STRATEGIES FOR COMMUNITY BASED FISHERIES MANAGEMENT IN THE LOW LYING WETLANDS OF BANGLADESH AND THE MEKONG DELTA M.G. Mustafa and A. K. M. Firoz Khan The WorldFish Center House 22B, Road 7, Block F, Banani Dhaka 1213, Bangladesh. Email: firstname.lastname@example.org Introduction Fisheries constitute a major component of food and livelihood systems in the flood-prone ecosystems in Bangladesh
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Cholesterol and cardiovascular risk advice leaflet july 201DUKES AVENUE PRACTICE CHOLESTEROL AND CARDIOVASCULAR RISK ADVICE
Your cholesterol should be measured as part of a RISK ASSESSMENT for cardiovascular disease (heart disease, stroke, TIA and peripheral arterial disease). Heart disease is a condition in which the blood vessels of the heart become narrowed or blocked by the build up of fat. Stroke is when the blood supply to the brain is cut off, which can damage the area of brain affected. TIA or Transient Ischaemic Attack is a mini-form of stroke which lasts less than 24 hours, and peripheral arterial disease is narrowing of the arteries, usually in the legs, due to the build up of fat.
Cardiovascular disease is the most common cause of death in the UK and is a major cause of illness, disability and poor quality of life. The major risk factors for cardiovascular disease are: WHETHER YOU SMOKE
YOUR BLOOD PRESSURE
WHETHER YOU HAVE DIABETES
YOUR FAMILY HISTORY
YOUR ETHNIC ORIGIN
YOUR CHOLESTEROL LEVEL
YOUR BMI (weight relative to height)
In making an assessment of your cardiovascular risk ALL these factors need to be taken into account. Your doctor will also take into account whether you have NEVER had any personal history of cardiovascular disease (advice and treatment is called PRIMARY prevention) or if you have previously suffered from cardiovascular disease (advice is then called SECONDARY prevention).
PRIMARY PREVENTION (if you have never had cardiovascular disease)
Stop smoking Smoking Cessation help and support is available in the practice, please
ask at reception.
Eat a Healthy Diet Eat less fat eg fried or processed foods, less saturated fats eg fatty
meat, butter, cheese, eat more unsaturated fats eg olive oil instead. Steam, poach, bake,
casserole or microwave foods rather than frying or roasting. Eat at least five portions of
fruit and vegetables a day. Eat at least two portions of fish a week including a portion of
oily fish eg herrings, sardines, mackerel or salmon. More information is available at
. There is no evidence of any benefit from spreads, drinks
and yoghurts containing plant sterols and stanols to lower cholesterol.
Reduce Salt High salt intake increases your risk of developing high blood pressure.
Exercise At least 30 minutes of moderate exercise a day, five days a week. Increasing
the amount of exercise you do is the single most beneficial action that you can take to
improve your health. It costs nothing and is infinitely more powerful than any medicine.
Healthy Weight Reducing your weight can have big benefits for your ability to exercise,
reducing your blood pressure, reducing your risk of developing diabetes and helping your
joints. Support and advice is available at the practice please see one of our nurses.
Reducing Alcohol intake Women should drink no more than 14 units of alcohol per week,
men no more than 21. Please use our surgery pod to log your alcohol intake or ask for an
AUDIT alcohol questionnaire. Alcohol advice and support is available at the practice
please ask at reception.
The lifestyle measures above will all aid your body to reduce your cardiovascular risk.
Your doctor will assess your risk of cardiovascular disease based on all of the above risk factors, using a risk assessment tool. This will give a result as a percentage: eg. 20% risk means that you have a one in five (20%) or greater risk of developing cardiovascular disease in the next 10 years. In primary prevention, If your risk is calculated as being less than 20%, then the lifestyle measures above are generally all that is necessary. There is very little evidence that any other treatment is merited.
If your risk is calculated as being greater than 20%, then your doctor will discuss more
active treatment for as many of the risk factors as possible. This may include treatment of
raised cholesterol. If this is the case, then you should be prescribed a standard dose of
SIMVASTATIN 40mg. Your liver function should be checked after 3 months and again at a
year, but there is no need to recheck your cholesterol level again. The very fact that you
are taking the Simvastatin will provide all the protection you need. There is no evidence
whatsoever that your cholesterol needs to be below any magic figure, nor that any
monitoring of level is necessary.
SECONDARY PREVENTION (if you have a history of cardiovascular disease)
All the above lifestyle measures apply. In ADDITION, your blood pressure and blood sugar will be carefully monitored and you will be offered treatment with a STATIN to reduce your cholesterol level. For secondary prevention, we will aim to get your cholesterol level to below 5.0, lower if you have diabetes. There are leaflets about lifestyle factors and cholesterol available from our practice nurses or in our surgery pod.
List of publications, Laurent M. Haegeli 1. Original papers (OP): Arentz T, Weber R, Jander N, Bürkle G, von Rosenthal J, Blum T, Stockinger J, Haegeli LM , Neumann FJ, Kalusche D. Pulmonary haemodynamics at rest and during exercise in patients with significant pulmonary vein stenosis after radiofrequency catheter ablation for drug resistant atrial fibrillation. Eur Heart J 2005 Jul