New Research Addresses the Mediterranean Diet, AED Effectiveness and Exercise Impacts on HCM
New research exploring Mediterranean diet benefits, effectiveness of automatic external defibrillators (AEDs) and the impacts of exercise on patients with hypertrophic cardiomyopathy (HCM) was presented Aug. 28 during ESC Congress 2016 in Rome as part of a special press conference on sudden cardiac death.
Results from the observational Moli-sani study showed a Mediterranean diet may be associated with a reduced risk of death in patients with a history of cardiovascular disease. The study followed 1,197 patients with a history of cardiovascular disease enrolled into the Moli-sani project, a prospective epidemiological study of approximately 25,000 adults living in the Italian region of Molise. Food intake was recorded using a questionnaire. Adherence to the Mediterranean diet was appraised with a nine-point Mediterranean diet score (MDS). All-cause death was assessed by linking data from the office of vital statistics in Molise.
During a median follow up of 7.3 years there were 208 deaths. A two-point increase in the MDS was associated with a 21 percent reduced risk of death after controlling for age, sex, energy intake, egg and potato intake, education, leisure-time physical activity, waist-to-hip ratio, smoking, hypertension, hypercholesterolaemia, diabetes and cancer at baseline. When considered as a three-level categorical variable, the top category (score 6–9) of adherence to the Mediterranean diet was associated with 37 percent lower risk of death compared to the bottom category (0–3).
AEDs fail to save lives when the public does not have basic life support education, according to results from a five-year national prospective assessment of public access defibrillation programs conducted throughout 51 districts in France.
Study investigators found huge discrepancies in public access defibrillation programs across the districts, with the proportion of educated persons varying from 6,955 to 36,636 per 100,000 inhabitants and the density of AEDs varying from five to 3,399 per 100,000 inhabitants/1,000 km2. Overall, only 35.3 percent of districts developed a significant program, defined by the authors as both AED density and educational rate above the median (more than 22 AEDs per 100,000 inhabitants/1000 km2 and more than 13,866 educated persons per 100,000 inhabitants).
“These discrepancies were way beyond those we expected,” said Nicole Karam, MD, an interventional cardiologist at the European Hospital Georges Pompidou in Paris, France, on behalf of the Paris Sudden Death Expertise Centre.
Exercise and HCM
Sudden death in patients with HCM is rarely associated with exercise, according to a study investigating the circumstances and demographics of sudden cardiac death (SCD) in 184 HCM patients at St George’s Hospital Cardiac Pathology center in the UK. According to study investigators, SCD occurred at various ages, with the highest prevalence in the third and fourth decades of life. The majority of patients (149/80 percent) died during rest. SCD during exertion occurred more frequently in young male patients. Twenty (11 percent) of the sudden death patients were recreational or competitive athletes.
“This study shows that sudden death in hypertrophic cardiomyopathy is rarely associated with exercise and occurs frequently in patients where diagnosis is missed during life,” said Gherardo Finocchiaro, MD, from St. George’s University of London, UK. “Better strategies aimed at detecting the disease, even in asymptomatic individuals, are needed. Future prospective randomised studies should assess the benefits and harms/risks of exercise in patients with HCM.”
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