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For everyone seeking a healthy heart



The Bill stop the show

TV stars shine at redlaces ball

First FSC opens its doors

West Midlands is home to new support centre

Our message goes to the heart of politics

HEART UK at the party conferences








What a difference a year makes

Michael Livingston

Director HEART UK

This time last year I penned in this

column that “by knowing you, by

being in better and if necessary

more constant contact will put us ahead of

the crowd and allow us to plan our future

together.” Writing 12 months later, I hope

that you will agree with me that we have

all started to go down this fascinating, but

sometimes difficult road together.

Our first step was to analyse our two patient

member surveys – one bravely asking you

what you like and appreciate about the

charity and more importantly what more

we can do for you. The other targeted the medical perspective so that

we could get a true understanding of your experiences in diagnosis,

treatment and management of your conditions.

This knowledge was put to good use later in the year when we liaised

closely with the National Institute for Health and Clinical Excellence

(NICE) on the first national familial hypercholesterolaemia (FH)

guidance. Dawn Davies, our own patient champion and now chair

of the Patient Committee, worked tirelessly on the NICE committee

and was invaluable in making your voices heard at the highest level.

FH is beginning to get deserved recognition and we are committed to

making sure that all those at risk are found and supported. This year

also saw the government launch its Putting Prevention First vascular

check strategy, something HEART UK has called for long and loud

and so I believe that we are on the right path in getting our message

across as generations to come will become better aware of their

heart and vascular risk.

We generated increased funds in 2008 to help us spread the word and

engage in new activities. Our Teamredlaces raised more than £500,000

as official charity for the 2008 Flora London Marathon. Once again,

a big thank you to all our runners and supporters, who defied aching

limbs, hail and rain to paint London red with laces.

Despite all these steps in the right direction we cannot afford to be

complacent. Our vital work goes on. The first of our Family Support

Centres opened on Halloween in Birmingham and pan-London centre

launched in early December. We will also continue to take our message

to the highest level and I am honoured to represent this charity on a

public health commission which should produce ground-breaking

recommendations for the nation’s health next year. Most importantly we

will never stop listening to you - our members.

Finally, on behalf of your Chairman, Trustees, Committee members and

my colleagues, I send best wishes to you and your family for Christmas

and the New Year.

Michael Livingston, The Director









Party conferences

Politicians listen to our message

News roundup

Vascular risk workshops

Family Support Centre

First FSC welcomes patients

redlaces ball

Fun and funds in London

Finding fats

Sorting good from bad

Ask Dawn

Children and statins

14 Fundraising

Leave a legacy


Sue McCarthy Travel Award

Lucy Aphramore on her trip to Iceland

No. 112 Volume 22

contact us...

0845 450 5988

Tuesday and Thursday from 10am - 4pm


Membership & business enquiries: 01628 777 046

Email: ask@heartuk.org.uk

Website: www.heartuk.org.uk


Telephone: 0845 873 9597

Email: info@teamredlaces.org.uk

Website: www.teamredlaces.org.uk

Hyperlipidaemia Education & Atherosclerosis Research Trust,

7 North Road, Maidenhead, Berkshire SL6 1PE

© 2008 HEART UK ISSN 1741-7864

Charity Registration No: 1003904

Company limited by guarantee No: 2631049


Editor: Diana Butler • dianabutler@echocoms.com

Designed & produced: Fusion Design • www.fusionweb.co.uk

HEART UK was at the very heart

of politics when it presented

two lively fringe events,

supported by AstraZeneca, at

the Labour and Conservative

Party conferences.

HEART UK goes to

the heart of politics

Labour tactics

“Excellence for all: Can primary care

reach those at risk?”, the breakfast

event at the Labour conference was

chaired by John Carvel, Social Affairs

Editor of The Guardian. Speakers

included Ben Bradshaw MP, Minister

of State for Health Services (pictured

left), Dr John Revill, a GP in Sheffield

(who was speaking on behalf of

HEART UK - The Cholesterol Charity)

and Sunder Katwala, General

Secretary of The Fabian Society.

Ben Bradshaw noted that narrowing the gap of health inequalities was

still a challenge for the government and he cited Tower Hamlets as being

an example of how primary care can meet the needs of at-risk groups.

The Minister of State for Health Services went on to state that the Prime

Minister has made improving access to GPs one of his priorities and he

made reference to the vascular checks programme, Putting Prevention

First, as an example of this. Mr Bradshaw added that health and social

care services needed to be provided together.

Dr John Revill explained that he would be discussing cardiovascular

health specifically, as this was the biggest problem facing the health of

the nation. He demonstrated how his approach to providing all patients

Conservative plans

“You are what you speak: How

would a Conservative Government

influence public health?” the evening

event at the Conservative conference

was chaired by Gavin Lockhart,

Head of Health at the think-tank Policy

Exchange. Speakers included Mark

Simmonds MP, Shadow Health Minister

(pictured left), Michaela Nuttall,

Cardiovascular Nurse Lead (speaking

on behalf of HEART UK) and Dr Chris

Spencer-Jones, Director of Public

Health at the Birmingham Primary Care Trust (PCT).

Dr Spencer-Jones commented on tobacco and alcohol; both of which

are major social issues and public health problems. Michaela Nuttall

gave an articulate presentation on cardiovascular disease and the new

vascular checks programme which HEART UK has been lobbying for

over a number of years. She successfully highlighted the need to ensure

that services are coordinated across PCTs to reach all members of the

at risk of cardiovascular disease with primary prevention treatment had

lowered his referral rate to secondary care, reduced stroke and heart

disease incidents, and improved outcomes significantly for his patients.

He revealed that over 27 years, coronary rates had reduced to a fifth of

what they were in his practice and he highlighted the need for on-going

GP training to ensure evidence-based medicine is implemented.

Representatives from organisations including The Royal College of

GPs, the British Medical Association, the NHS Confederation, the Royal

College of Nursing, and National Association for Primary Care and the

Long Terms Alliance then joined the discussion to highlight:

• the lack of capacity for practice based nurses within GP practices

• lack of training strategy for practice based nurses

• the need for incentives so that GPs follow best practice

• the clear evidence that social networks are the most effective way of

improving the health of communities – the more linked up people are,

the healthier they are

• the need to use modern technology (internet, mobile phones, digital

television), to access healthcare - such a personalised system of

healthcare would lead to better outcomes

• reminder of the need to include patients themselves in this debate

• recommendation that services should be re-designed to suit the

communities they are serving, not the people working within them.

community (e.g: in mosques and pharmacies, etc.). She also explained

that it is critical that when any sort of risk assessment takes place that

the information is fed back directly to the GP to ensure that the findings

are dealt with in a suitable manner. Quality control and a level of quality

assurance were highlighted as a key issue within a national programme.

