Association of dietary factors with severity of coronary artery disease

Dietary Adequacy of Individuals with Cardiovascular Disease According to Clinical Guidelines in the Brazilian Cardioprotective Nutritional (BALANCE)

BACKGROUND

Achieving nutritional goals established by scientific societies is a constant challenge and not always achieved.

OBJECTIVE

To investigate the dietary adequacy of individuals with cardiovascular disease (CVD), participants in the Cardioprotective Brazilian Food Program residing in the Northeast region of Brazil, according to the recommendations of the Brazilian Society of Cardiology (SBC).

METHODS

Cross-sectional analysis with data from the study implementing the Brazilian Cardioprotective Diet (DICA BR), which evaluated individuals with CVD treated in specialized cardiovascular health centers in eight states in the Northeast region. Food consumption was obtained by 24-hour dietary records and dietary adequacy followed SBC recommendations. Values of p < 0.05 were considered significant.

RESULTS

647 patients were studied, with a mean (standard deviation) age of 63.1 (9.4) years, 50.2% of whom were female. When evaluating food intake, a low adequacy of carbohydrates (52.3%), proteins (70.9%), lipids (38.8%), and fiber (22.4%) was observed. It was observed that the majority of women consumed a low-protein diet (59.2%) and the elderly had a greater inadequacy in carbohydrate consumption (52.6%). Regarding sodium intake, men had a higher intake (72.9%), while the elderly showed a 13% reduction. Furthermore, it was shown that men ate more fiber (28.1%) and individuals with higher education had a high consumption of saturated fatty acids (70.5%).

CONCLUSIONS

Most individuals did not achieve the recommended dietary therapy goals for secondary cardiovascular prevention. The findings of the present study reinforce the need to implement structured strategies to encourage healthy eating habits in these individuals.

Association between dietary copper and cardiovascular disease: A narrative review

Cardiovascular disease (CVD) is a major cause of mortality and morbidity. Several studies have investigated the relationship between trace element status, including copper status, and CVDs in population studies; however, there are controversies about the role of dietary copper and CVD. We aimed to review the association between dietary copper intake with CVD and this association's related factors by reviewing both animal models and human studies. Some animal model studies have reported a strong relationship between dietary copper intake and atherogenesis based on the possible molecular pathways, whilst other studies have not confirmed this relationship. Human studies have not revealed a relationship between CVDs and dietary copper intake, but there is uncertainty about the optimal amount of dietary copper intake in relation reducing the risk of CVDs. These associations may be influenced by ethnicity, gender, underlying co-morbidities and the methods used for its measurement.

Relationship between Copper, Zinc, and Copper-to-Zinc Ratio in Hair and Severity of Coronary Artery Disease according to the SYNTAX Score

Coronary artery disease (CAD) continues to be a foremost contributor to global mortality, and the quest for modifiable risk factors could improve prophylactic strategies. Recent studies suggest a significant role of zinc (Zn) and copper (Cu) deficiency in atheromatous plaque formation. Furthermore, hair was previously described as a valuable source of information on elemental burden during the 6-8 week period before sampling. The aim of this study was to investigate the possibility of correlation between the extent of CAD evaluated with the SYNergy Between PCI With TAXUS and the Cardiac Surgery (SYNTAX) score with Cu and Zn content in hair samples, as well as with the Cu/Zn ratio in a cohort of 130 patients. Our findings describe a statistically significant inverse correlation between Cu content and the Cu/Zn ratio in hair samples and the extent of CAD. In contrast, no significant correlation was found between Zn content and the extent of CAD. Considering the scarcity of existing data on the subject, the analysis of hair samples could yield a novel insight into elemental deficiencies and their potential influence on CAD extent.

Resealable Antithrombotic Artificial Vascular Graft Integrated with a Self-Healing Blood Flow Sensor

Coronary artery bypass grafting is commonly used to treat cardiovascular diseases by replacing blocked blood vessels with autologous or artificial blood vessels. Nevertheless, the availability of autologous vessels in infants and the elderly and low long-term patency rate of grafts hinder extensive application of autologous vessels in clinical practice. The biological and mechanical properties of the resealable antithrombotic artificial vascular graft (RAAVG) fabricated herein, comprising a bioelectronic conduit based on a tough self-healing polymer (T-SHP) and a lubricious inner coating, match with the functions of autologous blood vessels. The self-healing and elastic properties of the T-SHP confer resistance against mechanical stimuli and promote conformal sealing of suturing regions, thereby preventing leakage (stable fixation under a strain of 50%). The inner layer of the RAAVG presents antibiofouling properties against blood cells and proteins, and antithrombotic properties, owing to its lubricious coating. Moreover, the blood-flow sensor fabricated using the T-SHP and carbon nanotubes is seamlessly integrated into the RAAVG via self-healing and allows highly sensitive monitoring of blood flow at low and high flow rates (10- and 100 mL min^-1, respectively). Biocompatibility and feasibility of RAAVG as an artificial graft were demonstrated via ex vivo, and in vivo experiment using a rodent model. The use of RAAVGs to replace blocked blood vessels can improve the long-term patency rate of coronary artery bypass grafts.

