Genome-wide association meta-analysis of fish and EPA+DHA consumption in 17 US and European cohorts

Background: Regular fish and omega-3 consumption may have several health benefits and are recommended by major dietary guidelines. Yet, their intakes remain remarkably variable both within and across populations, which could partly owe to genetic influences. Objective: To identify common genetic variants that influence fish and dietary eicosapentaenoic acid plus docosahexaenoic acid (EPA+DHA) consumption. Design: We conducted genome-wide association (GWA) meta-analysis of fish (n = 86, 467) and EPA +DHA (n = 62, 265) consumption in 17 cohorts of European descent from the CHARGE (Cohorts for Heart and Aging Research in Genomic Epidemiology) Consortium Nutrition Working Group. Results from cohort-specific GWA analyses (additive model) for fish and EPA+DHA consumption were adjusted for age, sex, energy intake, and population stratification, and meta-analyzed separately using fixed-effect meta-analysis with inverse variance weights (METAL software). Additionally, heritability was estimated in 2 cohorts. Results: Heritability estimates for fish and EPA+DHA consumption ranged from 0.13

The role of myocardial contrast echocardiography to assess the origin of a mass in right cardiac cavities

We report the case of a patient with hepatocellular carcinoma who was admitted to our hospital with fatigue and edema of lower extremities. Transthoracic echocardiographic examination revealed a mobile echogenic cavoatrial mass that infiltrated the inferior vena cava and extended along the vessel protruding into the right cardiac cavities. The differential diagnosis included a tumor mass originating from the liver and subsequently infiltrating the inferior vena cava and extending into the right cardiac cavities or a large thrombus formed on the tumor mass that infiltrated the inferior vena cava. © 2008, the Authors

Homozygosity of the TT methylenetetrahydrofolate reductase C677T genotype is an independent long-term predictor of cardiac death in patients with premature myocardial infarction

Background: Methylenetetrahydrofolate reductase (MTHFR) C677T polymorphism is the main genetic modulator of homocysteine. Data suggest a potential association of homozygosity for the TT MTHFR genotype with premature myocardial infarction (MI). We explored whether TT homozygosity is associated with long-term prognosis in patients with premature ST-segment elevation MI (STEMI). Methods: A total of 265 consecutive patients who had survived their first STEMI ≤35 years of age were followed for a median of 8 years (5–12). Primary endpoints were cardiac death and secondary endpoints were hospitalizations for acute coronary syndrome, myocardial revascularization, arrhythmic event or ischemic stroke. Serum lipids, homocysteine, folate levels were measured at baseline and all patients were also tested for the MTHFR C677T polymorphism. Results: During follow-up 14 patients died (cardiac death) [5.3%] while 84 (31.7%) met the secondary endpoints. In univariate Cox regression analysis TT homozygosity predicted the occurrence of cardiac death (Hazard ratio (HR): 4.071; 95% confidence interval (CI): 1.404–11.809, p =.010) but not the occurrence of secondary endpoints (HR: 0.877; 95% CI: 0.479–1.605, p =.669). TT homozygosity remained an independent predictor of cardiac death after adjustment for conventional risk factors (i.e., sex, diabetes mellitus, hypertension, family history of premature coronary artery disease [CAD]) [HR: 4.350; 95% CI: 1.472–12.856, p =.008]. The association also remained after adjustment for left ventricular ejection fraction or the presence of significant CAD. Conclusions: Homozygosity for the TT MTHFR is an independent long-term predictor of cardiac death in patients with premature STEMI. © 2021 Informa UK Limited, trading as Taylor & Francis Group

Homocysteine is an independent predictor of long-term cardiac mortality in patients with stable coronary artery disease in the era of statins

Background Homocysteine (Hcy) is considered a risk factor for cardiovascular disease. Objective To explore the long-term prognostic value of Hcy in patients with stable coronary artery disease (CAD) in the era of statins. Methods A total of 876 consecutive patients with stable CAD were recruited and followed up for a median of 6.1 years. Lipids and Hcy levels were measured at baseline. Primary endpoints were cardiac death and secondary endpoints were hospitalizations for acute coronary syndrome, myocardial revascularization, arrhythmic event or ischemic stroke. Results Follow-up data were obtained from 842 patients of whom 70 had a cardiac death (8.3%), while 258 (30.6%) met the secondary endpoints. Seven hundred four patients (83.6%) were on statins. In univariate Cox regression analysis Hcy predicted the occurrence of cardiac death [hazard ratio: 1.030; 95% confidence interval (CI): 1.018-1.042, P < 0.001] but not the occurrence of secondary endpoints (hazard ratio: 1.010; 95% CI: 0.999-1.020, P = 0.081). Hcy remained an independent predictor of cardiac death after adjustment for conventional risk factors, ejection fraction and statin use (hazard ratio: 1.030; 95% CI: 1.017-1.044, P < 0.001). Patients in the highest tertile of Hcy levels (>14.1 μmol/L) had three times higher risk of cardiac death compared with patients in the lowest tertile (<10.3 μmol/L) (hazard ratio = 3.036, CI: 1.983-4.649, P < 0.001). Conclusion Hcy is an independent predictor of cardiac death in patients with stable CAD in the era of statins. © 2019 Wolters Kluwer Health, Inc. All rights reserved

