environments
in which we can regain,
and retain, our health."
the striking rise in obesity and sed-
entary lifestyles, and reliance on
sugar-packed, processed foods and
drinks all endanger the cardiovascu-
lar health of Canadians.
At the same time, our era offers un-
precedented opportunity for innova-
tion that will help us change the face
of these diseases through technology,
research and public policy.
Digital technology is empowering
more Canadians to actively manage
their health — and potentially reduce
the burden on our healthcare system.
For example, the Heart & Stroke Risk
Assessment — one of a suite of free on-
line eTools available — has helped more
than 850,000 people understand their
risk for heart disease and stroke, and
findsimplewaystoreduceit.We’realso
excitedtobedevelopingvirtualpeer-to-
peer support communities for people
livingwithourdiseases.
Scientific discovery is the epit-
ome of innovation, and research has
never been more important. Gen-
etics is one area of furious progress,
as scientists work to uncover the
genes that can pass heart disease risk
from one generation to the next. To-
day, we know only about 20 percent
of those genes. Across the country
Foundation-funded researchers are
sleuthing out the hereditary causes
behind such life-threatening condi-
tions as atrial fibrillation, long Q-T
syndrome, arrhythmogenic right
ventricular cardiomyopathy (ARVC)
and more, so we can learn how to
overcome what our genes have in
store for us.
Innovative public policies
Breakthrough discoveries cannot
fight cardiovascular disease alone.
Nor can individuals. We must have
innovative public policies to create
environments in which we can re-
gain, and retain, our health. It’s hor-
rifying that in just 30years,childhood
obesity rates have tripled, with chil-
dren facing the same risk factors as
their parents and grandparents. The
Foundation is advocating for public
policy changes to address these kinds
of issues; policies like restricting mar-
keting of foods and beverages to chil-
dren,and introducing measures to re-
duce sugar consumption, in particu-
lar sugary drinks.
If we can capitalize on these and
other innovations, the future looks
bright. I’m confident that — working
with partners who share our vision of
healthy lives free of heart disease and
stroke — we will make it happen,
together.
The Myths and Facts
of Heart Failure
An estimated 500,000 Canadians are living with
heart failure, and 50,000 new patients are
diagnosed annually. Yet many myths still surround
this condition. Canadians can take steps to improve
their heart health by understanding the realities of
heart failure.
Myth #1
Heart failure will kill you because your
heart has stopped beating.
Fact: Heart failure is serious but survivable. It happens
when your heart muscle or valves are damaged. That
meansyourheartcan’tpumpbloodoptimally.So“failure”
isreallylossoffunction.
Myth #2
Heart failure is just part of aging.
Fact:While most people who develop it are over the age
of60,heartfailureisn’taninevitablepartofgettingolder.
The dangers of this myth? People might think that noth-
ing can be done to avoid eventual heart failure, or that it
can’t happen to younger people. In fact, taking prevent-
ive measures – like exercising regularly, eating a healthy
dietandmanagingbloodpressure–canreduceyourrisk.
Myth #3
People with heart failure shouldn’t exercise
— it will only make things worse.
Fact:While this is a common fear, several studies point
to the effectiveness and safety of exercise for those with
heart failure.Talk to a doctor to find an exercise program
thatfitsyourconditionandfitnesslevel.
Myth #5
If you don’t have chest pain, you can’t have
heart failure.
Fact: Patients with heart failure can have many symp-
toms. Chest pain is only one. Other symptoms can in-
clude: palpitations; shortness of breath; fainting and/or
dizziness; rapid weight gain; feeling bloated all the time;
increased swelling of the legs/ankles/feet; increased fa-
tigue; and cough or cold symptoms that last longer than
aweek.These can bewarning signs of other conditions
aswell,butmaybeheart-related.Ifsymptomsaremild,
see your doctor; if they’re severe,go to the emergency
department.
Myth #4
If you have heart failure, little can be
done to treat it.
Fact: Healthy lifestyle choices can make a difference,
and so can treatments like medication (ACE inhibitors
thatwiden the bloodvessels to improve blood flow) and
implantabledefibrillators(atypeofpacemaker).
These treatments aren’t cures, but can reduce symp-
tomsanddelaytheprogressofheartfailure.Someofthe
biggest breakthroughs are relatively new, and heart ex-
pertsarelearningmoreabouteffectiveinterventionsall
thetime.
4. INSIGHT
4 personalhealthnews.ca
N
o medical proce-
dureismorecom-
mon than blood
pressure measu-
rement, and yet
there is a distur-
bing lack of in-
terest in Canada about its effective-
ness as a diagnostic tool.The sphyg-
momanometer — a recognizable de-
vicewithaninflatablecuffandamer-
cury or aneroid manometer that is
used,alongwithastethoscope,tome-
asure blood pressure — was populari-
zedaroundtheyear1900andremains
in common use today.That’s a start-
lingly long lifetime for any technolo-
gy;weconsiderflipphonesfrom2005
tobebonafideantiques.
In fact, healthcare professionals
have known for many years that bet-
ter and more accurate methods for
blood pressure measurement exist.
Getting Canada’s healthcare profes-
sionals to use them needs to be a top
priority for universities, profession-
al associations and governments.
Diagnosis is tricky
Seven and a half million Canadians —
that’s one in five — are living with high
blood pressure, or hypertension. The
only way to diagnose hypertension is
through accurate blood pressure meas-
urement,since high blood pressure has
nosignsorsymptomsattheoutset.The
antiquateduseofsphygmomanometers
in clinics means that tens of thousands
of Canadians are misdiagnosed with
hypertension every year. This misdiag-
nosisresultsfromthe‘whitecoateffect,’
and applies to as many as 25 percent of
people who are diagnosed with hyper-
tension. Their blood pressure meas-
ures high in clinics but is normal when
measured in non-clinical settings,
either by ambulatory 24-hour measure-
mentorbythemselvesathome.
“Missed” diagnosis is just as big
a problem: 25 percent of people liv-
ing with hypertension have ‘masked’
hypertension,making their high blood
pressure undetectable with in-office
blood pressure measurement. “People
withmaskedhypertensionareatasim-
ilar risk for cardiovascular disease as
people who have uncontrolled hyper-
tension.Withaccuratediagnosis,these
complications can often be avoided,”
explainsAngeliqueBerg,CEOofHyper-
tensionCanada.
Misdiagnosis reverberates
throughout the healthcare system:
scarce pharmacare dollars end up
spent on medicating people need-
lessly and these needless medica-
tions can have a negative impact
on people’s well-being. Meanwhile,
hypertension silently puts the un-
diagnosed at risk of cardiovascular
events such as strokes, heart attacks
and heart failure.
