Survival benefit of coronary revascularization after myocardial perfusion SPECT: The role of ischemia.

BACKGROUND: Survival benefit of revascularization over medical therapy (MT) in patients with stable ischemic heart disease (SIHD) is uncertain. We evaluated the prognostic effects of revascularization in patients with SIHD undergoing single-photon emission computed tomography myocardial perfusion imaging (SPECT-MPI). METHODS: Of 47,894 patients, 7973 had ischemia ≥ 5% of the left ventricle. Of these, 1837 underwent early revascularization (≤ 60 days after SPECT-MPI). The rest were MT subgroup. Follow-up period was 4.04 ± 1.86 years. Statin therapy intensity and adherence were assessed. Outcomes were all-cause mortality, death + non-fatal myocardial infarction (MI), and MACE [major adverse cardiac event = death + MI + late revascularization (> 60 days after SPECT-MPI)]. RESULTS: Among patients with moderate-severe ischemia (≥ 10%), death rate was lower in early revascularization compared to MT subgroup (1.42%/year vs 3.12%/year, adjusted hazard ratio (HR) 0.67 (95% CI 0.50-0.90, P = .008). Death + MI and MACE rates were also lower, adjusted HR 0.69 (0.55-0.88, P = .003) and 0.80 (0.69-0.92, P = .003). Revascularization was beneficial in optimal statin therapy subgroup (death rate 1.04%/year vs 2.36%/year, adjusted HR 0.51 (0.30-0.86, P = .012). In mild ischemia (5%-9%), revascularization did not improve survival or MI-free survival, and was associated with higher MACE rate (8.86%/year vs 7.67%/year, adjusted HR 1.30 (1.12-1.52, P < .001). CONCLUSION: Compared to MT, revascularization was associated with reduced risk of death, death + MI, and MACE in patients with moderate-severe ischemia, incremental over optimal statin therapy. In mild ischemia, revascularization was associated with higher risk of MACE, driven by late revascularization, with no impact on death and death + MI.

Adherence to a Mediterranean diet by vegetarians and vegans as compared to omnivores.

To assess adherence to the Mediterranean Diet (MedD) by vegetarians and vegans compared to omnivores, we recruited an internet-based convenience sample of 565, 151 and 514 Israeli (>20 years) vegans, vegetarians and omnivores. Studies assessing vegetarians' and vegans' adherence to the Mediterranean Diet (MedD) are scarce. We recruited an internet-based convenience sample of 565, 151 and 514 Israeli vegans, vegetarians and omnivores, mostly female with a normal weight. We assessed their MedD scores (MedDS) and their food groups' consumption by two food frequency questionnaires: (1) Trichopoulou's MedDS (range 0-9); (2) Literature-based MedDS (LBMedDS) (range 0-18). We found that vegans tend to consume significantly more legumes, nuts, fruits and vegetables than omnivores. The multivariable-adjusted odds for high MedDS (a score ≥4) (compared to omnivores) assessed by Trichopoulou's score were: 32.35-fold higher in vegans (95% CI, 21.43-48.84) and 3.13-fold higher in vegetarians (95% CI, 2.06-4.76). Using the LBMedDS, vegans had 2.30-fold higher odds for high MedD adherence (a score ≥12) and vegetarians 1.66-fold higher odds compared to omnivores. In conclusion, we found a higher MedD adherence among vegans and vegetarians compared to omnivores.