1
|
Garg N, Johnson J, Patel V, Pekmezaris R, Seepersaud H, Kumar P, Thomesen R, Luknauth H, Amlicke M, Ruelle M, Becker L. Understanding social risk factors in patients presenting to the emergency Department for Acute Heart Failure: A pilot study. Am J Emerg Med 2024; 84:7-14. [PMID: 39047343 DOI: 10.1016/j.ajem.2024.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 06/30/2024] [Accepted: 07/06/2024] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND The standard of care for congestive heart failure (CHF) aims to slow disease progression and maximize patient function, however there is an increase in emergency department (ED) revisits and readmissions. Social risk factors play a role in the disease management and prognosis of CHF. There is a gap in the identification of low-risk CHF patient who would be safely discharged using an initial social risk factor stratification. OBJECTIVES To generate a social risk profile for patients presenting to the ED with acute CHF exacerbation and identify variables that may increase the risk of 7-day and overall mortality, 30-day ED revisit, and readmission. METHODS We conducted a pilot prospective survey-based study among adult patients presenting to the ED with acute CHF exacerbation. The combination of a self-report questionnaire and retrospective chart review was used to generate a CHF risk profile. RESULTS A total of 62 patients were recruited in the pilot study with a mean age of 69.5 years. The preliminary data indicated that prior to this ED visit, 21% of patients were not aware of a previous CHF diagnosis; 64.5% of patients rated their sleep quality as poor or very poor; 72.6% reported orthopnea; and 43.5% reported recent weight gain. 37.1% of patients did not adhere to dietary recommendations and some patients did not adhere to their medication regime 100%. CONCLUSION This study suggests establishing a social risk profile for patients presenting to the ED with CHF can help formulate a CHF-specific care plan and optimize multidisciplinary management to reduce ED revisits and readmissions.
Collapse
Affiliation(s)
- Nidhi Garg
- South Shore University Hospital, Bayshore, New York, USA, Northwell Health, Department of Emergency Medicine.
| | - Jennifer Johnson
- North Shore University Hospital, Manhasset, NY, USA, Northwell Health, Department of Emergency Medicine.
| | - Vidhi Patel
- Department of Internal Medicine, Manhasset, NY, Northwell Health, USA.
| | - Renee Pekmezaris
- Department of Internal Medicine, Manhasset, NY, Northwell Health, USA.
| | | | | | | | - Harshani Luknauth
- New York Institute of Technology College of Osteopathic Medicine, Glen Head, NY, USA.
| | - Maire Amlicke
- Long Island Jewish Medical Center, New Hyde Park, NY, Northwell Health, Department of Emergency Medicine, USA.
| | - Marianne Ruelle
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, NY, USA.
| | - Lance Becker
- Long Island Jewish Medical Center, New Hyde Park, NY, Northwell Health.
| |
Collapse
|
2
|
Colin-Ramirez E, Sepehrvand N, Rathwell S, Ross H, Escobedo J, Macdonald P, Troughton R, Saldarriaga C, Lanas F, Doughty R, McAlister FA, Ezekowitz JA. Sodium Restriction in Patients With Heart Failure: A Systematic Review and Meta-Analysis of Randomized Clinical Trials. Circ Heart Fail 2023; 16:e009879. [PMID: 36373551 DOI: 10.1161/circheartfailure.122.009879] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Sodium restriction is a nonpharmacologic treatment suggested by practice guidelines for the management of patients with heart failure (HF). In this study, we synthesized the data from randomized controlled trials (RCTs) evaluating the effects of sodium restriction on clinical outcomes in patients with HF. METHODS In this aggregate data meta-analysis, Cochrane Central, MEDLINE (Medical Literature Analysis and Retrieval System Online), Embase Ovid, and CINAHL (Cumulative Index to Nursing and Allied Health Literature) Plus databases were searched up to April 2, 2022. RCTs were included if they investigated the effects of sodium/salt restriction as compared to no restriction on clinical outcomes in patients with HF. Outcomes of interest included mortality, hospitalization, change in New York Heart Association functional class, and quality of life (QoL). RESULTS Seventeen RCTs were identified (834 and 871 patients in intervention and control groups, respectively). Sodium restriction did not reduce the risk of all-cause death (odds ratio, 0.95 [95% CI, 0.58-1.58]), hospitalization (odds ratio, 0.84 [95% CI, 0.62-1.13]), or the composite of death/hospitalization (odds ratio, 0.88 [95% CI, 0.63-1.23]). The results were similar in different subgroups, except for the numerically lower risk of death with reduced sodium intake reported in RCTs with dietary sodium at the 2000 to 3000 mg/d range as opposed to <2000 mg/d (and in RCTs with versus without fluid restriction as a co-intervention). Among RCTs reporting New York Heart Association change, 2 RCTs (which accounted for two-thirds of the data) showed improvement in New York Heart Association class with sodium restriction. Substantial heterogeneity existed for QoL: 6 RCTs showed improvement of QoL and 4 RCTs showed no improvement of sodium restriction on QoL. CONCLUSIONS In a meta-analysis of RCTs, sodium restriction was not associated with fewer deaths or hospitalizations in patients with HF. Dietary sodium restriction may be associated with improvements in symptoms and QoL.
Collapse
Affiliation(s)
| | - Nariman Sepehrvand
- Canadian VIGOUR Centre, Department of Medicine (N.S., S.R., F.A.M., J.A.E.), University of Alberta, Edmonton, Canada
| | - Sarah Rathwell
- Canadian VIGOUR Centre, Department of Medicine (N.S., S.R., F.A.M., J.A.E.), University of Alberta, Edmonton, Canada
| | - Heather Ross
- Division of Cardiology, Peter Munk Cardiac Center, University of Toronto, Ontario, Canada (H.R.)
| | - Jorge Escobedo
- Canadian VIGOUR Centre, Department of Medicine (N.S., S.R., F.A.M., J.A.E.), University of Alberta, Edmonton, Canada
| | - Peter Macdonald
- Heart Failure and Transplant Unit, Cardiology Department, St. Vincent's Hospital, Sydney, Darlinghurst, New South Wales, Australia (P.M.)
| | - Richard Troughton
- Department of Medicine, Christchurch Heart Institute, University of Otago, New Zealand (R.T.)
| | - Clara Saldarriaga
- Centro Cardiovascular Colombiano Clinica Santa Maria (Clinica Cardio VID), Antioquia, Columbia (C.S.)
| | - Fernando Lanas
- Departamento de Medicina Interna, Facultad de Medicina, Universidad de la Frontera Temuco, Chile (F.L.)
| | | | - Finlay A McAlister
- Canadian VIGOUR Centre, Department of Medicine (N.S., S.R., F.A.M., J.A.E.), University of Alberta, Edmonton, Canada.,Division of General Internal Medicine, Department of Medicine (F.A.M.), University of Alberta, Edmonton, Canada
| | - Justin A Ezekowitz
- Division of Cardiology, Department of Medicine (J.A.E.), University of Alberta, Edmonton, Canada.,Instituto Mexicano del Seguro Social, Mexico City, Mexico (J.A.E.)
