Can This Common Blood-Thinner Prevent Stroke?


One of the most frightening aspects of atrial fibrillation — the most common kind of arrhythmia or irregular heartbeat — is the risk of a life-threatening stroke.

During atrial fibrillation, the heart’s two small upper chambers or atria beat chaotically, increasing the risk of blood clots. If a clot breaks free and travels to the brain, you can suffer a stroke which can be fatal. People with atrial fibrillation are five times more likely to have a stroke than those who don’t have the condition. In fact, one in four strokes in people over the age of 80 is a direct result of atrial fibrillation. That makes stroke prevention a key part of atrial fibrillation treatment.

Stephen Kopecky, MD, professor of medicine at the Mayo Clinic and president of the American Society for Preventive Cardiology, said that when working with patients who have atrial fibrillation, the biggest hurdle is deciding whether to prescribe an anticoagulant — a medication to prevent blood clots from forming. Because the average age of an atrial fibrillation patient is 76 years old, the risk of stroke has to be weighed against the risk of bleeding. After that, he said, the decisions get easier.

Preventive Treatment: Anticoagulant Pros and Cons

Anticoagulants, commonly called blood thinners, are medications that slow the clotting of blood, so they help prevent blood clots from forming and traveling to the brain to reduce stroke risk.

If your doctor is concerned about your stroke risk, the first line of preventive treatment is medication. Since the 1950s, warfarin (Coumadin) has been the most widely used anticoagulant. In the last few years, newer anticoagulants such as apixaban (Eliquis), dabigatran (Pradaxa), and rivaroxaban (Xarelto) have gained U.S. Food and Drug Administration (FDA) approval.

Aspirin reduces the risk of stroke by 20 percent; anticoagulants reduce that risk by 80 percent.

 

Because most people with atrial fibrillation are older, various factors need to be considered. Dr. Kopecky said the risks for stroke are higher in those who have diabetes, high blood pressure, or have experienced heart failure, making an anticoagulant an important part of overall treatment.

Kopecky said fragile patients who fall are at increased risk of problems from internal and external bleeding or who can’t remember to take medication as prescribed probably shouldn’t be taking an anticoagulant. For them, he said, it’s probably wise to simply recommend an aspirin every day. Aspirin reduces the risk of stroke by 20 percent. Anticoagulants reduce that risk by 80 percent.

For atrial fibrillation patients who have equal risks of bleeding and stroke, doctor and patient should together make an informed decision based on factors such as lifestyle, diet, physical activity, access to clinics and doctors, work, and travel. “Every patient is an individual,” said Andrew K. Krumerman, MD, a cardiologist at Montefiore Medical Center in New York and associate professor of clinical medicine at Albert Einstein College of Medicine, “and the decision about what medication to take should not be dictated by what you read in the media or what you hear from pharmaceutical companies, but by a long conversation between patient and doctor.”

Atrial Fibrillation Anticoagulants: Warfarin

Warfarin is a powerful drug that reduces the chemical reaction of vitamin K in the liver that causes — and lengthens the time it takes for — blood to clot. Its effectiveness depends on the amount of vitamin K in the body.

Vitamin K is found in many leafy, green vegetables such as spinach, Brussels sprouts, and kale. Warfarin interacts with those vegetables and with various medications, supplements, and over-the-counter drugs, making it vital that people on it be monitored at least once a month. Too much warfarin increases the risk of bleeding, and too little increases the risk of stroke. No new foods or medicines should be added or eliminated without consulting a doctor, and you’ll want to seriously limit the amount of alcohol you drink.

Patrick J. Tchou, MD, a cardiologist, associate section head of electrophysiology and cardiac pacing in the Robert and Suzanne Tomsich Department of Cardiovascular Medicine, and co-director of the Ventricular Arrhythmia Center at the Cleveland Clinic, said he still considers warfarin to be the gold standard for comparison with other anticoagulants. But the drawbacks, he noted, are that doses have to be individually adjusted, and a patient has to carefully watch levels of vitamin K. If you’re able and willing to regularly go for blood level measurement checks and keep in touch with your doctor about any diet or lifestyle changes, warfarin may be a good choice.

Warfarin is inexpensive when covered by insurance. Unlike some of the newer anticoagulants, an antidote exists for emergency situations such as during surgery when the drug must be immediately counteracted.

