ABSTRACT
The Mediterranean dietary pattern has been linked with reduced cardiovascular disease incidence and mortality. Components of the Mediterranean diet associated with better cardiovascular health include low consumption of meat and meat products, moderate consumption of ethanol (mostly from wine), and high consumption of vegetables, fruits, nuts, legumes, fish, and olive oil. Increasing evidence indicates that the synergy among these components results in beneficial changes in intermediate pathways of cardiometabolic risk, such as lipids, insulin sensitivity, oxidative stress, inflammation, and vasoreactivity. As a result, consumption of a Mediterranean dietary pattern favorably affects numerous cardiovascular disease risk factors, such as dyslipidemia, hypertension, metabolic syndrome, and diabetes. Moreover, strong evidence links this dietary pattern with reduced cardiovascular disease incidence, reoccurrence, and mortality. This review evaluates the current evidence behind the cardioprotective effects of a Mediterranean dietary pattern.
Subject(s)
Cardiovascular Diseases/prevention & control , Diet, Mediterranean , Animals , Cardiovascular Diseases/epidemiology , Cholesterol , Dairy Products , Diabetes Mellitus , Dietary Proteins , Endothelium, Vascular , Female , Humans , Hypertension , Insulin Resistance , Life Style , Lipoproteins , Male , Metabolic Syndrome , Nuts , Olive Oil , Oxidative Stress , Risk Factors , Spices , Vascular Stiffness , WineABSTRACT
BACKGROUND: The typical resident in surgery in the US will not care for a patient with advanced portal hypertension and will not participate in a portacaval shunt. The aim of this study is to compare the number of transjugular intrahepatic portasystemic stent shunts (TIPS) with the number of surgical shunts undertaken in the State of Florida and to assess whether these numbers are consistent with today's evidence-based medicine. METHODS: We examined the database of the Agency for Health Care Administration of the State of Florida from January 1, 2002, through September 30, 2005, for "intraabdominal venous shunt" (ICD-9 code, 39.1). Data collected include "case mix," "case severity," length of stay, total gross charges, and discharge status. Conclusions about longterm survival from a prospective randomized clinical trial comparing TIPS to surgical shunting were applied to this dataset to determine if the relative frequency of TIPS application in Florida was supported by evidence-based medicine. RESULTS: TIPS was undertaken more than 12 times as often as surgical shunting (860 patients versus 70 patients). After TIPS versus surgical shunts, average length of stay and hospital charges were less, but case mix, case severity, and in-hospital mortality (11.4% for each) were not different. Applying survival data from a randomized trial comparing TIPS with surgical shunting to the State of Florida database, 129 more people (p < 0.0001) would be alive at 2 years and 137 more (p < 0.0001) would be alive at 5 years after shunting if surgical shunts had been used in lieu of TIPS. CONCLUSIONS: TIPS leads to shorter hospitalizations and reduced hospital charges and is applied in numbers much greater than surgical shunts, despite evidence that suggests inferior longterm efficacy and survival. Current application of TIPS is not a result of evidence-based medicine, and application of surgical shunting is encouraged.
Subject(s)
Evidence-Based Medicine , Portasystemic Shunt, Transjugular Intrahepatic/statistics & numerical data , Diagnosis-Related Groups , Female , Florida , Humans , Length of Stay/statistics & numerical data , Male , Patient Selection , Postoperative Complications , Randomized Controlled Trials as Topic , Severity of Illness Index , Survival AnalysisABSTRACT
Antireflux fundoplications are undertaken with hesitation in older patients because of presumed higher morbidity and poorer outcomes. This study was undertaken to determine if symptoms of gastroesophageal reflux disease (GERD) could be safely abrogated in a high-risk/reward popu lation of older patients. One hundred eight patients more than 70 years of age (range, 70-90 years) underwent laparoscopic Nissen fundoplications undertaken between 1992 and 2005 and were compared with 108 concurrent patients less than 60 years of age (range, 18-59 years) to determine relative outcomes. Before and after fundoplication, patients scored the severity of reflux and dysphagia on a Likert Scale (0 = minor, 10 = severe). Before fundoplication, older patients had lower reflux scores (P < 0.01), but not lower dysphagia scores or DeMeester scores. One patient (86 years old) died from myocardial infarction; otherwise, complications occurred infrequently, inconsequentially, and regardless of age. At similar durations of follow-up, reflux and dysphagia scores significantly improved (P < 0.01) for older and younger patients. After fundoplication, older patients had lower dysphagia scores (P < 0.01) and lower reflux scores (P < 0.01). At the most recent follow-up, 82 per cent of older patients rated their relief of symptoms as good or excellent. Similarly, 81 per cent of the younger patients reported good or excellent results. Ninety-one per cent of patients 70 years of age or more versus 85 per cent of patients less than 60 years would undergo laparoscopic Nissen fundoplication again, if necessary. With fundoplication, symptoms of GERD improve for older and younger patients, with less symptomatic dysphagia and reflux in older patients after fundoplication. Laparoscopic fundoplication safely ameliorates symptoms of GERD in elderly patients with symptomatic outcomes superior to those seen in younger patients.
