Association Between Chocolate Consumption and Severity of First Infarction

Abstract Background: Cardiovascular diseases, such as acute myocardial infarction, are the main causes of death in the world. The flavonoids present in chocolate can have benefits for people who have risk factors to the development of cardiovascular diseases and have a coadjuvant effect on known therapies. Objective: To analyze the association between chocolate consumption, severity of coronary lesions, risk factors and severity of the first infarction in patients attended at the Cardiology Institute of Santa Catarina and other hospitals in the State of Santa Catarina. Methods: Subanalysis of the Catarina Heart Study cohort, evaluated 350 patients with first myocardial infarction. We evaluated clinical, echocardiographic, hemodynamic laboratorial variables. We used chi square test to evaluate qualitative variables, t student test in the case of parametric variables and U Mann Whitney test in non-parametric variables. We considered significant p < 0,05. Results: Lower prevalence of hypertension (43.2% % vs. 62.3% p = 0.003), diabetes mellitus (13.5% vs. 25.7%, p = 0.027) and smoking (24.3% vs. 37.7%, p = 0.032) among those who consume chocolate. Higher use of alcohol (40.5% vs. 26.4%, p = 0.018) and drugs (9.5% vs. 3.3%, p = 0.023) among those who consumed chocolate. Among the patients who consumed chocolate, there was a negative correlation between amount consumed and Syntax (r = -0.296, p = 0.019). Conclusion: There was association between chocolate consumption and lower prevalence of hypertension, diabetes and smoking. There was no association between amount of chocolate consumed and post-infarction ventricular function and TIMI frame count. Higher prevalence of alcohol and drug use among those who consume chocolate. Negative correlation between Syntax and the amount of chocolate consumed.

Influence of intermittent fasting on myocardial infarction-induced cardiac remodeling.

BACKGROUND: Information on the role of intermittent fasting (IF) on pathologic cardiac remodeling is scarce. We compared the effects of IF before and after myocardial infarction (MI) on rat cardiac remodeling and survival. METHODS: Wistar rats were intermittently fasted (food available every other day) or fed ad libitum for 12 weeks and then divided into three groups: AL - fed ad libitum; AL/IF - fed AL before MI and IF after MI; and IF - fed IF before and after MI. Echocardiogram was performed before MI and 2 and 12 weeks after surgery. Isolated hearts were evaluated in Langendorff preparations. RESULTS: Before surgery, body weight (BW) was lower in IF than AL. Final BW was lower in AL/IF and IF than AL. Perioperative mortality did not change between AL (31.3%) and IF (27.3%). Total mortality was lower in IF than AL. Before surgery, echocardiographic parameters did not differ between groups. Two weeks after surgery, MI size did not differ between groups. Twelve weeks after MI, left ventricular (LV) diastolic posterior wall thickness was lower in AL/IF and IF than AL. The percentage of variation of echocardiographic parameters between twelve and two weeks showed that MI size decreased in all groups and the reduction was higher in IF than AL/IF. In Langendorff preparations, LV volume at zero end-diastolic pressure (V0; AL: 0.41 ± 0.05; AL/IF: 0.34 ± 0.06; IF: 0.28 ± 0.05 mL) and at 25 mmHg end-diastolic pressure (V25; AL: 0.61 ± 0.05; AL/IF: 0.54 ± 0.07; IF: 0.44 ± 0.06 mL) was lower in AL/IF and IF than AL and V25 was lower in IF than AL/IF. V0/BW ratio was lower in IF than AL and LV weight/V0 ratio was higher in IF than AL. Myocyte diameter was lower in AL/IF and IF than AL (AL: 17.3 ± 1.70; AL/IF: 15.1 ± 2.21; IF: 13.4 ± 1.49 µm). Myocardial hydroxyproline concentration and gene expression of ANP, Serca 2a, and α- and ß-myosin heavy chain did not differ between groups. CONCLUSION: Intermittent fasting initiated before or after MI reduces myocyte hypertrophy and LV dilation. Myocardial fibrosis and fetal gene expression are not modulated by feeding regimens. Benefit is more evident when intermittent fasting is initiated before rather than after MI.