Methods need updating
Hypertension Canada has updated its
CHEP Guidelines for the treatment
and control of hypertension in order
to promote the use of current in-office
(automated) and out-of-office (ambu-
latory or home-based) technologies
that will help to end the scourge of
hypertension misdiagnosis. What’s
needed now is a coordinated effort
to turn common practice around by
bringingbloodpressuremeasurement
into this century and in line with the
latest research and technologies.
Medical, nursing and pharmacy
schools should integrate Canadian
best practice guidelines to their cur-
ricula. Professional associations can
help by dispelling the common
myths and misunderstandings that
accompany all new technologies.
Governments need to support the im-
plementation of best practices with
appropriate incentives for healthcare
professionals. The result of these co-
ordinated actions will be a more
cost-effective and focused response to
hypertension, which is currently the
leading cause of death and disability
around the world.
By Dr. Lyne Cloutier and
Dr. Mark Gelfer
“The antiquated use of
sphygmomanometers in
clinics means that tens of
thousands of Canadians
are misdiagnosed with
hypertension every year.”
Blood Pressure
Measurement:
Calling for a
Turn of the
Century
About the authors
Dr. Lyne Cloutier is a profes-
sor at the nursing depart-
ment of Université du Québec
à Trois-Rivières and is Direc-
tor of the Groupe interdisci-
plinaire de recherche ap-
pliquée en santé. Her main
research interests are opti-
mizing blood pressure meas-
urement and developing and
evaluating multidisciplinary
interventions for the care of
people with hypertension.
Dr. Mark Gelfer is a family
physicianbasedinVancouver,
British Columbia with more
than thirty years of medical
experience. He has served as
President of the BC College
of Family Physicians and is
currently a Clinical Assistant
Professor at the University of
British Columbia in the De-
partment of Family Practice.
Together, Dr. Gelfer and
Dr. Cloutier co-chair Hyper-
tension Canada’s CHEP
Guidelines Blood Pressure
Measurement and Diagnosis
subcommittee.
Fewer than 1/10 Canadian adults
and 1/5 youth were in ideal
cardiovascular health from
2003-2011
is the estimated
number of heart
attacks each year
in Canada
Every
7minsomeone dies from heart
disease or stroke in Canada
lives per year
Up to
40,000
cardiac arrests occur
each year in Canada
of Canadians have at least one risk
factor for heart disease or stroke
Smoking, alcohol, physical inactivity,
obesity, high blood pressure, high blood
cholesterol, diabetes
That’s one cardiac arrest every
12 min
Heart disease
and stroke costs
the Canadian
economy more than
every year in physician services, hospital
costs, lost wages and decreased productivity
Source: Heart & Stroke Foundation
5. MEDIAPLANET 5
Dietitian and Becel margarine
spokesperson Gina Sunderland
paused a moment when a client
boasted about following a fat-
free diet, but she knew it was
important to set the record
straight. She explained to
the client, a health-conscious
woman in her early 60s, that
some fat is part of a healthy
diet and she advised the
woman to incorporate a little
into her meals.
“As dietitians, we did huge disser-
vice with our messaging in the 80s
and early 90s,” says Sunderland, who
is based in Winnipeg, Manitoba. “We
should not have been emphasizing
low-fat this and low-fat that. We told
people not to eat fat, and that message
was way too simple.”
To be healthy, we need to embrace
fats that are good for us while avoid-
ing fats that are not.
Unsaturated fat can help lower bad
cholesterol (LDL) levels and, by ex-
tension, the risk of heart disease. It
can be found in vegetable oils, nuts,
seeds and fish. Unsaturated fat, which
is liquid at room temperature, in-
cludes two groups.
The first, monounsaturated fat, is
found in olive, canola and some other
oils as well as avocados and various
nuts, including almonds, peanuts and
cashews. The second, polyunsatur-
ated fat, is found in sunflower, soy-
bean, corn and safflower oil as well as
fish, walnuts, flax and other seeds.
Many of the items in the second
group have omega-3 and omega-6 fatty
acids, which the body can’t produce
on its own. Plant sources provide the
essential omega-3 fatty acids that the
body needs to function, which are al-
sobeinginvestigatedtodeterminetheir
importance for heart health. Fatty fish
like salmon, tuna and sardines are a
great source of these fatty acids as well.
Canadian healthcare providers en-
courage people to eat unsaturated fat
in moderation. They have also sound-
ed the alarm over two fats that in-
crease bad cholesterol and heighten
the risk of heart disease: saturated fat
and trans fats.
Saturated fat, which is solid at
room temperature, is found in red
meat, whole milk, cheese, coconut
oil and many commercially-pre-
pared foods. Trans fats appear nat-
urally in small quantities in some
foods, such as meats and dairy, while
industrially-processed trans fats are
sometimes found in items like cook-
ies, crackers, packaged snack foods
and deep-fried foods.
Butterisn’tbetter
The butter-versus-margarine debate has
been a flashpoint in the ongoing conver-
sationaboutfat.Whilesomepeoplepro-
mote butter as an “all-natural choice,”
mostdietitiansadvisetouselessofit.
“We’ve all heard the slogan, ‘Butter
is Better.’ Well, that is just not true!”
says Sunderland. She points out that
butter is high in saturated fat, while
margarine is made from a blend of
plant and seed oils and therefore con-
tains the “good” polyunsaturated and
monounsaturated fats.
In fact, the results of a recent study
by the Danish Dairy Research Foun-
dation established that even moder-
ate levels of butter consumption could
result in higher LDL cholesterol. The
study also showed that butter raises
blood cholesterol levels more than ol-
ive oil, a plant-based alternative.
Responding to consumers’ health
concerns, manufacturers have moved
away from hydrogenation, a process
that solidifies liquid vegetable oil but al-
so can generate trans fats. Instead, they
use a small amount of modified palm
and palm kernel oil to get the job done.
Non-hydrogenated margarine is more
spreadable than its predecessor and
contains no trans fats and up to 80 per-
cent less saturated fat than butter. Sun-
derland, a consulting dietitian, advises
her clients to use it.
Avoidingfata‘bigmistake’
Not surprisingly, some of her clients
remain skittish about fat in gener-
al because of its calories, so Sunder-
land emphasizes that a small amount,
two to three tablespoons, of good fat
per day is the right amount. You could
get much of your daily requirement by
spreading soft margarine on toast and
a sandwich, and by adding ground
flax seeds on top of a salad or into
your oatmeal.
