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Pinto E, Viegas C, Martins PV, Marreiros C, Nascimento T, Schurgers L, Simes D. Mediterranean Diet Favors Vitamin K Intake: A Descriptive Study in a Mediterranean Population. Nutrients 2024; 16:1098. [PMID: 38674788 PMCID: PMC11054598 DOI: 10.3390/nu16081098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Revised: 03/26/2024] [Accepted: 04/05/2024] [Indexed: 04/28/2024] Open
Abstract
The Mediterranean diet (MD) is associated with improved longevity and the prevention and management of chronic inflammatory diseases (CIDs). Vitamin K, which is present in MD core components such as leafy green vegetables, is also known as a protective factor for CIDs. Estimates of vitamin K intake in Mediterranean settings are still scarce, and the association between MD and vitamin K intake is yet to be established. This study analyzed vitamin K intake and MD adherence in the Algarve region, in Portugal. We conducted a cross-sectional study in a nonrandom sample of adults using an online questionnaire which included a validated food-frequency questionnaire and a screener for MD adherence. A total of 238 participants were recruited (68% women and 32% men). Adherence to the MD was low (11%). Only 10% of the participants had vitamin K intake below the adequate intake. Adherence to the MD was positively correlated with vitamin K intake (r = 0.463; p < 0.001) and age (r = 0.223; p < 0.001). Our findings underscore the importance of promoting adherence to the MD for optimal vitamin K intake, and future research should focus on developing effective interventions to promote this dietary pattern, particularly among younger individuals and men.
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Affiliation(s)
- Ezequiel Pinto
- Centro de Estudos e Desenvolvimento em Saúde, Universidade do Algarve, Campus de Gambelas, 8005-139 Faro, Portugal; (E.P.); (T.N.)
- Algarve Biomedical Center Research Institute (ABC-RI), Universidade do Algarve, Campus de Gambelas, 8005-139 Faro, Portugal
| | - Carla Viegas
- Centre of Marine Sciences (CCMAR), Universidade do Algarve, Campus de Gambelas, 8005-139 Faro, Portugal; (C.V.); (C.M.)
- GenoGla Diagnostics, Centre of Marine Sciences (CCMAR), Universidade do Algarve, Campus de Gambelas, 8005-139 Faro, Portugal
| | - Paula Ventura Martins
- Algarve Cyber-Physical Systems Research Centre (CISCA), Universidade do Algarve, Campus de Gambelas, 8005-139 Faro, Portugal;
| | - Catarina Marreiros
- Centre of Marine Sciences (CCMAR), Universidade do Algarve, Campus de Gambelas, 8005-139 Faro, Portugal; (C.V.); (C.M.)
| | - Tânia Nascimento
- Centro de Estudos e Desenvolvimento em Saúde, Universidade do Algarve, Campus de Gambelas, 8005-139 Faro, Portugal; (E.P.); (T.N.)
- Algarve Biomedical Center Research Institute (ABC-RI), Universidade do Algarve, Campus de Gambelas, 8005-139 Faro, Portugal
| | - Leon Schurgers
- Department of Biochemistry, Cardiovascular Research Institute Maastricht, 6200 MD Maastricht, The Netherlands;
| | - Dina Simes
- Centre of Marine Sciences (CCMAR), Universidade do Algarve, Campus de Gambelas, 8005-139 Faro, Portugal; (C.V.); (C.M.)
