Dietary Sodium Intake: Perceptions of an Urban Heart Failure Population

Background: Dietary sodium restriction is a mainstay of disease management and self-care in heart failure (HF). Heart failure education programs that include recommendations on limiting sodium intake are fairly variable across centers and populations. A clear assessment is lacking on efficacy of such programs in enhancing levels of patient understanding regarding recommendations on sodium intake and knowledge of sodium content in commonly consumed food items. This pilot study was designed to assess the knowledge pertaining to sodium-restricted diets in underserved, at-risk patients with chronic, stable HF at an urban, academic center. Methods: Adult English-speaking patients with either stable, chronic HF reduced ejection fraction (HFREF) or HF preserved ejection fraction (HFPEF) were included. Baseline characteristics such as demographics, knowledge of HF self-care including understanding of sodium intake and related health implications were collected. Subsequently, a pictorial survey was administered that asked participants to categorize food items into high-, medium- or low-sodium based on the FDA-recommended daily sodium intake of 2.4g. Unordered Pearson chi-square tests were performed for differences between each group. Results: A total of 24 participants (mean age 57.3, 58.3% male, 75% HFREF) participated in the survey. Seventy-five percent of participants had a high-school or equivalent level education and 25% had an advanced degree. Participants were able to accurately categorize foods into high-, moderate-, or low-sodium categories 74%, 36% and 63% of the time, respectively (respective 95% confidence intervals 0.69-0.79, 0.29-0.43, 0.56-0.63). These percentages differed significantly from each other (p Conclusions: Understanding of dietary sodium intake varies significantly among HF patients. Despite intensive HF education, patients were not able to accurately identify sodium content in appropriate categories. Further research is needed on barriers to understanding of dietary education and its effect on outcomes

Long-term Effect of CPAP Treatment on Cardiovascular Events in Patients With Resistant Hypertension and Sleep Apnea. Data From the HIPARCO-2 Study

Background: There is some controversy about the effect of continuous positive airway pressure (CPAP) on the incidence of cardiovascular events (CVE). However, the incidence of CVE among patients with both obstructive sleep apnea (OSA) ans resistant hypertension (HR) has not been evaluated. Our objective was to analyze the long-term effect of CPAP treatment in patients with RH and OSA on the incidence of CVE. Methods: Multi-center, observational and prospective study of patients with moderate-severe OSA and RH. All the patients were followed up every 3-6 months and the CVE incidence was measured. Patients adherent to CPAP (at least 4h/day) were compared with those with not adherent or those who had not been prescribed CPAP. Results: Valid data were obtained from 163 patients with 64 CVE incidents. Treatment with CPAP was offered to 82%. After 58 months of follow-up, 58.3% of patients were adherent to CPAP. Patients not adherent to CPAP presented a non-significant increase in the total CVE incidence (HR:1.6; 95%CI: 0.96-2.7; p=0.07). A sensitivity analysis showed that patients not adherent to CPAP had a significant increase in the incidence of cerebrovascular events (HR: 3.1; CI95%: 1.07-15.1; p=0.041) and hypertensive crises (HR: 5.1; CI95%: 2.2-11.6; p=0.006), but the trend went in the opposite direction with respect to coronary events (HR: 0.22; CI95%: 0.05-1.02; p=0.053). Conclusions: In patients with RH and moderate-severe OSA, an uneffective treatment with CPAP showed a trend toward an increase in the incidence of CVE (particularly neurovascular events and hypertensive crises) without any changes with respect to coronary events

Rheumatological Disease from Cardiac Point of View: A Systematic Review

Objectives Rheumatic diseases are associated with an increased risks of premature cardiovascular mortality. The aim of our study was to conduct a systematic review of the literature regarding the cardiovascular involvement in various rheumatic diseases. Commonly used treatments for rheumatic disease and their cardiovascular side effects were studied as well. Methods Online databases (Pubmed and Medline) were searched from inception to January 2016. Search terms included: “systemic lupus erythematosus”, “rheumatoid arthritis”, “cardiovascular diseases”, “cardiovascular mortality”, “sudden cardiac death”, and “atherosclerosis”. Studies meeting the following criteria were included: (a) Articles are written in English language, (b) Reference to the cardiac involvement in rheumatic diseases, and (c) Articles where full text available. Results We identified 12,336 citations. After screening retrieved citations, 160 articles were included based on the predetermined criteria. Overall, pericarditis was considered the most common finding in rheumatic disease (50 %). In addition, myocarditis was more prevalent in Churg-Strauss syndrome (30%), Takayasu\u27s disease (45%), and systemic sclerosis (25%), and coronary angiitis was more common in polyarteritis nodosa (40%), Takayasu\u27s disease (40%), and Behcet disease (17%). Accelerated atherosclerosis has been increasingly reported especially due to chronic systemic inflammation associated with rheumatic disease. As expected, the cardiac side effects of systemic glucocorticoids are well documented and frequently seen in the management of rheumatic diseases (12%). Followed by epoprostenole (11%) and rituximab (11%). Conclusions Cardiovascular diseases are commonly encountered in rheumatic disease. The current systematic review was useful in describing the prevalence of cardiovascular involvement in each of the rheumatic disease. Close collaboration is needed between cardiologists and rheumatologists in managing this group of patients for overlapping conditions. Further research is needed to understand the impact of cardiovascular diseases on morbidity and mortality in rheumatic diseases