Abstract 15565: Long-term Dietary and Weight Changes Following a Short-term Dietary Intervention Study: 4-year Follow-up of the Evade Cad Trial

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Siddhant Dogra ◽  
Alec Getz ◽  
Kathleen Woolf ◽  
Jonathan D Newman ◽  
Yuhe Xia ◽  
...  
Keyword(s):  
Dietary Intervention ◽  
Self Report ◽  
Vegan Diet ◽  
Major Adverse Cardiovascular Events ◽  
Dietary Adherence ◽  
Weight Changes ◽  
Dietary Recall ◽  
Vegan Group

Introduction: The randomized EVADE CAD trial demonstrated greater reduction in high sensitivity C-reactive protein and LDL-cholesterol with a vegan vs. AHA-recommended diet in patients with coronary artery disease on guideline-directed medical therapy. The 8-week intervention included provision of groceries, cooking tools, and regular contact with a registered dietitian. Methods: Trial participants underwent telephone follow-up to obtain self-reported dietary adherence, 24-hour dietary recall, self-reported weight, and major adverse cardiovascular events (MACE). Supporting medical documents for MACE were reviewed by investigators. Results: Two participants in the vegan arm withdrew during the trial leaving 98 participants available for follow-up. The vegan group reported significantly lower dietary adherence at all follow-ups when compared to the AHA group; however, adherence rates were numerically higher in both groups when assessed by 24-hour dietary recall vs. self-report (F1A-B). The two groups did not differ in self-reported rating of the healthiness of their current diet (F1C). Both groups continued to have significantly lower weight when compared to baseline up to 3 years follow-up, but only the vegan group remained lower at year 4. Percent weight lost from baseline did not differ between groups. Cumulative MACE incidence also did not differ between groups (F2). Conclusions: Although the vegan diet was not sustainable long-term when compared to the AHA-recommended diet, both groups did not differ in self-reported rating of the healthiness of their current diet or incidence of MACE and had sustained weight loss after the active intervention was complete.

P6424The association between long-term beta-blocker use and outcome in a contemporary large-scale cohort of patients with acute myocardial infarction

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
C X Song ◽  
R Fu ◽  
J G Yang ◽  
K F Dou ◽  
Y J Yang
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Beta Blocker ◽  
Cardiovascular Events ◽  
Beta Blockers ◽  
Left Ventricular Ejection ◽  
Major Adverse Cardiovascular Events ◽  
Baseline Characteristics

Abstract Background Controversy exists regarding the use of beta-blockers (BBs) among patients with acute myocardial infarction (AMI) in contemporary reperfusion era. Previous studies predominantly focused on beta-blockers prescribed at discharge, and the effect of long-term adherence to beta-blocker on major adverse cardiovascular events (MACE) remains unclear. Objective To explore the association between long-term beta-blocker use patterns and MACE among contemporary AMI patients. Methods We enrolled 7860 patients with AMI, who were discharged alive and prescribed with BBs based on CAMI registry from January 2013 to September 2014. Patients were divided into two groups according to BBs use pattern: Always users group (n=4476) were defined as patients reporting BBs use at both 6- and 12-month follow-up; Inconsistent users group were defined as patients reporting at least once not using BBs at 6- or 12-month follow-up. Primary outcome was defined as MACE at 24-month follow-up, including all-cause death, non-fatal MI and repeat-revascularization. Multivariable cox proportional hazards regression model was used to assess the association between BBs and MACE. Results Baseline characteristics are shown in table 1. At 2-year follow-up, 518 patients in inconsistent users group (15.6%) and 548 patients in always users group (12.3%) had MACE. After multivariable adjustment, inconsistent use of BBs was associated with higher risk of MACE (HR: 1.323, 95% CI: 1.171–1.493, p<0.001). Table 1 Baseline characteristics Variable Always user (N=4476) Inconsistent user (N=3384) P value Age (years) 60.6±12.0 61.2±12.2 <0.001 Male 3381 (75.7%) 2461 (74.3%) 0.084 Diabetes 892 (20.0%) 610 (18.4%) 0.003 Hypertension 2372 (53.2%) 1543 (46.6%) <0.001 Dyslipidemia 244 (5.5%) 126 (3.8%) <0.001 Prior myocardial infarction 351 (7.9%) 232 (7.0%) <0.001 Heart failure 88 (2.0%) 63 (1.9%) <0.001 Chronic obstructive pulmonary disease 66 (1.5%) 60 (1.8%) <0.001 Current smoker 2054 (46.1%) 1579 (47.8%) 0.179 Left ventricular ejection fraction (%) 53.7±11.48 54.0±10.9 <0.001 Major Adverse Cardiovascular Events 548 (12.3%) 518 (15.6%) <0.001 Conclusions Our results showed consistent BBs use was associated with reduced risk of MACE among patients with AMI managed by contemporary treatment. Acknowledgement/Funding CAMS Innovation Fund for Medical Sciences (CIFMS) (2016-I2M-1-009)