- GenoGla Diagnostics, Centre of Marine Sciences (CCMAR), Universidade do Algarve, Campus de Gambelas, 8005-139 Faro, Portugal
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Mediterranean Diet: A Tool to Break the Relationship of Atrial Fibrillation with the Metabolic Syndrome and Non-Alcoholic Fatty Liver Disease. Nutrients 2022; 14:nu14061260. [PMID: 35334916 PMCID: PMC8949975 DOI: 10.3390/nu14061260] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 03/11/2022] [Accepted: 03/14/2022] [Indexed: 12/15/2022] Open
Abstract
Atrial fibrillation (AF) is the most common supraventricular arrhythmia associated with increased cardiovascular and non-cardiovascular morbidity and mortality. As multiple factors may predispose the onset of AF, the prevention of the occurrence, recurrence and complications of this arrhythmia is still challenging. In particular, a high prevalence of cardio-metabolic comorbidities such as the metabolic syndrome (MetS) and in its hepatic manifestation, the non-alcoholic fatty liver disease (NAFLD), have been described in the AF population. A common pathogenetic mechanism linking AF, MetS and NAFLD is represented by oxidative stress. For this reason, in the past decades, numerous studies have investigated the effect of different foods/nutrients with antioxidant properties for the prevention of, and their therapeutic role is still unclear. In this narrative comprehensive review, we will summarize current evidence on (1) the association between AF, MetS and NAFLD (2) the antioxidant role of Mediterranean Diet and its components for the prevention of AF and (3) the effects of Mediterranean Diet on MetS components and NAFLD.
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Rosca CI, Kundnani NR, Tudor A, Rosca MS, Nicoras VA, Otiman G, Ciurariu E, Ionescu A, Stelian M, Sharma A, Borza C, Lighezan DF. Benefits of prescribing low-dose digoxin in atrial fibrillation. Int J Immunopathol Pharmacol 2021; 35:20587384211051955. [PMID: 34724841 PMCID: PMC8573519 DOI: 10.1177/20587384211051955] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
INTRODUCTION The role of digoxin (cardiac glycoside) in controlling the heart rate (HR) for the treatment of atrial fibrillation (AF) patients has not been explored in depth. METHODS To contribute to the limited data, our team conducted retrospective analysis of the clinical records of 1444 AF patients. We divided the AF patients into two groups, wherein group 1 patients were treated with beta-blockers (BB), low-dose digoxin, and an anticoagulant (vitamin K antagonist/factor-IIa inhibitor/factor-Xa inhibitor), and group 2 patients were treated with just BB and an anticoagulant. Our objectives were to compare the impact of combination therapy of BB and digoxin on the resting HR in patients with permanent AF and the patients' quality of life (QOL) at periodic intervals. RESULTS The findings of our study showed a better control of the resting HR rate (<110bpm) and an improved QOL among the group 1 patients when compared with group 2 patients. CONCLUSION Our findings are indicative of the favorable clinical outcomes that resulted from the addition of a low-dose of digoxin to the AF treatment regimen. However, larger studies/trials elucidating the outcomes of AF patients treated with the dual rate control therapy are required, to clarify the role of digoxin, guide the choice of agents, and standardize the AF treatment protocol.
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Affiliation(s)
- Ciprian Ilie Rosca
- Advanced Research Center for Cardiovascular Pathology and Haemostaseology, Department of Internal Medicine I - Medical Semiology I, 162271"Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania.,Family Physician Clinic, Civil Medical Society Dr Rosca, Teremia Mare, Timis, Romania.,Department of Internal Medicine, Municipal Emergency University Hospital, Timisoara, Romania
| | - Nilima Rajpal Kundnani
- Family Physician Clinic, Civil Medical Society Dr Rosca, Teremia Mare, Timis, Romania.,Department of Functional Sciences, Physiology, Centre of Immuno-Physiology and Biotechnologies (CIFBIOTEH), "162271Victor Babeș" University of Medicine and Pharmacy, Timisoara, Romania
| | - Anca Tudor
- Department of Functional Science, Discipline of Informatics and medical biostatistics, 162271"Victor Babes" University of Medicine and Pharmacy Timisoara, Timisoara, Romania
| | - Maria-Silvia Rosca
- Family Physician Clinic, Civil Medical Society Dr Rosca, Teremia Mare, Timis, Romania
| | - Violeta-Ariana Nicoras
- Department of Internal Medicine, Municipal Emergency University Hospital, Timisoara, Romania
| | - Gabriela Otiman