The Shadow Health Minister Mark Simmonds stated that the National

Health Service is the Conservative’s number one priority and they have

three key priorities: to make the NHS patient-centred; make it based on

outcomes, not central processes driven by targets; and have a greater

emphasis on public health. The Shadow Minister stated that his party plan

to create the role of Secretary of State for Public Health and to enhance the

role of the Chief Medical Officer. He added that the Conservatives intend

to ring-fence the budget for public health, without political interference

from the centre, and that they will introduce a new independent board for

overseeing public health spending, looking at coordination and why delays

are occurring in some areas. He also highlighted that the Conservatives will

have a responsibility agenda, to make sure that people recognise that their

own actions have an impact on their health and they plan to invest in health

accreditation schemes and focus on preventative health.







news, news, news

Charity hosts its first vascular risk workshops

HEART UK ran workshops for nurses and

dietitians in London in October and Newcastle

in November. The two events, entitled

“Vascular risk in primary care” were attended

by almost 100 practice nurses, dietitians and

healthcare professionals. The events were

supported by a grant from Flora (Unilever).

In London, Dr Sarah Jarvis, chair of HEART UK’s

healthcare committee, began with an overview of

identifying vascular risk in practice. She reminded

the group that the Department of Health (DH)

vascular risk screening programme would soon

be implemented across the UK for the over 40s

to help identify those at increased risk of future

events. Dr Jarvis urged healthcare professionals

to work together to help people realise that

many risk factors are modifiable. She concluded

that people can make a real difference to their

risk using lifestyle changes, with support from

healthcare professionals in primary care.

Michaela Nuttall, CHD Co-ordinator at the

Bromley PCT and a member of HEART

UK’s Healthcare Committee, focused on the

practicalities of setting up a vascular risk

assessment service. She noted that many

challenges remain to be addressed before

the DH vascular risk screening programme

could be fully implemented. For example,

communicating the importance of risk

assessment to people, implementing support

services, and standardisation of tests and

computer software. However, she noted that

this programme provided a huge opportunity

Website gets a revamp

to make a significant difference on a population

basis, and was a worthwhile challenge.

Michaela also encouraged the audience to find

out what their PCT is planning for vascular risk

assessment in their area, so they can help to

influence this exciting and important initiative.

Linda Main, Dietetic Advisor at HEART UK and

secretary to the charity’s Healthcare Committee,

emphasised that small dietary changes can

make a significant difference to cholesterol

levels. She suggested that eating plans such

as the Mediterranean diet, which are realistic

and sustainable, should be recommended.

Linda stressed that healthcare professionals

need to show people what to eat in ways they

understand and noted that a 5-10% weight loss

for most is usually achievable. She added that

encouraging people to make small, realistic and

manageable changes over time and building on

these works better than asking for a complete

lifestyle change. She concluded that health

professionals should aim to empower people

with knowledge, skills and the confidence to

agree and make their own lifestyle changes.

In Newcastle, Dr Dermot Neely, chair of

HEART UK’s Medical, Scientific and Research

Committee, began the workshop with an

overview of vascular risk and concluded

the event with a session entitled “Familial

Hypercholesterolaemia (FH) – Managing

patients and their relatives”.

Chrissy Briddon presented the practicalities of

setting up a vascular risk service.

The HEART UK website has been given a new look. Responding to feedback

from our patient members in a recent survey, the team at HEART UK and the

design company Fusion have updated the site and improved those areas that

generated the most comment. We hope you find the site easier to navigate

– please visit often to watch it grow and improve further! Please send any

comments or suggestions to HEART UK’s website co-ordinator, Claire James

at cj@heartuk.org.uk.

Visit HEART UK’s new website today at: www.heartuk.org.uk

New team members at HQ

HEART UK is delighted to welcome

Karen Brammer as its first Healthcare

Co-ordinator. She will work as a member

of our healthcare team, alongside

our dietitians, to provide support and

advice to the public on cholesterol and

cardiovascular health related matters, as

well as supporting the charity’s health

care projects. She will also work with

the management team and committee

chairs in developing the charity’s position

and profile within the NHS, primary care

trusts and strategic health authorities for

all health programmes. Although this is a

new role, Karen, a former staff nurse, is no

stranger to HEART UK as she is a former

member of the Healthcare Committee.

Another new face at the North Road HQ

is Tracey Sheppard. She has succeeded

Jo White, who has moved on after several

years as the charity’s accountant. Tracey

has spent 10 years working in the charity

sector, including roles at Age Concern.

After spending the last two years in the

corporate sector she admitted to being

“keen to return to the charity sector as it is

a nicer environment to work in.”

With the team at HEART UK now at full

capacity, the charity is more than ready

to face the new year with renewed drive

and determination.

SEARCH data fuels side effects discussion

Data from the SEARCH study presented at the recent

American Heart Association meeting created plenty of

discussion. The study failed to show any effect when looking

at folic acid and vitamin B12 to lower homocysteine compared

with placebo. Also in its investigation into more-versusless

LDL lowering, comparing 80mg and 20mg doses of

simvastatin, there was only a 6% reduction in vascular events.

While this in itself is not a significant result it is in line with all

the other more-versus-less data.

However, SEARCH did reveal significantly more cases of

myopathy (muscle damage) with the 80mg dose of simvastatin

than with the 20mg dose. The results call into question the

use of the maximum dose of simvastatin to achieve greater

cholesterol lowering at the expense of more frequent side

effects when the newer statins which are now available can

achieve better results with a bigger safety margin.

Unique partnership will help MI patients

Recent evidence suggests that the provision of treatment and follow-up

care for patients who have had a myocardial infarction (MI) - or heart

attack - varies significantly across the country. There is a real need for

clear guidance for primary care clinicians and patients in order that both

parties are better informed about what to expect with regards to post-

MI care in the UK. To address this situation, HEART UK, the Primary

Care Cardiovascular Society (PCCS) and Pfizer have come together

in a unique partnership to support the development of a management

protocol and patient materials for post MI patients.

