The SHARP message as strong as ever in its 22^nd year!

Now in its 22^nd year, the Scottish Heart and Arterial Risk Prevention (SHARP) charity held its annual scientific meeting in Dunkeld at the end of November. The theme of the meeting was “Partners in Cardiovascular Disease Prevention” and as usual attracted many high profile speakers for the event.

The work of SHARP falls into three main categories:

♥ implementation of evidence

♥ education

♥ research.

Many members play an important role in the development and implementation of national guidelines such as Scottish Intercollegiate Guideline Network (SIGN) guidelines for CVD and the NHS Quality Improvement in Scotland (QIS) standards on Coronary Heart Disease (CHD) and CVD. They have annual scientific meetings as well as regional educational meetings. SHARP also produces educational material for patients and staff including a Cardiovascular Risk Pack to assist in the identification and modification of risk factors for cardiovascular disease. SHARP also facilitates research into the causes and prevention of heart disease in Scotland.

Dr Robert Finnie (GP from Livingston) opened up the meeting with a formal thanks to Dr Shirley McEwan, a founding member and the driving force behind SHARP, who retired last year as this was the first year she had not attended the meeting.

The first plenary session brought an impressive list of guest speakers. Dr Jonathan Morrell, GP from Hastings and founding member of HEART UK and the Primary Care Cardiovascular Society (PCCS) spoke about primary care and cardiovascular disease. He told the meeting that a combination of smoking and raised lipids accounted for almost two thirds of all CVD risk. Risk tools, he told the audience, have their place but are not suitable for all patients and clinical judgement should be used for individual patients. He stressed the most important issue in dealing with risk in primary care is communicating cardiovascular risk in a way the patient will understand and modify lifestyle. He felt the work being done using a “heart age” may improve the way patients understand risk in the future.

Dr Jonathan Morrell and Professor Keith Fox

Professor Keith Fox, current President of the British Cardiovascular Society (BCS) and consultant cardiologist at the Edinburgh Heart Centre told the audience that the specialty of Cardiology has made a significant contribution to the management of patients with CVD and CHD. As well as the initiation of secondary prevention medication he highlighted the Rita-3 study which showed a 20% reduction in mortality in the group of patients with Non-ST Elevation Myocardial Infarction who had usual secondary prevention medication with PCI compared with those who did not have intervention. He also told the audience that the UK had better numbers than the USA in achieving 90 minute diagnostic ECG to balloon times. Dr Alan Rees, Chairman of HEART UK, finished of the first session with a presentation on lipid management for Primary Prevention; he warned the audience that a “blanket” Simvastatin 40mg daily for all would not work. Lipid management has to be tailored to each patient and may require more aggressive treatment depending on individual risk.

Dr Alan Rees presents at the SHARP meeting

Following the first session, there were well attended workshops covering topics as varied as atrial fibrillation and stenting to the management of familial hypercholesterolaemia and interpreting lipid values.

The afternoon plenary session was chaired by Dr Alan Begg, GP from Montrose and chair of the SIGN development group on the management of stable angina. This session focused on the specific problems around women and CVD then diabetes and CVD. Dr Robert Finnie informed the audience that despite presenting more frequently with angina, presenting later to hospital and having more silent MIs than men, women continue to be under researched, diagnosed and treated for CVD. Diabetes remains a major problem and risk factor for CVD. Professor John Betteridge from University College London told the group that diabetologists and cardiologists need to work more closely in the management of those patients with diabetes and CVD. He used data from the EMMACE study which showed that despite new advances in treatments such as drugs and cardiological interventions, those patients with diabetes still had similar mortality rates post-myocardial infarction in 2003 than the same group of patients in 1995. Patients with diabetes should be considered for more aggressive lipid management. LDL cholesterol remains a high risk marker for diabetic patients and Professor Betteridge suggested a target LDL of 1.8 for diabetic patients should be considered. Blood glucose control can aid in the reduction of CVD events such as MI and CVA and premature death. He used the PROactive study as an example of how this can be achieved, which used Pioglitazone on top of normal standard care, to control blood sugar. It demonstrated an increase in HDL cholesterol by 19% and a decrease in Triglycerides by 11% and a decrease in systolic blood pressure median 3mmHg over 3 years.

The final session of the day was a light-hearted discussion looking at who the major player is in CVD Prevention. “The Great Balloon Debate” pitted the wits of G.P. Professor Lewis Ritchie, Lipidologist Dr Robert Cramb, Hypertentionologist Professor John Webster and a Geneticist, Dr Alex Doney against each other. Each had 7 minutes to persuade the audience they had a more vital role to play in CVD prevention than their colleagues. After each had presented for their 7 minutes the audience voted and the group were reduced to the GP and lipidologist. After a question and answer session the Professor Lewis our GP in the group admitted that his contribution was as part of a team which included the practice nurses. After much banter the audience voted and the GP team won the contest as the most important player in the prevention of CVD. Dr Alan Begg closed the meeting by summarizing the event and thanking everyone who contributed and attended the successful meeting.

SHARP continues to be a major player in CVD risk prevention in Scotland and is always looking at new ways to spread its message.

To join SHARP click here.