scholarly journals Using the RISK-PCI Score in the Long-Term Prediction of Major Adverse Cardiovascular Events and Mortality after Primary Percutaneous Coronary Intervention

2019 ◽  
Vol 2019 ◽  
pp. 1-9
Author(s):  
Lidija Savic ◽  
Igor Mrdovic ◽  
Milika Asanin ◽  
Sanja Stankovic ◽  
Gordana Krljanac ◽  
...  
Keyword(s):  
Cardiovascular Events ◽  
Goodness Of Fit ◽  
Coronary Intervention ◽  
Major Adverse Cardiovascular Events ◽  
C Statistic ◽  
Percutaneous Coronary ◽  
Long Term Follow Up ◽  
One Year

Background/Aim. The RISK-PCI is a simple score for the prediction of 30-day major adverse cardiovascular events (MACE) and mortality in patients treated with primary PCI (pPCI). The aim of the present study is to evaluate the prognostic performance of the RISK-PCI score in predicting MACE and mortality in the long-term follow-up of STEMI patients treated with pPCI. Method. The present study enrolled 2,096 STEMI patients treated with pPCI included in the RISK-PCI trial. Patients presenting with cardiogenic shock were excluded. The composite end-point MACE comprising cardiovascular mortality, nonfatal reinfarction and stroke. Patients were followed up at 6 years after enrollment. Results. One-year and 6-year MACE occurred in 229 (10.9%) and 285 (13.6%) patients, respectively; and 1-year and 6-year mortality occurred in 128 (6.2%) and 151 (7.2%) patients, respectively. The RISK-PCI score was an independent predictor for 1-year MACE (HR 1.24, 95% CI 1, 18–1.31, p<0.001), 6-year MACE (HR 1.22, 95% CI 1.16–1.28, p<0.001), 1-year mortality (HR 1.21, 95% CI 1.13–1.29, p<0.001), and 6-year mortality (HR 1.23, 95% CI 1.15–1.31, p<0.001). The discrimination of the RISK-PCI score to predict 1-year and 6-year MACE and mortality was good: for 1-year MACE c-statistic 0.78, for 6-year MACE c-statistic 0.75, for 1-year mortality c-statistic 0.87, and for 6-year mortality c-statistic 0.83. The nonsignificant Hosmer–Lemeshow goodness-of-fit estimates for 1-year MACE (p=0.619), 6-year MACE (p=0.319), 1-year mortality (p=0.258), and 6-year mortality (p=0.540) indicated a good calibration of the model. Conclusion. The RISK-PCI score demonstrates good characteristics in the assessment of the risk for the occurrence of MACE and mortality during long-term follow-up after pPCI.

scholarly journals Dietary Modification and Breast Cancer Mortality: Long-Term Follow-Up of the Women’s Health Initiative Randomized Trial

