Agricultural policy and societal factors influence patients' ability to follow a healthy diet.

•Cardiovascular and cardiometabolic diseases are largely preventable, and are propagated by a poor diet.•Poor diet may be due to a lack of supply and access to healthy foods, agricultural subsidies, and marketing.•Improving national dietary intake starts with enhancing dietary guidelines, enacting legislative changes to optimize agricultural subsidies and food advertising, and incentivizing a plant-forward diet.

Relationship between extreme obesity and mortality in patients with reduced ejection fraction.

AIMS: Although obesity is associated with increased mortality, epidemiologic studies in heart failure have reported lower mortality in obese patients compared with matched nonobese patients (the 'obesity paradox'). However, the relationship between survival and extreme (morbid) obesity (BMI ≥ 40) is poorly understood. We evaluate survival in low ejection fraction patients across a range of BMI categories, including extreme obesity. METHODS: In a retrospective review, 12 181 consecutive patients receiving nuclear stress testing at a tertiary care center were stratified based on BMI and ejection fraction. Eight-year mortality data were collected using the social security death index. RESULTS: Normal ejection fraction patients (internal control, ejection fraction ≥50%) exhibited the J-shaped association between mortality and BMI that is observed in the general population. Among patients with reduced ejection fraction (<50%), survival improved as obesity increased (P < 0.0001). Those with extreme obesity had the lowest mortality (n = 1134, P < 0.05). CONCLUSION: In this cohort of reduced Ejection fraction patients, the obesity paradox was observed in all weight categories, with the highest survival of all observed in the extremely obese BMI category. This further supports hypotheses that an obesity-related physiologic phenomenon affects mortality in reduced ejection fraction patients.

Prevention information: patient perceptions regarding general and race-based instruction.

INTRODUCTION: The benefits of a healthy lifestyle are well-known. However, translating such information into behavior change is challenging. We explored patient perception in regard to how frequently this information is being disseminated, whether it may alter patient behavior, and whether information tailored to race versus general information is desirable. METHODS: Consecutive patients were asked to fill out an anonymous questionnaire directly prior to an outpatient cardiologist visit from 2006-2007. Six Likert scale questions were asked regarding physician education, its impact on behavior change, and the potential of race-based information to cause additional behavior change. RESULTS: Two hundred and six patients were queried, and 150 subjects completed the questionnaire. Mean age was 59 (+/-16) years, and 36% of the patients were men. Overall, 85% of patients reported being educated about lifestyle change. A large majority (greater than two-thirds) of the responders agreed or strongly agreed that education helps them make lifestyle changes, and that race-based information would be superior to general, non-race-based information in motivating lifestyle change. The responses were significantly higher than a hypothetical neutral score (p<.001) using the Wilcoxon rank-sum test. CONCLUSIONS: As a team, physicians are doing a good job disseminating preventive information. Patients report that this information does or will translate into behavior change. Information tailored to race appears to provide a superior impetus for the adoption of behavior change. Ongoing tailored education regarding a healthy lifestyle is warranted. Whether this information will lead to actual behavior change or to changes in clinical events requires further study.