Background dietary habits are strongly associated with the development of myocardial infarction at young ages: A case-control study

Background: We investigated whether dietary habits can discriminate young individuals with myocardial infarction (MI) from age-sex-matched controls. Methods: We enrolled 100 consecutive patients who had survived their first MI before the age of 36 years and 100 age- and sex-matched controls without a history of cardiovascular disease. Dietary habits were assessed through a semi-quantitative food frequency questionnaire, and a diet score that evaluates quality of diet was developed (ranging 14-60). Smoking habits, physical activity status, body mass index, clinical history and blood lipid levels were also measured. Results: Data analysis revealed that MI patients had less healthy dietary as compared to their matched controls (23 ± 4 vs. 31 ± 4; p < 0.001). Multi-adjusted logistic regression analysis showed that 1-unit increase in the diet score (i.e., better dietary habits) decreased by 40% (95% CI 15%-57%) the odds of having a MI, after controlling for smoking habits, body mass index, cholesterol levels, presence and management of hypertension and diabetes, physical activity status, and family history of coronary heart disease (CHD). Discriminant analysis showed that diet score was the strongest discriminator for MI, followed by cholesterol levels and pack-years of smoking. Conclusions: The present work provides scientific evidences that promotion of healthy eating from the youth may prevent the development of CHD. © 2008 European Society for Clinical Nutrition and Metabolism

Dronedarone and the incidence of stroke in patients with paroxysmal or persistent atrial fibrillation: A systematic review and meta-analysis of randomized trials

Background: Stroke is themost feared complication of atrial fibrillation (AF).Dronedarone is an antiarrhythmic drug with multichannel-blocking properties. Recently, a post hoc analysis of a large randomized trial has suggested a reduction of stroke risk in patients with paroxysmal or persistent AF receiving dronedarone. Objective: We performed a systematic review and meta-analysis on the effect of dronedarone on the occurrence of stroke or transient ischemic attack (TIA) in patients with paroxysmal or persistent AF. Methods: We searched PubMed, EMBASE, and ISI Web of Knowledge as well as abstracts of major conferences for randomized trials comparing dronedarone with placebo in patients with paroxysmal or persistent AF. The endpoint was the occurrence of stroke or TIA during follow-up. Fixed effect risk differences (RDs) were calculated with the Mantel-Haenszel method. We also performed random effects analysis with the DerSimonian Laird method. Results: Four trials were included in the analysis; a total of 5967 patients were analyzed, 3183 receiving dronedarone 400mg twice daily and 2784 receiving placebo. 160 strokes or TIAs were reported in the four trials: 67 in the dronedarone group (2.1%) and 93 in the placebo group (3.3%). In the fixed effect model, patients in the dronedarone group had a significantly lower risk for the occurrence of stroke or TIA during follow-up compared with patients in the placebo group. TheRDof the incidence of stroke or TIA in all trials between patients randomized to dronedarone and those randomized to placebo was -0.0094 (95% confidence interval [CI] -0.0178, -0.0011; p = 0.027). TheATHENAtrial had by far the highest statistical weight (79.5%). There was no evidence of heterogeneity (χ 2 = 2.41, p = 0.300). In the random effects model, the statistical weight of theATHENAtrial was much lower (45.1%) and the RD for stroke or TIA between the dronedarone and the placebo groups did not reach statistical significance (RD -0.0064, 95% CI -0.0144, 0.0016; p = 0.120). Limitations: First, stroke was not a prespecified outcome measure in the included trials. Second, we did not analyze trials studying patients with permanent AF; very recent data show an adverse outcome in patients with permanent AF receiving dronedarone. Conclusions: The meta-analysis indicates a reduced risk of stroke or TIA in patients with paroxysmal or persistent AF receiving dronedarone. These findings are largely due to the results of the ATHENA trial. Further research on this topic is necessary. © 2011 Adis Data Information BV. All rights reserved

Lack of association of angiotensin-converting enzyme insertion/deletion polymorphism and myocardial infarction at very young ages

We examined whether angiotensin-converting enzyme (ACE) insertion (I)/deletion (D) polymorphism is associated with the development of myocardial infarction (MI) at ≤35 years of age. The study sample consisted of 201 patients with premature MI and 140 age- and sex-matched healthy individuals. No difference was found in the distribution of ACE genotypes between the patients and controls. A higher prevalence of the DD genotype among hypertensives was found compared with the non-hypertensive patients (62.5% vs 35.6%, p=0.01). ACE polymorphism is not associated with the development of premature MI and this might be due to the low prevalence of hypertension in young coronary patients