Effects of high and low salt intake on left ventricular remodeling after myocardial infarction in normotensive rats.

The dietary-sodium restriction is a standard approach following an acute myocardial infarction (MI). We examined the hypothesis in which the use of a high or low-sodium diet would worsen post-infarction left ventricular remodeling in rats and facilitate the development of heart failure. Left coronary artery ligation or sham-operated (SO) was produced in male Wistar rats (250-290 g). After surgery, animals were assigned to one of the three diets: standard amount of sodium (0.3% NaCl, SO and MI groups), a high-sodium diet (0.6% NaCl, SO-High and MI-High groups), or a low-sodium diet (0.03% NaCl, SO-Low and MI-Low groups). Diets were provided for 8 weeks post-surgery. Mortality rate was elevated in high-salt group (MI-Low, 21.4%; MI, 35.3%; MI-High, 47.6%). Contractility parameter was seen to be impaired in MI-Low animals (3195 ± 211 mm Hg/s) compared with MI (3751 ± 200 mm Hg/s). Low-salt diet did not prevent myocardial collagen deposition (MI-Low, 5.2 ± 0.5%; MI, 5.0 ± 0.4%) nor myocyte hypertrophy (MI-Low, 608 ± 41µ(2); MI, 712 ± 53 µm(2)) in left ventricle after MI. High-salt intake increases collagen volume fraction (SO, 3.3 ± 0.4%; SO-High, 4.7 ± 0.4%) in animals sham, but no major changes after MI. Our results show that ventricular remodeling was not altered by immediate introduction of low sodium after MI, and it may be a safe strategy as a therapeutic intervention to avoid volume retention. However, high sodium can be harmful, accelerating the post-infaction ventricular remodeling.

Antioxidant characterization of soy derived products in vitro and the effect of a soy diet on peripheral markers of oxidative stress in a heart disease model.

This study analyzed and compared the content of isoflavones in 2 soy products, the effectiveness of isoflavones as antioxidants, in vitro, and demonstrated the antioxidant effect of a soy diet in rats with myocardial infarction (MI). Isoflavone content was analyzed in soybean hypocotyl (SH) and isolated soy protein (ISP). The quality (TAR) and quantity (TRAP) of antioxidants present in the samples was quantified. The amount of daidzin was higher in SH (9 times) and genistein in ISP (5 times). SH presented a 3-fold increase in TAR, while both products exhibited same TRAP. The rats were fed an ISP diet for 9 weeks. Animals were distributed among 6 treatment groups: (i) Sham Casein; (ii) Infarct Casein < 25%; (iii) Infarct Casein > 25%; (iv) Sham Soy; (v) Infarct Soy < 25%; and (vi) Infarct Soy > 25%. MI was induced 5 weeks after the commencement of the diets. Lipid peroxidation (LPO), antioxidant enzyme activity, and levels of nitrites/nitrates were determined in blood. Rats receiving the ISP diet demonstrated increased activity of antioxidant enzyme activity and nitrite/nitrate content. In addition, the increase in LPO seen in rats subjected to MI was significantly mitigated when the ISP diet was given. These findings suggest a nutritional approach of using a soy-based diet for the prevention of oxidative-stress-related diseases such as heart failure.

Diet with isolated soy protein reduces oxidative stress and preserves ventricular function in rats with myocardial infarction.

