Translator: Hiroko Kawano Reviewer: Tanya Cushman
Good afternoon.
I'm a cardiologist, and I want to tell you a story
about life and death and everything in between.
So, ancient cities like London were always built on the banks of a river,
and the mighty Thames is only a few hundred feet from here.
And often people say that the Thames is the lifeblood of London, which is true.
But within our own bodies, we also have our own lifeblood, literally,
that has to circulate to every organ, to every single cell to keep us alive,
and at the very centre of that is the heart.
And that beats 70 times a minute,
24 hours a day
from many months before we were born to the second that we die.
So obviously pretty important.
But its job is to circulate blood, oxygen, nutrients
to the rest of us.
And actually, the pipes that lead from the heart round our body -
the arteries, the capillaries, the veins -
are wondrously designed.
If you were to put them together, in each and every one of you, end to end,
it would stretch for 100,000 kilometres.
I'd like a gasp, please - 100,000 kilometres.
That's two-and-a-half times round the world, in your body.
And so, I'm going to show you a video of -
and I want you to imagine that you're a red blood cell,
and you're surfing through the pipes.
Don't worry, I'm not going to show you 100,000 kilometres of video.
It's only a short segment
to give you an idea of what's happening here:
lovely smooth walls, the blood coursing down to where it needs to be.
So let's have a look at this.
(Heartbeat)
That's not my heart,
but this is the heart here.
And it pumps the blood to the whole of the body
but also to itself to make sure it can provide the energy to pump.
(Heartbeat End)
So that's a great system, isn't it?
Now, I'm looking around the audience now,
and I'm sorry to say
that nearly all of you are furring up already.
You don't have a nice smooth vascular system.
You've got little lumps of cholesterol that are already developing.
Trying to find some teenagers in the audience -
even you have started this process.
Looking at some of the older people as well,
I'm afraid you're a bit like a kettle by now.
(Laughter)
You're really furring up.
And this process happens throughout life.
There's various thing we know that we can do to delay this,
but I want to show you another video of when this all goes wrong for us.
And on a more serious note,
about one in three of you will have a heart attack or stroke at some point.
So you might be personally affected,
and I'm sure within your families, you will be affected as time goes on.
And about one in four of us, and I don't exclude myself -
as you can tell I'm a Scotsman
although I've worked in London for 30 years.
A Scotsman considers it his birthright to die from heart disease.
(Laughter)
My grandfather died of it, my father died of it,
and by hell, I'm going to die of it too
(Laughter)
is a bit of the attitude which we have to change.
But let me show you the video of what happens when it goes wrong.
So in this video, you're going to see
a big lump of cholesterol, or fat, in the vessel wall.
But more importantly than that, which is there all the time in most of us,
is that actually it ruptures, the top splits,
and then blood clots on top of it and completely blocks off that artery.
So let me be silent whilst you look at the graphic of what happens here.
(Heartbeat)
(Heartbeat End)
And it blocks the artery,
and that bit of the artery that supplies the heart dies off;
you have a heart attack.
And that might happen.
So this is a serious business.
And that's why we all have to work together
to try and reduce the risk of you furring up.
And if you do fur up,
to try and prevent things like heart attack and stroke.
So let's, for just a second,
move from thinking about ourselves to a much more global perspective on this,
and it's been really quite dramatic.
In the past two generations,
this problem has become an epidemic across the world.
It used to be confined to very wealthy countries,
like the USA and Western Europe,
but now it is a global problem.
Eighteen million people die of this condition every year.
That's one person every two seconds.
It's the world's biggest killer
but doesn't get enough attention and focus in our minds.
So let's look at the world and see what this issue is.
It used to be that many parts of the world didn't really have this problem.
But that's changed very rapidly.
So it's not just North America.
It's South America.
It's also Asia,
where coronary heart disease was very uncommon.
And I'm giving you some clues here as to why this might be happening
within two generations.
But actually,
these are pretty obvious things, that I hope you know about.
You just need to walk outside here,
and you can see how much fast food is available.
Cigarette smoking is still very common, particularly in young women.
And look at this: our sedentary lifestyle.
We look at screens more and more.
We don't walk our children to school, for example.
And those are the factors that drive the change
in the epidemic across the world.
But these are things that we can change for ourselves,
for our children, for our grandchildren.
And it's great to see London being active in this,
giving us more activity, making it easier to cycle.
The London mayor - when they're building buildings now -
"Make sure the stairs, it's obvious," so you have a choice.
So if you only take one thing away from me,
whenever you see a flight of stairs,
think of me,
keep your weight down,
keep your cholesterol down, keep diabetes away,
and slow down that furring-up process.
But I don't want you to think this is just a problem in other countries.
Our country has still got a huge problem here that's not going away.
So let's just look at the UK, just for a second.
And you may think, actually,
that this is a problem that affects more men than women.
But I just want you to look at the facts and figures there,
that actually it's equal balance.
Many women reading the press
would think they're much more likely to die of breast cancer than this.
But women are twice as likely to die of a heart attack or stroke
than any malignancy.
So it's a really important issue
that none of us should be ignoring for our families.
Now, the final bit is to show you what we as doctors are doing.
So I've shown you this nasty process,
but here you can see little blue dots, and this is drug therapy:
new drugs that we're working on
to try and reduce the risk of heart attack and stroke.
So let me just share, before I finish, an example of new medical practice.
Now we as cardiologists are always doing clinical trials,
where we take an idea and we test it to see if it will benefit our patients.
And just very recently, a very large trial was finished:
27,000 volunteers in about 60 countries
took part in this.
Now, you've all heard of aspirin -
it's been around or 100, 120 years or so,
and it's pretty good at preventing clots forming in your arteries.
Pretty good, but certainly not perfect.
So cardiologists always had the suspicion
that perhaps if we added something on top of the aspirin,
we would get a better result.
But you can't just go on hunches; you've got to prove this.
So we did a very large clinical trial,
27,000 people,
half of them getting just aspirin,
half of them getting aspirin and a low dose of a blood thinner,
an anticoagulant.
Now, all of these people
have had a heart attack or a stroke or angina or a bypass operation.
So we all knew they had very furred-up arteries.
The question we were asking was,
Is aspirin on its own still the best treatment,
or should we be changing this?
And what was so good
was that this trial was stopped early by the Ethics Committee
because the benefit of adding the low-dose anticoagulant to the aspirin
was so dramatic
it was unethical to continue.
So the aspirin plus the other therapies - so much better:
reducing the risk of a heart attack or stroke
and people living longer.
So in due course,
when all the regulation goes through,
it's likely there'll be a change in how doctors treat this condition.
So we're doing our bit as cardiologists, working with patients
to try and get better solutions if you develop the problem.
But I'd like you also to realise that you have a responsibility as well,
for yourself, children, grandchildren, other friends.
Think about this beautiful system of pipes, the vascular system.
Think how easy it can be to protect it over a lifetime.
So working together - you and me, my profession -
let's beat the world's biggest killer.
Thank you very much indeed.
(Applause)