Intermittent Fasting: A Heart Healthy Dietary Pattern?

Dietary patterns, such as the Dietary Approaches to Stop Hypertension (DASH) and the Mediterranean diet, have been shown to improve cardiac health. Intermittent fasting is another type of popular dietary pattern that is based on timed periods of fasting. Two different regimens are alternative day fasting and time-restricted eating. Although there are no large, randomized control trials examining the relationship between intermittent fasting and cardiovascular outcomes, current human studies that suggest this diet could reduce the risk for cardiovascular disease with improvement in weight control, hypertension, dyslipidemia, and diabetes. Intermittent fasting may exert its effects through multiple pathways, including reducing oxidative stress, optimization of circadian rhythms, and ketogenesis. This review evaluates current literature regarding the potential cardiovascular benefits of intermittent fasting and proposes directions for future research.

Comparison of total 12-lead QRS voltage in a variety of cardiac conditions and its usefulness in predicting increased cardiac mass.

Echocardiography provides a more accurate method to determine increased cardiac mass than does electrocardiography. Nevertheless, most offices of physicians do not possess echocardiographic machines, but many possess electrocardiographic machines. Many electrocardiographic criteria have been used to determine increased cardiac mass, but few of the criteria have been measured against cardiac weight determined at necropsy or after cardiac transplantation. Such was the purpose of the present study. Cardiac weight at necropsy or after transplantation was determined in 359 patients with 11 different cardiac conditions, and total 12-lead electrocardiographic QRS voltage (from the peak of the R wave to the nadir of either the Q or the S wave, whichever was deeper) was measured in each patient. Even in hearts with massively increased cardiac mass (>1,000 g), the total 12-lead QRS voltage was clearly increased (>175 mm) in only 94%, but this criterion was superior to that of previously described electrocardiographic criteria for "left ventricular hypertrophy." Hearts with excessive adipose tissue infrequently had increased total 12-lead QRS voltage despite increased cardiac weight. Likewise, patients with fatal cardiac amyloidosis had hearts of increased weight but quite low total 12-lead QRS voltage. In conclusion, 12-lead QRS voltage is useful in predicting increased cardiac mass, but that predictability is dependent in part on the cause of the increased cardiac mass.

The effects of caloric restriction on health and longevity.

OPINION STATEMENT: There is increasing evidence that restricting caloric intake may have considerable health benefits in humans. Significant evidence in non-primate animals demonstrates that caloric restriction increases average and maximal life span. However, historically, caloric intake reduction in humans has been involuntary and accompanied by poverty, malnutrition, poor sanitation, and a lack of modern health care. As a result, caloric restriction in people typically has been accompanied by a reduction of both average and maximal life span. Conversely, improvements in standards of living usually are accompanied by an increased food supply and resultant improved health and longevity. The majority of the world is now in a new era where an abundance of caloric intake and its associated obesity are causing widespread chronic illness and premature death. What would happen if one were to institute caloric restriction with high-quality nutrition within an environment of modern sanitation and health care? This review argues that improved health and improved average life span would quite likely result. A lengthening of maximal human life span with this combination is perhaps possible but by no means certain.

The role of C-reactive protein as a risk predictor of coronary atherosclerosis: implications from the JUPITER trial.

Much controversy surrounds the use of high-sensitivity C-reactive protein (hs-CRP) as a marker of cardiovascular (CV) risk. Although data regarding the association of hs-CRP with CV disease is extensive and consistent, its role in clinical practice remains unclear. The American Heart Association (AHA) recently published a scientific statement regarding criteria for evaluation of novel markers of CV risk. This article provides a comprehensive review of data regarding hs-CRP as a risk marker for CV disease in the context of these AHA criteria. The impact of the JUPITER trial on the utility of hs-CRP as a risk marker is emphasized. The review concludes with an evidence-based statement regarding the current role of hs-CRP in CV risk prediction.

Revisiting niacin: reviewing the evidence.

Atherogenic dyslipidemia, defined by a cluster of lipoprotein abnormalities, including low high-density lipoprotein cholesterol (HDL-C) and elevated serum triglycerides, represents an important potential target for reducing cardiovascular risk. This has paved the way for revisiting niacin as a therapy in preventing progression of atherosclerosis. Niacin remains the safest and most effective agent for raising HDL-C and is a logical choice to target atherogenic dyslipidemia. While the clinical efficacy of niacin has been known for many years, it is only with development of newer formulations, which have lower side-effect profiles and improved compliance, that the potential for this agent been fully realized. In this review, we will examine some of the reasons that niacin can have important implications for reducing progression of atherosclerosis. We will first examine the different formulations and their variability, not only in side-effect profiles, but also in clinical efficacy. We will then consider the theoretical evidence for the benefit of HDL-raising produced by niacin on atherosclerotic progression. Finally, we will review clinical data suggesting the benefit of niacin on cardiovascular outcomes.

A retrospective electronic chart review of blood pressure changes in elderly patients treated with amlodipine or an angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker.

BACKGROUND: Despite the high costs of managing hypertension, pharmacologic intervention is cost-effective, particularly in patients at highest risk for cardiovascular events. The prevalence of hypertension in the elderly and the age-associated risks of coronary artery disease and stroke suggest that early identification and aggressive treatment should be priorities in this population. OBJECTIVE: The aim of this study was to compare the effect of amlodipine and angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) in the treatment of essential hypertension in elderly patients (>60 years) in an actual practice setting. METHODS: This was a retrospective cohort analysis using electronic medical records stored in the Physicians Data Corporation cardiology database. Patients aged >60 years who received care from a cardiologist and who had a recorded diagnosis of hypertension during 1997 or 1998 were identified. For inclusion, patients had to have received an initial prescription for amlodipine, an ACE inhibitor, or an ARB at the index visit. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) readings from the index visit and > or =1 subsequent visit (<180 days after the index visit) were assessed. RESULTS: A total of 192 patients (56.3% male; mean age, 71.9 years) met the inclusion criteria. Amlodipine-treated patients experienced a mean decrease in SBP of 26.7 mm Hg, compared with 18.8 mm Hg in patients receiving an ARB and 15.8 mm Hg for patients receiving an ACE inhibitor (P = 0.008, amlodipine vs ACE inhibitor). DBP decreased 8.8 mm Hg with amlodipine, 8.7 mm Hg with an ARB, and 6.2 mm Hg with an ACE inhibitor. After adjusting for age, sex, and disease severity, amlodipine-treated patients were -4 times as likely to move to a better blood pressure stage than patients treated with an ARB or an ACE inhibitor (odds ratio, ARB vs amlodipine: 0.245; 95% CI, 0.080-0.753; odds ratio, ACE inhibitor vs amlodipine: 0.234; 95% CI, 0.072-0.761). CONCLUSION: Results of this study indicate that in patients aged >60 years, amlodipine may be an effective therapy for hypertension.