- Department of Cardiology-Ambulatory internal medicine, 162271"Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania
| | - Elena Ciurariu
- Department of Functional Sciences, Physiology, Centre of Immuno-Physiology and Biotechnologies (CIFBIOTEH), "162271Victor Babeș" University of Medicine and Pharmacy, Timisoara, Romania
| | - Alin Ionescu
- Department of Family Medicine, 162271"Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania
| | - Morariu Stelian
- Department of Occupational Medicine, 473223Vasile Goldis University of Arad Faculty of Medicine, Arad, Romania
| | - Abhinav Sharma
- Family Physician Clinic, Civil Medical Society Dr Rosca, Teremia Mare, Timis, Romania.,Department of Cardio-vascular Rehabilitation, 162271"Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania
| | - Claudia Borza
- Department of Functional Science, Discipline of Physiopathology, Centre for cognitive research in neuro-psychiatric pathologies NEUROPSY-COG, 162271"Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania
| | - Daniel Florin Lighezan
- Advanced Research Center for Cardiovascular Pathology and Haemostaseology, Department of Internal Medicine I - Medical Semiology I, 162271"Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania.,Department of Internal Medicine, Municipal Emergency University Hospital, Timisoara, Romania
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Daniels MS, Park BI, McKay DL. Adverse Effects of Medications on Micronutrient Status: From Evidence to Guidelines. Annu Rev Nutr 2021; 41:411-431. [PMID: 34111363 DOI: 10.1146/annurev-nutr-120420-023854] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Recent dietary reference intake workshops focusing on nutrient requirements in chronic disease populations have called attention to the potential adverse effects of chronic medication use on micronutrient status. Although this topic is mostly ill defined in the literature, several noteworthy drug-nutrient interactions (DNIs) are of clinical and public health significance. The purpose of this narrative review is to showcase classic examples of DNIs and their impact on micronutrient status, including those related to antidiabetic, anticoagulant, antihypertensive, antirheumatic, and gastric acid-suppressing medications. Purported DNIs related to other drug families, while relevant and worthy of discussion, are not included. Unlike previous publications, this review is primarily focused on DNIs that have sufficient evidence supporting their inclusion in US Food and Drug Administration labeling materials and/or professional guidelines. While the evidence is compelling, more high-quality research is needed to establish clear and quantitative relationships between chronic medication use and micronutrient status. Expected final online publication date for the Annual Review of Nutrition, Volume 41 is September 2021. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
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Affiliation(s)
- Michael S Daniels
- Jean Mayer USDA Human Nutrition Research Center on Aging, Boston, Massachusetts 02111, USA; , .,Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts 02111, USA;
| | - Brian I Park
- Jean Mayer USDA Human Nutrition Research Center on Aging, Boston, Massachusetts 02111, USA; , .,Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts 02111, USA;
| | - Diane L McKay
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts 02111, USA;
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Zulkifly H, Cheli P, Lutchman I, Bai Y, Lip GYH, Lane DA. Anticoagulation control in different ethnic groups receiving vitamin K antagonist therapy for stroke prevention in atrial fibrillation. Thromb Res 2020; 192:12-20. [PMID: 32416364 DOI: 10.1016/j.thromres.2020.04.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 03/18/2020] [Accepted: 04/02/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Efficacy and safety of vitamin K antagonists (VKAs) is optimised in atrial fibrillation (AF) patients when the International Normalised Ratio (INR) is 2.0-3.0. Anticoagulation control comparing different ethnic groups is limited, although epidemiological studies suggest poorer INR control in non-white cohorts. METHODS VKA control was assessed retrospectively by time-in-the-therapeutic range (TTR) (Rosendaal method) and percentage INR-in-range (PINRR) in 991 White, Afro-Caribbean and South-Asian AF patients [overall mean (SD) age 71.6 (9.4) years; 55% male; mean (SD) CHA2DS2-VASc score 3.4 (1.6)] over a median (IQR) follow-up of 5.2 (3.2-7.0) years. RESULTS Compared to Whites, mean (SD) TTR and PINRR were significantly lower in South-Asians [TTR 67.9% vs. 60.5%; PINRR 58.8% vs. 51.6%, respectively] and Afro-Caribbeans [TTR 67.9% vs. 