| |
Collapse
|
3
|
Anwar F, Omar Asar T, Al-Abassi FA, Kumar V, Alhayyani S. Natural sea salt in diet ameliorates better protection compared to table salt in the doxorubicin-induced cardiac remodeling. JOURNAL OF TAIBAH UNIVERSITY FOR SCIENCE 2022. [DOI: 10.1080/16583655.2022.2154491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Firoz Anwar
- Department of Biochemistry, Faculty of Science, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Turky Omar Asar
- Department of Biochemistry, Faculty of Science, King Abdulaziz University, Jeddah, Saudi Arabia
- Department of Biology, College of Science and Arts at Alkamil, University of Jeddah, Jeddah, Saudi Arabia
| | - Fahad A. Al-Abassi
- Department of Biochemistry, Faculty of Science, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Vikas Kumar
- Natural Product Drug Discovery Laboratory, Department of Pharmaceutical Sciences, Faculty of Health Sciences, Sam Higginbottom Institute of Agriculture, Technology & Sciences, Allahabad, Uttar Pradesh, India
| | - Sultan Alhayyani
- Department of Chemistry, College of Sciences & Arts, King Abdulaziz University, Rabigh, Saudi Arabia
| |
Collapse
|
4
|
Ganes A, Davis JA, Virtanen JK, Voutilainen A, Tuomainen TP, Atherton JJ, Amerena J, Driscoll A, Hare DL, Wittert G, Ruusunen A, Marx W, Mohebbi M, O’Neil A. Urinary sodium concentration predicts time to major adverse coronary events and all-cause mortality in men with heart failure over a 28–33-year period: a prospective cohort study. BMC Cardiovasc Disord 2022; 22:391. [PMID: 36056320 PMCID: PMC9438140 DOI: 10.1186/s12872-022-02830-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 08/22/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Lower urinary sodium concentrations (UNa) may be a biomarker for poor prognosis in chronic heart failure (HF). However, no data exist to determine its prognostic association over the long-term. We investigated whether UNa predicted major adverse coronary events (MACE) and all-cause mortality over 28–33 years.
Methods
One hundred and eighty men with chronic HF from the Kuopio Ischaemic Heart Disease Risk Factor Study (KIHD) were included. Baseline data was collected between 1984 and 1989. MACE and all-cause outcomes were obtained using hospital linkage data (1984–2017) with a follow-up of 28–33 years. Cox proportional hazards models were generated using 24-h UNa tertiles at baseline (1 ≤ 173 mmol/day; 2 = 173-229 mmol/day; 3 = 230-491 mmol/day) as a predictor of time-to-MACE outcomes, adjusted for relevant covariates.
Results
Overall, 63% and 83% of participants (n = 114 and n = 150) had a MACE event (median 10 years) and all-cause mortality event (median 19 years), respectively. On multivariable Cox Model, relative to the lowest UNa tertile, no significant difference was noted in MACE outcome for individuals in tertiles 2 and 3 with events rates of 28% (HR:0.72; 95% CI: 0.46–1.12) and 21% (HR 0.79; 95% CI: 0.5–1.25) respectively.. Relative to the lowest UNa tertile, those in tertile 2 and 3 were 39% (HR: 0.61; 95% CIs: 0.41, 0.91) and 10% (HR: 0.90; 95% CIs: 0.62, 1.33) less likely to experience to experience all-cause mortality. The multivariable Cox model had acceptable prediction precision (Harrell's C concordance measure 0.72).
Conclusion
UNa was a significant predictor of all-cause mortality but not MACE outcomes over 28–33 years with 173–229 mmol/day appearing to be the optimal level. UNa may represent an emerging long-term prognostic biomarker that warrants further investigation.
Collapse
|
5
|
Li J, Zhen Z, Huang P, Dong YG, Liu C, Liang W. Salt restriction and risk of adverse outcomes in heart failure with preserved ejection fraction. Heart 2022; 108:1377-1382. [DOI: 10.1136/heartjnl-2022-321167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 05/24/2022] [Indexed: 11/04/2022] Open
Abstract
BackgroundThe optimal salt restriction in patients with heart failure (HF), especially patients with heart failure with preserved ejection fraction (HFpEF), remains controversial.ObjectiveTo investigate the associations of cooking salt restriction with risks of clinical outcomes in patients with HFpEF.MethodsCox proportional hazards model and subdistribution hazards model were used in this secondary analysis in 1713 participants with HFpEF from the Americas in the TOPCAT trial. Cooking salt score was the sum of self-reported salt added during homemade food preparation. The primary endpoint was a composite of cardiovascular death, HF hospitalisation and aborted cardiac arrest, and secondary outcomes were all-cause death, cardiovascular death and HF hospitalisation.ResultsCompared with patients with cooking salt score 0, patients with cooking salt score >0 had significantly lower risks of the primary endpoint (HR=0.760, 95% CI 0.638 to 0.906, p=0.002) and HF hospitalisation (HR=0.737, 95% CI 0.603 to 0.900, p=0.003), but not all-cause (HR=0.838, 95% CI 0.684 to 1.027, p=0.088) or cardiovascular death (HR=0.782, 95% CI 0.598 to 1.020, p=0.071). Sensitivity analyses using propensity score matching baseline characteristics and in patients who prepared meals mostly at home yielded similar results. Subgroup analysis suggested that the association between overstrict salt restriction and poor outcomes was more predominant in patients aged ≤70 years and of non-white race.ConclusionOverstrict cooking salt intake restriction was associated with worse prognosis in patients with HFpEF, and the association seemed to be more predominant in younger and non-white patients. Clinicians should be prudent when giving salt restriction advice to patients with HFpEF.
Collapse
|
6
|
Zhang J, Su G, Zhao T, Fan J, Ho CT, Zhao M. Preparation, Sensory Characterization, and Umami-Enhancing Mechanism of Novel Peptide Glycoconjugates. JOURNAL OF AGRICULTURAL AND FOOD CHEMISTRY 2022; 70:8043-8051. [PMID: 35723436 DOI: 10.1021/acs.jafc.2c03084] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Previous studies supposed that Amadori rearrangement products (ARPs) of peptides might have better umami-enhancing abilities. To confirm this, five ARPs (EP-ARP, AH-ARP, EE-ARP, β-AH-ARP, RFPHADF-ARP) were synthesized using a food-grade preparation method, and their chemical structures were clearly demonstrated by mass spectrometry and 1D/2D NMR. Sensory experiments showed that ARPs had better umami-enhancing abilities than the corresponding peptides in this research, though their enhancing performance varied. ARPs showed a synergistic effect with multiple umami substances (MSG and GMP), while their corresponding peptides did not. RFPHADF-ARP had good umami-enhancing capacity, despite that RFPHADF was a bitter peptide without any umami/umami-enhancing property. RFPHADF-ARP could bind to the T1R3, which is beneficial to the stability of the active conformation of the umami receptor. The introduction of glucose via the Maillard reaction increased the binding force of RFPHADF with the umami receptor by influencing the electron density distribution and offering more binding groups (hydroxide group).