In addition to risks of internal bleeding, side effects can include headaches, confusion, weakness, fever, numbness, nausea, and diarrhea — contact your doctor immediately because you may need a dose change.

 

Atrial Fibrillation Anticoagulants: New Options

Newer anticoagulants have now been proven to be as effective as warfarin, said Kopecky. According to a report in the September 2011 issue of the New England Journal of Medicine, several important studies showed they’re equal or superior at preventing blood clots than warfarin.

 

The drugs Pradaxa (dabigatran) and Eliquis (apixaban) are taken in fixed doses twice a day, get into the blood in a matter of hours, and don’t require close monitoring or dietary considerations. Xarelto (rivaroxaban) is taken in a fixed dose once a day for prevention of stroke in atrial fibrillation. However, these are not advised for anyone with heart valve disease or serious kidney or liver problems and, unlike warfarin, they’re expensive, costing about $3,000 a year. Side effects are similar to those of warfarin.

“As we get to know these drugs better,” said Kopecky, “we’re migrating toward them more.” He said he likes to recommend them for patients younger than 65, who are active and have no other health issues. “The only considerations when deciding which medication to put a patient on now,” he said, “are individual safety issues and cost.”

Life without sex – it’s better than you think


After I was diagnosed with a neurological condition, my partner left me and I decided to try celibacy. It has improved my friendships with women no end

 

Medieval monks took vows of celibacy – but it's rare for anyone to do the same today for non-religio

Medieval monks took vows of celibacy – but it’s rare for anyone to do the same today for non-religious reasons. Photograph: Archivo Iconografico, S.A./COR

I am celibate. I am a single, heterosexual, early-middle-aged male. I have all the appendages that nature intended and, although modesty forbids that I class myself as good-looking, attractive women still make me interesting offers of intimate entanglements – and, yes, some of them are even sober at the time. (Of course, being a Guardian reader also helps to make one irresistibly attractive to the opposite sex.)

So why am I celibate? More than a decade ago I was in a relationship when I discovered that I had a neurological condition that is likely, in time (I know not when), to deteriorate. That was the end of the relationship – a decision that my partner made and which, although I took it badly at the time, I now appreciate a lot better. After all, it is one thing to think that illness or death may happen to one or other of you half a century hence, another altogether when it may be only five years down the road.

Despite this, if you met me in the street you probably wouldn’t even know that there was anything wrong with me. Certainly nothing off-putting to any potential mate. So why celibacy? At first, after the break-up, I could have gone one of two ways. I could have dived head-first into a flurry of empty, hedonistic sex in a quest for revenge against all women for my ex-partner’s abandonment of me. I didn’t; although it crossed my mind. Instead, at first, I took some time out to grieve for the loss of a relationship that had meant a lot to me and, to be honest, to feel bloody sorry for myself.

But what to do after that? After I had spent some time in thought, both consciously and sub-consciously, I slowly came to the conclusion that celibacy was the way forward. I know within that I could live a life of permanent isolation like an anchorite, yet I know also that I would not want to. Frankly, I love women. I love their company, the sound of their voices, the way that although they occupy the same physical space as us blokes yet they seem to inhabit it so totally differently. The thought of not sharing their company was, and is, unthinkable to me. I have always preferred sex within a relationship to one-night stands. I am not a puritan, but I prefer the greater intimacy that you can achieve through a shared exploration of each other’s body and desires. Yet I could not, in conscience, enter into a relationship bringing the baggage of my illness; it would not be fair to do so. Neither to a partner or, conceivably, any potential children who might inherit my illness. (Before anybody suggests seeking “relief” with a prostitute – I am a Guardian reader, we don’t do that sort of thing). Such was my final decision, and it is one that I have stuck to.

Do I miss sex? Yes, but not as much as I thought that I would. Arguably, sex is an addiction. Break the cycle and, over time, the physical and psychological “need” for sex lessens – you can do without it, hard as that may be to believe. Yes, you still think about it, but over time those thoughts lose their power. I have read assiduously about the various techniques employed by monks and other religious adherents of various faiths, and the supposed benefits that they derive from abstinence. I have, however, yet to be convinced that there is any spiritual or physical gain to be had.

However, being celibate has actually improved my relationships with women – at least those that I already know (getting to know new people of the opposite sex is still no easier, although you can be seen as a “challenge” by some, which can be … interesting). Once you remove the potential for sex from the relationship, and both parties are aware of that, it changes the dynamic of the friendship. You can both be relaxed in each other’s company in a way that is not possible otherwise. Daft, but seemingly true. Look, for example, at the similarly close relationships that some women have with gay men.