2020 ◽  
Vol 38 (13) ◽  
pp. 1419-1428 ◽  
Author(s):  
Rowan T. Chlebowski ◽  
Aaron K. Aragaki ◽  
Garnet L. Anderson ◽  
Kathy Pan ◽  
Marian L. Neuhouser ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Dietary Fat ◽  
Dietary Intervention ◽  
Breast Cancer Incidence ◽  
Intervention Group ◽  
Dietary Modification ◽  
Fat Intake ◽  
Health Initiative

PURPOSE Observational studies of dietary fat intake and breast cancer have reported inconsistent findings. This topic was addressed in additional analyses of the Women’s Health Initiative (WHI) Dietary Modification (DM) clinical trial that evaluated a low-fat dietary pattern influence on breast cancer incidence. METHODS In the WHI DM trial, 48,835 postmenopausal women, ages 50-79 years, with no prior breast cancer, and a dietary fat intake of ≥ 32% of energy were randomly assigned at 40 US centers to a usual diet comparison group (60%) or dietary intervention group (40%). The goals were to reduce fat intake to 20% of energy and increase vegetable, fruit, and grain intake. Breast cancers were confirmed after central medical record review and serial National Death Index linkages to enhance mortality findings. RESULTS During 8.5 years of dietary intervention, breast cancer incidence and deaths as a result of breast cancer were nonsignificantly lower in the intervention group, while deaths after breast cancer were statistically significantly lower both during intervention and through a 16.1-year (median) follow-up. Now, after a long-term, cumulative 19.6-year (median) follow-up, the significant reduction in deaths after breast cancer persists (359 [0.12%] v 652 [0.14%] deaths; hazard ratio [HR], 0.85; 95% CI, 0.74 to 0.96; P = .01), and a statistically significant reduction in deaths as a result of breast cancer (breast cancer followed by death attributed to the breast cancer) emerged (132 [0.037%, annualized risk] v 251 [0.047%] deaths, respectively; HR, 0.79; 95% CI, 0.64 to 0.97; P = .02). CONCLUSION Adoption of a low-fat dietary pattern associated with increased vegetable, fruit, and grain intake, demonstrably achievable by many, may reduce the risk of death as a result of breast cancer in postmenopausal women.

scholarly journals Long-term weight status in regainers after weight loss by lifestyle intervention: status and challenges

2014 ◽  
Vol 73 (4) ◽  
pp. 509-518 ◽  
Author(s):  
Marta Stelmach-Mardas ◽  
Marcin Mardas ◽  
Jarosław Walkowiak ◽  
Heiner Boeing
Keyword(s):  
Weight Loss ◽  
Weight Status ◽  
Dietary Intervention ◽  
Self Regulation ◽  
Energy Restriction ◽  
Behaviour Therapy ◽  
Main Determinants ◽  
The Individual

After having participated in a weight loss trial, most participants do not stabilise the obtained weight loss but return to their initial weight. The aim of this review is to describe the main determinants of continued low weight status after weight loss, and the effectiveness of physical activity (PA), energy restriction and macronutrient composition of the diet for low long-term weight regain. Studies with intervention periods of at least 3 months duration of weight reduction measures and a follow-up at least 2 years after the intervention period were considered as eligible for the review. Owing to limited data, the studies describing the role of PA in weight management were eligible with a follow-up of 1 year only. It appears that a diet with self-regulation of dietary intake seems to be given a prominent role in the strategy of successful long-term weight loss among the obese. This measure could be combined with behaviour therapy and PA and tailored to the individual situation. However, considering available evidence it is difficult to conclude regarding unambiguous measures and to recommend a specific dietary intervention. Nevertheless, interventions should be effective in promoting intrinsic motivation and self-efficacy. The harmonisation and standardisation of data collection in the follow-up period of long-term weight loss studies is a major challenge.