Collapse
Affiliation(s)
- Jianan Zhang
- School of Food Science and Engineering, South China University of Technology, Guangzhou 510640, China
| | - Guowan Su
- School of Food Science and Engineering, South China University of Technology, Guangzhou 510640, China
| | - Tiantian Zhao
- Sericulture & Agri-food Research Institute Guangdong Academy of Agricultural Sciences, Key Laboratory of Functional Foods, Ministry of Agriculture and Rural affairs, Guangdong Key Laboratory of Agricultural Products Processing, Guangzhou 510610, China
| | - Jiangping Fan
- College of Food Science and Technology, Yunnan Agricultural University, Kunming, Yunnan 650201, China
| | - Chi-Tang Ho
- Department of Food Science, Rutgers University, 65 Dudley Road, New Brunswick, New Jersey 08901, United States
| | - Mouming Zhao
- School of Food Science and Engineering, South China University of Technology, Guangzhou 510640, China
| |
Collapse
|
7
|
Li Z, Hu L, Rong X, Luo J, Xu X, Zhao Y. Role of no table salt on hypertension and stroke based on large sample size from National Health and Nutrition Examination Survey database. BMC Public Health 2022; 22:1292. [PMID: 35788204 PMCID: PMC9254688 DOI: 10.1186/s12889-022-13722-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 06/16/2022] [Indexed: 11/25/2022] Open
Abstract
Background To assess the associations between no table salt and hypertension or stroke. Methods The data of 15,352 subjects were collected from National Health and Nutrition Examination Survey (NHANES) database. All subjects were divided into no hypertension or stroke group (n = 10,894), hypertension group (n = 5888), stroke group (n = 164) and hypertension and stroke group (n = 511). Univariate and multivariate logistic regression analysis was used to measure the associations of salt type used with hypertension and stroke and co-variables were respectively adjusted in different models. Results After adjusting age and gender, other salt intake was associated with 1.88-fold risk of hypertension (OR = 1.88, 95%CI: 1.44–2.46) and no table salt was associated with 1.30-fold risk of hypertension (OR = 1.30, 95%CI: 1.15–1.47). After adjusting age, gender, race, BMI, PIR, marital status, CVDs, whether doctors’ told them to reduce salt, and diabetes, the risk of hypertension was 1.23-fold increase in no table salt group (OR = 1.23, 95%CI: 1.04–1.46). After the adjustment of age and gender, the risk of hypertension and stroke was 3.33-fold increase (OR = 3.33, 95%CI: 2.12–5.32) in other salt intake group and 1.43-fold increase (OR = 1.43, 95%CI:1.17–1.74) in no table salt group. Conclusion Other salt intake or no table salt were associated with a higher risk of hypertension or hypertension and stroke. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13722-8.
Collapse
Affiliation(s)
- Zongqin Li
- Department of Neurology, Sichuan Mianyang 404 Hospital, Mianyang, 621000, Sichuan, China
| | - Lan Hu
- Department of Neurology, Affiliated Hospital of Southwest Medical University, Luzhou, 646000, Sichuan, China
| | - Xiaoxia Rong
- Department of Operations Management Division, Sichuan Mianyang 404 Hospital, Mianyang, 621000, Sichuan, China
| | - Jun Luo
- Department of Neurology, Sichuan Mianyang 404 Hospital, Mianyang, 621000, Sichuan, China
| | - Xuejie Xu
- Department of Neurology, Sichuan Mianyang 404 Hospital, Mianyang, 621000, Sichuan, China
| | - Yonglong Zhao
- School of Pharmacy, and Engineering Research Center for the Development and Application of Ethnic Medicine and TCM (Ministry of Education), Guizhou Medical University, Guiyang, Guizhou, 550004, China.
| |
Collapse
|
8
|
Chrysohoou C, Mantzouranis E, Dimitroglou Y, Mavroudis A, Tsioufis K. Fluid and Salt Balance and the Role of Nutrition in Heart Failure. Nutrients 2022; 14:1386. [PMID: 35405998 PMCID: PMC9002780 DOI: 10.3390/nu14071386] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 03/22/2022] [Accepted: 03/23/2022] [Indexed: 02/01/2023] Open
Abstract
The main challenges in heart failure (HF) treatment are to manage patients with refractory acute decompensated HF and to stabilize the clinical status of a patient with chronic heart failure. Beyond the use of medications targeted in the inhibition of the neurohormonal system, the balance of salt and fluid plays an important role in the maintenance of clinical compensation in respect of renal function. In the case of heart failure, a debate of opinion exists on salt restriction. Restricted dietary sodium might lead to worse outcomes in heart failure patients due to the activation of the neurohormonal system and malnutrition. On the contrary, positive sodium balance is the primary driver of water retention and, ultimately, volume overload in acute HF. Some recent studies reported associations of decreased salt consumption with higher readmission rates and increased mortality. Thus, the usefulness of salt restriction in heart failure management remains debated. The use of individualized nutritional support, compared with standard hospital food, was effective in reducing these risks, particularly in the group of patients at high nutritional risk.
Collapse
Affiliation(s)
- Christina Chrysohoou
- First Cardiology Clinic, School of Medicine, University of Athens, 11527 Athens, Greece; (E.M.); (Y.D.); (A.M.); (K.T.)
| | | | | | | | | |
Collapse
|
9
|
Torres NRSM, Freire FLDA, Dantas-Komatsu RCS, da Silva EP, Queiroz SIML, de Lira NRD, Diniz RVZ, Lima SCVC, Pedrosa LFC, Lopes MMGD, Sena-Evangelista KCM. Lack of Association between Inadequate Micronutrient Intake and Prognosis in Outpatients with Heart Failure. Nutrients 2022; 14:788. [PMID: 35215438 PMCID: PMC8874932 DOI: 10.3390/nu14040788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 01/03/2022] [Accepted: 01/08/2022] [Indexed: 01/27/2023] Open
Abstract
Inadequate nutrient intake can lead to worse outcomes in patients with heart failure (HF). This prospective cohort study aimed to assess the prevalence of inadequate micronutrient intake and their association with prognosis in 121 adult and elderly outpatients with HF. Habitual micronutrient intake was evaluated using 24-h dietary recalls (minimum 2 and maximum 6). Participants were grouped into moderate (n = 67) and high (n = 54) micronutrient deficiency groups, according to the individual assessment of each micronutrient intake. Patients' sociodemographic, clinical, and anthropometric data and clinical outcomes (hospitalization and mortality) within 24 months were collected. Overall and event-free survival rates were calculated using Kaplan-Meier estimates, and curves were compared using the log-rank test. The death risk rate (hazard ratio (HR)) was calculated using Cox's univariate model. The rate of inadequate intake was 100% for vitamins B1 and D and above 80% for vitamins B2, B9, and E, calcium, magnesium, and copper. No differences in overall survival and event-free survival were observed between groups of HF outpatients with moderate and high micronutrient deficiencies (HR = 0.94 (CI = 0.36-2.48), p = 0.91, and HR = 1.63 (CI = 0.68-3.92), p = 0.26, respectively), as well as when the inadequacy of each micronutrient intake was evaluated alone (all p > 0.05). In conclusion, a high prevalence of inadequate micronutrient intake was observed in outpatients with HF. Inadequate micronutrient intake was not associated with hospitalization and mortality in this group of patients.
