Adiposity and insulin resistance mediate the inverse association between legume intake and blood pressure in individuals: a cross-sectional analysis in secondary cardiovascular prevention

The legume food group has important bioactive components and amino acids that have beneficial effects on blood pressure. This study aimed to evaluate the association between legume intake and blood pressure, as well as the mediating role of cardiometabolic risk factors in patients in secondary cardiovascular prevention. Sociodemographic, anthropometric, clinical, and food intake data were collected from the baseline of the multicenter study Brazilian Cardioprotective Nutritional Program Trial - BALANCE (RCT: NCT01620398). The relationships between variables were explored through path analysis. In total, 2,247 individuals with a median age of 63.0 (45 - 91) years, 58.8% (n= 1,321) male, and 96.5% (n= 2,168) with diagnosis of hypertension were included. Negative associations were observed between histidine intake and systolic blood pressure (SBP) (SC= −0.057; p= 0.012), and between legume intake and body mass index (BMI) (SC= −0.061; p= 0.006). BMI was positively associated with TyG index (SC= 0.173; p< 0.001), SBP (SC= 0.144; p< 0.001) and diastolic blood pressure (DBP) (SC= 0.177; p< 0.001), and TyG index was positively associated with DBP (SC= 0.079; p= 0.001). A negative indirect effect was observed between the intake of legumes, SBP and DBP, mediated by BMI (SC = −0.009; p = 0.011; SC = −0.011; p = 0.010, respectively). In addition, an indirect negative effect was found between the intake of legumes and the DBP, mediated simultaneously by BMI and TyG index (SC = −0.001; p = 0.037). In conclusion, legume intake presented a negative indirect association with blood pressure, mediated by insulin resistance (TyG) and adiposity (BMI) in individuals of secondary care in cardiology.

Evaluating patients' satisfaction and preferences with a secondary prevention cardiovascular polypill: the Aurora Study

Aim: To evaluate the satisfaction, preferences and adherence of patients in secondary cardiovascular prevention treated with the CNIC cardiovascular polypill compared with patients treated with the separate monocomponents. Methods: Observational, cross-sectional and multicenter study. Satisfaction was evaluated by the Treatment Satisfaction Questionnaire for Medication 9 items, adherence by the Morisky-Green questionnaire and ad-hoc questions were asked regarding patient preferences. Results: Polypill patients reported higher satisfaction than patients treated with the monocomponents (77.3 vs 71.2%, p < 0.0001). 72.8% of patients treated with the monocomponents would prefer to change to the polypill. Patients treated with the polypill had significantly higher adherence than patients treated with the monocomponents (57.7 vs 41.1%) (p = 0.0027). Conclusion: Polypill patients show higher satisfaction and better adherence. Most patients receiving the monocomponents would prefer a polypill regime.

Hydrophilic or Lipophilic Statins?

Drugs can be classified as hydrophilic or lipophilic depending on their ability to dissolve in water or in lipid-containing media. The predominantly lipophilic statins (simvastatin, fluvastatin, pitavastatin, lovastatin and atorvastatin) can easily enter cells, whereas hydrophilic statins (rosuvastatin and pravastatin) present greater hepatoselectivity. Although the beneficial role of statins in primary and secondary cardiovascular prevention has been unequivocally confirmed, the possible superiority of one statin or other regarding their solubility profile is still not well-established. In this respect, although some previously published observational studies and clinical trials observed a superiority of lipophilic statins in cardiovascular outcomes, these results could also be explained by a greater low-density lipoprotein cholesterol reduction with this statin type. On the other hand, previous studies reported conflicting results as to the possible superiority of one statin type over the other regarding heart failure outcomes. Furthermore, adverse events with statin therapy may also be related to their solubility profile. Thus, the aim of the present review was to collect clinical evidence on possible differences in cardiovascular outcomes among statins when their solubility profile is considered, and how this may also be related to the occurrence of statin-related adverse effects.

Red blood cell distribution width as a novel prognostic marker after myocardial revascularization or cardiac valve surgery

The red blood cell distribution width (RDW) measures the variability in the size of circulating erythrocytes. Previous studies suggested a powerful correlation between RDW obtained from a standard complete blood count and cardiovascular diseases in both primary and secondary cardiovascular prevention. The current study aimed to evaluate the prognostic role of RDW in patients undergoing cardiac rehabilitation after myocardial revascularization and/or cardiac valve surgery. The study included 1.031 patients with available RDW levels, prospectively followed for a mean of 4.5 ± 3.5 years. The mean age was 68 ± 12 years, the mean RDW was 14.7 ± 1.8%; 492 patients (48%) underwent cardiac rehabilitation after myocardial revascularization, 371 (36%) after cardiac valve surgery, 102 (10%) after valve-plus-coronary artery by-pass graft surgery, 66 (6%) for other indications. Kaplan–Meier analysis and Cox hazard analysis were used to associate RDW with mortality. Kaplan–Meier analysis demonstrated worse survival curves free from overall (log-rank p < 0.0001) and cardiovascular (log-rank p < 0.0001) mortality in the highest RDW tertile. Cox analysis showed RDW levels correlated significantly with the probability of overall (HR 1.26; 95% CI 1.19–1.32; p < 0.001) and cardiovascular (HR 1.31; 95% CI 1.23–1.40; p < 0.001) mortality. After multiple adjustments for cardiovascular risk factors, hemoglobin, hematocrit, C-reactive protein, microalbuminuria, atrial fibrillation, glomerular filtration rate,left ventricular ejection fraction and number of exercise training sessions attended, the increased risk of overall (HR 1.10; 95% CI 1.01–1.27; p = 0.039) and cardiovascular (HR 1.13; 95% CI 1.01–1.34; p = 0.036)mortality with increasing RDW values remained significant. The RDW represents an independent predictor of overall and cardiovascular mortality in secondary cardiovascular prevention patients undergoing cardiac rehabilitation.

Obstructive Sleep Apnoea Syndrome: Continuous Positive Airway Pressure Therapy for Prevention of Cardiovascular Risk

Obstructive sleep apnoea (OSA) syndrome is characterised by the presence of apnoea or obstructive hypopnoea during sleep, accompanied by hypoxia. It is estimated that the syndrome affects approximately 10% of men and 15% of women. Diagnosis and treatment rates have increased in recent years, but the condition remains undiagnosed in a high percentage of patients. Recent evidence suggests that OSA may increase the risk of cardiovascular disease. The relationship between OSA and cardiovascular disease can be explained, at least in part, by the coexistence of cardiovascular risk factors in the two pathologies, such as age, overweight, smoking and sedentary lifestyle. However, OSA has been independently associated with the risk of developing hypertension, cerebrovascular disease, ischaemic heart disease, heart failure and arrhythmias. Clinical trials that have evaluated the efficacy of continuous positive airway pressure (CPAP) treatment in primary and secondary cardiovascular prevention have not demonstrated a significant reduction in the incidence or recurrence of cardiovascular events. This article analyses the relationship between OSA and cardiovascular risk and discusses recent clinical trials on the efficacy of CPAP in primary and secondary cardiovascular prevention.