Results from prospective cohort studies and randomized, controlled trials have provided evidence of a protective effect of n-3 fatty acids against cardiovascular diseases. We examined the effect of ...the marine n-3 fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) and of the plant-derived alpha-linolenic acid (ALA) on the rate of cardiovascular events among patients who have had a myocardial infarction.
In a multicenter, double-blind, placebo-controlled trial, we randomly assigned 4837 patients, 60 through 80 years of age (78% men), who had had a myocardial infarction and were receiving state-of-the-art antihypertensive, antithrombotic, and lipid-modifying therapy to receive for 40 months one of four trial margarines: a margarine supplemented with a combination of EPA and DHA (with a targeted additional daily intake of 400 mg of EPA-DHA), a margarine supplemented with ALA (with a targeted additional daily intake of 2 g of ALA), a margarine supplemented with EPA-DHA and ALA, or a placebo margarine. The primary end point was the rate of major cardiovascular events, which comprised fatal and nonfatal cardiovascular events and cardiac interventions. Data were analyzed according to the intention-to-treat principle, with the use of Cox proportional-hazards models.
The patients consumed, on average, 18.8 g of margarine per day, which resulted in additional intakes of 226 mg of EPA combined with 150 mg of DHA, 1.9 g of ALA, or both, in the active-treatment groups. During the follow-up period, a major cardiovascular event occurred in 671 patients (13.9%). Neither EPA-DHA nor ALA reduced this primary end point (hazard ratio with EPA-DHA, 1.01; 95% confidence interval CI, 0.87 to 1.17; P=0.93; hazard ratio with ALA, 0.91; 95% CI, 0.78 to 1.05; P=0.20). In the prespecified subgroup of women, ALA, as compared with placebo and EPA-DHA alone, was associated with a reduction in the rate of major cardiovascular events that approached significance (hazard ratio, 0.73; 95% CI, 0.51 to 1.03; P=0.07). The rate of adverse events did not differ significantly among the study groups.
Low-dose supplementation with EPA-DHA or ALA did not significantly reduce the rate of major cardiovascular events among patients who had had a myocardial infarction and who were receiving state-of-the-art antihypertensive, antithrombotic, and lipid-modifying therapy. (Funded by the Netherlands Heart Foundation and others; ClinicalTrials.gov number, NCT00127452.).
Consumption of flavonoid-rich foods such as cocoa and tea may reduce cardiovascular disease risk. The flavonoids epicatechin (in cocoa and tea) and quercetin (in tea) probably play a role by reducing ...endothelial dysfunction and inflammation, 2 main determinants of atherosclerosis.
We studied the effects of supplementation of pure epicatechin and quercetin on biomarkers of endothelial dysfunction and inflammation.
Thirty-seven apparently healthy (pre)hypertensive men and women (40-80 y) participated in a randomized, double-blind, placebo-controlled crossover trial. Participants ingested (-)-epicatechin (100 mg/d), quercetin-3-glucoside (160 mg/d), or placebo capsules for a period of 4 wk, in random order. Plasma biomarkers of endothelial dysfunction and inflammation were measured at the start and end of each 4-wk intervention period. The differences in changes over time between the intervention and placebo periods (Δintervention - Δplacebo) were calculated and tested with a linear mixed model for repeated measures.
Epicatechin changed Δepicatechin - Δplacebo for soluble endothelial selectin (sE-selectin) by -7.7 ng/mL (95% CI: -14.5, -0.83; P = 0.03) but did not significantly change this difference (-0.30; 95% CI: -0.61, 0.01; P = 0.06) for the z score for endothelial dysfunction. Quercetin changed Δquercetin - Δplacebo for sE-selectin by -7.4 ng/mL (95% CI: -14.3, -0.56; P = 0.03), that for IL-1β by -0.23 pg/mL (95% CI: -0.40, -0.06; P = 0.009), and that for the z score for inflammation by -0.33 (95% CI: -0.60, -0.05; P = 0.02).
In (pre)hypertensive men and women, epicatechin may contribute to the cardioprotective effects of cocoa and tea through improvements in endothelial function. Quercetin may contribute to the cardioprotective effects of tea possibly by improving endothelial function and reducing inflammation. This trial was registered at clinicaltrials.gov as NCT01691404.
Background: Prospective cohort studies showed inverse associations between the intake of flavonoid-rich foods (cocoa and tea) and cardiovascular disease (CVD). Intervention studies showed protective ...effects on intermediate markers of CVD. This may be due to the protective effects of the flavonoids epicatechin (in cocoa and tea) and quercetin (in tea). Objective: We investigated the effects of supplementation of pure epicatechin and quercetin on vascular function and cardiometabolic health. Design: Thirty-seven apparently healthy men and women aged 40–80 y with a systolic blood pressure (BP) between 125 and 160 mm Hg at screening were enrolled in a randomized, double-blind, placebo-controlled, crossover trial. CVD risk factors were measured before and after 4 wk of daily flavonoid supplementation. Participants received (−)-epicatechin (100 mg/d), quercetin-3-glucoside (160 mg/d), or placebo capsules for 4 wk in random order. The primary outcome was the change in flow-mediated dilation from pre- to postintervention. Secondary outcomes included other markers of CVD risk and vascular function. Results: Epicatechin supplementation did not change flow-mediated dilation significantly (1.1% absolute; 95% CI: −0.1%, 2.3%; P = 0.07). Epicatechin supplementation improved fasting plasma insulin (Δ insulin: −1.46 mU/L; 95% CI: −2.74, −0.18 mU/L; P = 0.03) and insulin resistance (Δ homeostasis model assessment of insulin resistance: −0.38; 95% CI: −0.74, −0.01; P = 0.04) and had no effect on fasting plasma glucose. Epicatechin did not change BP (office BP and 24-h ambulatory BP), arterial stiffness, nitric oxide, endothelin 1, or blood lipid profile. Quercetin-3-glucoside supplementation had no effect on flow-mediated dilation, insulin resistance, or other CVD risk factors. Conclusions: Our results suggest that epicatechin may in part contribute to the cardioprotective effects of cocoa and tea by improving insulin resistance. It is unlikely that quercetin plays an important role in the cardioprotective effects of tea. This study was registered at clinicaltrials.gov as NCT01691404.