Collapse
Affiliation(s)
- Núbia Rafaella Soares Moreira Torres
- Postgraduate Program in Nutrition, Center for Health Sciences, Federal University of Rio Grande do Norte, 3000, Senador Salgado Filho Avenue, Lagoa Nova, Natal 59078-970, Rio Grande do Norte, Brazil; (N.R.S.M.T.); (F.L.d.A.F.); (S.C.V.C.L.); (L.F.C.P.)
| | - Fernanda Lambert de Andrade Freire
- Postgraduate Program in Nutrition, Center for Health Sciences, Federal University of Rio Grande do Norte, 3000, Senador Salgado Filho Avenue, Lagoa Nova, Natal 59078-970, Rio Grande do Norte, Brazil; (N.R.S.M.T.); (F.L.d.A.F.); (S.C.V.C.L.); (L.F.C.P.)
| | - Raquel Costa Silva Dantas-Komatsu
- Postgraduate Program in Health Sciences, Center for Health Sciences, Federal University of Rio Grande do Norte, 620, Nilo Peçanha Avenue, Petrópolis, Natal 59012-300, Rio Grande do Norte, Brazil;
| | - Eduardo Paixão da Silva
- Multiprofessional Residency in Health—Cardiology, Onofre Lopes University Hospital, Federal University of Rio Grande do Norte, 620, Nilo Peçanha Avenue, Petrópolis, Natal 59012-300, Rio Grande do Norte, Brazil; (E.P.d.S.); (N.R.D.d.L.); (M.M.G.D.L.)
| | - Salomão Israel Monteiro Lourenço Queiroz
- Postgraduate Program in Public Health, Health Sciences Center, Federal University of Rio Grande do Norte, 3000, Senador Salgado Filho Avenue, Lagoa Nova, Natal 59078-970, Rio Grande do Norte, Brazil;
| | - Niethia Regina Dantas de Lira
- Multiprofessional Residency in Health—Cardiology, Onofre Lopes University Hospital, Federal University of Rio Grande do Norte, 620, Nilo Peçanha Avenue, Petrópolis, Natal 59012-300, Rio Grande do Norte, Brazil; (E.P.d.S.); (N.R.D.d.L.); (M.M.G.D.L.)
- Brazilian Hospital Services Company, Onofre Lopes University Hospital, Federal University of Rio Grande do Norte, 620, Nilo Peçanha Avenue, Petrópolis, Natal 59012-300, Rio Grande do Norte, Brazil
| | - Rosiane Viana Zuza Diniz
- Department of Clinical Medicine, Center for Health Sciences, Federal University of Rio Grande do Norte, 620, Nilo Peçanha Avenue, Petrópolis, Natal 59012-300, Rio Grande do Norte, Brazil;
| | - Severina Carla Vieira Cunha Lima
- Postgraduate Program in Nutrition, Center for Health Sciences, Federal University of Rio Grande do Norte, 3000, Senador Salgado Filho Avenue, Lagoa Nova, Natal 59078-970, Rio Grande do Norte, Brazil; (N.R.S.M.T.); (F.L.d.A.F.); (S.C.V.C.L.); (L.F.C.P.)
- Multiprofessional Residency in Health—Cardiology, Onofre Lopes University Hospital, Federal University of Rio Grande do Norte, 620, Nilo Peçanha Avenue, Petrópolis, Natal 59012-300, Rio Grande do Norte, Brazil; (E.P.d.S.); (N.R.D.d.L.); (M.M.G.D.L.)
- Department of Nutrition, Center for Health Sciences, Federal University of Rio Grande do Norte, 3000, Senador Salgado Filho Avenue, Lagoa Nova, Natal 59078-970, Rio Grande do Norte, Brazil
| | - Lucia Fatima Campos Pedrosa
- Postgraduate Program in Nutrition, Center for Health Sciences, Federal University of Rio Grande do Norte, 3000, Senador Salgado Filho Avenue, Lagoa Nova, Natal 59078-970, Rio Grande do Norte, Brazil; (N.R.S.M.T.); (F.L.d.A.F.); (S.C.V.C.L.); (L.F.C.P.)
- Department of Nutrition, Center for Health Sciences, Federal University of Rio Grande do Norte, 3000, Senador Salgado Filho Avenue, Lagoa Nova, Natal 59078-970, Rio Grande do Norte, Brazil
| | - Márcia Marília Gomes Dantas Lopes
- Multiprofessional Residency in Health—Cardiology, Onofre Lopes University Hospital, Federal University of Rio Grande do Norte, 620, Nilo Peçanha Avenue, Petrópolis, Natal 59012-300, Rio Grande do Norte, Brazil; (E.P.d.S.); (N.R.D.d.L.); (M.M.G.D.L.)
- Department of Nutrition, Center for Health Sciences, Federal University of Rio Grande do Norte, 3000, Senador Salgado Filho Avenue, Lagoa Nova, Natal 59078-970, Rio Grande do Norte, Brazil
| | - Karine Cavalcanti Maurício Sena-Evangelista
- Postgraduate Program in Nutrition, Center for Health Sciences, Federal University of Rio Grande do Norte, 3000, Senador Salgado Filho Avenue, Lagoa Nova, Natal 59078-970, Rio Grande do Norte, Brazil; (N.R.S.M.T.); (F.L.d.A.F.); (S.C.V.C.L.); (L.F.C.P.)