61.3%; PINRR 58.8% vs. 53.1%, respectively], despite similar INR monitoring intensity. Logistic regression revealed non-white ethnicity [OR 2.62; 95% Confidence Interval [CI] (1.67-4.10) and OR 3.47 (1.44-8.34)] and anaemia [OR 1.65 (1.00-2.70) and OR 6.27 (1.89-20.94)] as independent predictors of both TTR and PINRR < 70%, respectively. At follow-up, 329 (33.2%) patients experienced ≥1 major adverse clinical event. Cardiovascular hospitalisation was significantly higher among South-Asians (32.3%) compared to the Whites and Afro-Caribbeans (21.3% vs 25.6% respectively). CONCLUSIONS Ethnic disparities in quality of anticoagulation control are evident, with South-Asians and Afro-Caribbeans having poorer control compared to Whites, despite similar intensity INR monitoring. Non-white ethnicity remained the strongest independent predictor of poor TTR and PINRR. Interventions to improve anticoagulation control need to be implemented, particularly targeting ethnic minority patients.
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Affiliation(s)
- Hanis Zulkifly
- University of Birmingham Institute of Cardiovascular Sciences, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, United Kingdom; Fakulti Farmasi, Universiti Teknologi MARA Kampus Puncak Alam, Selangor, Malaysia
| | - Paola Cheli
- University of Birmingham Institute of Cardiovascular Sciences, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, United Kingdom
| | - Ivana Lutchman
- University of Birmingham Institute of Cardiovascular Sciences, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, United Kingdom.
| | - Ying Bai
- University of Birmingham Institute of Cardiovascular Sciences, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, United Kingdom
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, United Kingdom; Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
| | - Deirdre A Lane
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, United Kingdom; Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
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Mattioli AV, Palmiero P, Manfrini O, Puddu PE, Nodari S, Dei Cas A, Mercuro G, Scrutinio D, Palermo P, Sciomer S, Di Francesco S, Novo G, Novo S, Pedretti RF, Zito A, Parati G, Pedrinelli R, Farinetti A, Maiello M, Moscucci F, Tenaglia RL, Sucato V, Triggiani M, Cugusi L, Scicchitano P, Saba PS, Ciccone MM. Mediterranean diet impact on cardiovascular diseases. J Cardiovasc Med (Hagerstown) 2017; 18:925-935. [PMID: 28914660 DOI: 10.2459/jcm.0000000000000573] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Lin KJ, Singer DE, Glynn RJ, Blackley S, Zhou L, Liu J, Dube G, Oertel LB, Schneeweiss S. Prediction Score for Anticoagulation Control Quality Among Older Adults. J Am Heart Assoc 2017; 6:e006814. [PMID: 28982676 PMCID: PMC5721874 DOI: 10.1161/jaha.117.006814] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 08/23/2017] [Indexed: 01/18/2023]
Abstract
BACKGROUND Time in the therapeutic range (TTR) is associated with the effectiveness and safety of vitamin K antagonist (VKA) therapy. To optimize prescribing of VKA, we aimed to develop and validate a prediction model for TTR in older adults taking VKA for nonvalvular atrial fibrillation and venous thromboembolism. METHODS AND RESULTS The study cohort comprised patients aged ≥65 years who were taking VKA for atrial fibrillation or venous thromboembolism and who were identified in the 2 US electronic health record databases linked with Medicare claims data from 2007 through 2014. With the predictors identified from a systematic review and clinical knowledge, we built a prediction model for TTR, using one electronic health record system as the training set and the other as the validation set. We compared the performance of the new models to that of a published prediction score for TTR, SAMe-TT2R2. Based on 1663 patients in the training set and 1181 in the validation set, our optimized score included 42 variables and the simplified model included 7 variables, abbreviated as PROSPER (Pneumonia, Renal dysfunction, Oozing blood [prior bleeding], Staying in hospital ≥7 days, Pain medication use, no Enhanced [structured] anticoagulation services, Rx for antibiotics). The PROSPER score outperformed SAMe-TT2R2 when predicting both TTR ≥70% (area under the receiver operating characteristic curve 0.67 versus 0.55) and the thromboembolic and bleeding outcomes (area under the receiver operating characteristic curve 0.62 versus 0.52). CONCLUSIONS Our geriatric TTR score can be used as a clinical decision aid to select appropriate candidates to receive VKA therapy and as a research tool to address confounding and treatment effect heterogeneity by anticoagulation quality.
