Tuesday, October 25, 2016

Mortality and the Mediterranean diet

In the UK, the Mediterranean diet was associated with lower heart disease incidence and decreased all-cause mortality. BMC Med. 2016 Sep 29;14(1):135.

Comment: This study, unlike another recent study (Ann Intern Med. 2016 Oct 4;165(7):491-500) found that all-cause mortality was decreased by the Mediterranean diet. My impression is that the majority of studies point to a significant gain in life in terms of both years and quality. Until evidence points elsewhere, the Mediterranean diet is probably the best, and most studied.

Wednesday, October 12, 2016

How to Survive Your Hospitalization: Drink Coffee

Coffee reduces the risk of death after acute myocardial infarction: a meta-analysis.

Drinking coffee regularly after an acute myocardial infarction was found to be associated with a reduced risk of mortality. Coron Artery Dis. 2016 Nov;27(7):566-72.

Comment: This study found that routine heavy coffee drinkers (over 2 cups a day) had a lower mortality after acute myocardial infarction than routine light coffee drinkers (1 to 2 cups a day), who had a lower mortality after acute myocardial infarction than noncoffee drinkers. The risk reductions observed were significant: heavy versus light (31% risk reduction), heavy vs noncoffee drinkers (46% reduction), and light vs noncoffee drinkers (21% reduction). 

Should we allow, and possibly even encourage patients after an acute myocardial infarction to drink coffee?

How to Survive Your Hospitalization: Arrive Early

Symptom-to-door delay among patients with ST-segment elevation myocardial infarction in Singapore.

Waiting longer from symptom onset to arrival at the emergency department for people with an acute myocardial infarction is associated with higher morbidity and mortality. Emerg Med Australas. 2016 Oct 11

Comment: This research found that the factors associated with a longer symptom-to-ER time included: 
  • older age
  • diabetes mellitus
  • presenting symptoms of back and epigastric pain
  •  Malay ethnicity
 There are important implications of this research. First of all, it may likely be that older people and those with diabetes have less intense pain, and thus do not call emergency services right away. Therefore, these groups of people need to be more aware of the signs and symptoms of a heart attack, and have a low threshold for calling emergency services. Back and epigastric pain are not the "typical" symptoms of a heart attack, so having the general public more aware of this possibility, and making individual patients at high risk aware of the relationship between back pain, epigastric pain, and acute myocardial infarction may help. Certain cultures and ethnicities may also be less inclined to activate emergency services; this barrier may be overcome at least in part through improved community education about the benefits of rapid treatment in acute myocardial infarction.

The take-home message: if you have symptoms of a heart attack, activate emergency services promptly, and you will be more likely to survive and less likely to have complications in the hospital.

Sunday, October 9, 2016

How to Survive Your Hospitalization: Control Your Sugar Consumption Afterwards

After a myocardial infarction, long term prognosis is much worse for patients with an abnormal glucose tolerance test at post-hospitalization follow-up. Kardiol Pol. 2016 Oct 7

Comment: This study found that acute myocardial infarction patients had a much worse prognosis if their glucose metabolism was abnormal at a 7 month follow-up visit. This was regardless of whether or not their glucose metabolism was abnormal at hospital discharge. This study suggests that the glucose tolerance test (and likely the HgbA1c) is a strong prognostic factor. Normalizing glucose metabolism early after a myocardial infarction may have significant mortality benefits. Patients with abnormal glucose metabolism at follow-up had a 2.5 year mortality rate of 2 to 4 times that of patients with normal glucose metabolism (3% versus 6% - 11%). Diet and exercise appear to be critical factors to prolong mortality after acute myocardial infarction.

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