- Postgraduate Program in Health Sciences, Center for Health Sciences, Federal University of Rio Grande do Norte, 620, Nilo Peçanha Avenue, Petrópolis, Natal 59012-300, Rio Grande do Norte, Brazil;
- Department of Clinical Medicine, Center for Health Sciences, Federal University of Rio Grande do Norte, 620, Nilo Peçanha Avenue, Petrópolis, Natal 59012-300, Rio Grande do Norte, Brazil;
| |
Collapse
|
10
|
Prescription, Compliance, and Burden Associated with Salt-Restricted Diets in Heart Failure Patients: Results from the French National OFICSel Observatory. Nutrients 2022; 14:nu14020308. [PMID: 35057490 PMCID: PMC8779371 DOI: 10.3390/nu14020308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 12/21/2021] [Accepted: 12/24/2021] [Indexed: 12/03/2022] Open
Abstract
(1) Background: There is much debate about the use of salt-restricted diet for managing heart failure (HF). Dietary guidelines are inconsistent and lack evidence. (2) Method: The OFICSel observatory collected data about adults hospitalised for HF. The data, collected using study-specific surveys, were used to describe HF management, including diets, from the cardiologists’ and patients’ perspectives. Cardiologists provided the patients’ clinical, biological, echocardiography, and treatment data, while the patients provided dietary, medical history, sociodemographic, morphometric, quality of life, and burden data (burden scale in restricted diets (BIRD) questionnaire). The differences between the diet recommended by the cardiologist, understood by the patient, and the estimated salt intake (by the patient) and diet burden were assessed. (3) Results: Between March and June 2017, 300 cardiologists enrolled 2822 patients. Most patients (90%) were recommended diets with <6 g of salt/day. Mean daily salt consumption was 4.7 g (standard deviation (SD): 2.4). Only 33% of patients complied with their recommended diet, 34% over-complied, and 19% under-complied (14% unknown). Dietary restrictions in HF patients were associated with increased burden (mean BIRD score of 8.1/48 [SD: 8.8]). (4) Conclusion: Healthcare professionals do not always follow dietary recommendations, and their patients do not always understand and comply with diets recommended. Restrictive diets in HF patients are associated with increased burden. An evidence-based approach to developing and recommending HF-specific diets is required.
Collapse
|
11
|
Mueller M, Siegenthaler J, Fäh D, Schuetz P. [Nutrition in Case of Heart Failure]. PRAXIS 2022; 111:375-380. [PMID: 35611481 DOI: 10.1024/1661-8157/a003860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Nutrition in Case of Heart Failure Abstract. Despite the complexity of the subject, nutritional medicine has made important advances in recent years, especially regarding cardiovascular health and for patients with heart failure. There is quite good evidence on specific diets, such as the Mediterranean and plant-based diets, but also on individual micronutrients, such as intravenous iron supplementation of iron deficiency in heart failure. No precise quantities can yet be named when dealing with the recommended amount of salt in heart failure patients, but the intake of high amounts of salt (>12 g/day) should be avoided. Considering the risk of malnutrition in this vulnerable patient population, an individualized nutritional therapy is advisable for some patients. This requires targeted screening for malnutrition. Nutritional medicine research still lacks many answers to further questions regarding heart failure patients. More randomized controlled trials and their meta-analyses are therefore required. Studies available so far have - among other shortcomings - paid too little attention to differences in nutrition in the different types and stages of heart failure. Interdisciplinary collaboration between cardiologists, hospital internists, general practitioners and nutritional therapists is in any case crucial for optimal treatment of patients with heart failure.
Collapse
Affiliation(s)
- Marlena Mueller
- Abteilung Endokrinologie, Diabetologie und Metabolismus, Medizinischen Universitätsklinik, Kantonsspital Aarau AG, Aarau, Schweiz
- Abteilung für Allgemeine- und Notfallmedizin, Medizinische Universitätsklinik, Kantonsspital Aarau AG, Aarau, Schweiz
| | - Jolanda Siegenthaler
- Abteilung Endokrinologie, Diabetologie und Metabolismus, Medizinischen Universitätsklinik, Kantonsspital Aarau AG, Aarau, Schweiz
- Abteilung für Allgemeine- und Notfallmedizin, Medizinische Universitätsklinik, Kantonsspital Aarau AG, Aarau, Schweiz
| | - David Fäh
- Abteilung für Epidemiologie chronischer Krankheiten, Institut für Epidemiologie, Biostatistik und Prävention, Universität Zürich, Zürich, Schweiz
- Fachbereich Gesundheit - Ernährung und Diätetik, Berner Fachhochschule, Bern, Schweiz
| | - Philipp Schuetz
- Abteilung Endokrinologie, Diabetologie und Metabolismus, Medizinischen Universitätsklinik, Kantonsspital Aarau AG, Aarau, Schweiz
- Abteilung für Allgemeine- und Notfallmedizin, Medizinische Universitätsklinik, Kantonsspital Aarau AG, Aarau, Schweiz
- Medizinische Fakultät, Universitätsspital Basel, Basel, Schweiz
| |
Collapse
|
12
|
Alnuwaysir RIS, Hoes MF, van Veldhuisen DJ, van der Meer P, Beverborg NG. Iron Deficiency in Heart Failure: Mechanisms and Pathophysiology. J Clin Med 2021; 11:125. [PMID: 35011874 PMCID: PMC8745653 DOI: 10.3390/jcm11010125] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 12/17/2021] [Accepted: 12/22/2021] [Indexed: 12/15/2022] Open
Abstract
Iron is an essential micronutrient for a myriad of physiological processes in the body beyond erythropoiesis. Iron deficiency (ID) is a common comorbidity in patients with heart failure (HF), with a prevalence reaching up to 59% even in non-anaemic patients. ID impairs exercise capacity, reduces the quality of life, increases hospitalisation rate and mortality risk regardless of anaemia. Intravenously correcting ID has emerged as a promising treatment in HF as it has been shown to alleviate symptoms, improve quality of life and exercise capacity and reduce hospitalisations. However, the pathophysiology of ID in HF remains poorly characterised. Recognition of ID in HF triggered more research with the aim to explain how correcting ID improves HF status as well as the underlying causes of ID in the first place. In the past few years, significant progress has been made in understanding iron homeostasis by characterising the role of the iron-regulating hormone hepcidin, the effects of ID on skeletal and cardiac myocytes, kidneys and the immune system. In this review, we summarise the current knowledge and recent advances in the pathophysiology of ID in heart failure, the deleterious systemic and cellular consequences of ID.
Collapse
Affiliation(s)
| | | | | | | | - Niels Grote Beverborg
- Department of Cardiology, University Medical Center Groningen, University of Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands; (R.I.S.A.); (M.F.H.); (D.J.v.V.); (P.v.d.M.)
| |
Collapse
|
13
|
Gali K, Weidner G, Smits JMA, Beyersmann J, Spaderna H. Psychosocial Risk and Health Behaviors as Predictors of Clinical Events in Patients Wait-Listed for a New Heart: Results from 7 Years of Follow-Up. Life (Basel) 2021; 11:1438. [PMID: 34947969 PMCID: PMC8706706 DOI: 10.3390/life11121438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 12/09/2021] [Accepted: 12/10/2021] [Indexed: 11/16/2022] Open
Abstract
We examined the long-term relationship of psychosocial risk and health behaviors on clinical events in patients awaiting heart transplantation (HTx). Psychosocial characteristics (e.g., depression), health behaviors (e.g., dietary habits, smoking), medical factors (e.g., creatinine), and demographics (e.g., age, sex) were collected at the time of listing in 318 patients (82% male, mean age = 53 years) enrolled in the Waiting for a New Heart Study. Clinical events were death/delisting due to deterioration, high-urgency status transplantation (HU-HTx), elective transplantation, and delisting due to clinical improvement. Within 7 years of follow-up, 92 patients died or were delisted due to deterioration, 121 received HU-HTx, 43 received elective transplantation, and 39 were delisted due to improvement. Adjusting for demographic and medical characteristics, the results indicated that frequent consumption of healthy foods (i.e., foods high in unsaturated fats) and being physically active increased the likelihood of delisting due improvement, while smoking and depressive symptoms were related to death/delisting due to clinical deterioration while awaiting HTx. In conclusion, psychosocial and behavioral characteristics are clearly associated with clinical outcomes in this population. Interventions that target psychosocial risk, smoking, dietary habits, and physical activity may be beneficial for patients with advanced heart failure waiting for a cardiac transplant.
