Coronary artery disease

Coronary artery disease known as coronary heart disease or ischemic heart disease, involves the reduction of blood flow to the heart muscle due to build-up of plaque in the arteries of the heart. It is the most common of the cardiovascular diseases. Types include stable angina, unstable angina, myocardial infarction, sudden cardiac death. A common symptom is chest pain or discomfort which may travel into the shoulder, back, neck, or jaw, it may feel like heartburn. Symptoms occur with exercise or emotional stress, last less than a few minutes, improve with rest. Shortness of breath may occur and sometimes no symptoms are present. In many cases, the first sign is a heart attack. Other complications include an abnormal heartbeat. Risk factors include high blood pressure, diabetes, lack of exercise, high blood cholesterol, poor diet and excessive alcohol. A number of tests may help with diagnoses including: electrocardiogram, cardiac stress testing, coronary computed tomographic angiography, coronary angiogram, among others.

Ways to reduce CAD risk include eating a healthy diet exercising, maintaining a healthy weight, not smoking. Medications for diabetes, high cholesterol, or high blood pressure are sometimes used. There is limited evidence for screening people who do not have symptoms. Treatment involves the same measures as prevention. Additional medications such as antiplatelets, beta blockers, or nitroglycerin may be recommended. Procedures such as percutaneous coronary intervention or coronary artery bypass surgery may be used in severe disease. In those with stable CAD it is unclear if PCI or CABG in addition to the other treatments improves life expectancy or decreases heart attack risk. In 2015, CAD resulted in 8.9 million deaths. It makes up 15.6 % of all deaths. The risk of death from CAD for a given age decreased between 1980 and 2010 in developed countries; the number of cases of CAD for a given age decreased between 1990 and 2010. In the United States in 2010, about 20% of those over 65 had CAD, while it was present in 7% of those 45 to 64, 1.3% of those 18 to 45.

Chest pain that occurs with activity, after eating, or at other predictable times is termed stable angina and is associated with narrowings of the arteries of the heart. Angina that changes in intensity, character or frequency is termed unstable. Unstable angina may precede myocardial infarction. In adults who go to the emergency department with an unclear cause of pain, about 30% have pain due to coronary artery disease. Coronary artery disease has a number of well determined risk factors; these include high blood pressure, diabetes, lack of exercise, high blood cholesterol, poor diet, family history, excessive alcohol. About half of cases are linked to genetics. Smoking and obesity are associated with about 36% and 20% of cases, respectively. Smoking just one cigarette per day about doubles the risk of CAD. Lack of exercise has been linked to 7–12% of cases. Exposure to the herbicide Agent Orange may increase risk. Rheumatologic diseases such as rheumatoid arthritis, systemic lupus erythematosus and psoriatic arthritis are independent risk factors as well.

Job stress appears to play a minor role accounting for about 3% of cases. In one study, women who were free of stress from work life saw an increase in the diameter of their blood vessels, leading to decreased progression of atherosclerosis. In contrast, women who had high levels of work-related stress experienced a decrease in the diameter of their blood vessels and increased disease progression. Having a type A behavior pattern, a group of personality characteristics including time urgency, competitiveness and impatience, is linked to an increased risk of coronary disease. High blood cholesterol. HDL has a protective effect over development of coronary artery disease. High blood triglycerides may play a role. High levels of lipoprotein, a compound formed when LDL cholesterol combines with a protein known as apolipoprotein. Dietary cholesterol does not appear to have a significant effect on blood cholesterol and thus recommendations about its consumption may not be needed. Saturated fat is still a concern.

The heritability of coronary artery disease has been estimated between 40% and 60%. Genome-wide association studies have identified over 160 genetic susceptibility loci for coronary artery disease. Endometriosis in women under the age of 40. Depression and hostility appear to be risks; the number of categories of adverse childhood experiences showed a graded correlation with the presence of adult diseases including coronary artery disease. Hemostatic factors: High levels of fibrinogen and coagulation factor VII are associated with an increased risk of CAD. Low hemoglobin. In the Asian population, the b fibrinogen gene G-455A polymorphism was associated with the risk of CAD. Limitation of blood flow to the heart causes ischemia of the heart's muscle cells; the heart's muscle cells may die from lack of oxygen and this is called a myocardial infarction. It leads to damage and eventual scarring of the heart muscle without regrowth of heart muscle cells. Chronic high-grade narrowing of the coronary arte

John Boyd (diplomat)

Sir John Dixon Ikle Boyd was British ambassador to Japan from 1992 to 1996, was subsequently the Master of Churchill College, Cambridge from 1996 to 2006. He was Chairman of the Board of Trustees of the British Museum from 2002 to 2006. Boyd died on 18 October 2019, at the age of 83. Sir John was educated at Clare College, Cambridge. Sir John was a member of the British Diplomatic service from 1962–1996, he served twice in Hong Beijing twice. Other postings included Bonn and the UK Mission to the UN. At home he served as Deputy Under-Secretary for Defence and subsequently Chief Clerk of the FCO before his posting to Japan, his tenure in Tokyo saw a marked expansion in bilateral exchanges on a wide front. He holds the Grand Cordon of the Order of the Rising Sun. Sir John served as Chairman of Asia House from 2010 to 2017. Anglo-Japanese relations Foreign and Commonwealth Office Heads of the United Kingdom Mission in Japan

Andy Geppert

Andy Geppert is an Australian illustrator and author of children's books. He won the Crichton Award for new illustrators for his work on Little Big Tree in 2010, his follow up picture book Meep was selected as a Notable Book by the Children's Book Council of Australia in 2016. Geppert grew up on Queensland's Sunshine Coast, he studied graphic design at Design College and represented Australia at the Cannes Young Creative competition in 2001. He has spent 14 years in the advertising industry working across multiple roles including senior art director, head of art, two creative director titles. In 2010 Geppert was jointly awarded the Crichton Award for new Australian illustrator for his work on Little Big Tree written by Tim Brown. In 2015 he released his first solo picture book tilted MEEP; the First edition hardcover with dust jacket was published by Tiny Owl Workshop and was selected as a Notable Book by the Children's Book Council of Australia in 2016. It features a baby peacock who gives away his feathers to help his friends feel better about the way they look.

It's a story about kindness and being happy with the oddities and beautiful imperfections that make you, you and me, me. Or as the author says: For all the people who answer NO to the following question: Are you beautiful? A year Geppert released his second picture book along a similar theme of creating picture books with heart titled JOY, published in hardcover by Tiny Owl Workshop, it is picture book made for their grandparents. A granny rainbow wanders along unaware of the incredible transformations happening right behind her. If only she'd stop and look back... "JOY was written to celebrate our grandparents' lives and to uncover their stories, so they'll never be forgotten" says Geppert. 2010 Crichton Award 2016 Notable Book CBCA Official website Interview with Andy Geppert