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Cardiovascular Disease in the News

Geriatric Times

January/February 2002

Vol. III

Issue 1

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Legume Consumption May Reduce Risk of Coronary Heart Disease

There is abundant research linking consumption of legumes (such as dry beans, peas or peanuts) to a reduced risk of coronary heart disease (CHD). However, most of the research has focused on the nutritional components of legumes, such as protein and fiber, rather than dietary patterns. A study in Archives of Internal Medicine (2001;161[21]:2573-2578) is one of the first to examine the relationship between increased legume consumption and risk of CHD.

Lydia A. Bazzano, Ph.D., and colleagues studied 9,632 patients over 19 years, documenting the frequency of legume intake over three-month intervals. The incidence of CHD and cardiovascular disease (CVD) was determined at follow-up based on hospital records, patient interviews or death certificates.

The researchers found that patients who consumed more legumes had, on average, lower systolic blood pressure and lower total cholesterol and body mass index than those who consumed fewer legumes. In addition, those who consumed legumes at least four times a week had a 22% and 11% lower risk of CHD and CVD, respectively, than those who ate legumes less than once a week. Inter-estingly, those who ate legumes frequently were also more likely to be physically active, smoke and consume more saturated fats than their counterparts.

The researchers stressed the importance of their study in terms of evaluating food items as part of an overall dietary pattern: "It may be more instructive and useful to investigate the relationship between dietary patterns or specific food intakes and risk of CHD events because the results of such studies may have more direct public health implications" -- TB

Risk for Morbidity and Mortality in Depressed Post-MI Patients

Approximately one in six patients recovering from myocardial infarction (MI) experiences major depression, and at least twice as many have significant symptoms of depression soon after the event (JAMA 2001;286[13]:1621-1627). Cardiac rehabilitation programs and increasing levels of social support may help improve symptoms and should be recommended to all patients.

Recent data show that psychosocial factors, such as lack of social support and depression, are important predictors of morbidity and mortality in patients with coronary heart disease. The studies suggest that interventions which provide support and/or alleviate depression in patients recovering from MI may enhance their psychosocial recovery and decrease morbidity and mortality. To the extent that intervention can be shown to impact favorably on survival and recovery in patients who have experienced MI, the human and financial burden associated with heart disease can be reduced.

To substantiate whether or not treating depression can reduce morbidity or mortality, the National Heart, Lung, and Blood Institute sponsored the Enhancing Recovery in Coronary Heart Disease Patients (ENRICHD) study. The multicenter, randomized clinical trial investigated the effects of a psychosocial intervention on mortality and nonfatal MI in 2,481 patients who have had an acute MI and who were depressed or had low perceived social support. "Previous studies show that people who are the most isolated or depressed are about three times as likely to die after a heart attack as are people who are not depressed or have many more connections to other people," Lisa Berkman, Ph.D., chair of ENRICHD, told the press.

"About 25% to 30% of patients experience social isolation or depression or both following a heart attack. When you combine such a substantial risk with a very common problem, there is an urgent need to think about solutions for it," Berkman added.

The results of the study, presented at the American Heart Association's Scientific Sessions 2001 meeting, found no significant differences in clinical endpoints, although a statistically significant improvement in depression and low social support was observed. Researchers speculated that one reason for this finding was that the intervention may not have been delivered as effectively as intended: many patients may have lacked readiness or motivation or were unable to participate fully in therapy. Further research is needed to identify the most effective modalities and optimal timing for treating depression and poor social support, especially in medically vulnerable populations -- AV

Benefits of Aggressive Treatment May Outweigh Risks

Physicians have often been reluctant to take aggressive action when treating heart-related disease in high-risk patients and patients older than 75 years, citing such reasons as drug-drug interactions, the inevitability of blood vessel disease and the severe side effects the elderly are likely to suffer following heart surgery. Two recent studies may change this viewpoint and the way physicians treat their oldest patients.

In research supported by the National Institute on Aging and the National Heart, Lung, and Blood Institute, researchers in Florence, Italy, reviewed data from the Systolic Hypertension in the Elderly Program (SHEP) (Circulation 2001;104[16]:1923-1926). Using a risk-assessment tool developed by the American Heart Association, researchers calculated the risk of future heart attacks, stroke and heart failure in 4,453 SHEP participants older than 60 years. All participants had systolic blood pressure readings of at least 160 mmHg and were treated with either diuretics or ß-blockers to bring pressure within normal limits.

The researchers found that the patients who were at highest risk -- those who smoked, had diabetes or high cholesterol -- received the greatest benefit from treatment, compared to those at lower risk; in fact, treating such patients was four times more effective than treating the low-risk group. "These patients," the researchers wrote, "are prime targets for antihypertensive treatment."

Revascularization therapy has provided symptom relief for patients with symptomatic chronic coronary-artery disease, but findings have been based on middle-aged populations. Investigators of the trial of invasive versus medical therapy in elderly patients with chronic symptomatic coronary artery disease (TIME) set out to compare the quality of life and outcome of elderly patients (75 years and older) after either medical or revascularization therapy (Lancet 2001; 358:951-957). Researchers assigned 150 patients to medical therapy and 155 to invasive therapy. After six months, both groups experienced a decrease in angina severity and an increase in quality of life (measures were general health, bodily pain, vitality, Duke activity score index, Rose score, angina pectoris class and number of anginal medications). The investigators reported, however, that the improvements were significantly greater in patients who had undergone revascularization therapy and concluded that even the elderly with angina benefit more from revascularization than from optimised medical therapy and should be offered invasive assessment despite their high-risk profiles -- MB