Sex differences in health behavior change after premature acute coronary syndrome.

BACKGROUND: Limited information is available on the health behavior profile of patients with premature acute coronary syndrome (ACS). The purpose of this study is to desribe the health bahvior of young patients with ACS at the baseline and 1 year post-ACS and examine sex differences. METHODS: GENESIS-PRAXY is a prospective cohort study of adults (18-55 years old) hospitalized with ACS from 26 centers located in Canada, United States, and Switzerland. Data on diet, physical activity, smoking, alcohol consumption, and recreational drug use were collected through self-administered questionnaires at baseline and 1 year post-ACS. RESULTS: Our analysis included 740 patients with complete data. At baseline, the health behavior profile of young patients with ACS was worse than that of the general population. Men had a lower fruit and vegetable intake, consumed alcohol more, and used recreational drugs more than women. Conversely, fewer men than women were smokers (34% vs 42%). At 1 year post-ACS, the proportion of those consuming ≥5 daily servings of fruits and vegetables increased modestly (+5% vs +1%, for men vs women) but remained lower than the general population. Among women, the prevalence of smoking remained about twice as high as the general population. Recreational drug use also remained higher than in the general population. CONCLUSIONS: Despite small improvements at 1 year post-ACS, the health behavior profile of young patients remained worse than that of the general population. Greater efforts to improve health behaviors post-ACS among young patients are needed, and a sex-based approach may be required to ensure successful behavioral changes.

Potential factors associated with fruit and vegetable intake after premature acute coronary syndrome: a prospective cohort study.

Studies on dietary changes and their associated factors are limited, particularly with respect to younger cardiovascular patients. Our objective was to evaluate the factors associated with fruit and vegetable intake among adults with premature acute coronary syndrome (ACS) 1 year after the event. We used data from GENESIS-PRAXY, a multicentre prospective study of adults aged 18-55 years, hospitalised for ACS. Participants were 704 adults from 24 centres in Canada, 1 in USA and 1 in Switzerland. Data were collected through questionnaires and chart reviews at baseline and 1 year post-ACS. Fruit and vegetable intake was low among adults with premature ACS, and remained suboptimal at 1 year post-ACS, with only 21% meeting the minimum recommendations of at least 5 daily servings. The findings suggest that patient lifestyle characteristics, such as the number of hours spent at work and baseline intake are factors that may be associated with the intake of fruits and vegetables. More research is needed to assess effective strategies to increase fruit and vegetable intake among patients with premature ACS so that they meet dietary recommendations.

Fish consumption and acute coronary syndrome: a meta-analysis.

BACKGROUND: Findings on the association between fish consumption and acute coronary syndrome are inconsistent. We assessed the role of fish consumption in acute coronary syndrome by conducting a dose-response meta-analysis. METHODS: We conducted a literature search of MEDLINE and Embase databases from 1966 to June 2013 for prospective cohort and case-control studies that evaluated the association between fish consumption and acute coronary syndrome among general populations without cardiovascular disease history. Additional studies were identified via hand search of references of relevant articles. Estimates of relative risk (RR) were pooled using random-effects model. Sex and age effects were also evaluated. RESULTS: Our search retrieved 11 prospective cohort and 8 case-control studies, totaling 408,305 participants. Among prospective cohort studies, the highest category of fish consumption (ie, ≥4 times per week) was associated with the greatest risk reduction in acute coronary syndrome (RR 0.79; 95% confidence interval [CI], 0.70-0.89). In dose-response analysis, each additional 100-g serving of fish per week was associated with a 5% reduced risk (RR per serving 0.95; 95% CI, 0.92-0.97). Subgroup analysis and meta-regression suggested that the risk reduction did not differ across sex or age groups. No heterogeneity was observed among prospective cohort (P = .73) and case-control (P = .29) studies. There was no evidence of publication bias. CONCLUSION: Our meta-analysis demonstrated that there is an inverse association between fish consumption and the risk of acute coronary syndrome. Fish consumption appears beneficial in the primary prevention of acute coronary syndrome, and higher consumption is associated with greater protection.

Health-related quality of life in premature acute coronary syndrome: does patient sex or gender really matter?

