Abstract 4607: Lycopene Intake Predicts Event-Free Survival in Patients with Heart Failure

Background: Higher intake of the dietary carotenoid lycopene may be beneficial for heart disease. A main source of lycopene is processed tomato products, which are high in sodium. Increased dietary sodium intake is a primary reason for heart failure (HF) exacerbation and may counter the positive effects of lycopene. Purpose: To determine whether lycopene intake stratified by sodium intake predicts event-free survival. Methods: Detailed 4-day food diaries were kept by 149 HF pts (age 60 ± 12, 38% female). A registered dietitian reviewed the diaries with pt to verify serving sizes and preparation methods. Nutrient analysis was performed using Nutrition Data System software ™ . Pts were stratified into 2 groups by sodium intake based on the median of 2913 mg. Outcomes were then compared in these strata by 2 groups of lycopene intake formed by the median intake of the sample (2624 mcg). Kaplan Meier and Cox regression survival techniques were used to detect differences in event-free survival (survival free of HF or cardiac hospitalization) between lycopene groups in the 2 sodium strata. Results: High lycopene compared to low lycopene intake was associated with greater event free survival. (p=.012, figure ). This finding held in both sodium strata, although the best event-free survival was in the high lycopene group with the low sodium intake (p=.019). High lycopene intake was a predictor of event-free survival after controlling for age, gender, NYHA and EF (p=.014). Conclusion: These findings suggest the naturally occurring antioxidant lycopene has the potential for substantial impact on event free survival rates in HF pts, but its positive effect is attenuated by high sodium intake.

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P4540Obesity in patients with heart failure and without diabetes mellitus is associated with longer event-free survival only among those with high dietary sodium intake

European Heart Journal ◽

10.1093/eurheartj/ehz745.0931 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

Z Saleh ◽

T Lennie ◽

D Moser

Keyword(s):

Diabetes Mellitus ◽

Sodium Intake ◽

Dietary Sodium ◽

Obese Patients ◽

Event Free Survival ◽

Free Survival ◽

High Sodium ◽

High Sodium Intake ◽

Low Sodium ◽

Patients With Heart Failure

Abstract Background Obesity is paradoxically associated with better short- and long-term outcomes in patients with heart failure (HF) and without diabetes mellitus (DM). While excessive dietary sodium intake is common among obese persons, its impact on the association between obesity and outcomes has not been considered. Aim To determine whether dietary sodium intake levels would affect the association between obesity and better outcomes in patients with HF and without DM. Method A sample of 129 patients (age 60±12.4 years; 30% female) provided a single 24-hour urine collection sample to estimate dietary sodium intake. Patients were divided into 4 groups based on body mass index (BMI) and the sodium intake recommendation for HF of 3g/day (obese with high sodium intake [n=41; 32%], obese with low sodium intake [n=16; 12%], non-obese with high sodium intake [n=35; 27%], and non-obese with low sodium intake [n=37; 29%]). Patients were followed-up during an average period of 395 days to determine time to first event of all-cause hospitalization or death. Cox regression was used to determine the association between obesity and outcomes in the context of sodium intake after controlling for age, gender, NYHA class (I II vs. III IV) and LVEF. Results There were 41 patients (31.8%) who had an event of all-cause hospitalization or death. Obese patients with high sodium intake had 61% lower risk for events than those non-obese with low dietary sodium intake (figure). There were no differences in the event-free survival among other groups. Conclusion These data suggest that dietary sodium intake may be particularly important for obese patients with HF and without DM.

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High Dietary Sodium Intake is Associated with Shorter Event-Free Survival in Patients with Heart Failure and Comorbid Diabetes

Clinical Nursing Research ◽

10.1177/1054773819888743 ◽

2019 ◽

pp. 105477381988874 ◽

Cited By ~ 3

Author(s):

Zyad T. Saleh ◽

Terry A. Lennie ◽

Abdullah S. Alhurani ◽

Issa M. Almansour ◽

Hamza Alduraidi ◽

...