This management protocol will include an evidence-based protocol

for primary-care clinicians, on the management of MI patients after

discharge, in order to promote optimum and equal standards of care

across the UK. Materials for patients who have experienced a heart

attack will highlight what to expect in terms of post MI care and support.

HEART UK Trustee Brian Ellis is a member of the Steering Committee

for the project and he will provide the patient perspective. We would like

to encourage HEART UK members who have experienced a heart attack

to get involved too, by volunteering to review draft patient materials in

2009. We would be grateful to hear from any Digest readers who have

had a heart attack and have received information from the doctor or nurse

about what to expect next in terms of care, treatment and lifestyle. By

learning more about the types of information that heart attack patients are

currently receiving, we can make sure that materials developed through

this ‘Follow your heart’ project are of real value. Contact Cathy Ratcliffe at

HEART UK on 01628 777 046 or email her at cr@heartuk.org.uk.

Room for improvement in FH management

Since the last issue of Digest (Autumn 2008), the findings of the patient

survey supported by Schering Plough, have been further analysed.

The results for those with familial hypercholesterolaemia (FH) provide

many insights into the diagnosis and management of this condition.

Families affected by FH will probably already be aware of the paucity

of specialist services and support for children. The survey showed that

of the 91 respondents only one respondant to the survey indicated that

their child with FH had been seen a children-friendly clinical setting.

Lipid clinics around the country must begin to consider providing

services appropriate for children, given the importance of ensuring that

diagnosed youngsters begin to understand their condition.

Looking at the treatments being taken by people with FH, it seems

that a wide range of statins are currently taken, mostly at the higher

doses of 40mg or 80mg. Quite a number of respondents had tried bile

acid sequestrants in the past, but had switched when statins became

available as they often found formulation difficult to take or because their

cholesterol levels failed to drop sufficiently.

Many of the survey respondents highlighted their GP’s lack of specialist

knowledge regarding FH. Comments included delays and difficulty in

getting cholesterol tests, particularly for children, with some doctors just

not understanding the necessity. Others said that only total cholesterol

levels were provided, with doctors not even being aware of triglycerides!

Now that the NICE guidance is published, which provides the first

standards of detection and treatment of FH, HEART UK is committed to

ensuring that GPs in England and Wales are made aware of FH and NICE’s

recommendations - an FH toolkit is in development and we will bring you

more information through Digest next year. HEART UK is also campaigning

to encourage Scotland to introduce the principles of the NICE guidance too.

Thank you to everyone who responded to our survey. It is this kind of

information that is so valuable to the work of HEART UK to press for best

practice care.


Indian summer inspires Wellington walkers

Some 100 walkers took part in the recent Teamredlaces

sponsored walk at Wellington Country Park, near Reading,

Berkshire. The Choles-Stroll, sponsored by Shredded Wheat,

raised more than £500 for HEART UK. As the country was

experiencing an Indian summer all those taking part sported the

charity’s distinctive red T-shirts, as well as the essential redlaces.

As this event was part of HEART UK’s mission to raise awareness

of inherited high cholesterol conditions and the importance of

maintaining a healthy heart, all those walkers aged 21 or over had

the opportunity to have a free cardiovascular test, sponsored by

Flora, at the event. HEART UK’s own dietitian Linda Main was

also at the event to give dietary advice to complement the CVD

testing and hand out much needed bottles of water and apples.

Carole Gryglaszewska, Head of Fundraising, reflected on the

event, saying: “This has been a great day and we are really

grateful to all those who came to Wellington Country Park to raise

funds for us. The unexpected sunshine inspired us all and it was

so rewarding to see so many HEART UK T-shirts on display.”

Images kindly supplied by Reading Evening Post and Charles Armstrong-Wilson.







news, news, news

New study reveals the importance of early treatment in FH

Research published last month in the

European Heart Journal 1 revealed that

treatment with cholesterol lowering statin

drugs effectively “wipes out” the excess

risk of heart disease death in people with

familial hypercholesterolaemia (FH) – if they

can be identified and treated before they

develop symptoms.

This is the latest research from the Simon

Broome Familial Hyperlipidaemia Register

Group. The Scientific Steering Committee of

the Register has operated under the auspices

of HEART UK for 10 years. Its recent research

reports on a 26-year follow up (from 1980 to

2006), of 3,382 patients with FH diagnosed and

treated in 21 specialist lipid clinics in the UK – a

total of 46,580 person years. The report found

a dramatic fall in heart disease mortality since

statins became widely available in the clinics,

proving that with earlier diagnosis and effective

treatment it is possible to prevent any excess

heart disease mortality in early adulthood.

Professor Andrew Neil from the University of

Oxford and a trustee and former chairman of

HEART UK, who led this research said: “It is vital

that all primary care trusts (PCTs) implement a

screening programme, otherwise a patchwork

service will develop, with some PCTs providing

screening and others not. Cascade screening

only works really effectively where relatives can

be traced across the country, as the national

programme in the Netherlands has shown.”

JUPITER study reveals astounding results

Results from the JUPITER study have revealed

that the statin Crestor (rosuvastatin) can

significantly reduce major cardiovascular

(CV) events by 44% compared to placebo

in patients with low to normal levels of LDL

cholesterol, but at increased cardiovascular

risk due to elevated high sensitivity CRP. This

is the greatest relative risk reduction ever seen

in a large-placebo controlled statin outcome

study and featured patients who would not

normally receive treatment as they would be

perceived as low risk.

Michael Livingston, Director of HEART UK,

who was at the American Heart Association

meeting where these results were announced,

said: “We welcome these results which provide

much needed evidence around the benefits of

statins in the primary prevention of heart attacks

A cascade testing pilot funded by the

Department of Health has already been trialled

successfully in some parts of the UK and is well

established in other European countries, such as

Spain and the Netherlands. NICE recommends

that a nationwide, family-based, follow-up

system is established to enable comprehensive

identification of effected individuals.

Dr Alan Rees, Chairman of HEART UK and

author of an accompanying editorial in the

same issue of the European Heart Journal 2 ,

commented that: “This research is very timely

and emphasises how important it is that the

recently published NICE guidelines are fully

implemented in the UK as soon as possible. It

would be no exaggeration to say that this is a

race against time. Unfortunately there has been

no clear direction given to commissioning

bodies, however HEART UK has set up a

working group which has been working

very hard with NICE and local and national

commissioning bodies to find a way forward.”

