Title: Dietary Glycemic Load and Index and Risk of Coronary Heart Disease in a Large Italian Cohort: The EPICOR Study
Topic: Prevention/Vascular
Date Posted: 4/13/2010
Author(s): Sieri S, Krogh V, Berrino F, et al.
Citation: Arch Intern Med 2010;170:640-647.
Clinical Trial: No
Study Question: Is glycemic load associated with increased risk of coronary heart disease (CHD)?
Methods: Data from the European Prospective Investigation into Cancer and Nutrition (EPIC) study’s Italian cohort were used for the present study. Subjects were excluded if they had a prior history of cardiovascular disease or diabetes, or if data were missing on diet or lifestyle factors. The primary outcome of interest was CHD, defined as the occurrence of acute myocardial infarction, acute coronary syndrome, or coronary revascularization during follow-up.
Results: A total of 47,749 subjects (32,578) were followed over a median of 7.9 years. CHD events were experienced in 158 men and 305 women. Women in the highest quartile for carbohydrate intake had a significantly greater risk for CHD compared to those in the lowest quartile (relative risk [RR], 2.0; 95% confidence interval [CI], 1.16-3.43). No such association was observed in men. Increasing carbohydrate intake from high-glycemic index foods was also associated with increased risk for CHD in women (RR, 1.68; 95% CI, 1.02-2.75), which was not observed with low-glycemic index foods. A similar observation was noted for high glycemic load (RR, 2.24; 95% CI, 1.26-3.98) also among the women subjects, but not observed in men subjects.
Conclusions: The investigators concluded that among this cohort of Italian men and women, high dietary glycemic load (and index) and carbohydrate intake was associated with CHD risk in women, but not men.
Perspective: It is surprising that high glycemic load and carbohydrate intake is associated with increased CHD risk in women, but not men. Understanding factors that may explain this possible gender difference is warranted. Elizabeth A. Jackson, M.D., F.A.C.C.
Title: Enhanced Depression Care for Patients With Acute Coronary Syndrome and Persistent Depression Symptoms: Coronary Psychosocial Evaluation Studies Randomized Controlled Trial
Topic: General Cardiology
Date Posted: 4/13/2010
Author(s): Davidson KW, Rieckmann N, Clemow L, et al.
Citation: Arch Intern Med 2010;170:600-608.
Clinical Trial: yes
Study Question: Does an enhanced depression treatment for patients after acute coronary syndrome (ACS) improve depressive symptoms and reduce adverse cardiac events?
Methods: This was a randomized controlled trial conducted from January 2005 through February 2008 with ACS patients from five hospitals. A 3-month observation period prior to randomization was used to identify patients with persistent depressive symptoms. Following this observation phase, a 6-month trial was conducted. Patients were randomized to the intervention, which included patient preference for problem-solving therapy and/or pharmacotherapy, followed by a stepped-care approach. The control group received usual care and a third group of nondepressed patients was used as an observational group. The primary outcome of interest was patient satisfaction with depression care. Secondary outcomes included change in depressive symptoms (measured with Beck Depression Inventory), major adverse cardiac events, and death.
Results: A total of 237 patients were enrolled (80 in the intervention group, 77 in the control group, and 80 in the observation group). The number of patients who reported being satisfied with the depression care received was higher in the intervention group compared to those in the control group (odds ratio, 5.4; 95% confidence interval, 2.2-12.9). The Beck Depression Inventory Score decreased more in the intervention group (change, -5.7 vs. -1.9). At the end of the trial, three patients in the intervention group experienced adverse cardiac events, as did 10 patients in the usual care group and five in the nondepressed group.
Conclusions: The investigators concluded that an enhanced treatment for depression among patients with ACS was associated with greater satisfaction with care, reduced depressive symptoms, and a trend toward reduced cardiac events.
Perspective: Depressive symptoms are frequently experienced by patients after ACS. Finding effective interventions for depression can only help improve overall cardiac care. These findings suggest that this enhanced program may be effective for treatment of depression. Larger-scale studies are needed to confirm and extend these results. Elizabeth A. Jackson, M.D., F.A.C.C.