COGNITIVE BEHAVIOUR THERAPY AND ASSERTION TRAINING GROUPS FOR PATIENTS WITH DEPRESSION AND COMORBID PERSONALITY DISORDERS

2000 ◽  
Vol 28 (1) ◽  
pp. 71-85 ◽  
Author(s):  
Jillian Ball ◽  
Brian Kearney ◽  
Kay Wilhelm ◽  
Jodie Dewhurst-Savellis ◽  
Belinda Barton
Keyword(s):  
Personality Disorder ◽  
Personality Disorders ◽  
Depressive Symptomatology ◽  
Therapy Group ◽  
Self Report ◽  
Cognitive Behaviour ◽  
Long Term Follow Up ◽  
Assertion Training

Longitudinal evaluations were conducted on 61 adults who were referred to a Mood Disorders Unit with a history of depression (all index episodes reached criteria for DSM-III-R major depression or dysthymia) and who had completed a cognitive behavioural therapy group either on its own or in combination with an assertion training group. Assessment of personality was made using DSM-III-R Axis II personality disorder categories. These categories were aggregated to form three groups: (i) no personality disorder; (ii) Cluster B (dramatic-erratic); and (iii) Cluster C (anxious-fearful), and were used to identify responsiveness to treatment and outcome at long-term follow-up. A battery of self-report measures were administered pretreatment, posttreatment and at long-term follow-up (1–3 years later). Both groups showed significant improvements in mean scores during treatment and these gains were maintained over the follow-up period. However, improvement in those patients without personality disorders was greater at posttreatment and at long-term follow-up, both in level of depressive symptomatology and proportion of cases meeting criteria for recovery. The treatment implications of these results are discussed.

scholarly journals Developing Predictors of Long-Term Adherence to Exercise Among Older Veterans and Spouses

2019 ◽  
Vol 39 (10) ◽  
pp. 1159-1162
Author(s):  
Candace S. Brown ◽  
Richard Sloane ◽  
Miriam C. Morey
Keyword(s):  
Older Adults ◽  
Body Mass Index ◽  
Self Efficacy ◽  
Change Theory ◽  
Self Report ◽  
Social Barriers ◽  
Inclement Weather ◽  
Behavior Change Theory

Behavior change theory was used to explore predictors of long-term adherence (≥2 years) to exercise. A retrospective analysis of data from participants ( N = 97) who reached a 6-month follow-up, which served as the baseline, was evaluated for completion of yearly follow-up surveys. Variables examined at baseline, which included age, race, gender, body mass index (BMI), and self-report of comorbidities, symptoms, physical function, and a Barriers Specific Self-Efficacy Scale, were examined with significance set at p < .05. Lower BMI (29.1 ± 5.1 vs. 31.6 ± 6.5, p = .047) and higher self-efficacy to overcome environmental barriers ( p = .016) and social isolation ( p = .05) were associated with long-term adherence. Self-efficacy to overcome environmental and social barriers, such as inclement weather, access to exercise site, and opportunities for group-based exercise, should be addressed to promote long-term adherence to exercise among older adults.

Sex-Specific Differences in Short-Term and Long-Term Outcomes in Acute Stroke Patients from Qatar

2020 ◽  
Vol 83 (2) ◽  
pp. 154-161 ◽  
Author(s):  
Naveed Akhtar ◽  
Mahesh Kate ◽  
Saadat Kamran ◽  
Rajvir Singh ◽  
Zain Bhutta ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Major Adverse Cardiovascular Events ◽  
Stroke Patients ◽  
Long Term Outcomes ◽  
Short Term ◽  
Term Outcome ◽  
Contributory Factors ◽  
Short Term Outcome

