Reported obstructive sleep apnea does not diminish the cardiometabolic health benefits from a comprehensive lifestyle intervention program.

Obstructive sleep apnea (OSA) commonly coexists with the metabolic syndrome, a condition for which behavioral changes are often prescribed. Whether OSA diminishes the cardiometabolic health benefits from lifestyle interventions remains unclear. We evaluated 278 consecutive metabolic syndrome participants enrolled in a 12-week comprehensive lifestyle intervention program. The changes in blood pressure (BP), along with other metabolic health parameters, from baseline to follow-up were compared between those with and without OSA. Mean age was 52.4 ± 10.9 years and 37% were male. At enrollment, mean body mass index (BMI) was 38.2 ± 7.7 kg/m2 . OSA was reported in 126 of 269 final participants (47%). At baseline, participants with reported OSA were more likely to be male, older, have a higher BMI, waist and neck size (all P < 0.05). At program completion, participants with (-5.8 ± 16.1/-3.0 ± 10.0 mm Hg) and without OSA (-4.7 ± 13.1/-3.3 ± 8.2 mm Hg) had significant reductions in systolic and diastolic BP as well as BMI, fasting glucose, and triglyceride levels. There were no significant differences in the absolute or percentage changes in BP or other metabolic parameters between groups. Our findings support that patients with the metabolic syndrome can derive substantial health benefits, including reductions in BP, by a lifestyle intervention program regardless of the presence of OSA.

Acute necrotizing eosinophilic myocarditis in a patient taking Garcinia cambogia extract successfully treated with high-dose corticosteroids.

A previously healthy 48-year-old woman was evaluated for lightheadedness and chest heaviness 2 weeks after starting the herbal supplement Garcinia cambogia. She was found to be hypotensive and had an elevated serum troponin level. The patient had a progressive clinical decline, ultimately experiencing fulminant heart failure and sustained ventricular arrhythmias, which required extracorporeal membrane oxygenation support. Endomyocardial biopsy results were consistent with acute necrotizing eosinophilic myocarditis (ANEM). High-dose corticosteroids were initiated promptly and her condition rapidly improved, with almost complete cardiac recovery 1 week later. In conclusion, we have described a case of ANEM associated with the use of Garcinia cambogia extract.

A comparison of the use of traditional hand injection versus automated contrast injectors during cardiac catheterization.

OBJECTIVE: To compare the incidence of contrast-induced nephropathy (CIN) and vascular complications in patients undergoing cardiac catheterization using traditional manual contrast injection techniques with those in which an automated contrast injector device was used. BACKGROUND: It has been suggested that use of automated contrast injectors in coronary interventions could reduce complications by reducing contrast volume usage and allowing the use of smaller sheaths. METHODS: This was a retrospective cohort study with review of patient's electronic medical charts and the Heartbase registry. Complete data were available for 13107 patients between 1999 and 2009. Of those patients, 5137 procedures were performed with traditional manual contrast injection and 7970 procedures used automated contrast injection. The CIN event rate and vascular complication rates were compared between patients who underwent catheterization using these differing techniques. RESULTS: Overall, the incidence of CIN was comparable in traditional and automated contrast injector assisted catheterizations (9.07% vs 8.73%; P=.5). However, for the subgroup of patients that had a diagnostic cardiac catheterization and went on to have an ad hoc angioplasty, incidence of CIN was much lower in the automated contrast injector group (7.04% vs 5.50%; P=.007). The incidence of vascular complications was lower in the automated contrast injector group vs the traditional method (2.85% vs 2.17%; P=.02), irrespective of an ad hoc angioplasty. CONCLUSION: Use of automated contrast injectors resulted in a significant decrease in vascular complications across all cardiac catheterizations. Additionally, there was a significant decrease in CIN when the automated contrast injector was used for catheterizations that included a percutaneous coronary intervention.