So would I recommend celibacy to my fellow men? I appreciate that my circumstances are not normal – and anybody finding themselves in my position would have to make up their own mind on the matter. However, people consider celibacy for many and varied reasons; so if you are considering it, I would say that it is not something to fear and can indeed be a positive choice (and, let’s face it, if you try it and don’t like it then you can always change your mind). Even taking a break from sex, or at least taking a break from the obsessional quest for it, can often be incredibly rewarding.

Astronaut Reid Wiseman posts the first Vine video from space


Astronaut Reid Wiseman posts the first Vine video from space

‘Single Earth orbit. Sun never sets flying parallel w/terminator line,’ explains clip posted from International Space Station

Reid Wiseman posted a looping clip from space on Twitter’s Vine video-sharing network.

Since its launch January 2013, Twitter’s Vine smartphone app has been used to share a wide variety of up-to six-second looping videos. But never from space.

Now Nasa astronaut Reid Wiseman has changed that, posting a video shot on the International Space Station (ISS).

“1st Vine from space! Single Earth orbit. Sun never sets flying parallel w/terminator line,” he explained in the clip, which he posted over the weekend, sharing it on Vine and also with his 67.2k Twitter followers.

Wiseman has been tweeting photos regularly since beginning his stint on the ISS in late May: the latest use by Nasa staff of social media, in order to raise awareness of the agency’s work.

Fellow astronaut Chris Hadfield had a viral hit in 2013 with a video of his cover version of David Bowie’s Space Oddity, filmed on the ISS. It was recently made private on YouTube, after a one-year copyright licence ended.

Nasa’s Mars Curiosity rover mission has also been a hit on Twitter, with 1.57m followers on the social network for tweets purportedly sent by the unmanned rover vehicle as it goes about its research.

What is the Turing test? And are we all doomed now?


The Turing test has been passed by a robot named Eugene. It may be time to pledge fealty to the machines

A Sculpture of Alan Turing by Stephen Kettle at Bletchley Park, Milton Keynes, UK.

A Sculpture of Alan Turing by Stephen Kettle at Bletchley Park, Milton Keynes, UK. Photograph: Alamy

 

Programmers worldwide are preparing to welcome our new robot overlords, after the University of Reading reported on Sunday that a computer had passed the Turing test for the first time.

But what is the test? And why could it spell doom for us all?

The Turing Test?

Coined by computing pioneer Alan Turing in 1950, the Turing test was designed to be a rudimentary way of determining whether or not a computer counts as “intelligent”.

The test, as Turing designed it, is carried out as a sort of imitation game. On one side of a computer screen sits a human judge, whose job is to chat to some mysterious interlocutors on the other side. Most of those interlocutors will be humans; one will be a chatbot, created for the sole purpose of tricking the judge into thinking that it is the real human.

On Sunday, for the first time in history, a machine succeeded in that goal.

Or a Turing test?

But it might be better to say that the chatbot, a Russian-designed programme called Eugene, passed a Turing test. Alan Turing’s 1950 paper laid out the general idea of the test, and also laid out some specifics which he thought would be passed “in about 50 years’ time”: each judge has just five minutes to talk to each machine, and the machines passed if more than 30% of the judges thought that they were human. Those somewhat arbitrary, if historically faithful, rules were the ones followed by the University of Reading.

It remains impressive that Eugene had 33% of the judges “he” spoke to convinced of his humanity, but the robots still have a long way to go to pass the gold standard of modern Turing tests, using rules laid out in 1990 by the inventor Hugh Loebner. Those rules call for the computer and a human to have a 25-minute conversation with each of four separate judges. The machine only wins if it fools at least half the judges into thinking it’s the human (though every year there is a “bronze medal” awarded to the machine that convinces the most judges).

The hardest Turing test described so far is one set up as part of a $20,000 bet between the futurologist Ray Kurzweil and the Lotus founder, Mitch Kapor. Kapor bet that no robot would pass the test before 2029, and the rules call for the challenger and three human foils to have two-hour conversations with each of three judges. The robot must convince two of the three judges that it is human, and be ranked as “more human” on average than at least two of the actual human competitors.

How do the robots win?