Also, fat creates a feeling of fullness, so
peoplewhogowithoutitoftengethunger
pangs that send them running for prod-
ucts that contain refined carbohydrates,
which leads to weight gain. White bread,
refined flour crackers, white rice and
other products that fall into this category
causeasurgeinbloodsugar.Ifthesugaris
notusedforfuel,itcanbecomestoredand
resultinweightgain.
“The bottom line,” says Sunderland,
summing up the message she conveys
to health-conscious clients, “is to enjoy
two to three tablespoons of healthy
unsaturated fat every day. Avoiding fat
altogether is a big mistake.”
By Randi Druzin
Replace butter
with Becel®
1:1 for 80% less
saturated fat,
and zero trans fat.
Go to Checkout51.com
for $1.50 coupon.
Go to Becel.ca to sign up
for our Heart Healthy Newsletter.
BECEL is a registered trade-mark of Unilever Canada.
“The butter-versus-
margarine debate has been
a flashpoint in the ongoing
conversation about fat.
While some people promote
butter as an “all-natural
choice,” most dietitians
advise to use less of it.”
Commercial feature
6. insight
6 personalhealthnews.ca
HeartAttack101
WhatYouNeedToDefend
AgainstAHeartAttack.
E
ach year, there are
an estimated 70,000
heart attack cases in
Canada – translating
to one victim approx-
imately every 7 minu-
tes.Eachyear,heartat-
tacks claim the lives of 16,000 people
across the nation, according to the
HeartandStrokeFoundation.
Know your risk
Heart attacks are complicated and
combine multiple aspects of who you
are and how you live.
“There are certain [risk factors]
that can’t be changed and certain
ones that can be, you have to look at
them all,” explains Barbara Kennedy,
the executive director of the Cardiac
Health Foundation of Canada. “They
all interact.”
Inherent risks that can increase the
chance of suffering a heart attack in-
clude family history or advanced age.
However, factors like smoking, un-
healthy diet, lack of exercise, obesi-
ty, high blood pressure, high choles-
terol, diabetes, and stress can be con-
trolled or treated to lower the risk to
the heart.
Though heart attacks are often con-
sidered to be a concern for the un-
healthyorelderly,cardiologistDr.Rob-
ertWelsh says that is a misperception.
“I think we all live in a little bit of
denial, but if you look hard at yourself
or at people aroundyou,there arevery
few people who have none of the clas-
sic risk factors for heart attack,” he
says. “Everyone should be cautious of
their risk.”
Act quickly
A heart attack occurs when one of the
arteries that supply blood to the heart
becomes blocked,stopping the flow of
oxygen and nutrients.When this hap-
pens – prompting signs such as chest
discomfort, nausea, or shortness of
breath – time is of the essence.
“The symptoms of a heart attack
aren’t always devastating and cata-
strophic,” saysWelsh,explaining that
some signs can be easily misunder-
stood as indigestion or other minor
health issues. “People don’t think the
problem is as serious as it is until they
start to get really unwell from it.”
Without prompt treatment, heart
attacks can be fatal. Even if a patient
lives, delaying medical attention can
injure the heart, causing life-long
complications.
“The long-term risk is that if you
weaken the heart muscle, then you’re
both exposed to congestive heart fail-
ure – where you have lack of energy,
shortness of breath on exertion, in-
ability to live a high quality of life due
to limited heart function – and ab-
normal heart rhythms because the
more damage you have to your heart,
the more scarring you have and the
more at risk you are of lethal heart
rhythms,” explainsWelsh.
You simply need a doctor’s re-
ferral to access it after your
heart attack.
Cardiac rehab is designed for peo-
ple who have experienced a car-
diac event, such as a heart attack.
The program has evolved over the
years from a simple monitoring for
a safe return to physical activities to
a multidisciplinary approach that
focuses on patient education, in-
dividually tailored exercise train-
ing, modification of the risk factors
and overall well-being of the cardi-
ac patients. The program educates
and encourages patients to make
lifestyle adjustments with exercise
prescriptions; nutrition counsel-
ling; cholesterol, hypertension and
obesity management; symptom
and medication strategies; smok-
ing cessation; control of diabetes;
and stress and anxiety reduction.
Patients in a cardiac rehab pro-
gram feel safer, stronger and more
confident as a result of their partic-
ipation. But cardiac rehab isn’t just
about making patients feel good;
it produces concrete results. Evi-
dence-based research has concluded
that providing that transition back to
independence greatly improves pa-
tient outcomes in both the short and
long-term.
Benefits of cardiac rehab
■■ Improves exercise tolerance and
strength
■■ Reduces blood fat levels
If a patient experiences a heart at-
tack and the arteries are completely
blocked, Welsh estimates that they
have between three to six hours to get
medical therapy otherwise perma-
nent damage can be caused.
His advice: as soon as you spot
symptoms,call 911.“By activating the
system, you greatly reduce your risk
of death and disability,” he says.
Stay healthy
Kennedy advises Canadians to know
their risk factors for a heart attack
by talking to their healthcare profes-
sional. Though some factors are be-
yond a patient’s control,others can be
improved through diet, exercise, and
lifestyle changes.
“To us, exercise is medicine,” says
Kennedy, adding that this applies to
people of all ages.
By Ishani Nath
THE Warning Signs
Learn to recognize the
signs of a heart attack
so you can react quickly to save
a life. Warning signs can vary from person to person
and they may not always be sudden or severe.
Nausea Light-
headedness
Sweating
Shortness
of breath
Chest
discomfort
Discomfort
in other
areas of the
SOURCE: Heart & Stroke Foundation
!
“As soon as you spot
symptoms, call 911. By
activating the system, you
greatly reduce your risk of
death and disability.”
■■ Improves psychological well-being
■■ Improves quality of life
■■ Speeds up the ability to return to
work
■■ Increases awareness of cardiac risk
factors
■■ Reduces stress
■■ Reduces blood glucose for diabetes
Many individuals are not aware that
cardiac rehab programs are available
to them for free after their heart at-
tack. All that is required is a simple
referral to a program by a doctor. The
Cardiac Health Foundation of Canada’s
website ( www.cardiachealth.ca) is an
excellent source of information as to
which hospitals and sites across Cana-
da offer a cardiac rehab program.
What happens upon arrival at a
typical CR program?
The first meeting usually involves:
a stress test, an electrocardiogram
(EKG), blood pressure and oxygen level
tests.These tests allow the cardiologist
to prescribe the starting exercise regi-
men along with identifying the sched-
ule for the individual to follow. Some
programs offer an eight-week program
three times a week; others offer a six
month program for one day a week;
and still others offer a three month
plan twice a week.