While the Simon Broome Group researchers

expected to find an improvement in heart

disease mortality, they were surprised to find a

highly significant reduction of about one third

in all cause mortality, mainly due to reduction in

cancer disease deaths. The researchers consider

this most likely to be due to close adherence to

advice given as part of routine clinical care in

the specialist clinics, particularly to be physically

active, to make dietary changes, avoid obesity

and stroke. This study also confirms what we

already knew - that the lower the levels of LDL

cholesterol the better, in terms of reducing the

risk of cardiovascular events. The study raises

some very interesting questions for the future.”

JUPITER is the largest primary prevention statin

trial ever conducted and the first to explore the

benefits of statin therapy in such a large number

of women (38% of study population). Dr Sarah

Jarvis, Chairman of the charity’s Healthcare

Committee and Women’s Health Spokesperson

for the Royal College of General Practitioners,

added: “The JUPITER data is extremely exciting

as the level of relative risk reduction achieved

within the study is even greater than that seen in

the Cholesterol Triallists Collaboration metaanalysis.

The fact that the benefit extended to

mortality and morbidity, and to women as well

and stop smoking. Researchers cautioned that

these results are of most direct relevance to

patients referred for specialist care and might not

be reproduced in general practice.

Dr Dermot Neely, Chairman of HEART UK’s

Medical, Scientific and Research Committee,

to which the Simon Broome Register Group

reports, added: “These results are a testament

to the excellent work done in specialist lipid

clinics, not only in effectively wiping out the

excess heart disease risk among patients under

their follow up, but also in promoting healthy

diet and lifestyle choices which may have

contributed to the substantial reduction in overall

mortality and particularly cancer mortality. We

would urge commissioning bodies to ensure

that NICE FH guidelines 3 are implemented in

full, including implementation of DNA diagnosis,

family cascade testing and specialist lipid clinic

referral for every FH patient. This research has

also proven the value of long-term lipid clinic

follow up registries, without which this important

evidence would have been lost.”


1 Neil A, Cooper J, Betteridge J, et al. Reductions

in all-cause, cancer, and coronary mortality in

statin-treated patients with heterozygous familial

hypercholesterolaemia: a prospective registry

study. Eur Heart J. Oct 7 2008.

2 Rees A. Familial hypercholesterolaemia:

underdiagnosed and undertreated. Eur Heart J.

Oct 7 2008.

3 NICE Guidance. CG 71

as men, is further proof of the benefit of statins

in high risk patient populations.”

The JUPITER results also showed that for

patients in the trial taking Crestor (rosuvastatin)

the combined risk of heart attack, stroke or CV

death was reduced by nearly half (47%); the

risk of heart attack was cut by more than half

(54%); the risk of stroke was cut by nearly half

(48%); total mortality was significantly reduced

by 20% and LDL-C (bad cholesterol) was

reduced by 50%.

Your charity played a significant part in the

media reporting of this exciting study. Dr Sarah

Jarvis and Dr Dermot Neely appeared live

on BBC News 24 to discuss the fundings and

Sarah Jarvis and Michael Livingston were

widely quoted in the newspapers.

Calling all patients – CVC wants your views

The Cardio & Vascular Coalition (CVC) is a collaboration of voluntary and

professional organisations, including HEART UK, working for improved

cardio and vascular health. The CVC’s interests span all heart and

circulatory diseases, as well as the related conditions of kidney disease

and diabetes. As these conditions share many risk factors, the CVC is

campaigning for a Cardio & Vascular Health Strategy for 2010 – 2020.

The CVC is currently consulting with a range of organisations to build a

picture of what is being done well and what needs to be improved in the

prevention and treatment of cardio and vascular disease. The Coalition

knows that the views of patients are essential and so has launched an

online public survey alongside its consultation survey for organisations.

The CVC then plans to publish its proposals for a new Cardio & Vascular

Health Strategy early next year.

To access the public survey and look at the consultation for the

organisations (the Green Paper), please log on to

www.consultationfinder.com/cvc. A paper copy of the survey is also

available by contacting the CVC on 020 7487 8604 or emailing the

organisation at cvc@bhf.org.uk.

Prudent diet receives top marks


The INTERHEART study has indicated that unhealthy dietary intakes

may in part be responsible for the incidence of heart attacks across

the world. The study, which took place in 52 countries, enrolled 5,761

people who had already suffered an acute myocardial infarction (MI)

and compared them to more than 10,500 control subjects who had not

suffered an MI. All the subjects were assessed using a food frequency

questionnaire to determine their routine dietary intakes. As a result of

this assessment, three dietary patterns were identified:

• Oriental (because of its high content of tofu, soy and other sauces)

• Western (because of its high content of meat, fried food and

salty snacks)

• Prudent (because of its high content of fruit and vegetables)

At the highest levels of intake, the western diet was associated with a

higher risk of heart attack or MI. There was no overall association between

the oriental dietary pattern and heart attack and people eating the prudent

diet had a lower risk of suffering an MI. So the INTERHEART authors

concluded that, in line with other published research, an unhealthy dietary

intake increases the risk for heart attack in the region of 30%.

Circulation 2008; 118:1929-1937

First family support

centre opens its doors

The West Midlands is home to the UK’s first family support centre

(FSC), which opened its doors for the first time in early September

Based at Sandwell General Hospital in West Bromwich, this FSC

is headed up by HEART UK Trustee Dr Liz Hughes and Dr Inessa

Tracey. The Centre, which is funded by HEART UK, is a drop-in

centre offering a broad spectrum of advice and support to those

who have been diagnosed with familial hypercholesterolaemia

(FH) and other inherited high cholesterol conditions.

The centre is managed on the day-to-day basis by Suzanne

Sumara, a registered nurse who comes to the centre with many

years’ experience working in diabetic and cholesterol areas,

including more than 12 years working alongside Dr Hughes at

Sandwell. “The FSC has already had 37 referrals from Sandwell

alone and they have been either self referring or through Dr

Hughes and Dr Tracey’s clinics. Everyone’s response has been

very positive and we will soon be distributing information leaflets

on the centre to the wider West Midlands community. We are

one of two pilots [the second FSC opened in London in early

December] assessing the feasibility of targeting patients with FH

and other high inherited cholesterol conditions in this way.”

Suzanne and her team, which includes other nurses, a nutritionist

and administrative support, are passionate about keeping patients

informed on FH and to this end the support centre is always open.

As Suzanne herself says: “My mobile number is available 24/7 for

patients to contact me.”

