Cardiovascular Disease in the News
| Geriatric Times |
 |
January/February 2002 |
|
Vol. III |
|
Issue 1 |
Legume Consumption May Reduce Risk of Coronary Heart Disease
There is abundant research linking consumption of legumes (such as dry
beans, peas or peanuts) to a reduced risk of coronary heart disease (CHD).
However, most of the research has focused on the nutritional components of
legumes, such as protein and fiber, rather than dietary patterns. A study in
Archives of Internal Medicine (2001;161[21]:2573-2578) is one of the
first to examine the relationship between increased legume consumption and risk
of CHD.
Lydia A. Bazzano, Ph.D., and colleagues studied 9,632 patients over 19
years, documenting the frequency of legume intake over three-month intervals.
The incidence of CHD and cardiovascular disease (CVD) was determined at
follow-up based on hospital records, patient interviews or death
certificates.
The researchers found that patients who consumed more legumes had, on
average, lower systolic blood pressure and lower total cholesterol and body
mass index than those who consumed fewer legumes. In addition, those who
consumed legumes at least four times a week had a 22% and 11% lower risk of CHD
and CVD, respectively, than those who ate legumes less than once a week.
Inter-estingly, those who ate legumes frequently were also more likely to be
physically active, smoke and consume more saturated fats than their
counterparts.
The researchers stressed the importance of their study in terms of
evaluating food items as part of an overall dietary pattern: "It may be more
instructive and useful to investigate the relationship between dietary patterns
or specific food intakes and risk of CHD events because the results of such
studies may have more direct public health implications" -- TB
Risk for Morbidity and Mortality in Depressed Post-MI Patients
Approximately one in six patients recovering from myocardial infarction (MI)
experiences major depression, and at least twice as many have significant
symptoms of depression soon after the event (JAMA
2001;286[13]:1621-1627). Cardiac rehabilitation programs and increasing levels
of social support may help improve symptoms and should be recommended to all
patients.
Recent data show that psychosocial factors, such as lack of social support
and depression, are important predictors of morbidity and mortality in patients
with coronary heart disease. The studies suggest that interventions which
provide support and/or alleviate depression in patients recovering from MI may
enhance their psychosocial recovery and decrease morbidity and mortality. To
the extent that intervention can be shown to impact favorably on survival and
recovery in patients who have experienced MI, the human and financial burden
associated with heart disease can be reduced.
To substantiate whether or not treating depression can reduce morbidity or
mortality, the National Heart, Lung, and Blood Institute sponsored the
Enhancing Recovery in Coronary Heart Disease Patients (ENRICHD) study. The
multicenter, randomized clinical trial investigated the effects of a
psychosocial intervention on mortality and nonfatal MI in 2,481 patients who
have had an acute MI and who were depressed or had low perceived social
support. "Previous studies show that people who are the most isolated or
depressed are about three times as likely to die after a heart attack as are
people who are not depressed or have many more connections to other people,"
Lisa Berkman, Ph.D., chair of ENRICHD, told the press.
"About 25% to 30% of patients experience social isolation or depression or
both following a heart attack. When you combine such a substantial risk with a
very common problem, there is an urgent need to think about solutions for it,"
Berkman added.
The results of the study, presented at the American Heart Association's
Scientific Sessions 2001 meeting, found no significant differences in clinical
endpoints, although a statistically significant improvement in depression and
low social support was observed. Researchers speculated that one reason for
this finding was that the intervention may not have been delivered as
effectively as intended: many patients may have lacked readiness or motivation
or were unable to participate fully in therapy. Further research is needed to
identify the most effective modalities and optimal timing for treating
depression and poor social support, especially in medically vulnerable
populations -- AV
Benefits of Aggressive Treatment May Outweigh Risks
Physicians have often been reluctant to take aggressive action when treating
heart-related disease in high-risk patients and patients older than 75 years,
citing such reasons as drug-drug interactions, the inevitability of blood
vessel disease and the severe side effects the elderly are likely to suffer
following heart surgery. Two recent studies may change this viewpoint and the
way physicians treat their oldest patients.
In research supported by the National Institute on Aging and the National
Heart, Lung, and Blood Institute, researchers in Florence, Italy, reviewed data
from the Systolic Hypertension in the Elderly Program (SHEP) (Circulation
2001;104[16]:1923-1926). Using a risk-assessment tool developed by the American
Heart Association, researchers calculated the risk of future heart attacks,
stroke and heart failure in 4,453 SHEP participants older than 60 years. All
participants had systolic blood pressure readings of at least 160 mmHg and were
treated with either diuretics or ß-blockers to bring pressure within
normal limits.
The researchers found that the patients who were at highest risk -- those
who smoked, had diabetes or high cholesterol -- received the greatest benefit
from treatment, compared to those at lower risk; in fact, treating such
patients was four times more effective than treating the low-risk group. "These
patients," the researchers wrote, "are prime targets for antihypertensive
treatment."
Revascularization therapy has provided symptom relief for patients with
symptomatic chronic coronary-artery disease, but findings have been based on
middle-aged populations. Investigators of the trial of invasive versus medical
therapy in elderly patients with chronic symptomatic coronary artery disease
(TIME) set out to compare the quality of life and outcome of elderly patients
(75 years and older) after either medical or revascularization therapy (Lancet
2001; 358:951-957). Researchers assigned 150 patients to medical therapy and
155 to invasive therapy. After six months, both groups experienced a decrease
in angina severity and an increase in quality of life (measures were general
health, bodily pain, vitality, Duke activity score index, Rose score, angina
pectoris class and number of anginal medications). The investigators reported,
however, that the improvements were significantly greater in patients who had
undergone revascularization therapy and concluded that even the elderly with
angina benefit more from revascularization than from optimised medical therapy
and should be offered invasive assessment despite their high-risk profiles --
MB