During the exercise portion, in-
dividuals may be on a treadmill, or a
bike which has handles for moving
the arms while peddling, or be as-
signed to a rowing machine. During
the activity, blood pressure and oxy-
gen levels are constantly moni-
tored and recorded. Additional-
ly some may use a heart monitor
halter which is worn for 24 to 48
hours, monitoring the heart rate
and rhythm of the heart. In addi-
tion to counselling, individuals
are encouraged to develop a sup-
port network amongst the oth-
er members who are attending
the cardiac rehab program with
them. Some programs may in-
clude special events to promote
networking such as golfing and
or family sessions on nutrition
along with other cardiac rehab
members.
Cardiac rehabilitation pro-
motes lifestyle change. We en-
courage everyone to get a referral
from your family doctor or a walk-
in clinic, to participate in a pro-
gram that offers help and hope.
Co-authored by Barbara Ken-
nedy – Executive Director Car-
diac Health Foundation of Can-
ada and John Sawdon – GTA
Director of Heart Wise Exer-
cise/ a special project of the
Cardiac Health Foundation OF
Canada made possible through
an OTF grant
DidYouKnowThatCardiac
RehabIsFreeAcrossCanada,
AtSelectHospitalsAndClinics?
7. inspiration
MEDIAPLANET 7
Hearty
MealsMasterChef Canada
judge and restaurateur,
Claudio Aprile, shares his
passion for healthy home
cooking.
Mediaplanet How have your
careers as a restaurateur
and MasterChef Canada
judge allowed you to share
your passion for food with
Canadians?
Claudio Aprile MasterChef
Canada has given me an amazing
platform to share some of my
greatest passions — food and
mentoring. As I get older, I find
myself wanting to give far more than
I receive and I really enjoy being part
of something that is greater than its
individual parts, something that has
the power to change the outcome of
someone’s life.
The opportunity to be a judge on
MasterChef Canada came at the per-
fect time in my life. I was looking for
a new challenge, I wanted to be the
student. I now get the rare chance to
express how I feel about food to mil-
lions of people — that is profound.
Along with that comes a huge sense
of responsibility and privilege that I
don’t take lightly.
MP Food labels can often be
overwhelming. What are the
top three things that heart
health-conscious shoppers
should look for?
CA One of my rules when I read food
labels is expiry dates. If the expiry
date is longer than a few days, I avoid
it. I always smell all my food before
I eat it, that’s a very chef-y thing to
do. I don’t trust that it’s fresh unless
I verify through smell. If I get any off
smells, I won’t go near it. The other
thing is long lists of chemicals and
stabilizers that I don’t understand.
If I can’t spell it, I won’t eat it. High
levels of sugar and fat are also red
As the vice president
of a major construction
company, Greg Nevison
almost never calls in sick,
but two years ago, he knew
something was wrong.
Itwas nearing the end of the summer
and Nevison was out for his regular
swim, but his body didn’t feel up for
it. “It felt sort of like the flu,” he says,
explaining that he brushed it off and
continued with his workout. As he
swam, the discomfort worsened.
“It felt muscular, sort of in my
shoulders and arms, which you use
tremendously in swimming, so I
thoughtitwasrelatedtotheswimming,”
herecalls.Afterfinishinghisworkout,he
planned to go to his next appointment,
but on the drive over,hewas still feeling
offsohereroutedandwenthometorest
andsearchforanswers.
“It was a sensation I’d never really
flags for me. Never buy pre-made
salad dressings, they are so easy to
make at home.
MP How can home cooks make
their meals more heart healthy
without sacrificing flavour?
CA I never add salt to my meals when I
cookathome.Agreattrickisusingacidity
such as fresh lime or lemon and fresh
herbs to your food. Adding fresh herbs
and acidity elevates the flavour profile of
all your food without the added sodium.
I also try to eat more frequently.Another
great method is cooking vegetables for a
longperiodoftime.Cookyourvegetables
slow and low; allowing vegetables to
caramelizeincreasestheflavour.
MP What are some easy
dietary changes that all
Canadians can make?
CA Try to only use your freezer for ice
cream and ice cubes. Reduce processed
frozen meals. Reduce animal fats and
eat more vegetables, fruits and grains.
Cookwithyourkids,teachthemhowto
prepareameal.
MP What words of wisdom
do you have for aspiring
home cooks across Canada?
CA Canada is the most multi-cultural
country in the world, and we have
one of the most exciting food cultures
anywhere. Explore as many ethnic
cuisines as possible. If you have a local
restaurant that you frequent, ask the
chefifyoucanspendtimeinthekitchen.
Experiment at home with flavours and
techniques,there’snorightorwrong.
The word “perfect” has no place in a
home kitchen. Don’t be afraid to make
mistakes – the most important lesson
is to have fun. Practise moderation,
and that includes moderation itself –
every once in a while I think it’s ok to
cave in toyour guilty pleasures.
“Adding fresh
herbs and acidity
elevates the flavour
profile of all your food
without the added
sodium.”
Healthy competition MasterChef Canada. Follow Claudio on Twitter @claudioaprile. Photos: CTV networks
TakingABeat:AHeartAttackSurvivor’sStory
had before so that’s why I pulled out
my phone and started looking,” he
says. The pain was persistent and
worsening, mostly concentrated to
his chest area and radiating down his
arm. Nevison Googled his symptoms
and discovered they were classic
signs of a heart attack.
He called 911 and chewed two low
dose tablets (81mg) of acetylsalicylic
acid (ASA),and headed to the hospital.
MedicaltestsconfirmedthatNevison
hadexperiencedaheartattack.
“I was shocked,” he says. “I didn’t
really think it was that bad.”
The cardiologist told Nevison that
taking low dose ASA as soon as he
suspected a heart attack was “the
smartest thing you did.” In Canada,
low-dose Aspirin are approved for
emergency use during a heart attack
and may stop blood clots from
forming. Nevison’s cardiologist said
that it’s likely that these pills may
have helped save his life.
At the time of his heart attack,
Nevison was 56 and thanks to
exercising regularly, his doctors
considered him to be in good health.
He had no family history of heart
attacks, but he had been under
prolonged stress – considered a risk
factor for heart attacks – while his
family built their new home.
“I’m kind of high strung to start
with,” says the senior vice president
of Tridel Corporation.
According to the Heart and Stroke
Foundation, every seven minutes,
someone experiences a heart attack
and each year, heart attacks claim
nearly 16,000 lives.
If it wasn’t for his friend who had
suffered a massive heart attack only
a few months before, Nevison says
he wouldn’t have taken action. “I
probably would’ve ignored it and
gone to bed,” he says.
Knowing the signs and symptoms,
Nevison now tells all of his friends to
take precautions, including keeping
low doseASAin easily accessible places
likeyour bag,or in an office drawer.