Turing test competitions have been held for more than 20 years, and the strategies the robots employ have changed over time. Where originally the stumbling blocks were simply understanding the questions asked by the judges, now the bigger challenge is in answering them in a human-like manner. In recent years, winners have started changing the subject, asking questions of the judges, and simulating moods and typos.

The big breakthrough behind Eugene, the University of Reading’s winner, was in giving the robot the persona of a 13-year-old boy. “Our main idea was that [Eugene] can claim that he knows anything, but his age also makes it perfectly reasonable that he doesn’t know everything,” said the robot’s creator, Vladimir Veselov. It also makes affectations like misspellings look more plausible than they would coming from an “adult”.

What does a conversation with Eugene look like?

Here’s the transcript of a 2012 conversation with a judge which resulted in them picking Eugene over the human interlocutor on the other side of the screen:

[16:11:25] Judge: what music do you like?

[16:11:32] Eugene: I like Eminem – because he doesn’t have a thing to do with “polite-correctness”.

[16:11:46] Judge: OMG i love eminem, he’s my favourite artist!

[16:12:00] Eugene: I wonder what Eminem’s nick mean. I associate it only with a word “enema”. But he is a cool guy, I like his “The Real Slim Shady”.

[16:12:55] Judge: i know what his nick name means, his real name is Marshall Mathers. From the initials M&M phynetically sounding like Eminem.

[16:13:06] Eugene: Eminem is a famous crapper. No, raper… ripper… Yeah, I mean – rapper. I like his “Stan” and “The Real Slim Shady”.

[16:13:32] Judge: I like “Hailies song”

[16:13:46] Eugene: Interesting tastes. I like science fiction books, by the way. Where do you came from, by the way? Could you tell me about the place where you live?

[16:14:22] Judge: Epsom, home of the derby. yourself?

[16:14:27] Eugene: My guinea pig says that name Derby sounds very nice.

[16:14:41] Judge: i shopuld talk with him sometime

[16:14:48] Eugene: I think you should take some typing lessons. Or just type more accurately.

[16:15:04] Judge: that’s very rude?

[16:15:09] Eugene: Ummm… Frankly, I didn’t get your question:-(

[16:15:49] Judge: “Ummm” isnt a word. i think you need typing lessons

[16:15:58] Eugene: My thoughts are same. By the way, I still don’t know your specialty – or, possibly, I’ve missed it?

At the time, Eugene passed 28% of such conversations. Two years on, that extra 5% has made all the difference.

Is it time to pledge allegiance to our new robot overlords?

Probably not. For one thing, winning a competition by pretending to be a child with gaping holes in their knowledge does not exactly reinforce the idea that machines are something to be scared of.

But moreover, chatbots are a fairly limited application of the sort of artificial intelligence which science-fiction authors have been imagining for decades. By having to pretend to be human, they are prevented from being more than human.

They still offer new problems and possibilities for the future, from automatic scambots which carry out phishing attacks to customer support algorithms that don’t need to reveal that they aren’t actually a person.

But really, these machines say more about us than them. “You don’t write a program, you write a novel,” explain Eugene’s creators. “You think up a life for your character from scratch – starting with childhood – endowing him with opinions, thoughts, fears, quirks.” When the best way to pretend to be human is to imitate our foibles and weaknesses as much as our strengths, the victors of Turing tests will continue to be the least scary output of artificial intelligence research.

How soon should I lose weight after having a baby?


Seeing celebrities strutting round in skinny jeans just weeks after they’ve given birth can make new mothers anxious. But although it’s important to lose that extra weight, it’s best to do so gradually

Woman pushing pram

The Royal College of Midwives warns that women can feel ashamed of their post-baby bodies. Photograph: Jason Swain/Getty Images/Flickr RM

There is nothing more annoying than seeing a celebrity mum back in skinny jeans the week after giving birth. Last week, Luisa Zissman (of Celebrity Big Brother) was reported to have criticised Tamara Ecclestone for losing her baby weight too quickly. Celebrities should admit they employ nannies so they can exercise and “starve themselves thin”, said Zissman. Meanwhile, Halle Berry’s personal trainer, Ramona Braganza, has released a DVD called 321 Baby Bulge Be Gone, based on daily workouts that started a few weeks after Berry gave birth. They include free weights, squats, lunges and jumps. Advice from the Royal College of Obstetricians and Gynaecologists specifically advises against jumping exercises too soon after birth. And a new report warns that losing weight too rapidly is unhealthy for mothers and psychologically damaging for children. So is it better to wait to lose that weight?