Major Dietary Patterns Relationship with Severity of Coronary Artery Disease in Gaza-Strip, Palestine: A Cross-Sectional Study

Background

The association of dietary patterns (DPs) linked to the severity of coronary artery disease (CAD) is little known. Therefore, this study aims to explore the relationship between major DPs and the severity of CAD.

Methods

This cross-sectional study was conducted among423 newly discovered CAD patients (both genders, aged 35–65 years), who underwent coronary angiography. The severity of CAD was assessed by the Gensini score. All patients were tested using a semi-quantitative food frequency questionnaire and other related data through face-to-face interviews. Factor analysis and logistic regression were applied by using SPSS version-24.

Results

By principal component analysis, two major DPs were identified: “Unhealthy” DP that characterized mainly by high intakes of sugar and sweets, soft drinks, salts, cooking oils, and processed meats, and “Healthy” DP that consisting high intakes of fruits, fish, poultry, vegetables, whole grains. After adjustment for confounding variables, the odds of severe CAD was significantly higher in the third (T3) and second (T2) tertile of the unhealthy pattern by 4.79 and 2.48 times more compared to the first tertile (T1) (OR 4.79; 95%CI 2.60, 8.83; P<0.001) and (OR 2.48; 95%CI 1.40, 4.39; P=0.002), respectively. However, the odds of CAD severity in the T3 and T2 of the healthy pattern was lowered by 0.24 and 0.38 times less compared to the T1 (OR 0.24; 95%CI 0.12, 0.47; P=0.002) and (OR 0.38; 95%CI 0.20, 0.73; P=0.006), respectively.

Conclusion

The severity of CAD was significantly increased by the unhealthy dietary pattern, while decreased by adherence to the healthy pattern.

Major dietary patterns and metabolic syndrome associated with severity of coronary artery disease: A structural equation modeling

BACKGROUND

The association of dietary patterns and metabolic syndrome with the severity of coronary artery disease (CAD) is little known.

AIM

This study aimed to explore the relationship between major dietary patterns and the severity of CAD among newly discovered patients by using structural equation modeling (SEM).

METHODS

In this cross-sectional study, we included 423 newly diagnosed patients with CAD, aged 35-65 years, who underwent coronary angiography. The severity of CAD was assessed by the Gensini score. All patients were tested by using a semi-quantitative food frequency questionnaire, international physical activity questionnaire, perceived stress scale, lipid profile, fasting blood glucose, and anthropometric and blood pressure measurements. Statistical analysis was performed using SPSS and AMOS version 24.

RESULTS

Two dietary patterns (DPs) were identified by principal components analysis and labeled as "unhealthy DP" and "healthy DP". The results of SEM analysis showed that the unhealthy DP has a significant positive direct association with the severity of CAD (β=0.304, p<0.001), which is indirectly mediated by the presence of metabolic syndrome (β=0.021, p=0.021), adjusted for age and perceived stress scale. However, healthy DP has a significant negative direct association with the Gensini score (β=-0.213, p<0.001), and an indirect association through negative metabolic syndrome (β=-0.019, p=0.022), controlled for gender, physical activity, and perceived stress scale.

CONCLUSIONS

The severity of CAD was directly associated with the unhealthy DP and indirectly mediated by the presence of the metabolic syndrome, while a healthy DP had a direct inverse association with CAD severity and indirectly mediated by the absence of metabolic syndrome.

Dietary protein is the strong predictor of coronary artery disease; a data mining approach

BACKGROUNDS

Coronary artery disease (CAD) is the major cause of mortality and morbidity globally. Diet is known to contribute to CAD risk, and the dietary intake of specific macro- or micro-nutrients might be potential predictors of CAD risk. Machine learning methods may be helpful in the analysis of the contribution of several parameters in dietary including macro- and micro-nutrients to CAD risk. Here we aimed to determine the most important dietary factors for predicting CAD.

