Soltalk February 2019 | Page 44

Doctor’s notes
Dr Rik Heymans is a general practitioner in Nerja and writes
on developments in the world of medicine
Flu vaccines
adults is quite low in almost all European countries.
There is strong clinical evidence, including a recent UK study,
showing that influenza vaccination is associated with a reduced
risk of hospitalization for cardiovascular diseases and
pneumonia, and also with a decreased risk of mortality,
especially in the elderly.
Why are the elderly more vulnerable than young people? A
phenomenon called immunosenescense occurs. The term
“immunosenescence” refers to the diminished effectiveness of
the immune response over time. There is good evidence that
after 50 years of age, the immune system is declining; and thus
there is an increased susceptibility to infections and
autoimmune disorders. (Please take note: Immunosenescence
is not synonymous with immunodeficiency, it indicates a less
effective defence system, not a lacking of the defence system.)
And this is when extra help is needed, for instance under the
form of vaccinations.
Such studies highlight the ability to prevent some of these
common infections with simple, safe, relatively inexpensive
interventions (vaccinations), that are effective and generally
well tolerated. And there are trials that are ongoing to
investigate whether there is nonspecific immune system
stimulation happening as well, through these vaccinations.
Heart failure and Heart attacks are common in adults,
especially in the elderly patients, who are also at increased risk
for community-acquired pneumonia and influenza. These
infections have been shown to be triggers for severe cardiac
events. It is common for heart failure patients or patients with
coronary artery disease to have an acute decompensation that
is due to an infection, such as pneumonia, influenza, urinary
tract, or some other infection.
Iron Deficiency
Iron Deficiency (ID) is common in patients with stable heart
disease or decompensated Heart Failure (HF). The symptoms
of heart failure (Weakness, intolerance for exercise capacity)
are very similar to those of Iron Deficiency. Very often these
symptoms are attributed to anaemia; however, anaemia can be
present without Iron Deficiency. And the Iron Deficiency, not
anaemia, is associated with poor outcomes, including increased
mortality, reduced exercise capacity, and reduced quality of
life.
We cannot prevent all infections, but we have very effective
tools in these vaccines, to prevent pneumonia and influenza.
Unfortunately, however, the immunization rate among older
The European guidelines for the diagnosis and treatment of
patients with acute and chronic Heart Failure recommend to
proactively screen all patients with HF. The treatment
recommendations support the use of intravenous (IV) Iron in
all symptomatic HF patients with Iron Deficiency in order to
improve symptoms, quality of life, and exercise capacity. Oral
iron is ineffective in treating patients with HF and ID, because
oral iron has demonstrated some efficacy in patients with
anaemia it thus, incorrectly has been assumed that it would
also work in patients with HF and ID.
Omega-3 acids
As global populations age and prevalence of chronic disease
increases, public health priorities shift away from longevity
toward healthy aging (defined as living a meaningful lifespan
without chronic diseases, and with intact physical and mental
function).
Evidence from short-term studies suggests that Omega-3 acids
from seafood and plants have many beneficial molecular and
physiologic effects that could facilitate healthy aging. Higher
intake of these Omega-3 acids are each inversely associated
with the risk for cardiovascular disease (CVD): eating more of it
lowers the risk . People with the highest blood levels of omega-
3s mentioned when surveyed that they were eating fish about
two times per week.
However, this study did not study supplements, it only looked
at blood levels of (natural) omega-3s from seafood and
confirmed that higher levels were linked to a higher chance of
living healthy long lives. Whether this applies to supplements
will probably be studied in other studies.
© Dr RIK HEYMANS
c/ Angustias 24, Nerja.
Tel: [phone]
42