We investigated the effects of an isolated soy protein (ISP) diet offered over a 9-week period to rats in whom myocardial infarction (MI) had been induced, and a casein diet given as a control. Male Wistar rats were assigned to six groups after infarct size determination (n=8/group): Sham Casein (SC); Infarct Casein <25% (IC<25%); Infarct Casein >25% (IC>25%); Sham Soy (SS); Infarct Soy <25% (IS<25%); and Infarct Soy >25% (IS>25%). MI surgery was performed at the fifth week, and one month later, the animals were hemodynamically assessed to evaluate left ventricular systolic pressure (LVSP), left ventricular end diastolic pressure (LVEDP), contractility and relaxation indexes (+/-dP/dt). Lung and liver specimens were also collected for the estimation of organ congestion. Oxidative stress was evaluated in heart homogenates through chemiluminescence (CL), carbonyl groups, and antioxidant enzyme activities of superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (GPx). Infarcted groups treated with casein showed cardiac hypertrophy, lung and liver congestion, increased LVEDP and decreased LVSP and +/-dP/dt, all typical signals of heart failure. Ventricular dysfunction was correlated with increased myocardial oxidative damage as seen by CL and carbonyl groups data in the groups IC<25% and IC>25% (3 and 10-fold increase, respectively). The ISP diet was able to improve ventricular systolic and diastolic function in the groups IS<25% and IS>25% (LVEDP was reduced by 44% and 24%, respectively) and to decrease myocardial oxidative stress. The overall results confirm the preventive role of soy-derived products in terms of post-MI myocardial dysfunction probably by an antioxidant action.

Transdisciplinary approach to the follow-up of patients after myocardial infarction.

OBJECTIVES: To compare conventional and transdisciplinary care in a tertiary outpatient clinic for patients after their first acute myocardial infarction. METHODS: One hundred fifty-three patients with acute myocardial infarction were randomized at hospital discharge and followed-up to compare conventional (n=75) and transdisciplinary care (n=78). They were submitted to a clinical evaluation, received a dietary plan, and were re-evaluated twice in 60-180 days by a nurse, dietitian and physician, when new clinical and laboratory data were collected. The primary outcome was clinical improvement, as evaluated by an index including reduction of body weight, lowering of blood pressure, smoking cessation, increase in physical activity and compliance with medication. RESULTS: The groups were similar at baseline: 63.4% were men, 89.9% had an acute myocardial infarction with ST-segment-elevation, 32.7% were diabetic, and 72.2% were hypertensive. The clinical improvement index was similar between the studied groups: in 33.3 % (transdisciplinary care) vs. 30.4 % (conventional care) of patients, the improvement was very good (P=1.000). Rates of re-hospitalization and death (p=0.127) were similar between transdisciplinary and conventional care. Compliance with diet was higher for transdisciplinary care (50.0%) vs. conventional care (26.1%) (p=0.007), as was compliance with visits (73.3 vs. 40.3%, respectively, p<0.001). CONCLUSIONS: Compliance with diet and visits was higher for transdisciplinary care vs. conventional care; however, the transdisciplinary approach did not provide more clinical benefits than the conventional approach after patients' first acute myocardial infarction in this setting.

Transdiciplinary approach to the follow-up of patients after myocardial infarction

OBJECTIVES: To compare conventional and transdisciplinary care in a tertiary outpatient clinic for patients after their first acute myocardial infarction. METHODS: One hundred fifty-three patients with acute myocardial infarction were randomized at hospital discharge and followed-up to compare conventional (n=75) and transdisciplinary care (n=78). They were submitted to a clinical evaluation, received a dietary plan, and were re-evaluated twice in 60-180 days by a nurse, dietitian and physician, when new clinical and laboratory data were collected. The primary outcome was clinical improvement, as evaluated by an index including reduction of body weight, lowering of blood pressure, smoking cessation, increase in physical activity and compliance with medication. RESULTS: The groups were similar at baseline: 63.4 percent were men, 89.9 percent had an acute myocardial infarction with ST-segment-elevation, 32.7 percent were diabetic, and 72.2 percent were hypertensive. The clinical improvement index was similar between the studied groups: in 33.3 percent (transdisciplinary care) vs. 30.4 percent (conventional care) of patients, the improvement was very good (P=1.000). Rates of re-hospitalization and death (p=0.127) were similar between transdisciplinary and conventional care. Compliance with diet was higher for transdisciplinary care (50.0 percent) vs. conventional care (26.1 percent) (p=0.007), as was compliance with visits (73.3 vs. 40.3 percent, respectively, p<0.001). CONCLUSIONS: Compliance with diet and visits was higher for transdisciplinary care vs. conventional care; however, the transdisciplinary approach did not provide more clinical benefits than the conventional approach after patients' first acute myocardial infarction in this setting.