METHODS

A total of 273 cases with more than 50% obstruction in at least one coronary artery and 443 healthy controls who completed a food frequency questionnaire (FFQ) were entered into the study. All dietary intakes were adjusted for energy intake. The QUEST method was applied to determine the diagnosis pattern of CAD.

RESULTS

A total of 34 dietary variables obtained from the FFQ were entered into the initial study analysis, of these variables 23 were significantly associated with CAD according to t-tests. Of these 23 dietary input variables, adjusted protein, manganese, biotin, zinc and cholesterol remained in the model. According to our tree, only protein intake could identify the patients with coronary artery stenosis according to angiography from healthy participant up to 80%. The dietary intake of manganese was the second most important variable. The accuracy of the tree was 84.36% for the training dataset and 82.94% for the testing dataset.

CONCLUSION

Among several dietary macro- and micro-nutrients, a combination of protein, manganese, biotin, zinc and cholesterol could predict the presence of CAD in individuals undergoing angiography.

The association between dietary patterns with severity of coronary artery stenosis, serum leptin-to-adiponectin ratio, and some related risk factors in patients with coronary artery disease

Background

This research aimed to investigate the association between dietary patterns with severity of coronary artery stenosis, serum leptin-to-adiponectin ratio, and some related risk factors in patients with coronary artery disease referred for coronary angiography.

Methods

This cross-sectional study was carried out on 191 men patients with known coronary disease aged 40-70 years whom were admitted to angiography ward of Ahvaz teaching hospital, Ahvaz, Iran. Dietary patterns were investigated using 161-item semi-quantitative food frequency questionnaire. Anthropometric indices; blood pressure; serum levels of adiponectin and leptin, blood levels of glucose, total cholesterol, HDL-C, LDL-C, and triglycerides were measured. Patients were categorized based on the severity of coronary artery disease [number of vessel involved-single (VD1), double (VD2), triple (VD3)].

Results

Three major dietary patterns were recognized using a factor analysis approach: western, healthy, and traditional patterns. Linear regression analysis demonstrated that there was a negative association between healthy dietary pattern with LDL-C, total cholesterol, and triglycerides. This dietary pattern was positively related to HDL-C. Both traditional and western dietary patterns were related to fasting blood glucose level and lipid profile. General obesity was positively associated with traditional and western dietary patterns. There was a positive relationship between central obesity with traditional and western dietary patterns, but a negative association was reported between the healthy dietary pattern and central obesity. Traditional and western dietary patterns demonstrated a significant positive relationship with serum leptin levels and ratio of L/A, and an inverse relationship with adiponectin. Healthy dietary pattern had a significant negative association with serum leptin levels and ratio of L/A. Healthy dietary pattern was negatively related to the severity of vessel stenosis. Patients in the third quartile of healthy dietary pattern were less likely to have vessel stenosis (OR = 43%, 95% CI: 0.07-0.87).

Conclusions

The findings show that adherence to a healthy dietary pattern was negatively associated with coronary artery stenosis and its related risk factors. However, adherence to western and traditional dietary patterns was positively related to coronary artery disease risk factors.

Causal effects of dietary calcium, zinc and iron intakes on coronary artery disease in men: G-estimation and inverse probability of treatment weighting (IPTW) analyses

BACKGROUND & AIMS

Dietary minerals have significant effects on the risk of cardiovascular disease. However, the results of previous studies were not uniform across different countries. The current study aims to determine the causal effects of dietary calcium, zinc, and iron intakes on coronary artery disease (CAD) among Nepalese men.

METHODS

A matched case-control study was carried out at Shahid Gangalal National Heart Center. Dietary intakes of 466 male participants over the past 12 months were evaluated using a semi-quantitative customized food frequency questionnaire. G-estimation and inverse probability treatment weighting (IPTW) analyses were performed to determine the causal odds of CAD due to dietary calcium, zinc, and iron intakes.

RESULTS

Daily dietary calcium, zinc, and iron intakes were categorized into two groups: less than versus more than the median value and less than versus equal or more than recommended daily allowance (RDA). In G-estimation, dietary calcium intake was inversely associated with CAD in both medians (OR: 91; 91%CI: 0.86, 95) and RDA categories (OR: 0.88: 95%CI: 0.84, 0.97). However, in IPTW analysis, only median calcium intake was significantly associated with CAD (OR: 7; 91%CI: 0.5, 98). We observed a significant inverse association of equal or more than RDA of dietary zinc intake with CAD (OR: 0.91: 95%CI: 0.87, 0.96 in G-estimation, OR: 0.73: 95%CI: 0.66, 0.82 in IPTW); however, more than median dietary zinc intake showed inverse but not significant association with CAD in both analyses. Dietary iron intake was inversely but not significantly associated with CAD in G-estimation in both groups. Nevertheless, in IPTW analysis, equal or more than RDA iron intake was significantly positively (OR: 1.4; 95%CI: 1.14, 1.73) related to CAD.

