Rashad J. Belin

Diet quality and the risk of cardiovascular disease: the Women's Health Initiative (WHI)

BACKGROUND The association between diet quality and risk of incident cardiovascular disease (CVD) or heart failure (HF) in postmenopausal women is uncertain. OBJECTIVE This study aimed to determine whether a conventional index [Alternate Healthy Eating Index (AHEI)] or a novel index [Womens Health Initiative (WHI) Dietary Modification Index (DMI)] of diet quality was associated with the risk of incident CVD or HF in the WHI Observational Study (WHI-OS). DESIGN The WHI-OS is an observational cohort study of 93,676 women aged 50-79 y of diverse ethnicity and backgrounds followed for an average of 10.0 y for CVD events. The individual components of the AHEI and DMI were determined from the baseline WHI food-frequency questionnaire. Incident CVD was a composite of nonfatal myocardial infarction, coronary heart disease death, stroke, coronary revascularization, and incident HF. The association between AHEI or DMI and incident CVD or incident HF was determined by using Cox models adjusted for traditional CVD and HF risk factors. RESULTS Women with a DMI in the highest quintile had hazard ratios (HRs) of 0.88 (95% CI: 0.80, 0.95) and 0.91 (95% CI: 0.78, 1.06) for incident CVD and HF, respectively. Women with an AHEI in the highest quintile had HRs of 0.77 (95% CI: 0.70, 0.84) and 0.70 (95% CI: 0.59, 0.82) for incident CVD and HF, respectively. CONCLUSION Overall, adherence to current nutrient guidelines (as indexed by the DMI) are associated with lower total CVD risk, and additional dietary factors (as indexed by the AHEI) were associated with a lower risk of CVD and HF.

Fish Intake and the Risk of Incident Heart Failure The Women's Health Initiative

Background—Whether fish or the fatty acids they contain are independently associated with risk for incident heart failure (HF) among postmenopausal women is unclear. Methods and Results—The baseline Womens Health Initiative Observational Study cohort consisted of 93 676 women ages 50 to 79 years of diverse ethnicity and background, of which 84 493 were eligible for analyses. Intakes of baked/broiled fish, fried fish, and omega-3 fatty acid (eicosapentaenoic acid+docosahexaenoic acid, &agr;-linolenic acid), and trans-fatty acid were determined from the Womens Health Initiative food frequency questionnaire. Baked/broiled fish consumption was divided into 5 frequency categories: <1/mo (referent), 1 to 3/mo, 1 to 2/wk, 3 to 4/wk, ≥5/wk. Fried fish intake was grouped into 3 frequency categories: <1/mo (referent), 1–3/mo, and ≥1/wk. Associations between fish or fatty acid intake and incident HF were determined using Cox models adjusting for HF risk factors and dietary factors. Baked/broiled fish consumption (≥5 servings/wk at baseline) was associated with a hazard ratio of 0.70 (95% confidence interval, 0.51 to 0.95) for incident HF. In contrast, fried fish consumption (≥1 serving/wk at baseline) was associated with a hazard ratio of 1.48 (95% confidence interval, 1.19 to 1.84) for incident HF. No significant associations were found between eicosapentaenoic acid+docosahexaenoic acid, &agr;-linolenic acid, or trans-fatty acid intake and incident HF. Conclusions—Increased baked/broiled fish intake may lower HF risk, whereas increased fried fish intake may increase HF risk in postmenopausal women.

Crohn's colitis-induced myocarditis

Myocarditis can be idiopathic or arise in response to numerous systemic insults. Myocarditis occurring in the setting of an exacerbation of inflammatory bowel disease is a rare extra-intestinal manifestation of both ulcerative and Crohns-related colitis. Here, we present a unique case of a 56-year-old female patient presenting with an acute Crohns colitis flare that was eventually complicated by myocarditis. Our case is unique in that we clearly delineate the clinical course and development of myocarditis in a patient with focal myocardial inflammation in a pattern that is atypical for myocarditis. <Learning objective: To illustrate the clinical course and resolution, along with cardiac magnetic resonance imaging and echocardiographic findings, of Crohns-induced myocarditis.>.