Collapse
Affiliation(s)
- Kathleen Gali
- Hamburg Center for Health Economics, University of Hamburg, 20354 Hamburg, Germany;
- University Cancer Center Hamburg (UCCH), University Medical Center-Eppendorf (UKE), 20251 Hamburg, Germany
| | - Gerdi Weidner
- Department of Biology, Romberg Tiburon Campus, San Francisco State University, Tiburon, CA 94920, USA
| | | | - Jan Beyersmann
- Institute of Statistics, Ulm University, 89081 Ulm, Germany;
| | - Heike Spaderna
- Department of Nursing Science, Section Health Psychology, Trier University, 54286 Trier, Germany
| |
Collapse
|
14
|
Simão DO, Júlia da Costa R, Fonseca Verneque BJ, Ferreira do Amaral J, Chagas GM, Duarte CK. Sodium and/or fluid restriction and nutritional parameters of adult patients with heart failure: A systematic review and meta-analysis of randomized controlled trial. Clin Nutr ESPEN 2021; 45:33-44. [PMID: 34620336 DOI: 10.1016/j.clnesp.2021.08.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 07/27/2021] [Accepted: 08/16/2021] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Heart failure (HF) is a clinical syndrome resulting from the structural and/or functional impairment of blood supply to tissues. Congestion and edema associated with water retention are the main symptoms presented by patients. Fluid (FR) and sodium restriction are non-pharmacological measures indicated in clinical practice to mitigate this symptom, despite their low evidence level. AIM Assessing the impact of sodium and/or fluid restriction on nutritional parameters of adult patients with HF, based on systematic review with meta-analysis. METHODS The study was conducted in June 2020, on the following databases: EMBASE, PubMed/MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL) and Web of Science. Citations were also collected in the gray literature such as thesis banks and preprints. Randomized clinical trials conducted with patients in the age group 18 years, or older, who were hospitalized or under outpatient/clinical follow-up, and who were subjected to intervention based on fluid and/or sodium restriction in comparison to the control, were herein selected. RESULTS Although FR-based diets are effective in reducing liquid intake, they increase individuals' thirst sensation and body weight in comparison to non-FR diets. The association between this intervention and sodium restriction is also effective in reducing liquid intake as sodium intake decreases. However, the association of the most severe (<2000 mg/day) and moderate (2000-2400 mg/day) sodium restrictions with FR has reduced energy intake, although without evidence of weight change - only the most severe sodium restriction was capable of keeping individuals' thirst sensation. In addition, moderate sodium restrictions (2300 to 3000 mg/day) in association with FR were capable of decreasing urinary sodium excretion. On the other hand, prescriptions of severe or moderate sodium restriction (<2,400 mg/d) alone have reduced individuals' body weight and BMI, although they did not change their caloric intake. However, severe sodium restriction (<2,000 mg) has led to higher body weight than the low-sodium diet (2000 to 2,4000 mg/day). CONCLUSION Sodium restriction may not be an effective strategy because it adversely affects individuals' weight, a fact that suggests increased congestion. Weight-based FR is supported to bethe best way to individualize this non-pharmacological treatment and it does not appear to affect nutritional parameters capable of putting patients with HF at higher malnutrition risk.
Collapse
Affiliation(s)
- Daiane Oliveira Simão
- Unidade Multiprofissional e Reabilitação - Nutrição Clínica, Hospital Das Clínicas da Universidade Federal de Minas Gerais, Brazil
| | - Renata Júlia da Costa
- Departamento de Nutrição da Escola de Enfermagem da Universidade Federal de Minas Gerais, Brazil
| | | | - Joana Ferreira do Amaral
- Departamento de Nutrição Clínica e Social da Escola de Nutrição da Universidade Federal de Ouro Preto, Brazil
| | - Gicele Mendes Chagas
- Unidade Multiprofissional e Reabilitação - Nutrição Clínica, Hospital Das Clínicas da Universidade Federal de Minas Gerais, Brazil
| | - Camila Kümmel Duarte
- Departamento de Nutrição da Escola de Enfermagem da Universidade Federal de Minas Gerais, Brazil.
| |
Collapse
|
15
|
Nakajima T, Murata M, Nitta S, Shitara T, Kazama H, Satoh Y, Takizawa M, Mori A, Kobayashi Y, Adachi H. Sodium Restriction Counseling Reduces Cardiac Events in Patients With Heart Failure. Circ J 2021; 85:1555-1562. [PMID: 34162773 DOI: 10.1253/circj.cj-20-1215] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Many heart failure (HF) guidelines recommend sodium restriction for patients with HF, but the outcome of sodium restriction counseling (SRC) for HF patients is still unknown. We wanted to clarify whether SRC reduces cardiac events in patients with HF.Methods and Results:Overall, 800 patients (77±12 years) who were hospitalized for HF were enrolled. During HF hospitalization, patients received SRC; patients were required to have a salt intake of <6 g/day. After discharge, death or HF rehospitalization events were investigated. During a mean follow-up of 319±252 days, 83 patients died, and 153 patients were rehospitalized for HF. SRC significantly decreased all-cause death (odds ratio, 0.42; 95% confidence interval [CI], 0.23-0.76; P<0.01), especially cardiac death of hospitalized HF patients after discharge. In the multivariate analysis adjusted for age, sex, SRC, body mass index, hypertension, dyslipidemia, β-blockers, and mineralocorticoid receptor antagonist intake, cardiac rehabilitation, and the type of HF, SRC remained a significant predictor of death. Kaplan-Meier analysis showed that SRC significantly reduced deaths and the combined outcome of HF rehospitalization and death. In patients with reduced left ventricular ejection fraction, SRC significantly decreased the mortality rate (odds ratio, 0.27; 95% CI, 0.10-0.71; P<0.01). CONCLUSIONS SRC reduced the mortality rate after discharge of hospitalized HF patients.