CONCLUSIONS

A significant inverse association of dietary zinc intake above RDA indicates the potential protective effect of higher dietary zinc against CAD. However, causal odds of CAD are inconsistent across the median or RDA of calcium and iron intakes. Therefore, cohort and randomized clinical trial studies with a large sample size are recommended to substantiate these nutrients' causal link with CAD development in the Nepalese population.

Major dietary patterns and food groups in relation to rheumatoid arthritis in newly diagnosed patients

BACKGROUND

Evidence suggests that dietary patterns might act as environmental triggers in the development of chronic disorders such as rheumatoid arthritis (RA). However, data regarding the relationship between food patterns and RA are still limited and conflicting. In the current study, the authors aim to evaluate a link between major dietary patterns and RA in new case patients.

METHODS

This study was conducted in a case-control manner on 50 patients with newly diagnosed RA and 100 healthy individuals living in Mashhad, Iran. The individuals' dietary intake was assessed using a validated food frequency questionnaire (FFQ). The major dietary patterns were identified using factor analysis based on data from FFQ. Multivariable-adjusted logistic regression models were used to measure the associations between patterns and RA.

RESULTS

Three major dietary patterns were identified. High-level adherence to Western pattern had a positive association with RA (multivariable-adjusted OR tertile 3 vs. 1:1.95; 95% CI: 1.09-3.92; p-trend: .046), while the healthy pattern was inversely related to RA (multivariable-adjusted OR tertile 3 vs. 1:0.12; 95% CI: 0.03-0.44; p-trend: .001). No significant association was observed between the traditional pattern and RA.

CONCLUSIONS

Our findings revealed that people with dietary behaviors close to the Western dietary pattern are more likely to develop the disease. However, adhering to healthy and well-balanced dietary patterns rich in whole grains, low-fat dairies, white meats, eggs, fruits, vegetables, tea, and vegetable oils was found to be inversely correlated with the risk of RA.

The implications of vitamin content in the plasma in reference to the parameters of carbohydrate metabolism and hormone and lipid profiles in PCOS

So far, there have been no analyses of correlations between the level of water-soluble vitamins in women with polycystic ovary syndrome (PCOS) and hormone and lipid profiles as well as carbohydrate metabolism. The unpopular concept that PCOS may also be conditioned by a chronic infection leads to a suspicion that water-soluble vitamins may be involved in the struggle against PCOS. This is why the aim of this research was to determine whether there are any indications that could confirm this hypothesis. The study included 64 women of Caucasian race: 50 patients aged 29.52 ± 7.01 years with PCOS, diagnosed according to the Rotterdam criteria. The control group consisted of 14 women aged 30.23 ± 6.3 years with correct BMI. HPLC Infinity1260 Binary LC (Agilent Technologies, Waldbronn, Germany) was used to analyze nine vitamins. The vitamins were separated using the gradient method, a buffer of 25 mM HK2PO4 with pH equal to 7.0, and 100 % methanol buffer. The acquired results were compared using Statistica 12.0 (Statsoft, Tulsa, Oklahoma, USA). Non-parametric tests were used: Mann-Whitney tests for comparisons between groups (PCOS and control group, CG), in which p < 0.05 was considered statistically significant. Subsequently, we performed a correlation matrix of the biochemical parameters of blood with vitamins at p ≤ 0.05. Higher concentrations of ascorbic acid were observed in PCOS. The content of the remaining vitamins was higher in the control group, and the statistical differences were significant in reference to thiamine, riboflavin, pyridoxine and folic acid in comparison to the control group. A significant positive correlation was observed between vitamin C and testosterone/insulin, another between riboflavin and androstenedione/testosterone, next between biotin and thyrotropic hormone (TSH), between pantothenic acid and dehydroepiandrosteron (DHEA-SO4), and finally between pyridoxine and androstenedione. A negative correlation was observed in the case of niacin with sex hormone binding protein (SHBG) and high density lipoprotein (HDL). Water-soluble vitamins play an important role in the therapy of women with PCOS through the reduction of antioxidative stress and low-intensity inflammation caused by various factors, including chronic infection.