The solution

This latest report, from the Government Equalities Office, is written by psychotherapist Susie Orbach and Holli Rubin, a specialist in body image. It reviews the research literature on attachment theory and argues that new mothers who are worried about their baby fat may be less focused on bonding with their babies. Instead of mother and baby getting to know each other, says the report, women are pressurised into presenting themselves “physically as though nothing as momentously life-changing or body-changing as having a baby has occurred”. As a call for new mothers to shelve restricting calories until they are less exhausted and emotionally overwrought, it makes sense. A survey by the Royal College of Midwives (RCM) of 6,252 women found that six out of 10 felt pressurised by the example of celebrities to lose weight quickly after giving birth. The RCM warns that women can easily feel ashamed of their post-baby bodies.

Research shows that it is best to lose baby fat gradually, starting after three months. Women normally gain up to 20% of their bodyweight during pregnancy. Eating healthily, taking moderate exercise such as brisk walking and aiming to lose a couple of pounds a week is tough, but more achievable than a juice diet and five sessions a week at the gym.

Weight Watchers has some good tips on losing baby fat. The National Institute for Health and Care Excellence recommends weight loss over the first year. The problem with not shifting baby fat is that increasing weight in subsequent pregnancies increases the risk of diabetes and pre-eclampsia. Even without future pregnancies, significant weight gain can increase the likelihood of high blood pressure and heart disease. But, as Orbach says, wait until you’ve got used to having a baby. Skinny jeans can wait.

Can film scripts help people understand anxiety?


Anxiety is one of the most common mental health conditions, now with its own arts festival. But can seeing various disorders played out in films such as Solaris and Walz With Bashir further our understanding?

 

The Headless Woman

Verónica, in The Headless Woman, whose tipping point comes after a car accident.

Anxiety has always been woven into the fabric of film-making. From the nail-biting Hitchcock thriller to the bombastic Hollywood action movie, most films work to keep viewers on the edge of their seats; even a romantic comedy can bring a level of worry about whether everything will turn out as it should.

But can films actually help us understand anxiety as a clinical condition, experienced – according to the Mental Health Foundation – by almost 5% of the UK population? Yes, says Jonathan Keane, film curator for the foundation’s first Anxiety arts festival, taking place in London this month. “The history of film,” he says, “is the history of anxiety. At a screening of the Lumière brothers’ early film The Arrival of a Train at La Ciotat, people ran out screaming: they thought the train was coming right at them. But film doesn’t just make us feel anxious: it also stages anxiety, and helps us to understand how it works.”

Here, then, is a selection of films that do this best, as chosen by Keane and a panel of psychologists.

Safe

Todd Haynes’s 1995 drama stars Julianne Moore as a suburban housewife who convinces herself she is being assailed by invisible pollutants. Psychologist Colette Hirsch of King’s College London says the character’s condition bears many of the hallmarks of generalised anxiety disorder. “There’s a lot of ambiguity set up in the film,” she says. “This relates very much to the way people with the disorder apply negative interpretations to apparently innocuous things. In a 2010 study, we showed that if you help people to develop a more positive interpretation of situations – more like those used by the rest of the population – this reduces their tendency to worry.”

If only that treatment had been offered to Moore’s character: instead, she ends up ensnared in a sinister cult.

The Headless Woman

For Keane, this 2008 Argentinian film – called a “masterpiece” by the Guardian’s Peter Bradshaw – is a study of the importance of the “tipping point”: the moment when a particular experience or incident kicks off an unhealthy cycle of worry. In the film, this comes when the main character, Verónica, hits something with her car, and doesn’t stop. Gradually, she becomes convinced that she has killed a child; the director, Lucrecia Martel, cleverly depicts her emotional disintegration. “It’s a brilliant exploration of how anxiety can cause people to start seeing things that aren’t there,” Keane says. “The character literally loses her head. There’s no easy resolution, but we do see her start to find closure. That’s useful, too, in reminding people with anxiety that there will be an end to it.”