Nevison says that often times,
people will think they’re fine,
attributing symptoms to the flu or a
workout,likehedid,butheencourages
people to take these signs seriously.“If
you have any suspicions, call 911 and
then crush and chew two low dose
ASA,” he says.
By Ishani Nath
“At the time of his heart
attack, Nevison was 56
and thanks to exercising
regularly, his doctors
considered him to be
in good health.”
8. Research
8 Personalhealthnews.ca
Heart disease kills six times
more Canadian women than
breast cancer and it’s the
leading cause of death among
women. This doesn’t have to
be the case. Boosting awa-
reness and embracing new
education tools and knowled-
ge can help curb the upward
trend of the disease.
Sue Williams, a retired nurse and pro-
fessor from Ryerson University in To-
ronto, was one of the lucky ones. In
2007, at age 60, she suffered a full car-
diac arrest during a vacation to Eng-
land. She had a family history of heart
disease, but no other risk factors. She
did the right things to monitor her
health,likehavinghercholesteroland
blood pressure monitored,underwent
a stress test and got annual check-ups.
But, she says, “I went from quite fine
to nearly dead in 30 minutes.”
Because of her nursing background,
Williamsknewtheearlysignsofaheart
attack – pain in the neck,jaw,back and
arms, nausea, sweating, shortness of
breath and lightheadedness. Her hus-
band got her to the nearest hospital
quickly where doctors were able to re-
suscitateherandinsertastentintoher
heart. After a period of rest, Williams
madethetriphomeandgothergeneral
practitioner to refer her to a cardiac re-
habilitation program (designed specif-
ically for women) at Women’s College
Hospital to continue her journey back
tohealth.
Misdiagnoses in women
Fortunately, Williams received
proper treatment from her doc-
tors in England, however, there is a
lack of recognition for the signifi-
cant differences in the way men
and women exhibit symptoms of
cardiovascular disease and their risk
factors. Women tend to develop it
about 10 years later than men, with
post-menopause being the prime
time for onset.
“We absolutely need complete
equity when it comes to how we
address cardiovascular disease
in women,” says Dr. Paula Har-
vey, Head of the Division of Cardi-
ology, Women’s College Hospital,
in Toronto. “I’ve been research-
ing cardiovascular disease for dec-
ades and we are making progress.
Yet women are still being misdiag-
nosed and risk factors missed.” It’s
also important to note that younger
women are developing the disease
at an increasing rate.
Identifying risk factors
There is still much more knowledge
to be gained so that women are prop-
erly monitored for the signs of heart
disease. Recognizing risk factors is
key.They include: a sedentary life-
style and co-morbidity with other
conditions, like autoimmune dis-
orders such as lupus and type-2 dia-
betes. For example, a woman with
type-2 diabetes has an eight times
higher risk of heart disease than one
without diabetes.The latest find-
ings also examine the connection be-
tween a woman’s reproductive his-
tory and an increased risk of heart
disease. Researchers have deter-
mined that issues such as premature
menopause, complications during
pregnancy and irregular periods may
be linked to heart disease.
The fact that men and women do
not exhibit the same symptoms of
cardiovascular disease is something
that Dr. Harvey says is important
to note. A woman presenting symp-
toms such as chest pain is some-
times thought to have a different
condition like angina. There is still
some belief that cardiovascular dis-
ease is more of a man’s disease. It’s
not and statistics back that up with
more women than men dying be-
cause of it. Even diagnostic tools,
like stress tests and ECGs, can result
in false positives and inaccurate re-
sults for women, which underscores
the importance of treating patients
according to gender.
Knowledge is the key
Dr. Harvey is pushing for greater
public awareness, increased educa-
tion and more accurate diagnoses
for women. “Cardiac disease is life-
changing. Women must have the
same access to treatment and care
as men,” she says. She emphasiz-
es that it’s crucial for women to pay
heed to their symptoms, not brush
them aside. As caregivers and nur-
turers,women often put themselves
second and fail to make their own
health a priority
Getting the facts about cardio-
vascular disease is a crucial first step
in saving women’s lives. Women’s
College Hospital, in partnership
with Shoppers Drug Mart’s women’s
health program – Shoppers LOVE
YOU, is helping women stay focused
on being their best, by offering two
sources of expert advice on women’s
health topics: womenshealthmat-
ters.ca, Canada’s trusted source of
information, news and research
findings, and myhealthmatters.ca,
which offers health information
based on personal health priorities
and an individual’s stage of life in
order to help manage and improve
heart health.
Today, Sue Williams, an active
grandmother of four, shares her
story with other women and does
volunteer work with Women’s Col-
lege Hospital and other organiza-
tions. She tells them, “It could hap-
pen to you. It’s important to under-
stand your risk factors, and make the
necessary life modifications to mini-
mize them. And don’t hesitate to
seek medical treatment.”
By Michele Sponagle
Heart attack survivor Sue Williams with WCH advance practice nurse, Jennifer Price. Women’s College Hospital created North America’s first cardiac prevention and rehabilitation
program designed exclusively for women. Photos: Elif Rey Photography
Women receive personalized care plans to help prevent and manage heart disease at Women’s College Hospital.
As part of an integrated health
program, pharmacists and doc-
tors go hand in hand to optimize
treatment for patients dealing
with cardiovascular issues.
While Canadians see physicians as
trusted sources of information, they
should know that pharmacists can al-
so provide advice, offer lifestyle modi-
fication tips,and support and guidance
on getting the most out of their medi-
cation.Patientscanreapmultiplebene-
fits from pharmacists’ expertise and
wealthofknowledge.
Getting to know your
pharmacist
The next time you visit your phar-
macy, don’t just grab your meds and
go.Talk to your pharmacist about your
health.You’ll be surprised bywhatyou
can learn.
JamesNg,apharmacistandownerof
a Shoppers Drug Mart on West Broad-
way in Vancouver, recalls a conversa-
tion he had with one customer. “He
initially asked me for medicine that
would treat his recurring headaches,”
Ng says. “I began to ask him questions
about why they were occurring. I sug-
gested that we test his blood pressure
with the machine we have available in
the store. It turned out that his blood
pressure was skyrocketing, which ex-
plained his headaches.I recommended
thatheseehisdoctorrightaway.”
High blood pressure is a key risk fac-
torincardiovasculardisease,soitwasa
potentially life-saving exchange. Many
patients don’t realize that with a min-
imum of five years in university study-
ing everything from anatomy to path-
ology, pharmacists have a vast, sol-
id foundation of knowledge, making
them invaluable sources of guidance
andinformation.