Keyword(s):

Heart Failure ◽

Cox Regression ◽

Left Ventricular ◽

Dietary Sodium ◽

Left Ventricular Ejection ◽

Event Free Survival ◽

Urine Sodium ◽

Ventricular Ejection Fraction ◽

Free Survival ◽

Patients With Heart Failure

The aim was to determine whether 24-hour urine sodium excretion predicted event-free survival of patients with heart failure (HF) and diabetes mellitus (DM). Twenty-four hour urine sodium, as an indicator of dietary sodium, was collected from 107 patients with HF and comorbid DM. Patients were followed for a median period of 337 days to determine time to the first event of either all-cause hospitalization or cardiac-related mortality. There were 44 patients (41%) who had an event of death or hospitalization. Cox regression showed that higher urine sodium (>3.8 gm/day) was associated with 2.8 times greater risk for an event than lower urine sodium after controlling for age, gender, New York Heart Association class (I/II vs. III/IV), left ventricular ejection fraction, and body mass index. These data suggest that dietary sodium restriction may be beneficial for patients with HF and DM.

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Dietary sodium restriction below 2 g per day predicted shorter event-free survival in patients with mild heart failure

European Journal of Cardiovascular Nursing ◽

10.1177/1474515113517574 ◽

2013 ◽

Vol 13 (6) ◽

pp. 541-548 ◽

Cited By ~ 17

Author(s):

Eun Kyeung Song ◽

Debra K Moser ◽

Sandra B Dunbar ◽

Susan J Pressler ◽

Terry A Lennie

Keyword(s):

Heart Failure ◽

Sodium Intake ◽

Nyha Class ◽

Heart Association ◽

Dietary Sodium ◽

Sodium Restriction ◽

Class Iii ◽

Event Free Survival ◽

Food Diary ◽

Free Survival

Background: Despite a growing recognition that a strict low sodium diet may not be warranted in compensated heart failure (HF) patients, the link between sodium restriction below 2 g/day and health outcomes is unknown in patients at different levels of HF severity. Purpose: The purpose of this study was to compare differences in event-free survival among patients with <2 g/day, 2–3 g/day, or >3 g/day sodium intake stratified by New York Heart Association (NYHA) class. Method: A total of 244 patients with HF completed a four-day food diary to measure daily sodium intake. All-cause hospitalization or death for a median of 365 follow-up days and covariates on age, gender, etiology, body mass index, NYHA class, ejection fraction, total comorbidity score, the presence of ankle edema, and prescribed medications were determined by patient interview and medical record review. Hierarchical Cox hazard regression was used to address the purpose. Results: In NYHA class I/II ( n=134), patients with <2 g/day sodium intake had a 3.7-times higher risk ( p=0.025), while patients with >3 g/day sodium intake had a 0.4-times lower risk ( p=0.047) for hospitalization or death than those with 2–3 g/day sodium intake after controlling for covariates. In NYHA class III/IV ( n=110), >3 g/day sodium intake predicted shorter event-free survival ( p=0.044), whereas there was no difference in survival curves between patients with <2 g/day and those with 2–3 g/day sodium intake. Conclusion: Sodium restriction below 2 g/day is not warranted in mild HF patients, whereas excessive sodium intake above 3 g/day may be harmful in moderate to severe HF patients.

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Abstract 5961: Defining An Evidence-Based Cutpoint for Medication Adherence in Heart Failure

Circulation ◽

10.1161/circ.118.suppl_18.s_1039-a ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Jia-Rong Wu ◽

Terry A Lennie ◽

Marla J De Jong ◽

Mary Kay Rayens ◽

Misook L Chung ◽

...

Keyword(s):

