A special issue of the Journal of the American College of Cardiology (JACC), published Feb. 27, focuses on the promotion of cardiovascular health, including topics such as dietary habits, antioxidant pills and physical activity – and the prevention of cardiovascular disease and other related conditions.

Highlights of the issue include:

Dietary Recommendations and Heart Health: Following current dietary recommendations may lead to small improvements in overall cardiovascular health in overweight individuals, according to a study by David J.A. Jenkins, MD, PhD, DSc, et al. Patients were divided into three treatment groups: dietary advice only; weekly food basket only; and both dietary advice and weekly food basket. After six months, only small increases were observed in the intake of fruits, vegetables, whole grains and cholesterol lowering foods across all groups, and the only consistent increases were seen in the group that received both food provisions and advice. At 18 months, small increases remained for the intake of healthy foods, but these increases were significantly reduced from the already modest six month increases. In an accompanying editorial comment, Ramon Estruch, MD, PhD, notes these results can be viewed as “glass half-full.” “The key question is how to entice the general population to adhere to healthy dietary patterns,” he said.

Physical Activity, BMI and HF Risk: Lifestyle patterns, including physical activity and body mass index (BMI), are associated with a risk of overall heart failure (HF) but are more strongly associated with the HF subtype HF with preserved ejection fraction (HFpEF). “We consistently found an association between physical activity, BMI and overall HF risk,” said lead-author Jarett D. Berry, MD. “This was not unexpected, however, the impact of these lifestyle factors on HF subtypes was quite different.” When compared to no physical activity, low levels of physical activity were associated with 6 percent lower risk of HF. Researchers found that higher levels of physical activity had even lower risk of HF – 11 percent lower risk for those who met the guideline-recommended amount of activity and 22 percent lower risk for greater than guideline-recommended physical activity. In an accompanying editorial, Sanjiv J. Shah, MD, FACC, said the researchers “have provided strong evidence that lack of physical activity is associated with incident HFpEF.”

Antioxidant Pills, Juicing, Other Dietary Fads: Researchers analyzed nutrition studies to cut through the confusion about the best dietary patterns to reduce cardiovascular disease. The review concludes current evidence strongly supports eating plenty of fruits, vegetables, whole grains, legumes and nuts in moderation. Although more controversial, some heart-healthy diets may also include very limited quantities of lean meat, fish, low-fat and nonfat dairy products and liquid vegetable oils. “There is a great amount of misinformation about nutrition fads, including antioxidant pills, juicing and gluten-free diets,” said Andrew Freeman, MD, FACC. “However, there are a number of dietary patterns that have clearly been demonstrated to reduce the risk of many chronic diseases, including coronary heart disease.” The review also covers eggs and cholesterol, vegetable oils, berries and antioxidant supplementation, nuts, juicing, and gluten.

Herbal Medication Use in CVD Patients: Physicians should be well-versed in the herbal medications cardiovascular disease patients may take to be able to effectively discuss their clinical implications, potential benefits and side effects – despite a lack of scientific evidence to support their use. Researchers selected 10 of the most commonly used herbal medications that have a possible indication for treating one or more cardiovascular condition – including hypertension, heart failure, coronary artery disease, dyslipidemia, thromboembolic disorders or peripheral artery disease – and discussed possible indications, biological and clinical data, and safety concerns. The researchers said that despite all the clinical evidence on these herbal medications, there is an overall lack of evidence available, and it is not always possible to clearly establish a cause-effect link between exposure to herbal medications and potential side effects. They concluded that because of the popularity of these medications and the potential for drug interactions or other safety concerns, physicians should start a conversation around herbal medication use to effectively counsel their patients.