Focusing on prevention
“Patients are now realizing that we
don’t just count pills. We can offer a
great deal of support and advice - not
just on potential drug interactions, but
on things like diet and exercise recom-
mendations, too. We focus on treat-
ment, but also on the prevention of
diseases and that’s first and foremost”,
saysNg.
Ng offers a couple of tips for ward-
ing off cardiovascular disease. Exer-
cise is avery effective tool,just half an
hour of activity – anything that gets
your heart pumping – three times a
week is a good place to start. Ng al-
so notes how patients’ reliance on
high-fat and low nutrition fast food
is detrimental to health. Since hun-
ger and being short on time can lead
to bad food choices, Ng recommends
that patients plan their meals ahead.
“Even small changes in lifestyle can
go a long way,” he says.
Pharmacists are there to offer sup-
port and pragmatic tips. And, while it
can sometimes take time to see a phys-
ician, pharmacists are often accessible
in the evenings and on weekends, and
are trusted resources available to help
withcredible,currentinformation.
Seeing the big picture
Looking at a patient’s total health pro-
file is something pharmacists can do.
More than just addressing symptoms,
proper healthcare is about looking at
underlying conditions and future pre-
vention. Ng emphasizes the import-
anceofnotwaitinguntilsymptomsap-
pear before seeking professional input
onyouroverallhealth.
Having support for lifestyle changes
from your pharmacist for a personal
health plan can be a source of inspir-
ation. To work with your pharmacist
effectively, Ng advises that it’s import-
anttoknowsomekeynumbers–blood
pressure, cholesterol, blood sugar and
body mass index (BMI). However,
many patients don’t always under-
stand what the numbers mean. “It’s
crucial that they understand what’s
happening inside their bodies,” he
says. “A proactive approach to health
really works,so it’s important to know
basic information.”
At many pharmacies, blood pressure
andbloodsugartestingcanbedoneright
onsite.Pharmacistswill review the data
fromlogbooksofferedtopatientstokeep
track of their blood pressure readings
and can discuss results.This helps iden-
tify risk factors, an important measure
indiseaseprevention.
By Michele Sponagle
Heart Of The Matter
“Looking at a patient’s total health profile
is something pharmacists can do.
More than just addressing symptoms,
proper healthcare is about
looking at underlying conditions
and future prevention.”
New Risk Factors For Women Underscore The Need
For Greater Awareness Of Heart Disease
Pharmacists Play A Key Role In Providing
Patients With Heart Health Information
“I went from quite
fine to nearly dead
in 30 minutes.”
9.
10. innovatIon
10 personalhealthnews.ca
When Carol Johnson found
out she needed an implantable
cardioverter defibrillator (ICD),
a device that prevents death
from sudden cardiac arrest,
she did a lot of research.
Shedecidedshewantedtogetthenew-
est version of the device and wouldn’t
take no for an answer. Johnson, who
sufferedthreeheartattacksbeforehav-
ingbypasssurgeryin1999,wasdelight-
ed when she finally found a cardiolo-
gist who would refer her to a specialist
thatcouldimplantthedevice.
In March 2014, Dr. Jeff Healey, an
associate professor in the Division of
Cardiology, Department of Medicine
at McMaster University,fitted Johnson
with the subcutaneous implantable
cardioverterdefibrillator(S-ICD).
Unlike the traditional ICD, which
is implanted in the shoulder area and
uses leads (wires with electrodes) that
extendthroughtheveinsintotheheart
to monitor its rhythm,the S-ICD is im-
plantedonthesideofthechestandthe
leads are placed under the skin above
the breastbone with no components of
the S-ICD entering the blood vessels or
theheart.
Like many people using the new de-
vice, Johnson is happy with it. “For
the first few days after the procedure, I
walkedaroundworriedthatIwouldget
a shock any second but then I got used
toit,”saysthe72-year-old.“Now,Idon’t
evennoticeit’sthere.”
Undeniable benefits
Use of the traditional ICD became
widespreadinthelate1990s,morethan
two decades after itwas pioneered by a
team of doctors at a hospital in Balti-
more, Md.The battery-powered device
keeps track of the patient’s heart rate
and if it detects an abnormal one, it
delivers an electric shock through the
leads to restore a normal rate.Without
this help,the patient’s heart could stop
beatingaltogether.
Sudden cardiac arrest is a medical
emergency.If not treated immediately,
it causes death. It’s one of the leading
causes of death among adults over the
ageof40.
ICDs have proven very effective in
preventingsuddencardiacarrestinpa-
tients with various heart conditions.
StudiesindicateICDshavearoleinpre-
venting cardiac arrest in patients who
are at risk of having (but have not yet
had) life-threatening ventricular ar-
rhythmias, which are abnormal heart
rhythms that originate in the bottom
chambersoftheheart.
The ICD also has the ability to func-
tion as a pacemaker. In this capacity
it can make sure the heart does not
beat too slowly and can correct cer-
tain types of inappropriate fast heart
rhythms.
Use of the traditional ICD has un-
deniable benefits but it also has
some drawbacks, including possible
vascular obstruction (decreased
blood flow caused by the obstruction
of blood vessels), thrombosis (a clot
formed in a blood vessel or heart)
and even cardiac perforation (hole in
the heart).
Also, it is possible that after a
number of years traditional leads
may break, which could result in in-
appropriate shocks from the ICD or
an inability to deliver a life-saving
shock. This means some patients
may need to have them replaced sev-
eral times over the course of their
lives. If removal of old leads is need-
ed, the procedure can be challenging
and can lead to complications, in-
cluding death.
Furthermore, some patients have
blocked veins, recurring heart infec-
tions and other conditions that rule out
theuseofatraditionalICDaltogether.
A “simple, elegant” solution
The S-ICD provides the benefits of the
traditional ICD without many of the
drawbacks because it leaves the heart
and blood vessels alone and intact —
so,although it can’t function as a pace-
maker, it’s a better option for many
heartpatientslikeJohnson.
Also, the device is placed under the
armpit,whereitcan’tbeseenwhilethe
patient is wearing street clothes, and
this makes it especially appealing to
fashion-conscious women. Healey de-
scribesitas“asimple,elegantsolution”
formanypeople.
He emphasizes that by preventing
sudden cardiac arrest, ICDs “really do
save lives.” He adds that heart patients
in Canada have access to quite a few
specialistswho “are educated about the
S-ICDandaregoodatimplantingit.”
Great sense of security
Johnson and her husband Jerry Ran-
dall, 69, were installing a sunroof in
their trailer in Julywhen they received
more heart related news. A medical
exam revealed that Jerry,who had suf-
fered a massive heart attack in 1991,al-
soneededanICD.
