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VOLUME 8 NUMBER 3 • SEPTEMBER 2011
HANDS ON
SA JOURNAL OF DIABETES & VASCULAR DISEASE
Key references
Cancer Research UK: smoking statistics available from
•
.
htm#percent
Cahill K, Stead LF, Lancaster T. Nicotine receptor partial agonists for smoking cessa-
•
tion.
Cochrane Database of Systematic Reviews
, 2007 Issue 1. Art No: CD006103.
DOI: 10.1002/14651858.CD006103.pub2.
DiClemente, Carlo C.; Prochaska James O,
•
et al
. The process of smoking cessation:
An analysis of precontemplation, contemplation, and preparation stages of change.
Journal of Consulting and Clinical Psychology
1991;
59
(2): 295-304.
Resources
ASH Action on Smoking and Health
•
Department of Health website
•
Education for Health –
– for a distance learning course
•
on smoking cessation
NHS Quit Kit available from
•
NICE website
•
Quitline – helps smokers to stop
•
Publications
Percival J.
•
You can stop smoking
. Virgin Books. 2007 (for patients)
Percival J.
•
Helping people to stop smoking
. Mims for Nurses Pocket Guide Haymarket
Medical Media Ltd, London. 2009 (for nurses)
more information
Reports of psychiatric changes in patients taking varenicline have been
exaggerated by the media. However, it is known that smoking cessation
itself may lead to mood changes and exacerbations of underlying mental
health problems, so patients taking this drug (and arguably any other
drug used to support smoking cessation) should be advised about the
need to report any changes in mood or behaviour, including increased
levels of agitation and/or depression. Any cause for concern should lead
to discontinuation of the product.
SUMMING UP
In summary, smoking continues to be a major challenge to improving
public health and primary care clinicians are in a key position when it
comes to providing advice and support to patients during the quit proc-
ess.
The chances of quitting successfully are significantly increased when
a combination of behavioural changes and pharmacological interventions
are used. Decisions about the type of interventions used should be made
in line with guidance from the Department of Health and NICE but should
focus primarily on the individual needs of the patient concerned. The ef-
fort is well worthwhile in terms of the health benefits you will help your
patient to gain by stopping smoking for good.
H
igh levels of chocolate consumption
might be associated with a one-third
reduction in the risk of developing heart
disease, finds a study published on bmj.com
recently.
The findings confirm results of existing
studies that generally agree on a potential
beneficial
link
between
chocolate
consumption and heart health. However,
the authors stress that further studies are
needed to test whether chocolate actually
causes this reduction or if it can be explained
by some other unmeasured (cofounding)
factor.
The World Health Organisation predicts
that by 2030, nearly 23.6 million people will
die from heart disease. However, lifestyle
and diet are key factors in preventing heart
diease, says the article.
A number of recent studies have shown
that eating chocolate has a positive influence
on human health due to its antioxidant and
anti-inflammatory properties. This includes
reducing blood pressure and improving
insulin sensitivity (a stage in the develop-
ment of diabetes).
However, the evidence on how eating
chocolate affects your heart still remains
unclear. So, Dr Oscar Franco and colleagues
from the University of Cambridge carried
out a large-scale review of the existing
evidence to evaluate the effects of eating
chocolate on cardiovascular events such as
heart attack and stroke.
They analysed the results of seven
studies, involving over 100 000 participants
with and without existing heart disease.
For each study, they compared the group
with the highest chocolate consumption
against the group with the lowest
consumption. Differences in study design
and quality were also taken into account to
minimise bias.
Five studies reported a beneficial link
between higher levels of chocolate con-
sumption and the risk of cardiovascular
events. They found that the ‘highest levels
of chocolate consumption were associated
with a 37% reduction in cardiovascular dis-
ease and a 29% reduction in stroke com-
pared with lowest levels’. No significant
reduction was found in relation to heart
failure.
The studies did not differentiate between
dark and milk chocolate and included con-
sumption of chocolate bars, drinks, biscuits
and deserts.
The authors say the findings need to
be interpreted with caution, in particular
because commercially available chocolate is
very calorific (around 500 calories for every
100 grams) and eating too much of it could
lead to weight gain, risk of diabetes and
heart disease.
However, they conclude that given the
health benefits of eating chocolate, ini-
tiatives to reduce the current fat and sugar
content in most chocolate products should
be explored.
News from the European Society of Cardiology
It’s official – chocolate linked to heart health