Background: Sex differences may determine presentation, utility of treatment, rehabilitation, and occurrences of major adverse cardiovascular events (MACEs) in acute stroke (AS). Objective:The purpose of the study was to evaluate the short-term prognosis and long-term outcomes in MACEs in Qatari nationals admitted with AS. Methods: All AS patients admitted between January 2014 and February 2019 were included. We evaluated the preadmission modified Rankin scale (mRS) score, etiology and severity of symptoms, complications, and functional recovery at discharge and 90 days. MACEs were recorded for 5 years. Results: There were 891 admissions for AS (mean age 64.0 ± 14.2 years) (male, n = 519 [mean age ± SD 62.9 ± 14.1 years]; female, n = 372 [mean age ± SD 65.6 ± 14.2 years] p = 0.005). There were no differences in the preadmission mRS and severity of symptoms as measured on National Institute of Stroke Scale. At discharge, the outcome was better (mRS 0–2) in men (57.8 vs. 46.0%), p = 0.0001. This difference persisted at the 90-day follow-up (mRS 0–2, male 69.4% vs. female 53.2%, p = 0.0001). At the 90-day follow-up, more women died (total deaths 70; women 38 [10.2%] versus men 32 [6.2%], p = 0.03). MACEs occurred in 25.6% (133/519) males and 30.9% (115/372) females over the 5-year follow-up period (odds ratio 0.77, 95% confidence interval 0.57–1.0, p = 0.83). Conclusions: Female patients have a poor short-term outcome following an AS when corrected for age and comorbidities. While our study cannot explain the reasons for the discrepancies, higher poststroke depression and social isolation in women may be important contributory factors, and requires further studies are required to confirm these findings.

Differential Impact of Cigarette Smoking on Prognosis in Women and Men Undergoing Percutaneous Coronary Intervention

Angiology ◽  
2019 ◽  
Vol 71 (3) ◽  
pp. 281-287
Author(s):  
Li Xia Yang ◽  
Zhi Jian Wang ◽  
Dong Mei Shi ◽  
Meng Chai ◽  
Lin Zhang ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Cigarette Smoking ◽  
Smoking Status ◽  
Coronary Intervention ◽  
Major Adverse Cardiovascular Events ◽  
Target Vessel Revascularization ◽  
Percutaneous Coronary ◽  
Artery Disease

We sought to compare the effects of smoking on clinical outcomes in women and men with coronary artery disease undergoing percutaneous coronary intervention (PCI). We prospectively followed up 10 369 patients undergoing elective PCI. All patients were stratified according to smoking status and sex. The impacts of smoking on long-term major adverse cardiovascular events (MACEs, the composite of all-cause death, myocardial infarction, or target vessel revascularization) were assessed. Among 7773 men and 2596 women undergoing PCI, the prevalence of cigarette smoking was 66.7% (n = 5185) and 11.0% (n = 286; P < .001). During the 3 years of follow-up (median: 20.6 months), smoking increased MACE in both men and women (men 10.8% vs 8.1%, P < .001; women 23.2% vs 6.4%; P < .001). After adjusting for baseline characteristics, smoking had a greater effect on MACE in women (hazard ratio [HR]: 3.68, 95% confidence interval [CI]: 1.86-7.28; P < .001) compared with men (HR: 1.35, 95% CI: 1.03-1.77; P = .005, interaction P = .026). There was a lower prevalence of smoking in women compared to men among patients undergoing PCI. However, smoking confers a higher excess risk for MACE among women compared with men.

Enhanced MRI Evaluation of Children with Sickle Cell Following Hematopoietic Stem Cell Transplantation

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 981-981
Author(s):  
Nancy S. Green ◽  
Monica Bhatia ◽  
Erica Griffin ◽  
Mahvish Qureshi ◽  
Courtney Briamonte ◽  
...  
Keyword(s):  
Stem Cell ◽  
Hematopoietic Stem Cell Transplantation ◽  
Parent Report ◽  
Self Report ◽  
Small Vessel ◽  
Hematopoietic Stem ◽  
Mri Scans ◽  
Clinical Mri