Solaris

Solaris Solaris, ‘a compelling example of how those with an anxiety disorder will try to categorise their feelings’. Photograph: Moviestore Collection/Rex

In Andrei Tarkovsky’s 1972 movie, adapted from a science-fiction novel by Stanislaw Lem, a psychologist, Kris Kelvin, is dispatched to help three astronauts apparently going insane on a distant space station. According to Vyv Huddy, a lecturer in clinical psychology at University College London, the film provides a compelling example of how those with an anxiety disorder will try to categorise their feelings, and then avoid exposure to their source. “We see that tendency towards avoidance in Kelvin’s behaviour,” he says. “We also get a sense of the anxiety created by being so far away from home, and the different ways people try to cope.” And with Kelvin gradually becoming implicated in the strange world of the space station, Huddy thinks it’s a particularly useful film for clinicians, too. “We see how difficult it can be,” he says, “to separate yourself completely from the people you are treating.”

Waltz With Bashir

Waltz With Bashir Waltz With Bashir, a powerful evocation of post-traumatic stress disorder. Photograph: Moviestore Collection/Rex

Made by Israeli film-maker Ari Folman in 2008, this powerful animation stands between documentary and autobiography: it’s an attempt, in film, to recover the director’s lost memories of serving in the Israeli invasion of Lebanon in 1982. Nick Grey, a consultant clinical psychologist at the South London and Maudsley NHS trust, says it is also a powerful evocation of post-traumatic stress disorder, one of anxiety’s best-known manifestations. “The film deals with trying to complete gaps in memory,” he says, “and also with some of the powerful beliefs that people with PTSD are left with: ‘I didn’t do enough’, ‘I abandoned him’. It’s those beliefs that keep the anxiety going.”

Opening Night

Gena Rowlands starred in her husband John Cassavetes’ 1977 examination of anxiety on- and offstage. She plays veteran Broadway actor Myrtle Gordon, whose confidence is severely shaken after a young female fan is killed in an accident. “There are two levels of anxiety at work here,” Keane says. “One is performance-related, and the other is about how a woman is to grow old when she has been so defined by her image. She begins to go off-script while acting – not unlike what we see in real life in people with anxiety problems. They sometimes start to say things that don’t make sense.”

Of course all these films – and the many others that describe anxiety, and its treatment – are works of art: none of them can be expected to offer the rigorous analysis of a clinical research paper. What they can do, though, is help cut through the levels of silence and misunderstanding that still surround this complex condition. “We seem to feel that anxiety is a personal problem,” Keane says, “and one we can’t do anything about. My hope is that anyone who sees these films – and others – will understand that they’re not alone. Anxiety often makes people feel that they’re stuck. Films like these might just be able to help get them moving.”

Aspirin ‘not best to stop strokes’


Aspirin

Doctors are being told not to routinely prescribe aspirin for a common heart condition that increases stroke risk.

Guidelines from the National Institute of Health and Care Excellence (NICE) are set to recommend other drugs instead for patients with an irregular heartbeat, called atrial fibrillation.

Warfarin or similar blood-thinning medicine is best, says NICE in draft advice to be finalised this month.

The advice will affect hundreds of thousands of patients.

“Start Quote

Patients who are unclear on whether or not they should continue to take aspirin should speak to their doctor”

Prof Peter Weissberg British Heart Foundation

But experts say most doctors already follow the advice to prescribe blood-thinners other than aspirin and that the guidelines are “playing catch-up” – this is the first time they will have been updated since they were first issued in 2006.

Stroke prevention

Atrial fibrillation (AF) is the most common heart rhythm problem, affecting up to 800,000 people – roughly one in 100 – in the UK.

In AF, the heart cannot work as well as it should and blood clots can form, which, in turn, increases the risk of a stroke.

Aspirin has been used for years to help protect patients from strokes, but mounting evidence suggests the drug’s benefits are too small compared with other treatments.

The NICE guidelines for England and Wales look set to say that although daily aspirin might still be beneficial for some patients, most should be offered something else as well or instead.

According to its draft advice, NICE says warfarin or a newer type of oral anticoagulant is often best.

The British Heart Foundation said most doctors were already doing this.

Prof Peter Weissberg, medical director at the British Heart Foundation, said: “Strokes caused by atrial fibrillation are both common and preventable but only if the abnormal heart rhythm is identified in the first place and if effective drugs are given to prevent blood-clot development.

“The revised NICE guidance reflects accumulating evidence that warfarin and the newer anticoagulants are much more effective than aspirin at preventing strokes.

“This does not mean that aspirin is not important and effective at preventing heart attacks and strokes in other circumstances. Patients who are unclear on whether or not they should continue to take aspirin should speak to their doctor.”