Dietary Intakes Are Associated with HDL-Cholesterol in Survivors of Childhood Acute Lymphoblastic Leukaemia

Survivors of childhood acute lymphoblastic leukemia (cALL) are at high risk of developing dyslipidemia, including low HDL-cholesterol (HDL-C). This study aimed to examine the associations between food/nutrient intake and the levels of HDL-C in a cohort of children and young adult survivors of cALL. Eligible participants (n = 241) were survivors of cALL (49.4% boys; median age: 21.7 years old) recruited as part of the PETALE study. Nutritional data were collected using a validated food frequency questionnaire. Fasting blood was used to determine participants' lipid profile. Multivariable logistic regression models were fitted to evaluate the associations between intakes of macro- and micronutrients and food groups and plasma lipids. We found that 41.3% of cALL survivors had at least one abnormal lipid value. Specifically, 12.2% had high triglycerides, 17.4% high LDL-cholesterol, and 23.1% low HDL-C. Low HDL-C was inversely associated with high intake (third vs. first tertile) of several nutrients: proteins (OR: 0.27, 95% CI: 0.08-0.92), zinc (OR: 0.26, 95% CI: 0.08-0.84), copper (OR: 0.34, 95% CI: 0.12-0.99), selenium (OR: 0.17, 95% CI: 0.05-0.59), niacin (OR: 0.25, 95% CI: 0.08-0.84), riboflavin (OR: 0.31, 95% CI: 0.12-0.76) and vitamin B12 (OR: 0.35, 95% CI: 0.13-0.90). High meat consumption was also inversely associated (OR: 0.28, 95% CI: 0.09-0.83) with low HDL-C while fast food was positively associated (OR: 2.41, 95% CI: 1.03-5.63) with low HDL-C. The role of nutrition in the development of dyslipidemia after cancer treatment needs further investigation.

Coronary artery disease and body mass index: What is the relationship?

INTRODUCTION

Nowadays, obesity is considered an independent risk factor for the development of cardiovascular diseases (CVD), which has been presented as an important cause of worldwide morbidity and mortality, especially coronary artery disease (CAD). The objective of the study was to verify the association between body mass index (BMI) and severity of CAD, its risk factors and surgical and percutaneous treatment in patients hospitalized in cardiological units.

METHODS

An ambispective, cross-sectional study was performed with patients older than 18 years attended by nutrition in the cardiology units, who underwent coronary angiography. The severity of CAD was categorized into two distinct classifications (CAD Class I and II), considering the presence of CAD as lesions ≥50% and ≥70%. The nutritional status of the patient was established based on BMI according to the World Health Organization (WHO) for the total sample and group of adults, and according to the Pan American Health Organization (PAHO) for the elderly. Age, gender, presence of associated comorbidities, history of smoking, and performed procedures were collected in patients' records. For statistical analysis Kruskal Wallis and Chi-square tests were used, and Hodges-Lehmann estimate was used for the median. Comparisons and associations were considered significant when p < 0.05.

RESULTS

A total of 703 patients were included, of which 495 had arterial lesions ≥70% and 513 patients' lesions ≥50%. The average age was 61 years, women were older (63 vs 61; p = 0.008), had a higher BMI (28.16 kg/m² vs 26.68 kg/m², p = 0.001) and were more likely to have diabetes mellitus (DM) (p < 0.001), dyslipidemia (DSLP) (p < 0.001), and hypertension (HTN) (p = 0.001). The majority of the sample consisted of men, who more often underwent percutaneous coronary intervention (PCI) (53,9% vs 39%, p < 0.001), and were more likely to present more severe CAD (p < 0.001 and p = 0.003). In patients diagnosed with CAD the increase in BMI was positively associated with the presence of DM (p < 0.001), DSLP (p < 0.001) and HTN (p < 0.001), and negatively with age (p = 0.007). Patients with obesity III, were diagnosed with CAD, in average, 11 years earlier than patients with normal BMI (p = 0.05). Therefore, the higher the BMI, the lower the age at the moment of the examination in the total sample, and in the group of elderly, and this association was not found in adults. There was no significant association of BMI with the severity of CAD, or with PCI and coronary artery bypass grafting (CABG). The greater severity of CAD was positively associated with the presence of DM (p = 0.012 and p = 0.001), HTN (p = 0.033 and p = 0.003) and older age (p = 0.005 and p = 0.015). Patients who underwent CABG had a higher incidence of and HTN (p = 0.003), DM (p = 0.006), whereas patients who had PCI had a lower incidence of HTN (p = 0.021) and DM (p = 0.004).

CONCLUSION

Obesity was showed to be as an independent risk factor for the early incidence of CAD, which is strongly associated with the presence of comorbidities such as DM, HTN and DSLP. The greater severity of CAD and coronary interventions were associated with the presence of risk factors for CAD.