Encouraged by his wife’s glowing
reviews and a preference for getting a
device to protect him against sudden
cardiac arrest that didn’t have to go in-
to heart, he requested the S-ICD. Hea-
ley performed the procedure and the
couple became the first husband-wife
teamin Canadatoboth getthe newde-
vice. Randall’s experience with it has
beenaspositiveasthatofhiswife,who
praises Healey for his ability to explain
medical procedures and devices in
plainlanguage.
“Jerry got his device put in a few
weeks ago and he is doing well. I am
fine too,” says Johnson, who recently
spent a weekend camping in her trail-
er near Peterborough, On., along with
her husband and other family mem-
bers. “With the S-ICD we can still
enjoy life’s activities and we feel com-
fortablewhile doing so.This increased
sense of security is just great.”
By Randi Druzin
A “Simple, Elegant” New Device
Saves Heart Patients’ Lives
Transvenous ICD System
(electrical wires placed through
the veins into the heart)
IMPLANTABLE DEFIBRILLATOR OPTIONS
Subcutaneous ICD System
(electrode placed under the skin
with nothing inside the heart)
Carol Johnson and her husband Jerry Randall both have S-ICDS and live
life to the fullest. Photo: Submitted.
11. Perspective
MEDIAPLANET 11
Approximately 40 percent of
Canadians will be diagnosed
with cancer at some point in
their lifetime however there is
reason for optimism.
Modern treatment strategies have led to
improvementinthechancesofsurviving
adiagnosisofcancer;thefive-yearsurviv-
al for early stage breast cancer increased
from 79 percent in 1990 to 88 percent in
2012 and similar improvements have
been seen with other cancers including
non-Hodgkins lymphoma and testicular
cancer. Modern cancer treatments how-
evercancomeatacost.
Cardiotoxicity, a relatively new term
in the medical literature, refers to the
impact of cancer therapies on the heart
and cardiovascular system. Cardiac
complications from cancer treatments
canresultfrommultiplefactorsinclud-
ing: pre-existing patient factors (e.g
high blood pressure), cancer-related
factors, and toxic effects of the chemo-
therapy drugs. Cardiotoxic manifesta-
tionsofcancertherapyincludeleftven-
tricular dysfunction (decrease in car-
diac contractile function) and heart
failure (clinical syndrome resulting
fromtheinabilityofthehearttosupply
sufficient blood flow to meet the body’s
needs), myocardial ischemia, infarc-
tion, hypertension, and bradycardia
(lowheartrate).
A new branch of medicine
Cardiotoxicity is now recognized as
a leading cause of long-term morbid-
ity and is the second leading cause of
death among cancer survivors.The in-
creasing awareness by healthcare pro-
viders of the potential negative impact
of cancer treatments on cardiovascu-
lar health has resulted in the develop-
ment of a new branch of medicine –
Cardio-oncology. Cardio-oncology is
a multidisciplinary approach, involv-
ing oncologists, cardiologists, phar-
macists,nursesandotheralliedhealth
care providers, developed to provide
patients with the best cancer treat-
ments available without negatively
impacting cardiac health. For patients
“at risk” or with a history of heart dis-
ease, oncologists and cardiologists
work together to develop strategies to
avoid or minimize cardiac complica-
tions related to cancer treatment.
A collaborative approach
Our population is aging: many Can-
adians will face a diagnosis of heart
disease, cancer or both. Working
together we can strive to provide in-
dividuals with “state of the art” can-
cer therapy while optimizing cardiac
health – the cured cancer patient of
today does not want to become the
heart failure patient of tomorrow.
This integrated multidisciplinary ap-
proach, has resulted in the establish-
ment of several cardio-oncology pro-
grams in Canada, the United States,
Europe and South America.
While our understanding of how
modern cancer therapies impact the
heartcontinuestoevolve,manyknow-
ledge gaps persist: how can we predict
who will develop cardiotoxicity, what
is the best prevention strategy, how
should we monitor those at risk of
cardiotoxicity and what are the best
management strategies? There is an
urgent need for collaborative studies
to address these questions. Organiza-
tions such as the Canadian Cardio-
vascular Society (CCS), Canadian Car-
diac Oncology Network and the Inter-
national Cardiooncology Society, will
play an important role in the promo-
tion of clinical care models, develop-
ment of educational programs (for pa-
tients and healthcare providers) and
facilitation and promotion of evi-
dence-based research.
By Dr. Susan Dent
Medical Oncologist, Depart-
ment of Medicine Associate
Professor, University of Ottawa
Founder and Director, Canadi-
an Cardiac Oncology Network
“Cardiotoxicityisnow
recognizedasaleading
causeoflong-termmorbidity
andisthesecond leading
cause ofdeath among
cancer survivors.”
A New Approach to Treating CHF
Cancer And Heart Disease:
Should We Be Concerned?
C
ongestive Heart Fai-
lure (CHF), the con-
dition where your
heart can’t pump
enough blood to
meet the demands
of your body, has
reached epidemic proportions in Ca-
nadawith an estimated 1 in 60 people
living with it and a national cost to
healthcare of at least $3 billion. CHF
is the single commonest reason a pa-
tient goes to a hospital ER for treat-
mentandthesinglecommonestdiag-
nosis for hospital admission. What’s
more,the average life expectancy af-
teraCHFdiagnosisisamere2.1years.
Expert insight
Recently, two of Canada’s leading cardi-
ologists, Ontario Association of Cardiol-
ogists(OAC)BoardMembersDr.Heather
Ross and Dr. Mike Hartleib were inter-
viewedtodiscussthesizeoftheproblem,
the enormous healthcare costs associat-
edwith it and newways of approaching
CHFtosavelivesandsavemoney.
“Heart failure is an epidemic. But, it
isn’t just a problem for the healthcare
system.This is an incredible burden on
the patient,their family and their care-
givers. Wewant to,and have to,be able
tochangethat,”saidDr.Ross.
“Both Heather and I work in com-
munitycareandlargehospitalenviron-
ments andwe know first-hand that the
hospital environment is not always
the best place to treat CHF. It’s huge-
ly expensive and often adds stress that
is more difficult for patients and their
familiestomanage,”saysDr.Hartleib.
“For sure there are times when the
hospital environment is absolutely
needed but the goal should be to keep
people away from the ER by providing
early diagnosis, rapid access to care and
support for patient self-management
in a far more cost-effective setting than
a hospital. And after someone has been
treated in hospital, we want to keep
them out, to make recovery easier for
themandlesscostlyforthesystem.”
Dr. Hartleib continues, “did you
know the cost of treating uncomplic-
ated CHF in hospital starts at $12,000
and if it is complicated it can easily rise
toatleast$42,000?”
