Meditation Reduces Sympathetic Activation and Improves the Quality of Life in Elderly Patients with Optimally Treated Heart Failure: A Prospective Randomized Study

OBJECTIVE

We tested whether meditation can reduce sympathetic activation, evaluated by norepinephrine blood levels (NE), and improve quality of life in elderly persons with congestive heart failure (CHF).

DESIGN AND SETTING

This was a prospective, randomized study conducted from April 2000 to October 2001 in an ambulatory care teaching hospital in São Paulo, Brazil.

SUBJECTS

We studied 19 patients with CHF, 74.8 +/- 6.7 years old, receiving diuretics, optimal doses of an angiotensin-converting enzyme inhibitor or angiotensin II inhibitor, maximum tolerated carvedilol dose (23.1 +/- 13.6 mg) and spironolactone 25 mg (10 patients).

INTERVENTIONS

After 2 months of optimal treatment with carvedilol, patients were randomized into two groups. The meditation group (M) was provided an audiotape, 30 minutes long, to listen to at home, twice a day, for 12 weeks, plus a weekly meeting. The control group (C) just had weekly meetings.

MAIN OUTCOME MEASURES

We determined before and after 14 +/- k1 weeks, NE (in pg/mL); quality of life with the Minnesota Living with Heart Failure Questionnaire (MLWHFQ); VO2 and VE/VCO2 slope by cardiopulmonary exercise testing; left ventricular ejection fraction (LVEF), and left ventricular end-diastolic volume index (LVDDi) measured by echocardiography.

RESULTS

Meditation reduced NE (mean +/- SEM) from 677.7 +/- 96.6 to 387.1 +/- 39.1 pg/mL (p = 0.008) in M versus 491.4 +/- 35.9 to 470.6 +/- 31.2 (p = 0.34) in C; improved MLWHFQ total score (mean +/- SEM) from 33.2 +/- 6.6 to 21.6 +/- 6.8 points (p = 0.02) in M versus 18.4 +/- 8.0 to 25.1 +/- 8.9 (p = 0.41) in C; and reduced the VE/VCO2 slope (mean +/- SEM) from 31.2 +/- 3.0 to 28.2 +/- 2.6 (p = 0.04) in M versus 28.4 +/- 2.7 to 28.8 +/- 2.6 (p = 0.24) in C. No changes occurred in LVEF, LVDDi, and VO(2).

CONCLUSIONS

In elderly patients with optimally treated CHF, meditation reduced NE, improved quality of life, and reduced the VE/VCO(2) slope. Our results support the possible role of meditation as a new hope in the treatment of CHF.

Risk factors for atherosclerosis in an elderly outpatient population in the city of São Paulo

OBJECTIVE

To analyze in out clinic elderly patients of both sexes for the prevalence of risk factors for atherosclerosis and study their association with the complications of atherosclerosis.

METHODS

Five hundred and sixteen outpatients, 152 men and 364 women, 60 years or older, were studied. The prevalences of hypertension, dyslipidemia, diabetes mellitus, cigarette smoking and obesity were determined in both sexes and compared using the chi-square test. The association between these factors and the presence of atherosclerotic complications was analyzed by logistic regression.

RESULTS

The comparative analysis of the factors in both sexes showed that hypertension, total cholesterol > or = 240 mg/dL, LDL-cholesterol > or = 160 mg/dL, and body mass index > 27.5 were more frequent among women, but HDL-cholesterol < 35 mg/dL and cigarette smoking were more frequent among men, and no difference occurred between sexes in relation to the frequency of triglycerides > or = 250 mg/dL and diabetes mellitus. After adjustment of the variables in the regression model, we observed that in the total of elderly patients, risk factors for complications of atherosclerosis were: triglycerides > or = 250 mg/dL, hypertension, and male sex. Among men, the risk factors were: LDL-cholesterol > or = 160 mg/dL, diabetes mellitus, HDL-cholesterol < 35 mg/dL and hypertension. Among women, the risk factors were: triglycerides > or = 250 mg/dL and hypertension.

