CLINICAL
NEWS JOURNAL WRAP
Foods associated with a decreased
risk of MACE in the analysis adjusted for treatment only were fruits,
vegetables, fish, alcohol, dairy food
and tofu/soybean. Consumption of
legumes, whole grains, sweetened
drinks, refined grains, desserts, sweet
snacks, and meat were not associated
with the risk of MACE. In fully adjusted models, fish and tofu/soybean
were the only food groups significantly associated with lower MACE.
The authors found that high Mediterranean diet scores were observed
in diverse geographic locations with
different dietary patterns, suggesting that these findings are broadly
applicable.
“These observations suggest
dietary guidelines for secondary prevention of CHD should focus more on
encouraging greater consumption of
‘healthy’ foods,” the authors conclude.
Stewart RA, Wallentin L, Benatar J, et al., on
behalf of the STABILITY Investigators. Eur
Heart J 2016;doi:10.1093/eurheartj/ehw125.
Reproductive Risk
Factors May Be
Associated with
Coronary Heart
Disease
Reproductive history—including age
at first birth, stillbirths and miscarriages, and breastfeeding—may be
associated with the development of
coronary heart disease (CHD) after
menopause, according to a recent
study published in Circulation.
Researchers, led by Nisha I.
Parikh, MD, MPh, used data from
the Women’s Health Initiative Observational Study for this analysis.
Multivariate models included age,
pregnancy status, number of live
births, age at menarche, menstrual
irregularity, age at first birth, stillbirths,
miscarriages, and infertility ≥ 1 year,
as well as traditional CHD risk factors.
Each candidate’s reproductive factor
was examined by adding the variable
to an established CHD risk factor
model. A final model was created
with the significant reproductive factors and the established CHD risk fac-
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CardioSource WorldNews
tors. Improvement in C-statistic, net
reclassification index (NRI) (or NRI
with risk categories of < 5%, < 5 to
< 10%, and ≥ 10% 10-year CHD risk),
and integrated discriminatory index
were assessed.
Among 72,982 women with a
median follow-up of 12 years, 4,607
CHD events occurred. Mean age of
the participants was 63.2 years. After
adjustment for established CHD risk
factors, younger age at first birth,
number of still births, number of
miscarriages, and lack of breastfeeding were positively associated with
CHD. Reproductive factors modestly
improved model discrimination, with
an increase in the C-statistic from
0.726 to 0.73 (p < 0.0001). Net
reclassification for women with CHD
events was not improved (NRI events
= 0.007, p = 0.18). Among women
without events, net reclassification
was marginally improved (NRI events
= 0.002, p = 0.04).
Parikh and colleagues concluded
that key reproductive factors are
associated with CHD events, independent of established CHD risk factors.
Model discrimination improved modestly with the addition of reproductive
factors; however, net reclassification
did not improve for women who experienced CHD events.
Parikh NI, Jeppson RP, Berger JS, et al.
Circulation. 2016;doi:10.1161/CIRCULATIONAHA.115.017854
High Rates of
Sleep-disordered
Breathing Reported
in Acute Ischemic
Stroke Patients
Almost 90% of acute ischemic stroke
patients were found to have sleep-disordered breathing and a third suffered
severely in a recent study published
in Stroke.
This was a single-center prospective observational study with
consecutive stroke patients ages >18
years admitted within 24 hours of
an acute ischemic stroke. Excluded
were patients with prior sleep-disordered breathing or chronic pul-
monary disease. To diagnose sleep
apnea, all underwent a portable sleep
test in the hospital within 48 hours
of stroke, using a peripheral arterial
tonometry (PAT) device. Blood samples were obtained the morning after
stroke admission to measure tumor
necrosis factor, interleukin-6, and
plasminogen activator inhibitor-1
levels. Prevalence of sleep apnea was
defined as an apnea-hypopnea index
(AHI) ≥ 15 events/hour. Comparison
of sleep apnea patients was made to
those with an AHI < 15.
A total of 43 patients with acute
stroke were admitted during the study
period and 22 (55%) were found to
have sleep apnea. AHI ≥ 5 was found
in 86% of patients and severe obstructive sleep apnea (OSA) (AHI ≥ 30)
was found in 32.5% of patients.
Patients with OSA tended to
have a higher body mass index and
a higher prevalence of atrial fibrillation (AF) than those without OSA.
OSA was diagnos ed in eight of 11
stroke patients and five of six AF
patients. Blood pressure and stroke
severity and symptoms did not differ between patient groups.
Median AHI was 14.3, median
time spent in Spo2 < 90% (T90 score)
was 0.4 and inter quartile range was
0.1 to 4.9 with 41.9% have T90 score
> 1. Patients with small vessel stroke
had higher T90 score than cardio
embolic or patients with large vessel
stroke. Sleep-disordered breathing
was associated with increased levels
of plasminogen activator inhibitor-1,
interleukin-6 and tumor necrosis
factor. The authors found a correlation between AHI and indicators of
inflammation and coagulability. These
increased levels of inflammation
The findings
[...] stress the
importance of this
pathophysiological
pathway in stroke
development.
biomarkers possibly provide evidence
for the cause of OSA.
The authors acknowledge that
this was a single-institute study with
a small sample size are limitations
of the study. Because the sleep-disordered breathing was not formally
assessed before the hospitalization for
stroke, causality or even temporality
between OSA and stroke cannot be
answered. However, the authors write
that the findings of a high prevalence
of sleep-disordered breathing with
evidence of the associated elevation of
the inflammatory and procoagulation
biomarkers stress the importance of
this pathophysiological pathway in
stroke development. ■
Ifergane G, Ovanyan A, Toledano
R, et al. Stroke. 2016;doi:10.1161/
STROKEAHA.115.011749
June 2016