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Affiliation(s)
- Kueiyu Joshua Lin
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Daniel E Singer
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Robert J Glynn
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Suzanne Blackley
- Clinical and Quality Analysis, Information Systems, Partners HealthCare System, Boston, MA
| | - Li Zhou
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
- Clinical Informatics, Partners eCare, Partners HealthCare System, Boston, MA
| | - Jun Liu
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Gina Dube
- Department of Pharmacy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Lynn B Oertel
- Anticoagulation Management Service, Department of Nursing, Massachusetts General Hospital, Boston, MA
| | - Sebastian Schneeweiss
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
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Violi F, Soliman EZ, Pignatelli P, Pastori D. Atrial Fibrillation and Myocardial Infarction: A Systematic Review and Appraisal of Pathophysiologic Mechanisms. J Am Heart Assoc 2016; 5:e003347. [PMID: 27208001 PMCID: PMC4889200 DOI: 10.1161/jaha.116.003347] [Citation(s) in RCA: 125] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 03/28/2016] [Indexed: 12/22/2022]
Abstract
BACKGROUND A growing body of evidence suggests that atrial fibrillation (AF) is associated with myocardial infarction (MI). However, incidence and management of MI in AF is still undefined. METHODS AND RESULTS We searched MEDLINE via PubMed and Cochrane database between 1965 and 2015. All observational clinical studies and interventional trials reporting 1-year incidence of MI in AF were included. We also discussed pathophysiological mechanisms, predictors, and therapeutic approaches to reduce the risk of MI in AF. Twenty-one observational studies and 10 clinical trials were included. The annual rate of MI in observational studies including AF patients ranged from 0.4% to 2.5%. Higher rates of MI were reported in AF patients with stable coronary artery disease (11.5%/year), vascular disease (4.47%/year), heart failure (2.9%/year), and in those undergoing coronary artery interventions (6.3%/year). However, lower annual rates have been described in AF patients from Eastern countries (0.2-0.3%/year), and in those enrolled in clinical trials (from 0.4 to 1.3%/year). CONCLUSIONS AF patients had a significant residual risk of MI despite anticoagulant treatment. Coexistence of atherosclerotic risk factors and platelet activation account for the increased risk of MI in AF. Identification of high-risk AF patients is a needed first step to develop cost-effective approaches for prevention. A new score, the 2MACE score, has been recently developed to stratify MI risk in AF, and may help not only in allocating resources to high-risk groups, but also in design of studies examining novel therapies for prevention of MI in AF.