CONCLUSION

The results showed that, in the elderly, the risk factors for atherosclerosis persist, but with different behaviors between men and women. The study suggests that the relative importance of the risk factors can change with the aging process.

[Chronic atrial fibrillation in the elderly]

PURPOSE

To evaluate the different aspects of chronic atrial fibrillation (CAF) in elderly patients.

METHODS

Forty nine patients with CAF (18 men) aged 66 to 87 years (76.1 years on average) were studied. Their evaluation consisted of clinical examination, blood tests, electrocardiogram, chest X-Ray and echocardiogram.

RESULTS

The frequency of CAF in the out-patient Geriatric Clinic was 4.8% and it rose with aging. Cardiocirculatory diseases were observed in 39 (79.6%) patients: 25 (51.0%) had systemic arterial hypertension, 11 (22.4%) had mitral valve disease and six (11.2%) had aortic valve disease. Thirty patients had diseases of other systems, eight (16.3%) of whom were diabetic and seven (14.3%) had hyperthyroidism. Vascular brain disease was observed in four (8.2%) patients. Electrocardiographic changes other than CAF were observed in 41 (83.7%) patients. Changes in the ST-T segment were the more frequent, being observed in 28 (57.1%) patients, followed by left ventricular hypertrophy in 15 (30.1%). Cardiomegaly was seen in 36 (78.3%) out of 46 patients who did the chest radiography. An echocardiogram was performed in 35 patients, being found normal in seven (20.0%). In the remaining cases, the abnormality more frequently seen was the left atrial enlargement, seen in 16 (45.7%) patients. Four patients didn't show clinical, electrocardiographic, radiological or echocardiographic evidence of cardiocirculatory disease and in these, the thyroid function was normal. Digitalis therapy was used in 37 patients. Of the remaining 12, 10 had normal ventricular frequency without the use of the drug.

CONCLUSION

The CAF in the elderly patient is observed not only in patients with cardiocirculatory diseases, but in thyrotoxic patients and sometimes without known etiology.

[Megaloblastic anemia in the elderly]

From 1974 to 1984, the authors reviewed the clinical records of 20 elderly patients (10 male) at the Clinics Hospital of the School of Medicine of the University of São Paulo, who were admitted with megaloblastic anemia. Ages varied from 62 to 84 (mean 70.4 years). Clinical conditions was varied and usually severe, major systems affected being the hematologic, cardiocirculatory, neurologic, and digestive. Among hematological findings the most common were anemia with elevated cell volume, high neutrophil segmentation rate, leukopenia, thrombocytopenia and hemolysis. Pathological findings were present in all cases where endoscopy and gastric biopsy were performed. Clinical and hematological conditions were similar in patients with folic acid or vitamin B12 deficiency. 19 patients (90.0%) responded to therapy in an usually prompt and clear manner, however some neurological signs may persist. On the other hand, untreated patients may become seriously ill and even die due to cardiac, hemorrhagic, or infectious complications.

[The importance of mitral calcification in the elderly]

The echocardiographic study of 480 patients over 60 years (medium age: 75.4) revealed 37 (33 women) of them having mitral calcification (MC). The analysis of clinical and metabolic data of these 37 patients plus their electro, phono and echocardiographic assessment revealed: 1) MC was observed in 7.7% of this elderly population and its incidence tended to increase with age; 2) MC was more frequent and more pronounced in women; 3) cardiocirculatory abnormalities responsible for a high systolic pressure in the left ventricle, such as hypertension (64.9%) and aortic stenosis (10.8%) were the most commonly associated cardiac pathologies; 4) no history of illnesses usually aggressive to the mitral valve was detected; 5) plasma lipids and calcium were normal; 6) in 27.0% of patients with MC there was some degree of mitral stenosis and/or insufficiency and surgical correction has been considered in some cases; 7) changes in production and/or conduction properties were frequent, causing bradyarrhythmias, tachyarrhythmias and intraventricular block. Taking these points into consideration, a careful follow-up of confirmed cases is suggested, in order to detect and treat any complications without delay.