The FSC is not just for the patient either. It also provides a

support system to the extended members of the patient’s family.

Crucially too, in such a multicultural area, the team has extensive

knowledge and understanding of the both the South Asian and

Afro Caribbean communities, thereby ensuring that some of the

most at risk groups in the area will be able to utilise this much

needed resource.

Although based at Sandwell Hospital, the FSC is self governed

and managed via its partnership group. The centre also arranges

education events to help raise awareness of IHC and provides

social activities so that patients do not feel that they are battling

their condition on their own.

Look out for news from the London FSC in the next edition

of Digest.

Dr Hughes made the top bid

for the David Suchet signed

Hercule Poirot photograph,

held here by HEART UK’s

Mark Dewey, at the Charity’s

recent ball. The picture will now

have pride of place in the

FSC at Sandwell.







Rachel, Michael & Sally

Rob & Sue Cramb

The Flora Team

The police steal the limelight

at the redlaces ball

HEART UK celebrates a remarkable year with a sparkling event full of stars

There was a strong police presence at HEART UK

- The Cholesterol Charity’s recent redlaces Ball

at the Royal Garden Hotel in London. Luckily for

the guests these officers were from Sun Hill – the

main base for the actors starring in the regular

TV series The Bill. Cast members including Ali

Bastian, Ben Richards and Chris Simmons may

have been off duty, but they worked hard for

HEART UK, helping to raise more than £3,500

in the evening’s main auction. The team even

donated a “swag” bag, which included a private

tour around the studios, which auctioneer,

broadcaster Patrick Lunt, sold for £425.

One of the guests, Ian Cooper, generously

donated one night at The Royal Garden Hotel

to the auction. He had only received this prize

himself earlier in the evening after winning the

amusing Heads and Tails competition which had

been organised by toastmaster Paul Deacon.

Ian’s generosity added a further £350 to the

evening’s grand total.

Fran Sivers & husband

The TV actors were not the only stars of the

show, which was supported by Unilever,

Flora and Cereal Partners. HEART UK’s

fundraising team had arranged a surprise

awards ceremony for its own stars from the

2008 Flora London Marathon. Named Night

at the Floras Awards, they were presented

by Flora proactive’s Brand Manager, Erin

Merlin. The winners were:

Cover star: Alex Smith and Paul White who

stood out in the crowd on Marathon Day

in their Union Jack shorts and went on to

become the Teamredlaces image for the

Flora London Marathon 2009.

Leader of the pack: Ben Blake, Brand

Manager for Cereal Partner’s Shredded Wheat,

who was an inspiration for many a runner.

Bravest runner: Caroline Radford, who ran

the marathon in memory of her late husband.

Fittest trustee: Dr Alan Rees, Chairman of

HEART UK, as he knocked 10 minutes of his

previous time.

Most ambitious runner: Tom Rigden of

Genzyme. His Just Giving page stated that he

wanted to finish the Marathon in less than two

hours, but was delighted with a time of 4:50.

Erin & Sophia

Most elegant runner: Mel Evans who

remained stylish despite the occasional

hailstorm on Marathon Day.

Media star: Rosie Ellis, who became HEART

UK’s media expert. She found herself talking

about her Marathon achievements on the sofa

at GMTV as well as at BBC Radio Berkshire.

Running sisters: Caroline Cleaver and Katie

Mansfield took this honour after they held

hands crossing the line in 5:02.22.

Closest couple: Partners Izabelle

Kwasniewski and Tim May also finished in an

identical time of 5:23:43.

Most glamorous competitor: Sophia

Holdsworth was proof positive that Marathon

running need not be drab.

Dawn & Neil Davies

Most angelic runner: Tania Daniels was an

inspiration to her fellow runners.

Most stylish runner: Chris Millican gave the

girls a run for their money in the style stakes.

Special awards: HEART UK’s Fundraising

Team – Carole Gryglaszewska, Mark Dewey

and Claire James. Their marathon efforts

resulted in the charity netting more than

£500,000 from its role as Official Charity of

the 2008 Flora London Marathon.

Special mention: Was made of Diana

Lipton, who was unable to attend the Ball.

She was the charity’s biggest individual

fundraiser, raising more than £25,000 for

HEART UK in memory of her late husband,

Professor Peter Lipton.

A few officers from the regular TV series 'The Bill'

Carole & Aldo

Special awards

Fittest trustee

Leader of the pack

Running sisters







what’s in a fat?

Linda Main, HEART UK’s dietitian, cuts

through the jargon to give clear advice

Dietary guidance for reducing cholesterol

levels centres around reducing saturated fat

and replacing it with unsaturated fats called

monounsaturated and polyunsaturated fats.

But many people, when first told they have

raised cholesterol, ask what these are and

where can they find them in the foods they

eat? To confuse us even more, saturated,

monounsaturated and polyunsaturated fats

are usually found in combination in foods.

Some foods however, are richer in one kind

of fat than another, so Digest can provide the

following guidance.

Lowering saturated fat intake

It is generally thought that reducing

saturated fat intake can bring about

a reduction in LDL (bad) cholesterol

of around 5-10%. But the true effect

is really based on how much change

people are able to make. Someone who

is already eating a relatively healthy diet

may not be able to reduce their saturated

fat intake much further.

Saturated fat:

Usually solid at room temperature and

generally of animal origin.

Foods rich in saturated fats include:

• Butter, ghee, lard, hard margarines and

foods made from these (cakes, biscuits,

puddings, pies, pastries and pasties)

• Dairy fats (full cream milk, cheese, full fat

yoghurt, crème fraiche and cream)

• Fatty meats and meat products

(sausages, burgers, salami)

• Palm and coconut oils

Monounsaturated fats:

Usually liquid at room temperature and

vegetable origin.

Foods rich in mono unsaturated fats


• Olive oil, rapeseed oil

and spreads based on these

• Av o c a d o

• Nuts, flaxseed

Polyunsaturated fats:

Usually liquid at room temperature and

vegetable origin.

Foods rich in polyunsaturated fats include:

• Corn, safflower and sunflower oil

and spreads based on these

• Oily fish such as salmon, trout,

herring and mackerel

• Sunflower and other edible seeds

Guidance in the UK recommends lowering

saturated fat intake to less than 10%

of energy intake, whilst in the USA the

American Heart Association recommends

a reduction below 7% of energy. Both

recommend increasing intakes of mono

and polyunsaturated fats. Ten percent of

energy from saturated fat is inline with UK

Guideline Daily Amounts.