Collapse
Affiliation(s)
| | - Makoto Murata
- Department of Cardiology, Gunma Prefectural Cardiovascular Center
| | - Syogo Nitta
- Department of Rehabilitation, Gunma Prefectural Cardiovascular Center
| | - Tatsunori Shitara
- Department of Rehabilitation, Gunma Prefectural Cardiovascular Center
| | - Hiroko Kazama
- Department of Rehabilitation, Gunma Prefectural Cardiovascular Center
| | - Yukiko Satoh
- Nutrition and Cooking Division, Gunma Prefectural Cardiovascular Center
| | - Masayo Takizawa
- Nutrition and Cooking Division, Gunma Prefectural Cardiovascular Center
| | - Akemi Mori
- Nutrition and Cooking Division, Gunma Prefectural Cardiovascular Center
| | - Yasuyuki Kobayashi
- Department of Physiological Examination, Gunma Prefectural Cardiovascular Center
| | - Hitoshi Adachi
- Department of Cardiology, Gunma Prefectural Cardiovascular Center
| |
Collapse
|
16
|
Hypertension and heart failure with preserved ejection fraction: position paper by the European Society of Hypertension. J Hypertens 2021; 39:1522-1545. [PMID: 34102660 DOI: 10.1097/hjh.0000000000002910] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Hypertension constitutes a major risk factor for heart failure with preserved ejection fraction (HFpEF). HFpEF is a prevalent clinical syndrome with increased cardiovascular morbidity and mortality. Specific guideline-directed medical therapy (GDMT) for HFpEF is not established due to lack of positive outcome data from randomized controlled trials (RCTs) and limitations of available studies. Although available evidence is limited, control of blood pressure (BP) is widely regarded as central to the prevention and clinical care in HFpEF. Thus, in current guidelines including the 2018 European Society of Cardiology (ESC) and European Society of Hypertension (ESH) Guidelines, blockade of the renin-angiotensin system (RAS) with either angiotensin-converting enzyme inhibitors or angiotensin receptor blockers provides the backbone of BP-lowering therapy in hypertensive patients. Although superiority of RAS blockers has not been clearly shown in dedicated RCTs designed for HFpEF, we propose that this core drug treatment strategy is also applicable for hypertensive patients with HFpEF with the addition of some modifications. The latter apply to the use of spironolactone apart from the treatment of resistant hypertension and the use of the angiotensin receptor neprilysin inhibitor. In addition, novel agents such as sodium-glucose co-transporter-2 inhibitors, currently already indicated for high-risk patients with diabetes to reduce heart failure hospitalizations, and finerenone represent promising therapies and results from ongoing RCTs are eagerly awaited. The development of an effective and practical classification of HFpEF phenotypes and GDMT through dedicated high-quality RCTs are major unmet needs in hypertension research and calls for action.
Collapse
|
17
|
Sousa MMD, Almeida TDCF, Gouveia BDLA, Freire MEM, Sousa FSD, Oliveira SHDS. Persuasive communication and the diminution of the salt intake in heart failure patients: a pilot study. Rev Bras Enferm 2021; 74:e20200715. [PMID: 34133675 DOI: 10.1590/0034-7167-2020-0715] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 12/21/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES to evaluate the effect of persuasive communication in the modulation of the behavioral intention of reducing the consumption of salt in heart failure patients. METHODS pilot quasi-experimental study with one group, before and after the application of audiovisual persuasive communication, as guided by the Theory of Planned Behavior. This study used a form built and validated to measure behavioral variables (Beliefs, Attitude, Subjective Norm, and Perceived Behavioral Control). Wilcoxon's test and Spearman's correlation were applied. RESULTS 82 heart failure patients who were being monitored in outpatient clinics participated. The medians of the behavioral variables increased significantly after the exposition to persuasive communication, showing a high level of intention to execute the behavior. CONCLUSIONS persuasive communication positively contributed to influence the behavioral intention of reducing the consumption of salt in people with cardiac insufficiency.
Collapse
|
18
|
Salt for Patients with Heart Failure and Hyponatremia? Am J Med 2021; 134:e356. [PMID: 33962716 DOI: 10.1016/j.amjmed.2020.10.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 10/28/2020] [Indexed: 11/20/2022]
|
19
|
Khan MS, Jones DW, Butler J. The Reply. Am J Med 2021; 134:e357. [PMID: 33962717 DOI: 10.1016/j.amjmed.2020.12.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 12/27/2020] [Indexed: 10/21/2022]
Affiliation(s)
| | - Daniel W Jones
- Department of Medicine, University of Mississippi, Jackson
| | - Javed Butler
- Department of Medicine, University of Mississippi, Jackson.
| |
Collapse
|
20
|
DNA Methylation of the Angiotensinogen Gene, AGT, and the Aldosterone Synthase Gene, CYP11B2 in Cardiovascular Diseases. Int J Mol Sci 2021; 22:ijms22094587. [PMID: 33925539 PMCID: PMC8123855 DOI: 10.3390/ijms22094587] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 04/21/2021] [Accepted: 04/22/2021] [Indexed: 12/20/2022] Open
Abstract
Angiotensinogen (AGT) and aldosterone play key roles in the regulation of blood pressure and are implicated in the pathogenesis of cardiovascular diseases. DNA methylation typically acts to repress gene transcription. The aldosterone synthase gene CYP11B2 is regulated by angiotensin II and potassium. DNA methylation negatively regulates AGT and CYP11B2 expression and dynamically changes in response to continuous promoter stimulation of each gene. High salt intake and excess circulating aldosterone cause DNA demethylation around the CCAAT-enhancer-binding-protein (CEBP) sites of the ATG promoter region, thereby converting the phenotype of AGT expression from an inactive to an active state in visceral adipose tissue and heart. A close association exists between low DNA methylation at CEBP-binding sites and increased AGT expression in salt-sensitive hypertensive rats. Salt-dependent hypertension may be partially affected by increased cardiac AGT expression. CpG dinucleotides in the CYP11B2 promoter are hypomethylated in aldosterone-producing adenomas. Methylation of recognition sequences of transcription factors, including CREB1, NGFIB (NR4A1), and NURR1 (NR4A2) diminish their DNA-binding activity. The methylated CpG-binding protein MECP2 interacts directly with the methylated CYP11B2 promoter. Low salt intake and angiotensin II infusion lead to upregulation of CYP11B2 expression and DNA hypomethylation in the adrenal gland. Treatment with the angiotensin II type 1 receptor antagonist decreases CYP11B2 expression and leads to DNA hypermethylation. A close association between low DNA methylation and increased CYP11B2 expression are seen in the hearts of patients with hypertrophic cardiomyopathy. These results indicate that epigenetic regulation of both AGT and CYP11B2 contribute to the pathogenesis of cardiovascular diseases.