Prof Peter Elwood, an expert at Cardiff University, warned it could be unsafe to suddenly stop taking aspirin. “If aspirin is to be stopped, it should be stopped gradually,” he said.

line break

Do I have atrial fibrillation (AF)?

checking pulse
  • An irregular pulse could be a sign that you have AF
  • It will feel erratic, and beats may be variable in strength
  • AF is most common in people aged over 55
  • If you think you might have AF, you should get yourself checked out by a doctor
  • Often, the underlying cause is not found, but AF is more common in people with high blood pressure and heart disease

Bad sleep ‘dramatically’ alters body


A run of poor sleep can have a potentially profound effect on the internal workings of the human body, say UK researchers.

The activity of hundreds of genes was altered when people’s sleep was cut to less than six hours a day for a week.

Writing in the journal PNAS, the researchers said the results helped explain how poor sleep damaged health.

Heart disease, diabetes, obesity and poor brain function have all been linked to substandard sleep.

What missing hours in bed actually does to alter health, however, is unknown.

So researchers at the University of Surrey analysed the blood of 26 people after they had had plenty of sleep, up to 10 hours each night for a week, and compared the results with samples after a week of fewer than six hours a night.

More than 700 genes were altered by the shift. Each contains the instructions for building a protein, so those that became more active produced more proteins – changing the chemistry of the body.

How to get a better night’s sleep

A man yawning

Sources: Mental Health Foundation and BBC Science

Meanwhile the natural body clock was disturbed – some genes naturally wax and wane in activity through the day, but this effect was dulled by sleep deprivation.

Prof Colin Smith, from the University of Surrey, told the BBC: “There was quite a dramatic change in activity in many different kinds of genes.”

Areas such as the immune system and how the body responds to damage and stress were affected.

Prof Smith added: “Clearly sleep is critical to rebuilding the body and maintaining a functional state, all kinds of damage appear to occur – hinting at what may lead to ill health.

“If we can’t actually replenish and replace new cells, then that’s going to lead to degenerative diseases.”

He said many people may be even more sleep deprived in their daily lives than those in the study – suggesting these changes may be common.

Dr Akhilesh Reddy, a specialist in the body clock at the University of Cambridge, said the study was “interesting”.

He said the key findings were the effects on inflammation and the immune system as it was possible to see a link between those effects and health problems such as diabetes.

The findings also tie into research attempting to do away with sleep, such as by finding a drug that could eliminate the effects of sleep deprivation.

Dr Reddy said: “We don’t know what the switch is that causes all these changes, but theoretically if you could switch it on or off, you might be able to get away without sleep.

“But my feeling is that sleep is fundamentally important to regenerating all cells.”

‘World’s smallest’ pacemaker fitted


The world’s smallest pacemaker has been fitted inside the heart of a UK patient, medics have said.

The Micra Transcatheter Pacing System was fitted for the first time in England at Southampton General Hospital.

Consultant cardiologist Prof John Morgan said the procedure was a “landmark moment”.

He said the device was “not much larger than an antibiotic pill” and was one tenth the size of traditional models.

Prof John Morgan

A brief history of the pacemaker

  • Electrical activity within the heart was discovered in the 1800s
  • The first artificial pacemaker, built by Albert Hyman in 1932, was powered by a hand-cranked motor
  • Post World War 2 smaller devices were pioneered, with some worn like a necklace
  • In 1958 the first implanted pacemaker was given to Arne Larsson in Sweden, but the device failed after three hours
  • Early pacemaker batteries had short lifetimes until Wilson Greatbatch pioneered long-life lithium batteries in the 1970s

Source: The Science Museum, London

Currently, pacemakers, which use electrical impulses to regulate the beating of the heart, are inserted under the skin and connected to the heart via a lead.

The lead carries electrical signals to correct slow or irregular heartbeats, but they can require replacement due to broken or dislodged wires.

The new device can be implanted directly in the heart and delivers electrical impulses from an electrode, removing the need for a lead.

Prof Morgan said: “In addition to the advantages of the device’s size and wireless technology, the procedure reduces the risk of infection and extended recovery time associated with traditional, more invasive surgical pacemaker implants.

“This a big step forward in patient treatment and a milestone for cardiac rhythm management in the UK.”

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Analysis

By Fergus Walsh, BBC Medical correspondent

This new technology has several potential advantages.