Profound Aortopathy: A Rare Case of Massive Ascending and Descending Aortic Aneurysms, Type B Aortic Dissection, and Severe Aortic Valve Regurgitation in an Adult Patient With Uncorrected Congenital Aortic Coarctation

Graphical abstract

Fish Intake and the Risk of Incident Heart Failure

Background—Whether fish or the fatty acids they contain are independently associated with risk for incident heart failure (HF) among postmenopausal women is unclear. Methods and Results—The baseline Womens Health Initiative Observational Study cohort consisted of 93 676 women ages 50 to 79 years of diverse ethnicity and background, of which 84 493 were eligible for analyses. Intakes of baked/broiled fish, fried fish, and omega-3 fatty acid (eicosapentaenoic acid+docosahexaenoic acid, &agr;-linolenic acid), and trans-fatty acid were determined from the Womens Health Initiative food frequency questionnaire. Baked/broiled fish consumption was divided into 5 frequency categories: <1/mo (referent), 1 to 3/mo, 1 to 2/wk, 3 to 4/wk, ≥5/wk. Fried fish intake was grouped into 3 frequency categories: <1/mo (referent), 1–3/mo, and ≥1/wk. Associations between fish or fatty acid intake and incident HF were determined using Cox models adjusting for HF risk factors and dietary factors. Baked/broiled fish consumption (≥5 servings/wk at baseline) was associated with a hazard ratio of 0.70 (95% confidence interval, 0.51 to 0.95) for incident HF. In contrast, fried fish consumption (≥1 serving/wk at baseline) was associated with a hazard ratio of 1.48 (95% confidence interval, 1.19 to 1.84) for incident HF. No significant associations were found between eicosapentaenoic acid+docosahexaenoic acid, &agr;-linolenic acid, or trans-fatty acid intake and incident HF. Conclusions—Increased baked/broiled fish intake may lower HF risk, whereas increased fried fish intake may increase HF risk in postmenopausal women.

Fish Intake and the Risk of Incident Heart Failure: The Women9s Health Initiative

Background—Whether fish or the fatty acids they contain are independently associated with risk for incident heart failure (HF) among postmenopausal women is unclear. Methods and Results—The baseline Womens Health Initiative Observational Study cohort consisted of 93 676 women ages 50 to 79 years of diverse ethnicity and background, of which 84 493 were eligible for analyses. Intakes of baked/broiled fish, fried fish, and omega-3 fatty acid (eicosapentaenoic acid+docosahexaenoic acid, &agr;-linolenic acid), and trans-fatty acid were determined from the Womens Health Initiative food frequency questionnaire. Baked/broiled fish consumption was divided into 5 frequency categories: <1/mo (referent), 1 to 3/mo, 1 to 2/wk, 3 to 4/wk, ≥5/wk. Fried fish intake was grouped into 3 frequency categories: <1/mo (referent), 1–3/mo, and ≥1/wk. Associations between fish or fatty acid intake and incident HF were determined using Cox models adjusting for HF risk factors and dietary factors. Baked/broiled fish consumption (≥5 servings/wk at baseline) was associated with a hazard ratio of 0.70 (95% confidence interval, 0.51 to 0.95) for incident HF. In contrast, fried fish consumption (≥1 serving/wk at baseline) was associated with a hazard ratio of 1.48 (95% confidence interval, 1.19 to 1.84) for incident HF. No significant associations were found between eicosapentaenoic acid+docosahexaenoic acid, &agr;-linolenic acid, or trans-fatty acid intake and incident HF. Conclusions—Increased baked/broiled fish intake may lower HF risk, whereas increased fried fish intake may increase HF risk in postmenopausal women.

Fish Intake and the Risk of Incident Heart FailureClinical Perspective

Background—Whether fish or the fatty acids they contain are independently associated with risk for incident heart failure (HF) among postmenopausal women is unclear. Methods and Results—The baseline Womens Health Initiative Observational Study cohort consisted of 93 676 women ages 50 to 79 years of diverse ethnicity and background, of which 84 493 were eligible for analyses. Intakes of baked/broiled fish, fried fish, and omega-3 fatty acid (eicosapentaenoic acid+docosahexaenoic acid, &agr;-linolenic acid), and trans-fatty acid were determined from the Womens Health Initiative food frequency questionnaire. Baked/broiled fish consumption was divided into 5 frequency categories: <1/mo (referent), 1 to 3/mo, 1 to 2/wk, 3 to 4/wk, ≥5/wk. Fried fish intake was grouped into 3 frequency categories: <1/mo (referent), 1–3/mo, and ≥1/wk. Associations between fish or fatty acid intake and incident HF were determined using Cox models adjusting for HF risk factors and dietary factors. Baked/broiled fish consumption (≥5 servings/wk at baseline) was associated with a hazard ratio of 0.70 (95% confidence interval, 0.51 to 0.95) for incident HF. In contrast, fried fish consumption (≥1 serving/wk at baseline) was associated with a hazard ratio of 1.48 (95% confidence interval, 1.19 to 1.84) for incident HF. No significant associations were found between eicosapentaenoic acid+docosahexaenoic acid, &agr;-linolenic acid, or trans-fatty acid intake and incident HF. Conclusions—Increased baked/broiled fish intake may lower HF risk, whereas increased fried fish intake may increase HF risk in postmenopausal women.