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Affiliation(s)
- Francesco Violi
- Department of Internal Medicine and Medical Specialties, I Clinica Medica, Atherothrombosis Centre, Sapienza University of Rome, Italy
| | - Elsayed Z Soliman
- Epidemiological Cardiology Research Center, Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC Department of Internal Medicine-Cardiology Section, Wake Forest School of Medicine, Winston-Salem, NC
| | - Pasquale Pignatelli
- Department of Internal Medicine and Medical Specialties, I Clinica Medica, Atherothrombosis Centre, Sapienza University of Rome, Italy
| | - Daniele Pastori
- Department of Internal Medicine and Medical Specialties, I Clinica Medica, Atherothrombosis Centre, Sapienza University of Rome, Italy
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Violi F, Lip GY, Pignatelli P, Pastori D. Interaction Between Dietary Vitamin K Intake and Anticoagulation by Vitamin K Antagonists: Is It Really True?: A Systematic Review. Medicine (Baltimore) 2016; 95:e2895. [PMID: 26962786 PMCID: PMC4998867 DOI: 10.1097/md.0000000000002895] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Educational advice is often given to patients starting treatment with vitamin K Antagonists (VKAs). A great emphasis is made on nutritional information. Common belief is that dietary vitamin K intake could counteract the anticoagulant effect by VKAs and for many years, patients have been discouraged to consume vitamin-K-rich foods, such as green leafy vegetables.The objective of this study is to summarize the current evidence supporting the putative interaction between dietary vitamin K intake and changes in INR with the VKAs.Data sources are MEDLINE via PubMed and Cochrane database.All clinical studies investigating the relationship between dietary vitamin K and measures of anticoagulation were included. We excluded all studies of supplementation of vitamin K alone.We performed a systematic review of the literature up to October 2015, searching for a combination of "food," "diet," "vitamin K," "phylloquinone," "warfarin," "INR," "coagulation," and "anticoagulant."Two dietary interventional trials and 9 observational studies were included. We found conflicting evidence on the effect of dietary intake of vitamin K on coagulation response. Some studies found a negative correlation between vitamin K intake and INR changes, while others suggested that a minimum amount of vitamin K is required to maintain an adequate anticoagulation. Median dietary intake of vitamin K1 ranged from 76 to 217 μg/day among studies, and an effect on coagulation may be detected only for high amount of vitamin intake (>150 μg/day).Most studies included patients with various indications for VKAs therapy, such as atrial fibrillation, prosthetic heart valves, and venous thromboembolism. Thus, INR target was dishomogeneous and no subanalyses for specific populations or different anticoagulants were conducted. Measures used to evaluate anticoagulation stability were variable.The available evidence does not support current advice to modify dietary habits when starting therapy with VKAs. Restriction of dietary vitamin K intake does not seem to be a valid strategy to improve anticoagulation quality with VKAs. It would be, perhaps, more relevant to maintain stable dietary habit, avoiding wide changes in the intake of vitamin K.
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Affiliation(s)
- Francesco Violi
- From the Center of Atherothrombosis (FV, PP, DP), I Medical Clinic, Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Umberto I Policlinic of Rome, Rome, Italy; and Centre for Cardiovascular Sciences (GYHL), City Hospital, University of Birmingham, Birmingham, UK
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Alyousif SM, Alsaileek AA. Quality of anticoagulation control among patients with atrial fibrillation: An experience of a tertiary care center in Saudi Arabia. J Saudi Heart Assoc 2016; 28:239-43. [PMID: 27688671 PMCID: PMC5034360 DOI: 10.1016/j.jsha.2016.02.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 01/07/2016] [Accepted: 02/01/2016] [Indexed: 11/19/2022] Open
Abstract
Background Atrial fibrillation (AF) is the most common chronic rhythm disorder. Patients with AF are at an increased risk of ischemic stroke. Therefore, optimal anticoagulation is essential to reduce the risk of stroke. The aim of this study was to assess the level of anticoagulation control achieved in patients with nonvalvular AF receiving medical care in a tertiary care hospital. Methods This was a retrospective cohort study in ambulatory care clinics at tertiary care hospital in Saudi Arabia. We included 110 nonvalvular AF patients treated with warfarin for at least 3 months at King Abdulaziz Medical City, Riyadh, Saudi Arabia, between May 1, 2012, and July 31, 2012. Thereafter, international normalized ratio results were collected for 1 year. Anticoagulation control was assessed by calculating time within therapeutic range (TTR) as per the Rosendaal method. Results The mean age was 64.9 ± 16.5 years; 60.9% were female. The mean TTR was 59%. Almost one third of the patients (32.7%) had poor anticoagulation control; TTR of <50%. Poor anticoagulation control was significantly associated with higher CHADS2 (congestive heart failure, hypertension, age, diabetes, stroke) score (p = 0.043). TTR was not significantly different between men and women. Similarly, TTR was not associated with age or duration of anticoagulation. There was no adequate information to assess the effect of other factors such as diet, compliance, and level of education on anticoagulation. Thirty-one patients (28.2%) had a history of prior stroke. The overall quality of anticoagulation was not significantly different between patients with and without stroke, (TTR was 56.3% and 60.1%, respectively; p = 0.46). Conclusion Quality of anticoagulation in patients with AF receiving medical care in a tertiary care hospital was suboptimal, with nearly 40% of the time spent outside the therapeutic range. Methods to improve anticoagulation control among patients with AF should be implemented.