Abstract Introduction: Sickle cell disease (SCD) CNS vasculopathy (SCNSV) is a frequent indication for hematopoietic stem cell transplantation (HSCT). Untreated, SCNSV can be progressive and impair quality of life (QoL) and cognitive functioning. By clinical MRI/MRA assessment, HSCT is thought to halt progression of SCNSV. Quantitative analysis of T2-weighted FLAIR MRI for white matter hyperintensity (WMH) can provide a meaningful estimate of small vessel cerebrovascular burden. Adding WMH assessment, we asked whether HSCT for SCD halted long-term progression of SCNSV, including small vessel involvement, despite transplant-associated CNS risks. QoL assessment can track school functioning and physical, emotional and social functioning. Methods: This retrospective single site study compared MRI analyses pre-transplant to 1-7-years post-HSCT. Subject eligibility required availability of clinical MRI scans from within 2 months pre-HSCT and at 1-year intervals for at least one year post-HSCT. Interim scans performed for acute clinical indications were not included in the analysis. MRI scans were evaluated independent to the initial clinical read by one neuroradiologist, and via in-house developed software to quantitate WMH burden. QoL was completed by parent- and child-report pre-HSCT and annually thereafter using the Peds QL 4.0TM with scores 0-100; higher numbers reflected higher QoL. Results: 25 patients who received HSCT for SCD between 2003-2014 were evaluated. Median age at HSCT was 9.9 years (1.4-21.9); male:female 18:7; HbSS (17), HbSC (3), HbS-Bthalassemia (5). Donors were related (14) or unrelated (11). Stem cell sources were: related bone marrow (BM) (10), unrelated BM (5), related cord blood (CB) (3), unrelated CB (6), or related peripheral blood stem cells (1). Eight patients had CNS pathology as the indication for HSCT. Transplant complications were: PRES (2), stroke (1), graft failure (2), death (1). Duration of follow-up was: 1 yr (9), 2 yrs (10), >2 yrs (6). Only a minority of patients had normal pre-HSCT MRI (5) and normal MRA (11; 6 had 1-2 stenoses <2mm and were rated as ambiguous). At 1 to 7 yrs post-HSCT, 5 originally normal MRIs were unchanged, 15 MRIs were stable and 4 were improved at 1 year post-HSCT, without subsequent changes by clinical assessment. One MRI worsened due to peri-HSCT hemorrhagic stroke. MRAs were unchanged following HSCT. Preliminary analysis of 18 patients at pre-HSCT revealed that 5 did not have elevated WMH, while elevated WMH was detected in 13 patients. WMH remained stable in 16 of 18 patients over subsequent annual assessments. In the 2 patients with markedly elevated WMH pre-HSCT, values decreased at follow-up, corresponding to the resolution of acute or recent infarction. Overall pre-HSCT QoL by parent-report (N=19) was 65.3 (SD16.3); while child self-report (N=14) was 67.6, (SD13.1). After mean follow-up of 3 years, parent-report QoL improved to 78.8 (SD15.8), and self-report to 78.7 (SD15.2). Conclusions: Most children in this retrospective cohort had MRI abnormalities pre-HSCT, and all but 1 were stable or improved post-HSCT, despite PRES and other potential CNS complications. Pre-HSCT WMH appeared to be unchanged for most of these patients, while stroke-induced WMH appears to decrease over time, suggesting stable small vessel SCNSV following transplantation. Overall, by MRI/MRA and by preliminary WMH, HSCT appears to have stabilized large and small vessel SCNSV in all but 1 of 25 children. While only a modest number of patients were assessed, WMH was reproducible at multiple annual time points. Long-term parent and self-reported QoL indicated improvement from HSCT. Chronically transfused SCD patients could not be compared due to lack of annualized assessment. Future transplant protocols will include enhanced MRI-based tracking, in conjunction with QoL and neuropsychological assessments. These data could be useful for decision-making about SCD transplantation. Disclosures No relevant conflicts of interest to declare.

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