Typical energy intake 2500 2000

UK Guideline Daily Amount of saturated fat No more than 30g No more than 20g

USA recommendations for saturated fat (



budget baking...

Careful spending does not mean a cutback in taste.

Try these HEART UK recipes for healthy meals for four for under a fiver...

Chilli con carne Serves: 4


• 400g /14ozs of lean minced beef, minced

turkey, Quorn mince or minced beef

extended with soya mince

• 1 tablespoon oil

• 1 large onion, peeled and diced

• 2 cloves garlic, crushed

• 400g can of chopped tomatoes

• 1 beef stock cube

• 1 tablespoon mild chilli powder (or to taste)

• 2 tablespoon tomato puree

• Black pepper to season

• 450g can red kidney beans (or equivalent in

dried, soaked and pre-boiled beans)


1Cook diced onion and garlic in oil for a

few minutes.

2Add minced meat and cooked until

well browned.

3Add the chopped tomatoes, beef stock

cube, chilli powder, tomato puree, kidney

beans and season with a generous pinch

of pepper.

4Reduce the heat and simmer uncovered

for 15-20 until well cooked and of the

right consistency.

5Serve with seasonal vegetables and

boiled brown rice.

6Freeze any left over portions for use on

another day. Alternatively once cool,

portions can be kept in the fridge for up to

2 days.

Roasted vegetables

with cous cous Serves: 4


• 2-4 tablespoons oil (corn, rapeseed,

sunflower oil, non-virgin olive oil)

• 2 tablespoons balsamic vinegar

• 2 garlic cloves crushed

• 2 lbs seasonal vegetables peeled and cut

into chunks...

winter: carrots, broccoli, squashes, sweet

potato, parsnips, red onions, beetroot)

summer: peppers, cherry tomatoes,

aubergine, courgette, new potatoes

• Herbs to season

• 1 small can of tuna


1Put all vegetables into a wide baking

tray, season well, mix together balsamic

vinegar, oil and garlic, pour over vegetables

and combine until well coated. Leave to

marinade for ¾-1 hour before cooking.

2Preheat oven temperature to

200°C/400°F/Gas 6.

3Place marinated vegetables in the oven

and cooked for 20-30 minutes or until soft.

4Soak cous cous according to the

manufacturers instructions.

5Add roasted vegetables to the prepared

cous cous, add a can of flaked tuna

and mix.

6Serve hot or cold with crusty

wholegrain bread.

Warming winter

vegetable soup Serves: 4


• 2 tablespoons oil

• 1 small onion, diced

• 2-3 rashers lean bacon diced

• 1 leek sliced

• 2-3 sticks of celery washed and diced

• 2 carrots peeled and diced

• 1 parsnip, peeled and diced

• 1 small sweet potato or ¼ butternut squash

peeled and cut into dice

• 500-750ml vegetable or chicken stock

• 1 bay leaf and a selection of fresh

or dried herbs

• 1 inch grated ginger (optional)


1Cook the onion in the olive oil in a large

pan for a few minutes. Add the bacon and

cook until browned.

2Add the remaining vegetables, herbs and

enough stock to cover the vegetables.

3Bring to the boil and simmer

20-30 minutes.

4Serve with crusty wholegrain bread.

Cauliflower and

almond soup Serves: 4


• 50g (2ozs) almonds

• 1 medium onion, chopped

• 2 sticks of celery, chopped

• 1 tablespoon oil

• 500ml vegetable stock

• 1 medium cauliflower, cut into pieces

• 150ml skimmed or semi skimmed milk

• Black pepper and nutmeg to season


1Lightly toast the almonds in a non stick

frying pan or under the grill taking care not

to burn them.

2Cook the onion and celery in the olive oil

in a large pan until softened.

3Add the stock, cauliflower and almonds

and cook for 5-10 minutes until the

cauliflower is tender.

4Blend until the mixture is smooth and

return to a clean pan.

5Add the milk and heat gently

for 5 minutes.

6Season and serve with toasted

wholemeal bread.


Dear Digest,

After some concern about my raised cholesterol levels and

heart health I have been trying to change my diet. My doctor has

suggested I should follow the principles of the Mediterranean

diet. Can you explain more about this and how it works?

Mrs C

Dear Mrs C

Your doctor is right to point you in this direction. It seems that people

living around the Mediterranean suffer less heart disease than

those of us that live in the UK and northern Europe. This has led

researchers to question whether the Mediterranean diet might be a

model diet which could contribute to improved health and longevity.

Traditionally people in the Mediterranean eat more fruit and vegetables,

wholegrain breads and cereals, nuts, pulses (peas, beans and lentils)

seeds and fish than we do in northern Europe. In addition they eat less

saturated fat from dairy and red meat sources in fact most of their fats

come from one source: olive oil. As a result their diets are:

• rich in monounsaturated oils which are heart healthy

(olive oil and nuts)

• a good source of omega 3 fatty acids. (seafood generally, but

especially oily fish)

• rich in potassium (wholegrain cereals, fruit, vegetables and nuts)

• rich in fibre including soluble fibre (wholegrain cereals,

vegetables, fruit, beans, peas)

• low in salt

• rich in antioxidants including vitamins E and C, carotenoids

and flavonoids

• rich in B vitamins including folic acid

• low in saturated fat (little red meat and high fat dairy foods)

So how might these changes benefit your heart? Well it is

this combination of lowering saturated fat and increasing

monounsaturated and polyunsaturated fats (including omega 3s)

which can help to reduce LDL (bad) cholesterol and increased HDL

(good) cholesterol. A diet rich in potassium and low in salt also

favours a reduction in blood pressure in those with hypertension.

Initial research also suggests that diets rich in wholegrain can help

protect against heart disease, diabetes and cancer risk. Although

the jury is still out on folic acid, it remains possible that folic acid and

other B vitamins can positively influence heart health by reducing

homocysteine, an independent risk factor for heart disease.

Soluble fibre from oats, pulses and fruits and vegetables help

to reduce the amount of cholesterol and bile (a by-product of

cholesterol) that your body absorbs. The effect is to ultimately

reduce cholesterol levels. The huge range of colourful produce in

the Mediterranean also results in a diet rich in beneficial antioxidants

that are thought to help prevent heart disease and cancer.

Finally increased oily fish intake is also a good dietary source of

vitamin D, a nutrient that increasingly seems to play a part in heart

health as reported in our last two digests.