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Affiliation(s)
- Sarah M. Alyousif
- Pharmaceutical Care Department, King Abdulaziz Cardiac Center, King Abdulaziz Medical City, Ministry of National Guard, Saudi Arabia
- Corresponding author.
| | - Ahmed A. Alsaileek
- King Abdulaziz Cardiac Center, King Abdulaziz Medical City, Ministry of National Guard, Saudi Arabia
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11
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Reply to: “Inadequate anticoagulation by vitamin K antagonists and major adverse cardiovascular events other than stroke”. Int J Cardiol 2016; 202:934-5. [DOI: 10.1016/j.ijcard.2015.10.122] [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: 10/07/2015] [Accepted: 10/17/2015] [Indexed: 11/17/2022]
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Park JN, Lee JS, Noh MY, Sung MK. Association Between Usual Vitamin K Intake and Anticoagulation in Patients Under Warfarin Therapy. Clin Nutr Res 2015; 4:235-41. [PMID: 26566518 PMCID: PMC4641985 DOI: 10.7762/cnr.2015.4.4.235] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Revised: 10/24/2015] [Accepted: 10/26/2015] [Indexed: 01/24/2023] Open
Abstract
This study aimed to explore the correlation between usual vitamin K intake and response to anticoagulant therapy among patients under warfarin therapy. We conducted a retrospective survey of patients (n = 50) on continuous warfarin therapy. Clinical information and laboratory parameters were sourced from medical records. Anticoagulant effect was evaluated by using the percent time in therapeutic range (TTR) and the coefficient of variation (CV) of International normalized ratio (INR). Dietary vitamin K intake was assessed using a semi-quantitative food frequency questionnaire that has been developed for the purpose of assessing dietary intake of vitamin K. A total of 50 patients aged between 21 and 87 years were included in the study. The mean vitamin K intake was 262.8 ± 165.2 µg/day. Study subjects were divided into tertiles according to their usual vitamin K intake. The proportion of men was significantly higher in second and third tertile than first tertile (p = 0.028). The mean percent TTR was 38.4 ± 28.4% and CV of INR was 31.8 ± 11.8%. Long-term warfarin therapy group (≥ 3 years) had a higher percentage of TTR as compared to the control group (< 3 years) (p = 0.046). No statistically significant correlation was found between usual vitamin K intake and percent TTR (p > 0.05). In conclusion, no significant association was observed between usual vitamin K intake and anticoagulant effects. Further studies are required to consider inter-individual variability of vitamin K intake. Development of assessment tools to measure inter-individual variability of vitamin K intake might be helpful.
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Affiliation(s)
- Ji Na Park
- Department of Food and Nutrition, Sookmyung Women's University, Seoul 04310, Korea
| | - Ji Sun Lee
- Department of Nutrition, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul 06591, Korea
| | - Min Young Noh
- Department of Nutrition, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul 06591, Korea
| | - Mi-Kyung Sung
- Department of Food and Nutrition, Sookmyung Women's University, Seoul 04310, Korea
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