New strategy for CHF
In Dr. Ross’ opinion, a new approach is
needed. “Given the stark patient out-
comes and health system costs associ-
atedwith CHF,governments across the
countrymustconsiderfundingnewap-
proaches to CHF care aimed at keeping
patients out of hospital and receiving
careclosertohome.”
This is at the core of a recent OAC
proposal to the Ontario government
called the CHF Regional Hubs Initia-
tive. It addresses the gap that cur-
rently exists between hospital and
community-based care. It ensures
timely cardiac specialist expertise is
available in the community to high-
risk CHF patients recently discharged
from the hospital.
“When you put together a program
likethis,youlooktotheliteraturewhich
shows that early access to care, to the
healthteam,rapidresponseforpatients,
early access post-discharge… all have
beenshowntoimproveoutcomesforpa-
tients,”Dr.Rossobserved. “Itistheright
care, for the right patient, at the right
time,bytherightpersonandthat’swhat
we are trying to do with the Regional
Hubsproject,”sheadds.
The OAC represents the majority of
cardiologists in Ontario and is one of
the most knowledgeable groups on
issues of cardiac care in the province.It
continues to meet with the provincial
governmenttoofferitsexpertiseincar-
diac care in order save dollars and lives.
This fall it will launch a public cam-
paigntoincreaseawarenessofCHFand
newmethodsoftreatment.
ontarioheartdoctors.ca
CHF is Killing Us
Physically &
Financially
A Practical Community Care
Solution is Needed
Learn more at: ontarioheartdoctors.ca/stories/chf-hubs/
OAC members researching the effectiveness of a community approach to CHF in Ontario. Photo: Submitted
12. INSIGHT
12 personalhealthnews.ca
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Science For a Better Life — It’s our promise and our commitment
to all Canadians. Every day, we put science to work to improve the
quality of life for people, for animals and for communities.
Our innovations in healthcare lead to breakthroughs that
fight diseases and offer healthier alternatives to existing
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high-tech, high-performance materials improve the design
and functionality of products we all use regularly.
Who is Bayer? We’re Canadians, we’re inventors.
Together, we’re making life better for everyone.
A
trial fibrillation (AF) is a
heart condition affecting
roughly three percent of
all North Americans. AF
is characterized by irre-
gular or rapid beating of the heart, and
itcanleadtoseriouscomplicationssuch
asstroke.ForpeoplesufferingfromAF,it
canbebothconfusingandfrightening.
When Alice first experienced symp-
toms of AF, she was sitting on her
couch watching TV and suddenly felt
her heart racing as though she were
running a marathon.Shewas prompt-
ly diagnosed at the ER, but in many
ways that was the beginning, not the
end, of her troubles. Suggestions from
doctors on how to manage her AF
seemed to vary with each new doctor
shetalkedto.
At the heart of the matter are the
many faces of AF. The potential caus-
es of AF are wide-ranging, and the
ideal treatment for each individual
can be equally varied. Uncertainty
about treatment leads to fear. “For the
first while I didn’t want my husband
to leave the house,” says Alice. “That’s
howafraidIwasofit.”
Convenience and
compliance: just as
vital as efficacy
Historically, the AF drug of choice has
been Warfarin, an anticoagulant. It’s
a very effective drug, in use since the
50s, but it has its downsides.There are
people who are resistant to it, or who
have drug-drug interactions, but most
importantly it requires constant mon-
itoring of blood thinning levels,which
meansfrequenttripstolabsfortesting.
For many Canadians,this is a substan-
tial hardship in terms of time off work
aswell as travel time and expenses,es-
pecially for more remote patients who
musttravellongdistancesforlabwork.
“Because Warfarin is such a pain in
the neck,we had a pretty high bar a pa-
tienthadtoclearbeforewewouldbegin
on anti-coagulants,” says Dr.Jafna Cox,
who has been heavily involved in the
development of national guidelines for
the treatment of atrial fibrillation. A
new class of drugs,known as novel oral
anticoagulants (NOACs), however is
changing the landscape. “At the end of
theday,theyarenotthatmuchmoreef-
fectivethanWarfarin,butwhattheydo
offerismarkedeaseofuse.They’reeasi-
ertotakeandthushopefullyhavebetter
patientcompliance.”
And with AF, drug compliance is of
paramount importance.A recent study
of AF patients in Ontario found that 61
percent stopped taking the drugswith-
infiveyears,drasticallyincreasingtheir
risk of stroke. Furthermore, AF strokes
tend to be both larger and more con-
sequential than non-AF strokes,with a
substantially higher rate of both mor-
talityandpermanentincapacitation.
Real world data trumps all
So, if NOACs can improve compliance,
and convenience, without sacrificing
efficacy, they have the potential to be a
game changer. As with any new treat-
ment,ofcourse,thetruetestcomesfrom
real-lifedata.“Ofteninclinicaltrials,out
of100patientsthatyouscreen,youmay
only have five accepted into the study
because you have exclusion criteria af-
ter exclusion criteria,” says Dr. Cox. “So
youalwayswonder,doyouhavepatients
thataretoouncomplicated,withtoofew
otherconditions?”
As these new drugs make their way
into clinical use, the good news is that
the real-life data is beginning to re-
affirm the safety and efficacy of the
NOACs that was seen in the clinical
trials,with a safety profile substantial-
lybetterthanWarfarin’s.WhileNOACs
will not be the answer for every pa-
tient,theybenefiteveryonebyexpand-
ing the toolkit available to physicians.
ThisisgreatnewsforpatientslikeAlice
whonowhavenewoptionsformanag-
ingtheirlifewithatrialfibrillation.
By D.F. McCourt
Atrial Fibrillation:
The Value of Options
350,000
Canadians
20%
66%
Atrial Fibrillation
affects approximately
It is estimated that
of all strokes are caused
by atrial fibrillation
Hospital
admissions
for atrial
fibrillation
have increa-
sed by
Clinical Trials Real-life Evidence
How Real-life Evidence Is Making
A Difference In Atrial Fibrillation
Objective
Test safety and efficacy
of a drug vs. a comparator
Understand patterns of use
of a medication in clinical
practice
Setting
Controlled clinical trials Real-life clinical practice
Subjects
Highly selected by applying
many inclusion/exclusion
criteria
Less selected as there are
very few inclusion/exclusion
criteria
Uses of data
Determine efficacy and
safety of drug before it can
be used in clinical practice
Monitor and report on
effectiveness and safety of
drug after it is approved
for use
Treatment
Pre-specified regimen Flexible regimen
Sources: Heart & Stroke Foundation, European Heart Rhythm Association