Expert patient

Dawn Davies

The recent launch of the NICE guidance on familiar

hypercholesterolemia (FH) and the subsequent media flurry has led

a few people, who are no more than acquaintances, to ask that if I

had children would I put them on statins?

My answer has been yes. I have three children and they were all screened

for FH by having a blood sample taken. As a mum I wanted to know but I

did not want them to suffer the procedure unduly. So I waited, until for one

reason or another they needed to have blood taken such as pre-op. I then

asked if they could do a full cholesterol check. As the children grew up

this has been repeated just to make sure they have not got the condition.

My children are now all adults and luckily they have all escaped the genes

effects and have normal LDL (low density lipoprotein levels often referred

to as bad cholesterol).

If any of my children had severely raised cholesterol levels like my own,

I would not hesitate to agree to statin treatment for them because I am

acutely aware of what delaying the treatment can mean. I started taking

statins some 23 years ago at the age of 22. The disease process, called

atherosclerosis, was already well progressed and statins were prescribed

to try and slow this process down.

I can understand parents not wanting their child to be on lifelong

medication so it is important that they speak openly to their GP,

paediatrician and lipid specialist about all the ways available for reducing

cholesterol levels in order to lessen the long term risk of heart disease. It

is through this communication that the child and the family will be able

to take on the facts about benefit and risk and be active in the decision

making process.

Well I never knew! More from Dawn Davies,

HEART UK Trustee and FH expert patient

In my drive to get back into the workforce I have been seeking

the advice of The Benefits Agency. This particular area has

been passed onto a company called Working Links

www.workinglinks.co.uk. You can also telephone for an

appointment on freephone 0800 917 9262.

My health will never be great but it is probably as good as it will get

and I feel I have something to give to society. Realistically, my plan

is to start working eight hours a week and to increase this to 16

hours after three months. I would then reassess and increase again

if my heart failure was coping.

My recent enquiries have revealed that I can still obtain incapacity

benefit for one year while I make this transition as long as I do not go

over 16 hours or £88.50 and stay in touch with a government advisor.

There is also other help, dependent on individual circumstances.









It’s not too late to join

Teamredlaces for the Flora

London Marathon 2009!

Have a heart for HEART UK

All heart accessories is an on-line store which is

passionate about heart-shaped jewellery.

They have teamed up with designer, Ellie Morris, who has

come up with some stunning original designs. Among the

materials Ellie uses to create her jewellery are sterling silver,

silver plate, fresh water pearls, Murano glass, foiled beads,

natural mineral stones and Swarovski crystals.

redlaces ramble

How about a redlaces ramble?

The weather may be getting colder and the nights are drawing in but

there is still plenty of daylight left to organise a redlaces ramble. It

may also be the perfect excuse to get the family away from the TV or

computer and experience some fresh air! So why not organise your own

event in aid of HEART UK? It might be a brisk walk along the seafront

and back, a rustle through autumn leaves in your local woods, or even a

walk through your local town spotting all the Christmas decorations.

A new chapter in our Marathon story

Even though we do not have Official Charity Status this year, we do

have the benefit of 100 much-coveted Guaranteed Places and, of

course, we have plenty of Teamredlaces running vests for runners

who have acquired their own place through the ballot.

HEART UK would be delighted to hear from any runner wishing to

join Teamredlaces for the Flora London Marathon 2009, whatever

their age, running experience or speed. All that is needed is a

determination to train for the event and a passion to spread the

redlaces message and raise vital funds. The pledge level for a

Guaranteed Place for ’09 is £1500, but no pledge is necessary for

someone running on their own ballot place.

Still time to support our 2008 team

Although the team is still totting up the very last bits of sponsorship

money, HEART UK - The Cholesterol Charity - is delighted to

announce that the charity raised more than £500,000 from its great

efforts in the Flora London Marathon 2008. This was a great effort

from everybody involved, not least all our runners, many of whom

have signed up to run again in 2009. If you haven’t yet sponsored

our Teamredlaces but are inspired by their heroic efforts then there

is still time – please just send a cheque, writing Teamredlaces FLM

on the reverse, or call us on 0845 873 9597 to pay by credit card.

Alternatively, you can log on to our fundraising page at:

www.justgiving.com/supportteamredlaces and donate online.

Leaving a legacy to keep

young hearts running

As we rely heavily upon voluntary

income, including legacies, to be

able to continue our work, we are

in the process of designing two

new HEART UK legacy leaflets.

We would very much appreciate

and value some feedback from

Members on the style, design and

content of our leaflets and so, for

that reason, we will shortly be

mailing you the two versions of

our leaflet and a questionnaire which gives you

the opportunity to let us know your views.

The leaflets will feature Dr John Reckless,

Consultant Endocrinologist and HEART UK

Trustee, and why he has already made a

bequest in his Will to HEART UK. John

explains, “We’ve made great strides in

diagnosing and treating patients with high

cholesterol since the Charity was founded

and I want to ensure that what I believe in

continues after I’ve gone – that

there’s funding to carry on

our work and keep young

hearts running!”

Supporters needed!

Even if you’re not a runner, HEART UK still needs

you! You can join our band of cheering supporters

lining the route to spur on weary runners and

keep them focused on the Finish! Please book the

date in your diary now - Sunday 26th April 2009.

Many HEART UK supporters at the recent redlaces Ball had

the chance to experience the pleasure of owning an all heart

accessory as a delicate, red heart necklace was presented to

every female guest. All heart accessories will give 5% of all their

profits to HEART UK, so any purchase you make from their

website: www.allheartaccessories.com will benefit us.

Christmas shopping sorted at anolivebranch

HEART UK is one of 10 charity partners of a newly created

online fundraising website. The website, anolivebranch.co.uk

is a shopping portal from which you can both purchase a wide

range of products and raise funds for your favourite charity.

The site is ideal for all your Christmas shopping and caters for

everyone, whether they be 8 or 80.

The host website www.anolivebranch.co.uk offers around

80 electrical products at the best prices, as well as a virtual

department store providing clothes, footwear, menswear, gifts,

holidays and even groceries

through high street names

such as M&S, La Senza, Asda,

Boots, John Lewis, Tesco,

and Travelodge.

Whenever you purchase an

item from anolivebranch.co.uk,

or from one of the other partner

stores via anolivebranch. co.uk

website, a donation is made to

HEART UK at no extra cost to

you! Once you have made your

first purchase on-line and can see how easy it is, and how good it

makes you feel, please forward the details to your family, friends

and colleagues, explaining that they too can shop online at:

www.anolivebranch.co.uk and raise vital funds for HEART UK.

