The study results, presented at the Experimental Biology 2008 meeting this week, were derived from an analysis of adult food consumption data collected in the 1999-2004 National Health and Nutrition Examination Survey (NHANES), the government's largest food consumption and health database.
Dr. Victor Fulgoni analyzed the data, specifically looking at the association between consumption of apples and apple products, nutrient intake and various physiological parameters related to metabolic syndrome. When compared to non-consumers, adult apple product consumers had a 27% decreased likelihood of being diagnosed with metabolic syndrome.
Fulgoni notes, We found that adults who eat apples and apple products have smaller waistlines that indicate less abdominal fat, lower blood pressure and a reduced risk for developing what is known as the metabolic syndrome.
In addition to having a 30% decreased likelihood for elevated diastolic blood pressure and a 36% decreased likelihood for elevated systolic blood pressure, apple product consumers also had a 21% reduced risk of increased waist circumference “ all predictors of cardiovascular disease and an increased likelihood of metabolic syndrome. Additionally, adult apple product consumers had significantly reduced C-reactive protein levels, another measurable marker related to cardiovascular risk.
Furthermore, apple product consumers' diets were healthier than non-consumers “ they had an overall greater intake of fruit and key nutrients, including dietary fiber, vitamins A and C, calcium and potassium. These consumers also ate less total fat, saturated fat, discretionary fat and added sugars.
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The first study, led by Princy Thottathil, found that patients with LQTS that also have asthma, and that receive standard asthma treatment with stimulants to clear airways (e.g. beta-agonist therapy), have approximately twice the risk of having their first LQTS-related cardiac event (fainting, aborted cardiac arrest or sudden death) as the average patient. Conversely, those treated with beta-blocker therapy to address their arrhythmia risk, along with beta-agonist therapy for their asthma, enjoyed an 80 percent reduction in cardiac events (HR = 0.14; P = 0.05).
Past studies have suggested that treatment with beta-blockers, widely used hypertension drugs, is prudent as a preventive measure in all LQTS patients. The study examined 3,287 patients enrolled in the International LQTS Registry. Statistical analysis used to assess the independent contribution of clinical factors for first cardiac events from birth through age 40. Beta-agonist therapy for asthma was associated with an increased risk for cardiac events (hazard ratio [HR] = 2.00, 95% confidence interval 1.26-3.15, p = 0.003) after adjustment for relevant covariates including time-dependent beta-blocker use, sex, QTc, and history of asthma. This risk was augmented within the first year after the initiation of beta-agonist therapy (HR = 3.53; p = 0.006). The combined use of beta-agonist and anti-inflammatory steroids was associated with an elevated risk for cardiac events (HR = 3.66; p < 0.01).
In the second study led by Jehu S. Mathew, researchers found that going through menopause provided LQTS patients with a four-fold reduction in risk of cardiac events, providing further evidence that estrogen levels affect event risk. Past studied have determined that the risk of events is highest for women during child-bearing years, when estrogen levels are, on average, higher, and highest during the year a woman gives birth. The study involved 1,624 women, with 560 having undergone menopause (average age: 47). The primary endpoint was the occurrence of any cardiac event between the ages of 20 and 70 years. When assessing annualized cardiac event rates, meaningfully lower cardiac event rates were seen after menopause. This held true when patients were grouped by prior syncope, by QTc length and by genotype.
The last study, led by Edward Y. Sze, observed the effects of combining inherited risk for cardiac created by the LQTS syndrome with inevitable age-related heart disease. While most previous studies have focused on the course of LQTS on patients within the first four decades of life, the current study looked at risk in 641 patients aged 40 and older (with a QTc of greater than 449ms). Patients were identified as having coronary disease if they had a history of hospitalization for myocardial infarction, coronary angioplasty, coronary artery bypass graft surgery, or were treated with medication for angina. LQTS-related cardiac events included the first occurrence of syncope, aborted cardiac arrest, or sudden cardiac death without evidence suggestive of an acute coronary event.
The study found that coronary disease, developed with age, was associated with a more than two-fold increase in risk of LQTS-related cardiac events (hazard ratio 2.24, 95% confidence interval 1.24-4.04, p=0.008) after adjustment for syncopal history before age 40, QTc, and gender.
This is the first study to demonstrate that coronary disease augments the risk for LQTS-related cardiac events in LQTS, Moss said. The findings highlight the need for more focused preventive therapy in LQTS patients above the age of 40. Inherited plus acquired disease is a bad combination.
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