Heart Disease in Chinese Population: Researchers in China have found that adherence to a healthy lifestyle may substantially lower the burden of cardiovascular disease in the country. The study examined the associations of six lifestyle factors with ischemic heart disease and ischemic stroke in the China Kadoorie Biobank of 461,211 participants 30 to 79 years of age who did not have cardiovascular diseases, cancer or diabetes at baseline. Low-risk lifestyle factors were defined as nonsmoking status or having stopped smoking for reasons other than illness; alcohol consumption of <30 g/day, a median or higher level of physical activity; a diet rich in vegetables and fruits and limited in red meat; a body mass index of 18.5 to 23.9 kg/m2; and a waist-to-hip ratio <0.90 for men and <0.85 for women. Researchers found that current nonsmoking status, light to moderate alcohol consumption, high physical activity, a diet rich in vegetables and fruits and limited in red meat, and low adiposity were independently associated with reduced risks of major coronary events and ischemic stroke. In an accompanying editorial, Thomas A. Gaziano, MD, FACC, adds that “more research is needed to understand both the long-term effects of … interventions and the reproducibility of these interventions in low-income settings. In the end, we must find a simple but clear message regarding diet and exercise that is a little like what our grandmother might say, ‘Everything in moderation but make sure you eat your vegetables.’”

Predicting Presence of CAD: Nasrien E. Ibrahim, MD, FACC, et al., developed a clinical and biomarker scoring strategy to reliably diagnose severe epicardial coronary artery disease (CAD). The scoring system consisted of clinical variables (male sex and previous PCI) and four biomarkers (midkine, adiponectin, apolipoprotein C-I and kidney injury molecule–1). At optimal cutoff, the score had 77 percent sensitivity, 84 percent specificity, and a positive predictive value of 90 percent for ≥70 percent stenosis. Partitioning the score into five levels allowed for identifying or excluding CAD with >90 percent predictive value in 42 percent of subjects. According to the authors, “advantages of such a reliable clinical and biomarker score include the fact such a technology can be widely disseminated in a cost-effective manner, is easily interpreted, and might be associated with a well-defined sequence of therapeutic steps to reduce risk for CAD-related complications, such as antiplatelet or lipid-lowering therapy.” In an accompanying editorial, Robert A. Vogel, MD, adds that “the findings of this study … must be considered preliminary because the investigators chose to divide a single population of patients referred for coronary angiography into training and validation groups.”

Neutrophil Counts and Initial Presentation of CVD: Neutrophil counts were strongly associated with the incidence of some cardiovascular diseases, but not others, even within the normal range, consistent with underlying disease mechanisms differing across cardiovascular diseases. Among 775,231 individuals in the cohort, 154,179 had complete blood counts performed under acute conditions and 621,052 when they were stable. Over a median 3.8 years of follow-up, 55,004 individuals developed cardiovascular disease. The study revealed a strong association between neutrophil counts and heart failure, peripheral arterial disease, unheralded coronary death, abdominal aortic aneurysm, and nonfatal myocardial infarction. According to an editorial comment from Benjamin D. Horne, PhD, MPH, FACC, the usefulness of the neutrophil count for prognostic purposes is evident in large sample, broad scope, clinically based investigations … an inexpensive, commonly ordered measure of inflammation and infection, the neutrophil count seems to contain independent, clinically significant information regarding prognosis.”

Read the full issue of JACC and listen to the audio commentary by JACC Editor-in-Chief Valentin Fuster, MD, PhD, MACC.

Keywords: Adiponectin, Adiposity, Alcohol Drinking, Aortic Aneurysm, Abdominal, Apolipoprotein C-I, Biological Specimen Banks, Biomarkers, Blood Cell Count, Body Mass Index, China, Cholesterol, Chronic Disease, Constriction, Pathologic, Coronary Angiography, Coronary Artery Disease, Cytokines, Dairy Products, Diabetes Mellitus, Diet, Gluten-Free, Drug Interactions, Dyslipidemias, Exercise, Fabaceae, Feeding Behavior, Fruit, Glutens, Health Promotion, Heart Failure, Hypertension, Inflammation, Midazolam, Myocardial Infarction, Neoplasms, Neutrophils, Nuts, Obesity, Peripheral Arterial Disease, Plant Oils, Prognosis, Reference Values, Reproducibility of Results, Smoking, Stroke, Vegetables, Waist-Hip Ratio, Secondary Prevention

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