BACKGROUND: Limited data exist as to the relative contribution of sex and gender on health-related quality of life (HRQL) among patients with acute coronary syndrome (ACS). This study aims to evaluate the effect of sex and gender-related variables on long-term HRQL among young adults with ACS. METHODS AND RESULTS: GENESIS-PRAXY (GENdEr and Sex determInantS of cardiovascular disease: from bench to beyond-Premature Acute Coronary SYndrome) is a multicenter, prospective cohort study (January 2009 to August 2013) of adults aged 18 to 55 years, hospitalized with ACS. HRQL was measured at baseline, 1, 6, and 12 months using the Short Form-12 and Seattle Angina Questionnaire (SAQ) among 1213 patients. Median age was 49 years. Women reported worse HRQL than men over time post-ACS, both in terms of physical and mental functioning. Gender-related factors were more likely to be predictors of HRQL than sex. Femininity score, social support, and housework responsibility were the most common gender-related predictors of HRQL at 12 months. We observed an interaction between female sex and social support (ß=0.44 [95% confidence interval, 0.01, 0.88]; P=0.047) for the physical limitation subscale of the SAQ. CONCLUSIONS: Young women with ACS report significantly poorer HRQL than young men. Gender appears to be more important than sex in predicting long-term HRQL post-ACS. Specific gender-related factors, such as social support, may be amenable to interventions and could improve the HRQL of patients with premature ACS.

Dairy products and prevention of type 2 diabetes: implications for research and practice.

A growing body of scientific evidence has linked dairy intake to a reduced type 2 diabetes (T2D) risk. Using an evidence-based approach, we reviewed the most recent and strongest evidence on the relationship between dairy intake and the risk of T2D. Evidence indicates that dairy intake is significantly associated with a reduced T2D risk, and likely in a dose-response manner. The association between low-fat dairy and T2D risk reduction appears consistent. A beneficial impact is suggested for regular-fat dairy. The role of specific dairy products needs to be clarified. Potential underlying mechanisms include the role of dairy products in obesity and metabolic syndrome, as well as several dairy components, such as calcium, vitamin D, dairy fat, and specifically trans-palmitoleic acid. To conclude, there is strong, consistent, and accumulating evidence that dairy intake reduces the risk of T2D. More research is needed to better understand the role of regular-fat and specific dairy products. Well-designed randomized controlled trials and mechanistic studies are needed to support these findings. Efforts to translate this evidence into clinical practice and public health guidance are needed.

Temporal trends in medication use and outcomes in atrial fibrillation.

BACKGROUND: Novel therapies for anticoagulation and rhythm control for atrial fibrillation (AF) have been developed recently. To best evaluate the comparative effectiveness of newer agents, practice patterns and outcomes of existing therapies must be characterized at the population level. METHODS: We conducted a retrospective population-based cohort study of patients ≥ 65 years with a first diagnosis of AF over a 9-year period in Québec and Ontario. Using hospital and drug claims databases, trends of filled prescriptions, and rates of strokes, bleeding complications, and mortality within 1 year were estimated. RESULTS: From 1998 to 2006, 338, 479 patients were hospitalized with an AF diagnosis. Median age was 77.5 years and 50.4% were male. Use of rate control was 3-fold higher than rhythm control therapy. There was a modest decrease in rate control therapy until 2001 (71.9% to 70.6%, P = 0.01), followed by a progressive increase (70.6% to 76.4%, P = 0.014). An opposite trend was observed for rhythm control. Although warfarin prescriptions increased (51.0% to 64.5%, P < 0.0001), stroke rates tended to decrease (3.8% to 3.5%, P = 0.148). Bleeding complications increased mostly because of emergency room visits (4.8% to 6.1%, P = 0.007). Mortality remained high despite a small but statistically significant decline (27.6% to 25.8%, P = 0.018). CONCLUSIONS: With increased anticoagulation use, stroke rates are declining and emergency room bleeding complications are increasing. Despite an increased use of evidence-based AF therapies, mortality remains high in this population. These findings highlight the need to focus on AF prevention in addition to minimizing its complications.