Collapse
|
21
|
Ishikawa Y, Sattler ELP. Nutrition as Treatment Modality in Heart Failure. Curr Atheroscler Rep 2021; 23:13. [PMID: 33594492 DOI: 10.1007/s11883-021-00908-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW This review aims to discuss recent evidence and controversies regarding nutrition as a treatment modality for heart failure (HF) patients. RECENT FINDINGS Adequate nutrition is known to promote health-related quality of life by addressing malnutrition and promoting optimal functioning among older adults and has an established role in the prevention of HF; however, evidence is limited on the effects of nutrition as a treatment modality in HF. While guidance of sodium restriction to address fluid overload is an ongoing debate among experts, evidence from case studies and small clinical trials suggest a positive impact of plant-based and Dietary Approaches to Stop Hypertension (DASH) dietary patterns on HF-related pathophysiology, quality of life, hospital admissions, and mortality. More clinical trials are needed to establish an evidence base to support dietary management strategies for patients with HF. Clinical and Translational Science Alliances (CTSAs) may provide infrastructure to overcome enrollment barriers.
Collapse
Affiliation(s)
- Yuta Ishikawa
- Department of Foods and Nutrition, College of Family and Consumer Sciences, University of Georgia, 305 Stanford Drive, Dawson Hall, Athens, GA, 30602, USA
| | - Elisabeth L P Sattler
- Department of Foods and Nutrition, College of Family and Consumer Sciences, University of Georgia, 305 Stanford Drive, Dawson Hall, Athens, GA, 30602, USA. .,Department of Clinical and Administrative Pharmacy, College of Pharmacy, University of Georgia, 250 West Green Street, R.C. Wilson Pharmacy, Athens, GA, 30602, USA.
| |
Collapse
|
22
|
Billingsley HE, Hummel SL, Carbone S. The role of diet and nutrition in heart failure: A state-of-the-art narrative review. Prog Cardiovasc Dis 2020; 63:538-551. [PMID: 32798501 PMCID: PMC7686142 DOI: 10.1016/j.pcad.2020.08.004] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 08/09/2020] [Indexed: 02/07/2023]
Abstract
Heart Failure (HF) incidence is increasing steadily worldwide, while prognosis remains poor. Though nutrition is a lifestyle factor implicated in prevention of HF, little is known about the effects of macro- and micronutrients as well as dietary patterns on the progression and treatment of HF. This is reflected in a lack of nutrition recommendations in all major HF scientific guidelines. In this state-of-the-art review, we examine and discuss the implications of evidence contained in existing randomized control trials as well as observational studies covering the topics of sodium restriction, dietary patterns and caloric restriction as well as supplementation of dietary fats and fatty acids, protein and amino acids and micronutrients in the setting of pre-existing HF. Finally, we explore future directions and discuss knowledge gaps regarding nutrition therapies for the treatment of HF.
Collapse
Affiliation(s)
- Hayley E Billingsley
- Department of Kinesiology & Health Sciences, College of Humanities & Sciences, Virginia Commonwealth University, Richmond, VA, United States of America; VCU Pauley Heart Center, Division of Cardiology, Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA, United States of America
| | - Scott L Hummel
- University of Michigan Frankel Cardiovascular Center, Ann Arbor, MI, United States of America; Ann Arbor Veterans Affairs Health System, Ann Arbor, MI, United States of America
| | - Salvatore Carbone
- Department of Kinesiology & Health Sciences, College of Humanities & Sciences, Virginia Commonwealth University, Richmond, VA, United States of America; VCU Pauley Heart Center, Division of Cardiology, Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA, United States of America.
| |
Collapse
|
23
|
Bennett J, Deslippe AL, Crosby C, Belles S, Banna J. Electrolytes and Cardiovascular Disease Risk. Am J Lifestyle Med 2020; 14:361-365. [PMID: 33281514 PMCID: PMC7692015 DOI: 10.1177/1559827620915708] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The relationship between sodium intake and blood pressure is a well-studied phenomenon; however, the impact of sodium intake on cardiovascular disease risk and mortality is controversial. Recent studies conclude that weak evidence exists to support sodium restriction for the prevention of cardiovascular mortality in normotensive and hypertensive adults, suggesting that sodium restriction may be an ineffective strategy for disease prevention. Further evidence points to the importance of balancing sodium and potassium intake, a balance commonly achieved with a healthier diet containing greater quantities of fruits and vegetables. The purpose of this article is to highlight dietary strategies that may prove to be more effective in reducing cardiovascular disease risk. Limitations of current methods used to estimate nutrient intake are described as they relate to this topic. Further research is needed to advance understanding of various aspects of dietary intake that are health protective and allow for the development of more effective public education strategies.
Collapse
Affiliation(s)
- Jonathan Bennett
- Department of Nutrition Sciences, University of Hawaii,
Honolulu, Hawaii (JBennett)
- University of Hawaii Cancer Center, Honolulu, Hawaii
(JBennett)
- School of Population and Public Health, University of
British Columbia, Vancouver, British Columbia, Canada (ALD)
- British Columbia Children’s Hospital Research Institute
(BCCHR), Vancouver, British Columbia, Canada (ALD); The Queen’s Medical Center, Honolulu,
Hawaii (SB)
- College of Tropical Agriculture and Human Resources,
Honolulu, Hawaii (JBanna)
| | - Alysha L. Deslippe
- Department of Nutrition Sciences, University of Hawaii,
Honolulu, Hawaii (JBennett)
- University of Hawaii Cancer Center, Honolulu, Hawaii
(JBennett)
- School of Population and Public Health, University of
British Columbia, Vancouver, British Columbia, Canada (ALD)
- British Columbia Children’s Hospital Research Institute
(BCCHR), Vancouver, British Columbia, Canada (ALD); The Queen’s Medical Center, Honolulu,
Hawaii (SB)
- College of Tropical Agriculture and Human Resources,
Honolulu, Hawaii (JBanna)
| | - Christine Crosby
- Department of Nutrition Sciences, University of Hawaii,
Honolulu, Hawaii (JBennett)
- University of Hawaii Cancer Center, Honolulu, Hawaii
(JBennett)
- School of Population and Public Health, University of
British Columbia, Vancouver, British Columbia, Canada (ALD)
- British Columbia Children’s Hospital Research Institute
(BCCHR), Vancouver, British Columbia, Canada (ALD); The Queen’s Medical Center, Honolulu,
Hawaii (SB)
- College of Tropical Agriculture and Human Resources,
Honolulu, Hawaii (JBanna)
| | - Sally Belles
- Department of Nutrition Sciences, University of Hawaii,
Honolulu, Hawaii (JBennett)
- University of Hawaii Cancer Center, Honolulu, Hawaii
(JBennett)
- School of Population and Public Health, University of
British Columbia, Vancouver, British Columbia, Canada (ALD)
- British Columbia Children’s Hospital Research Institute
(BCCHR), Vancouver, British Columbia, Canada (ALD); The Queen’s Medical Center, Honolulu,
Hawaii (SB)
- College of Tropical Agriculture and Human Resources,
Honolulu, Hawaii (JBanna)
| | - Jinan Banna
- Jinan Banna, PhD, RD, CDN, College of Tropical
Agriculture and Human Resources, 1955 East West Road, Honolulu, HI 96822; e-mail:
| |
Collapse
|