A High Polyphenol Diet Improves Psychological Well-Being: The Polyphenol Intervention Trial (PPhIT)

Mental ill health is currently one of the leading causes of disease burden worldwide. A growing body of data has emerged supporting the role of diet, especially polyphenols, which have anxiolytic and antidepressant-like properties. The aim of the present study was to assess the effect of a high polyphenol diet (HPD) compared to a low polyphenol diet (LPD) on aspects of psychological well-being in the Polyphenol Intervention Trial (PPhIT). Ninety-nine mildly hypertensive participants aged 40-65 years were enrolled in a four-week LPD washout period and then randomised to either an LPD or an HPD for eight weeks. Both at baseline and the end of intervention, participants' lifestyle and psychological well-being were assessed. The participants in the HPD group reported a decrease in depressive symptoms, as assessed by the Beck Depression Inventory-II, and an improvement in physical component and mental health component scores as assessed with 36-Item Short Form Survey. No differences in anxiety, stress, self-esteem or body image perception were observed. In summary, the study findings suggest that the adoption of a polyphenol-rich diet could potentially lead to beneficial effects including a reduction in depressive symptoms and improvements in general mental health status and physical health in hypertensive participants.

Initial Experience of Bioabsorbable Polymer Everolimus-Eluting Synergy Stents in High-Risk Patients Undergoing Complex Percutaneous Coronary Intervention With Early Discontinuation of Dual-Antiplatelet Therapy

AIMS

As more elderly and co-morbid patients require percutaneous revascularization, 1 year of dual-antiplatelet therapy (DAPT) becomes concerning. Synergy stents (Boston Scientific) allow for early cessation of DAPT. This study assessed those in our unit who underwent percutaneous coronary intervention (PCI) with a Synergy stent to examine a minimum of 6 months of clinical outcomes after early discontinuation of DAPT.

METHODS AND RESULTS

All non-trial patients in our unit who had PCI with a Synergy stent from August 2013 to February 2016 were retrospectively analyzed. Follow-up was by medical record review or direct contact for postprocedural complications or adverse events. In total, 185 patients underwent PCI with a Synergy stent over 1 year prior. The mean patient age was 72.0 ± 11.0 years (range, 41-97 years). Stenting involved left main stem (14.1%), multivessel disease (33.0%), and chronic total occlusion (33.0%). DAPT discontinuation occurred in 78.4% by 3 months with no stent thrombosis. Three patients required target-vessel revascularization (TVR) by 1 year. There were no cardiac deaths or myocardial infarctions. Twenty-five patients were able to have non-cardiac procedures within the study period.

CONCLUSION

The use of the Synergy everolimus-eluting stent allows for early discontinuation of DAPT, reducing risk of bleeding complications and facilitating non-cardiac procedures, without an increase in stent thrombosis and with excellent results for TVR.

Beneficial effect of a polyphenol-rich diet on cardiovascular risk: a randomised control trial

OBJECTIVES

There is previous epidemiological evidence that intake of polyphenol-rich foods has been associated with reduced cardiovascular disease risk. We aimed to investigate the effect of increasing dietary polyphenol intake on microvascular function in hypertensive participants.

METHODS

All participants completed a 4-week run-in phase, consuming <2 portions of fruit and vegetables (F&V) daily and avoiding berries and dark chocolate. Subjects were then randomised to continue with the low-polyphenol diet for 8 weeks or to consume a high-polyphenol diet of six portions F&V (including one portion of berries/day and 50 g of dark chocolate). Endothelium-dependent (acetylcholine, ACh) and endothelium-independent (sodium nitroprusside) vasodilator responses were assessed by venous occlusion plethysmography. Compliance with the intervention was measured using food diaries and biochemical markers.

RESULTS

Final analysis of the primary endpoint was conducted on 92 participants. Between-group comparison of change in maximum % response to ACh revealed a significant improvement in the high-polyphenol group (p=0.02). There was a significantly larger increase in vitamin C, carotenoids and epicatechin in the high-polyphenol group (between-group difference p<0.001; p<0.001; p=0.008, respectively).

CONCLUSIONS

This study has shown that increasing the polyphenol content of the diet via consumption of F&V, berries and dark chocolate results in a significant improvement in an established marker of cardiovascular risk in hypertensive participants.

TRIAL REGISTRATION NUMBER

NCT01319786.

Clinical Impact of Stent Design

The introduction and widespread adoption of drug-eluting stents into routine clinical practice has seen tremendous changes in the practice of interventional cardiology. For a prolonged period, manufacturers have focused research on drugs and polymers that are the key to the prevention of in-stent restenosis. However, stent platform design and its clinical implications have now come back to the fore. This has occurred for numerous reasons, but has primarily been driven by the need for modern stents to perform well in increasingly demanding clinical scenarios. This paper reviews the historical evolution of stent platform design. Current manufacturing processes and materials are also explored. Geometric stent construction and its implications for longitudinal stability and the longer term risks of stent fracture are reviewed. Finally, the implications of the specific stent chosen for different clinical applications including the treatment of bifurcations and left main disease are also summarised. This article will familiarise cardiologists with the crucial impact of each of these factors on modern day practice, as well as acute and long-term outcomes for patients.

Clinical Impact of Stent Design

The introduction and widespread adoption of drug-eluting stents into routine clinical practice has seen tremendous changes in the practice of interventional cardiology. For a prolonged period, manufacturers have focused research on drugs and polymers that are the key to the prevention of in-stent restenosis. However, stent platform design and its clinical implications have now come back to the fore. This has occurred for numerous reasons, but has primarily been driven by the need for modern stents to perform well in increasingly demanding clinical scenarios. This paper reviews the historical evolution of stent platform design. Current manufacturing processes and materials are also explored. Geometric stent construction and its implications for longitudinal stability and the longer term risks of stent fracture are reviewed. Finally, the implications of the specific stent chosen for different clinical applications including the treatment of bifurcations and left main disease are also summarised. This article will familiarise cardiologists with the crucial impact of each of these factors on modern day practice, as well as acute and long-term outcomes for patients.

A carotid artery aneurysm with a twist: case report and review

BACKGROUND

Since their original description in 1687, aneurysms of the extracranial internal carotid artery (ICA) remain rare and account for less than 2% of all carotid operations (Zwolak et al. in: J Vasc Surg 1:415-422, 1984; El-Sabrout, Cooley in: J Vasc Surg 31:702-712, 2000). Cerebrovascular morbidity and mortality rates remain high without intervention (Zwolak et al. in: Vasc Surg 1:415-422, 1984).

CASE REPORT

We report an unusual case of a saccular extracranial ICA aneurysm associated with kinking of the ICA and highlight the potential complications and risks associated with such an extreme anatomical deformation.

CONCLUSION

Extracranial ICA aneurysm can be associated with unusual anatomical variations which can lead to unstable clinical symptomatology due to the variable presence of atherosclerotic material. Despite advances in diagnosis and treatment, surgical repair is not without risks and patients need to be informed of the potential complications.