Heart Failure ◽

Medication Adherence ◽

Cox Regression ◽

Enzyme Inhibitor ◽

Roc Curves ◽

Evidence Based ◽

List Type ◽

Medication Regimen ◽

Event Free Survival ◽

Free Survival

Patients with heart failure (HF) are required to take multiple medications. Long-term adherence to the HF medication regimen is necessary in order to achieve better patient outcomes. Despite the importance of adherence, clinically relevant cutpoints for distinguishing the level of adherence associated with outcomes are unknown. The purpose of this study was to use outcomes (i.e., event-free) as a criterion to determine the level of medication adherence required to achieve the best clinical outcomes. The specific aim was to determine the cutpoint above which there is a positive relationship between level of medication adherence and outcomes. This was a longitudinal study of 135 patients with HF. Medication adherence was measured using a valid and objective measure, the Medication Event Monitoring System (MEMS). Two indicators of adherence were assessed by the MEMS: dose-count, percentage of prescribed doses taken and dose-days, percentage of days correct number of doses taken. Patients were followed up to 3.5 years to collect data on outcomes. A series of Kaplan-Meier plots with log-rank tests, Cox-survival analyses, and receiver operating characteristic (ROC) curves were assessed comparing event-free survival in patients divided at one point incremental cutpoints. Event-free survival was significantly better when the prescribed number of doses taken [dose-count] or the correct dose [dose-day]) was ≥ 88%. This level was confirmed in a Cox regression model controlling for age, gender, ejection fraction, NYHA, comorbidity, angiotensin-converting enzyme inhibitor use, and beta-blocker use. ROC curves showed that adherence rates above 88 – 89% produced the optimal combination of sensitivity and specificity with respect to predicting better event-free survival. With this as the adherence cutpoint, patients in the nonadherent group were 2.2 times (by dose-count) to 3.2 times (by dose-day) more likely to experience a first event ( p = .021 and .002, respectively), compared to patients in the adherent group. The results of this study provide clinicians and researchers with an evidence-based recommendation about the level of adherence needed to achieve the best outcomes.

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Abstract 15644: Proinflammatory Diet Independently Predicts Shorter Event-free Survival in Patients With Heart Failure

Circulation ◽

10.1161/circ.142.suppl_3.15644 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Junghee Kang ◽

Debra K Moser ◽

Martha J Biddle ◽

Terry A Lennie

Keyword(s):

Heart Failure ◽

Proportional Hazards ◽

Proportional Hazards Model ◽

Cox Regression ◽

Enzyme Inhibitor ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model ◽

Event Free Survival ◽

Free Survival ◽

Phone Calls

Introduction: Inflammation is a common biological process accompanying chronic conditions, such as heart failure (HF) that can be moderated by diet. The association between foods thought to promote inflammation and event-free survival in patients with HF has not been investigated. Hypothesis: The inflammatory potential of individuals’ diets, measured using the dietary inflammatory index (DII), will be associated with event-free survival in patients with HF. Methods: The DII scores were calculated from 4-day food diaries recorded at baseline by 213 patients with HF (age 61±12years, 35% female, 43% NYHA III/IV). Patients were followed for a median of 365 days by monthly phone calls, medical record review, and death records to determine time to all cause-hospitalization or death. The DII scores were dichotomized using median value for the Cox regression model. Hierarchical multivariate Cox proportional hazards model was used to determine whether DII scores predicted event-free survival after controlling for age, gender, body mass index, prescribed angiotensin-converting-enzyme inhibitor, beta-blocker, cholesterol lowering agent, antiinflammatory agent, N-terminal pro B-type natriuretic peptide, comorbidity, depressive symptoms, and the New York Heart Association functional classification. Results: The DII scores independently predicted event-free survival in the model constant ( p = 0.012). Higher DII scores were associated with more than double the risk of an event compared to lower DII scores (HR: 2.28, 95% Confidence Interval =1.21-4.36). Conclusions: Greater intake of foods considered to promote inflammation was associated with shorter event-free survival in patients with HF. These results provide further evidence of the importance of diet to HF outcomes.

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Three Gram Sodium Intake is Associated With Longer Event-Free Survival Only in Patients With Advanced Heart Failure

Journal of Cardiac Failure ◽

10.1016/j.cardfail.2010.11.008 ◽

2011 ◽

Vol 17 (4) ◽

pp. 325-330 ◽

Cited By ~ 84

Author(s):

Terry A. Lennie ◽

Eun Kyeung Song ◽

Jia-Rong Wu ◽

Misook L. Chung ◽

Sandra B. Dunbar ◽

...