Most important is the absence of a wire or lead which carries the electrical impulse from conventional pacemakers to the heart. These wires can come under immense pressure and can be a source of complications.

Standard pacemakers are implanted under the skin in the chest which can be a potential infection risk. By contrast, the tiny pacemaker used in these trials is inserted via a catheter from the groin and sits in the heart.

At 26mm long and weighing 2g, the Micra TM used in Southampton can claim to be the world’s smallest pacemaker.

Southampton General is the only UK hospital which is taking part in a global clinical trial of the device.

A patient in Austria was the first to have the device implanted in December 2013. A rival system called Nanostim from St Jude Medical is also undergoing trials. It is 41mm long.

A third technology under development by EBR Systems combines a pacemaker implanted under the skin which wirelessly sends ultrasound energy to a receiving electrode – about the size of a grain of rice – implanted in the left ventricle.

Male faces ‘evolved to take punches’


broken jaw
The jaw bone is frequently fractured in fist fights and was strengthened in some of our evolutionary ancestors

A new theory suggests that our male ancestors evolved beefy facial features as a defence against fist fights.

The bones most commonly broken in human punch-ups also gained the most strength in early “hominin” evolution.

They are also the bones that show most divergence between males and females.

The paper, in the journal Biological Reviews, argues that the reinforcements evolved amid fighting over females and resources, suggesting that violence drove key evolutionary changes.

Fossil records show that the australopiths, immediate predecessors of the human genus Homo, had strikingly robust facial structures.

For many years, this extra strength was seen as an adaptation to a tough diet including nuts, seeds and grasses. But more recent findings, examining the wear pattern and carbon isotopes in australopith teeth, have cast some doubt on this “feeding hypothesis”.

“In fact, [the australopith] boisei, the ‘nutcracker man’, was probably eating fruit,” said Prof David Carrier, the new theory’s lead author and an evolutionary biologist at the University of Utah.

Masculine armour

Instead of diet, Prof Carrier and his co-author, physician Dr Michael Morgan, propose that violent competition demanded the development of these facial fortifications: what they call the “protective buttressing hypothesis”.

In support of their proposal, Carrier and Morgan offer data from modern humans fighting. Several studies from hospital emergency wards, including one from the Bristol Royal Infirmary, show that faces are particularly vulnerable to violent injuries.

Paranthropus boisei, "nutcracker man" The strong brow ridges, cheek bones and jaw of early hominins like “nutcracker man” (Paranthropus boisei) may have evolved as a defence against the fists of other males, instead of for other reasons such as diet

“Jaws are one of the most frequent bones to break – and it’s not the end of the world now, because we have surgeons, we have modern medicine,” Prof Carrier explained. “But four million years ago, if you broke your jaw, it was probably a fatal injury. You wouldn’t be able to chew food… You’d just starve to death.”

The jaw, cheek, eye and nose structures that most commonly come to grief in modern fist fights were also the most protected by evolutionary changes seen in the australopiths.

Furthermore, these are the bones that show the most differences between men and women, as well as between our male and female forebears. That is how you would expect defensive armour to evolve, Prof Carrier points out.

“In humans and in great apes in general… it’s males that are most likely to get into fights, and it’s also males that are most likely to get injured,” he told BBC News.

Long-running debate

Interestingly, the evolutionary descendents of the australopiths – including humans – have displayed less and less facial buttressing.

This is consistent, according to Prof Carrier, with a decreasing need for protection: “Our arms and upper body are not nearly as strong as they were in the australopiths,” he explained. “There’s a temporal correlation.”

The facial buttressing idea builds on a previous observation by Prof Carrier and Dr Morgan that the early hominins were the first primates to evolve a hand shape compatible with making a fist – and thus, throwing a punch.

Human and ancestral skull reconstructions
Stronger facial bones appear in the australopiths (second and third rows) at about the same time as shifting hand proportions enabled our ancestors to clench their fists, then decline in parallel with upper body strength

That earlier paper attracted criticism from some other researchers, and Prof Carrier expects this new contribution may also prove controversial. He says that debate about the role of violence in human evolution is not new.

“[Our paper] does address this debate of whether our past was violent or peaceful,” he told the BBC. “That’s an argument that’s been going on for a very long time.”

“The historical record goes back a short time, the archaeological record goes back a few tens of thousand years more… But the anatomy holds clues to what selection was important, what behaviours were important, and so it gives us information about the very distant past.”