The more customers we have, the more funds we will raise!

Delegates at HEART UK’s Conference took part in an early morning redlaces walk.

Earlier this year, volunteer Jo Traill led friends on a five-mile redlaces

ramble in Buckinghamshire to raise awareness and funds. Jo’s

friends each paid for the outing and were given a pair of redlaces

and information about the Charity. Jo’s advice as a seasoned leader

of rambles is: “Make sure you have suitable footwear and clothing,

especially if it’s wet and muddy. It’s a good idea to start and finish in the

same place, like a favourite pub, or your own home - and that way there’s

always something tasty to look forward to at the end of the ramble.”

If you would like to arrange your own redlaces ramble, you can contact

us on: 0845 873 9597 or email: info@teamredlaces.org.uk and we will

send you a Teamredlaces event pack and a supply of redlaces.

Christmas Collection

Our Christmas shop will be processing

orders until midday on Wednesday

17th December.

Our Christmas Card Collection this year

includes a variety of colourful styles,

shapes and sizes, with designs ranging

from the traditional to the arty. Prices

range from £3.00 to £3.95 for a pack of

10 cards of one design.

Please call our hotline with your

enquiries: 0845 873 9597.






lucy’s prize reveals new thinking

Sue McCarthy Travel Award winner discovers that Iceland provides food for thought

Lucy Aphramor,

this year’s winner of

the Sue McCarthy

Travel Award,

presented annually


in memory of

lipid nurse Sue

McCarthy, travelled

to Iceland in May

to attend the

Weight and Health Symposium at Reykjavik

University. A cardiac dietitian, and researcher

at Coventry University, Lucy is particularly

interested in effective, cardioprotective

nutritional interventions in high risk groups.

Therefore, she relished the opportunity

to attend this symposium. “Winning this

award gave me the opportunity to see how

researchers in other countries have taken

their work forward in influencing general dayto-day

practice and at a policy level.”

She said that when she heard of the

symposium she was determined to get to

Iceland. “I knew that two leading American

researchers were speaking at the symposium.

I was really keen to meet with them and

Iceland is a lot closer than the USA! “

Lucy is currently researching an approach

known as Health At Every Size (HAES).

This evidence-based approach emphasises

the benefits of promoting healthy eating,

realistic fitness and body respect for people

of all shapes and sizes. Lucy is now helping

to establish the first HAES UK group and

believes that her Iceland trip has acted as

catalyst to this. “My visit to the symposium

brought me up to speed with international

research that challenges conventional

wisdom around weight and health. HAES is

an effective and evidence-based approach

yet barely, if ever, gets a look in when weight

policies are being discussed. That’s why,

together with other HAES advocates in the

UK, I’ve since been working to establish

HAES UK as a stakeholder group. I’ve been

interested in improving interventions around

weight and health for some time and feel I now

have sufficient knowledge of the evidence,

and of ethical dimensions of practice, to

debate HAES at a higher level.”

“There is little mainstream awareness in the UK

of the evidence that dietary quality, and health

outcomes, are not necessarily linked to weight

management per se. However my trip has

enabled me to get the debate going.”

Lucy has already presented her findings

to her team in Coventry. “They asked lots

of questions of course, but have been

persuaded that there is a need for a new

approach,” she explained. “And as part of

my prize I have the opportunity to present at

the HEART UK conference next June. I look

forward to highlighting the evidence to the

delegates there and hope to start a fruitful

discussion, ultimately leading to real change.”

challenge events

HEART UK - The Cholesterol Charity - has

teamed up with a number of challenge event

providers to bring you a wide range of exciting

challenges in the UK, Europe and Worldwide.

You can choose from a variety of cycles and

treks to push yourself to the limit whilst raising

much needed funds for charity.

Why not do something different today and

sign up for a once in a lifetime challenge.

If you would like to register your interest or for

more information about any of the HEART UK

Challenge events, please call HEART UK on

0845 873 9597 or email Claire at:

cj@heartuk.org.uk. Together, we can keep

young hearts running!

Big heart bike ride across the Sinai Desert

When: 7 - 15 November 2009

A spectacular 420km cycle ride across the

Sinai Desert in Egypt. Camp out under the

stars on two nights and finish on the shores of

the Red Sea (includes a visit to the pyramids

at Giza).

Registration fee: £250.

Minimum sponsorship: £2500.

Cycle London to Paris with Classic Tours

When: 26 - 29 June 2009

This long weekend covers around 300km in

just 3 days finishing at the Eiffel Tower. The

fourth day is a free day to explore Paris.

Registration fee: £150.

Minimum sponsorship: £1000.

Cycle London to Paris with Discover Adventure

When: 2 - 6 September 2009

Passing through the Kent countryside, across

the Channel and continue through the villages

and medieval market towns of Northern

France, finishing at the Eiffel Tower.

Registration fee: £149.

Minimum sponsorship: £1250.

Climb Mt Kilimanjaro

When: 17 - 27 September 2009

Climb to an altitude of 5895 meters. Marvel

at the diverse ecosystem from cultivated

farmlands, lush rainforest and alpine meadow

to the lunar landscape at the top.

Registration fee: £350.

Minimum sponsorship: £3000.

Trek the 3 volcanoes (Italy)

When: 24 - 29 September 2009

Enjoy some of Italy’s most spectacular

scenery while scaling its three famous

volcanoes. The challenge culminates on the

slopes of smoldering Mount Etna in Sicily.

Registration fee: £200.

Minimum sponsorship: £2000.

Trek the Great Wall of China

When: 10 - 18 October 2009

Explore different sections of the Great Wall of

China, in the hills around Beijing away from

the places where tourists normally visit. Visit

the Forbidden City and Tianamen Square.

Registration fee: £250.

Minimum sponsorship: £2500.

Trek the Inca Trail

When: 14 - 23 May 2009

The Inca Trail includes very different terrain

from high desert plateau to tropical Andean

rainforests. Our ultimate destination is

Machu Picchu - the “Lost City” of the Incas.

Registration fee: £299.

Minimum sponsorship: £2650.



HEART UK DIGEST Although HEART UK has endeavoured to ensure the

accuracy of the entire publication, no liability will be accepted by the Trust,

Officers or members of staff, for information and opinions herein given.

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