Evaluación de una maniobra nutricional tendiente a reducir los niveles de colesterol en pacientes portadores de enfermedad coronaria en el sistema público de salud chileno / Evaluation of a nutritional intervention to reduce cholesterol levels in patients with coronary artery disease

Background: The mainstay of cholesterol reduction therapy is the diet. But the lack of compliance and prescription problems limit its usefulness. Aim: To compare the effectiveness of a nutritional intervention given by a nutritionist with the usual recommendations given by a physician to reduce the LDL cholesterol levels in patients with coronary artery disease, treated at the Regional public hospital in Temuco. Material and Methods: One hundred and forty patients with coronary heart disease (last acute episode at least three months before), without nutritional interventions nor cholesterol-lowering drugs, who gave informed consent, were randomized to receive either instructions by their physician or to take part in a nutritional program. The nutritional intervention consisted in five educational sessions, adapted from the NCEP and from a program of the Nutrition Department of the Catholic University of Chile. Patients randomized to the medical intervention received the standard written recommendations about diet. Lipid profile was measured before the intervention and after a three and twelve months follow up. Results: After one year the group on the nutritional program reduced LDL cholesterol by 11.1% (p=0.03). There were no changes in the medical group. However, only 10% patients on the nutritional intervention group and 8% of those with medical recommendations achieved LDL cholesterol levels less than 100 mg/dl. There were no changes in triglycerides, weight or body mass index during the period. Conclusions: Although this nutritional intervention proved to be more effective than usual medical instructions, most patients on secondary prevention did not achieve acceptable LDL cholesterol levels (Rev Méd Chile 2004; 132: 1457-65).

[Evaluation of a nutritional intervention to reduce cholesterol levels in patients with coronary artery disease]. / Evaluación de una maniobra nutricional tendiente a reducir los niveles de colesterol en pacientes portadores de enfermedad coronaria en el sistema público de salud chileno.

BACKGROUND: The mainstay of cholesterol reduction therapy is the diet. But the lack of compliance and prescription problems limit its usefulness. AIM: To compare the effectiveness of a nutritional intervention given by a nutritionist with the usual recommendations given by a physician to reduce the LDL cholesterol levels in patients with coronary artery disease, treated at the Regional public hospital in Temuco. MATERIAL AND METHODS: One hundred and forty patients with coronary heart disease (last acute episode at least three months before), without nutritional interventions nor cholesterol-lowering drugs, who gave informed consent, were randomized to receive either instructions by their physician or to take part in a nutritional program. The nutritional intervention consisted in five educational sessions, adapted from the NCEP and from a program of the Nutrition Department of the Catholic University of Chile. Patients randomized to the medical intervention received the standard written recommendations about diet. Lipid profile was measured before the intervention and after a three and twelve months follow up. RESULTS: After one year the group on the nutritionalprogram reduced LDL cholesterol by 11.1% (p=0.03). There were no changes in the medical group. However, only 10% patients on the nutritional intervention group and 8% of those with medical recommendations achieved LDL cholesterol levels less than 100 mg/dl. There were no changes in triglycerides, weight or body mass index during the period. CONCLUSIONS: Although this nutritional intervention proved to be more effective than usual medical instructions, most patients on secondary prevention did not achieve acceptable LDL cholesterol levels.