Fish Intake and the Risk of Incident Heart FailureClinical Perspective: The Women's Health Initiative

Background—Whether fish or the fatty acids they contain are independently associated with risk for incident heart failure (HF) among postmenopausal women is unclear. Methods and Results—The baseline Womens Health Initiative Observational Study cohort consisted of 93 676 women ages 50 to 79 years of diverse ethnicity and background, of which 84 493 were eligible for analyses. Intakes of baked/broiled fish, fried fish, and omega-3 fatty acid (eicosapentaenoic acid+docosahexaenoic acid, &agr;-linolenic acid), and trans-fatty acid were determined from the Womens Health Initiative food frequency questionnaire. Baked/broiled fish consumption was divided into 5 frequency categories: <1/mo (referent), 1 to 3/mo, 1 to 2/wk, 3 to 4/wk, ≥5/wk. Fried fish intake was grouped into 3 frequency categories: <1/mo (referent), 1–3/mo, and ≥1/wk. Associations between fish or fatty acid intake and incident HF were determined using Cox models adjusting for HF risk factors and dietary factors. Baked/broiled fish consumption (≥5 servings/wk at baseline) was associated with a hazard ratio of 0.70 (95% confidence interval, 0.51 to 0.95) for incident HF. In contrast, fried fish consumption (≥1 serving/wk at baseline) was associated with a hazard ratio of 1.48 (95% confidence interval, 1.19 to 1.84) for incident HF. No significant associations were found between eicosapentaenoic acid+docosahexaenoic acid, &agr;-linolenic acid, or trans-fatty acid intake and incident HF. Conclusions—Increased baked/broiled fish intake may lower HF risk, whereas increased fried fish intake may increase HF risk in postmenopausal women.

20 UNIQUE PARASYMPATHETIC PROFILE OF THE PULMONARY VEINS AND POSTERIOR LEFT ATRIUM.

Background The pulmonary veins (PVs) have recently been shown to play a major role in the genesis of atrial fibrillation (AF). Focal “triggers” and “drivers” in the PV appear to be significantly modified or regulated by the parasympathetic nervous system. Nonetheless, the detailed autonomic profile of the PVs-especially as it compares with the posterior left atrium (PLA) and the rest of the left atrium-has not been well characterized. We hypothesized that the left atrium exhibits a heterogeneous electrophysiologic response to autonomic maneuvers, with the activation and repolarization characteristics of the PVs being different from the rest of the left atrium. Since IKAch is the ion channel that is primarily responsible for vagal effects on left atrial refractoriness, we further hypothesized that interregional variation in repolarization (in response to vagal maneuvers) is due to differences in the expression and spatial distribution of IKAch within the PVs, PLA, and left atrial appendage (LAA). Methods In 14 dogs, high-density plaques were sutured onto the left inferior PV (8 × 5 electrodes), the PLA (7 × 3 electrodes), and LAA (7 × 3 electrodes) for bipolar electrogram recording and pacing. Epicardial mapping was performed in the PVs, PLA, and LAA under the following conditions: baseline, 20 Hz cervical vagal stimulation (VS), propranolol (P), P + VS, and P + atropine. Effective refractory periods (ERPs) were measured and conduction vectors were computed at multiple sites. Western blotting and immunostaining were performed for IKAch (Kir3.1/3.4). Results In response to VS, there was a significant decrease in ERP (9%) in the PV compared with baseline (p = .001). In contrast, ERP changes in the PLA and LAA in response to VS were not as pronounced. In the presence of beta-blockade, vagal stimulation (P + VS) resulted in a more pronounced decrease in ERP in the PV (17.7%), PLA (19.9%), and LAA (11.6%) (P + VS vs P − PV: p < .001, PLA: p = .003, LAA: p = .036) compared with VS alone. ERP decrease in the PV and PLA was significantly greater than in the LAA (p < .05). Cumulative vagal effect (ERP difference between P + VS and P + ATR) was found to be greatest in the LAA (ERP change: LAA > PV, p = .04; LAA > PLA, p = .12). The cumulative vagal effect in the PV, PLA, and LAA corresponded to the relative expression of the IKAch subunits Kir3.1 and Kir3.4 in these regions (for both Kir3.1 and 3.4, LAA > PLA > PV). However, vagal-induced ERP shortening was significantly more heterogeneous in the PLA compared with the LAA (variance of ERP shortening: PLA > LAA, p = .04). Heterogeneity of ERP shortening corresponded to the heterogeneity of IKAch distribution in each region (variance of the number of Kir3.1-positive cells counted under six high-power (40×) fields: PV = PLA > > LAA, p < .01). With VS and/or P, there was evidence of regional conduction delay in the PVs with a significant change in activation direction. Similar activation changes were not seen in the PLA and LAA. Conclusions The PVs and PLA demonstrate unique activation and repolarization characteristics in response to autonomic manipulation. The heterogeneity of vagal responses correlates with the pattern of IKAch distribution in the left atrium. The peculiar autonomic characteristics of the PVs and PLA may create substrate for reentry and atrial fibrillation.