Keyword(s):

Heart Failure ◽

Sodium Intake ◽

Advanced Heart Failure ◽

Event Free Survival ◽

Free Survival

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African American Race Is Associated With Poorer Outcomes in Heart Failure Patients

Western Journal of Nursing Research ◽

10.1177/0193945916661277 ◽

2016 ◽

Vol 39 (4) ◽

pp. 524-538 ◽

Cited By ~ 2

Author(s):

Kelly L. Wierenga ◽

Rebecca L. Dekker ◽

Terry A. Lennie ◽

Misook L. Chung ◽

Kathleen Dracup

Keyword(s):

Heart Failure ◽

African American ◽

African Americans ◽

Health Care Disparities ◽

Cox Regression ◽

Functional Class ◽

Event Free Survival ◽

Free Survival ◽

Nyha Functional Class ◽

African American Race

Health care disparities associated with African American race may influence event-free survival in patients with heart failure (HF). A secondary data analysis included 863 outpatients enrolled in a multicenter HF registry. Cox regression was used to determine whether African American race was associated with shorter HF event-free survival after controlling for covariates. The multivariable-adjusted hazard ratios (95% confidence intervals [CI]) of older age (1.03, 95% CI = [1.01, 1.04]), New York Heart Association (NYHA) functional class (1.73, 95% CI = [1.29, 2.31]), depressive symptoms (1.05, 95% CI = [1.02, 1.07]), and African American race (1.64, 95% CI = [1.01, 2.68]) were predictors of shorter event-free survival (all ps < .05). Comparisons showed that NYHA functional class was predictive of shorter event-free survival in Caucasians (1.81, 95% CI = [1.33, 2.46]) but not in African Americans (1.24, 95% CI = [.40, 3.81]). African Americans with HF experienced a disparate risk of shorter event-free survival not explained by a variety of risk factors.

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Is socio-demographic status, body mass index, and consumption of food away from home associated with high sodium intake among adults in Malaysia?: findings from the Malaysian Community Salt Survey (MyCoSS)

Journal of Health Population and Nutrition ◽

10.1186/s41043-021-00236-z ◽

2021 ◽

Vol 40 (S1) ◽

Author(s):

Ruhaya Salleh ◽

Shubash Shander Ganapathy ◽

Norazizah Ibrahim Wong ◽

Siew Man Cheong ◽

Mohamad Hasnan Ahmad ◽

...

Keyword(s):

Body Mass Index ◽

Logistic Regression ◽

Body Mass ◽

Sodium Intake ◽

Daily Intake ◽

Dietary Sodium ◽

Cooking Methods ◽

High Sodium ◽

High Sodium Intake ◽

Meal Consumption

Abstract Background Studies have shown that having away from home meals contributes to high sodium intake among young people and those who lived in urban areas. This study aimed to determine the association between dietary sodium intake, body mass index, and away from home meal consumption behaviour among Malaysian adults. Methods MyCoSS was a cross-sectional household survey involving 1440 adults age 18 years and above. This study utilized stratified cluster sampling to obtain a nationally representative sample. Data was collected between October 2017 and March 2018. Socio-demographic information, dietary assessment using food frequency questionnaire (FFQ), and away from home meal consumption were assessed through a face-to-face interview by trained health personnel. Descriptive analysis and logistic regression were applied to identify the association of socioeconomic status and away from home meal consumption with dietary sodium intake. Results A total of 1032 participants completed the FFQ, with a mean age of 48.8 + 15.6 years. Based on the FFQ, slightly over half of the participants (52.1%) had high sodium intake. Results showed that 43.6% of participants consumed at least one to two away from home meals per day, while 20.8% of them had their three main meals away from home. Participants aged less than 30 years old were the strongest predictor to consume more sodium (adjusted OR: 3.83; 95%CI: 2.23, 6.58) while those of Indian ethnicity had significantly lower sodium intake. Surprisingly, having three away from home meals per day was not associated with high dietary sodium intake, although a significant association (crude OR; 1.67, 95% CI: 1.19, 2.35) was found in the simple logistic regression. Obese participants were less likely to have high dietary sodium intake compared with the normal BMI participants in the final model. Conclusion Over half of the participants consumed sodium more than the recommended daily intake, especially those who consumed three away from home meals. However, there was no significant association between high sodium intake and having three away from home meals per day. The promotion of healthy cooking methods among the public must continue to be emphasized to reduce the dietary sodium intake among Malaysian adults.

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