Although dietary recommendations have focused on restricting saturated fat (SF) consumption to reduce cardiovascular disease (CVD) risk, evidence from prospective studies has not supported a strong ...link between total SF intake and CVD events. An understanding of whether food sources of SF influence these relations may provide new insights.
We investigated the association of SF consumption from different food sources and the incidence of CVD events in a multiethnic population.
Participants who were 45-84 y old at baseline (n = 5209) were followed from 2000 to 2010. Diet was assessed by using a 120-item food-frequency questionnaire. CVD incidence (316 cases) was assessed during follow-up visits.
After adjustment for demographics, lifestyle, and dietary confounders, a higher intake of dairy SF was associated with lower CVD risk HR (95% CI) for +5 g/d and +5% of energy from dairy SF: 0.79 (0.68, 0.92) and 0.62 (0.47, 0.82), respectively. In contrast, a higher intake of meat SF was associated with greater CVD risk HR (95% CI) for +5 g/d and a +5% of energy from meat SF: 1.26 (1.02, 1.54) and 1.48 (0.98, 2.23), respectively. The substitution of 2% of energy from meat SF with energy from dairy SF was associated with a 25% lower CVD risk HR (95% CI): 0.75 (0.63, 0.91). No associations were observed between plant or butter SF and CVD risk, but ranges of intakes were narrow.
Associations of SF with health may depend on food-specific fatty acids or other nutrient constituents in foods that contain SF, in addition to SF.
We studied sleep duration and sleep quality in relation to cardiovascular disease (CVD) incidence.
Dutch population-based cohort study.
20,432 men and women aged 20-65 and with no history of CVD.
...N/A.
Sleep duration and sleep quality were assessed by a self-administered questionnaire. Morbidity data, vital status, and causes of death were obtained through linkage with several national registries. Hazard ratios (HRs) and 95% confidence intervals (95% CIs) were calculated using Cox proportional hazards models.
During 10-15 years of follow-up, 1,486 CVD and 1,148 coronary heart disease (CHD) events occurred. Short sleepers (≤ 6 h) had a 15% higher risk of total CVD (HR: 1.15; 95%CI: 1.00-1.32) and a 23% higher risk of CHD (HR: 1.23 1.04-1.45) compared to normal sleepers (7 h) after adjustment for all confounders. Additional adjustment for intermediate biological risk factors attenuated these relative risks to 1.11 (0.97-1.27) for total CVD and to 1.19 (1.00-1.40) for CHD. Short sleepers with poor sleep quality had a 63% higher risk of CVD (HR: 1.63 1.21-2.19) and a 79% higher risk of CHD incidence (HR: 1.79 1.24-2.58) compared to normal sleepers with good sleep quality, after adjustments for all confounders. We observed no associations between long sleep duration (≥ 9 h) and CVD or CHD incidence.
Short sleepers, especially those with poor sleep quality, have an increased risk of total CVD and CHD incidence. Future investigations should not only focus on sleep duration, but should also take sleep quality into account.
BACKGROUND: Indications have been seen of a protective effect of fish consumption and the intake of n-3 fatty acids on cognitive decline. However, studies are scarce and results inconsistent. ...OBJECTIVE: The objective of the study was to examine the associations between fish consumption, the intake of the n-3 fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) from fish and other foods, and subsequent 5-y cognitive decline. DESIGN: Data on fish consumption of 210 participants in the Zutphen Elderly Study, who were aged 70-89 y in 1990, and data on cognitive functioning collected in 1990 and 1995 were used in the study. The intake of EPA and DHA (EPA+DHA) was calculated for each participant. Multivariate linear regression analysis with multiple adjustments was used to assess associations. RESULTS: Fish consumers had significantly (P = 0.01) less 5-y subsequent cognitive decline than did nonconsumers. A linear trend was observed for the relation between the intake of EPA+DHA and cognitive decline (P = 0.01). An average difference of almost equal to380 mg/d in EPA+DHA intake was associated with a 1.1-point difference in cognitive decline (P = 0.01). CONCLUSIONS: A moderate intake of EPA+DHA may postpone cognitive decline in elderly men. Results from other studies are needed before definite conclusions about this association can be drawn.
We investigated associations between leisure-time physical activity (LTPA) at different intensities (moderate and vigorous or moderate-to-vigorous) and prospective weight gain in non-obese people. We ...also examined whether these associations were independent of other lifestyle factors and changes in muscle mass and whether they were age-dependent and changed over a person's life course.
The data were extracted from the Lifelines cohort study (N = 52,498; 43.5% men) and excluded obese individuals (BMI > 30 kg/m
). We used the validated SQUASH questionnaire to estimate moderate-to-vigorous (MVPA; MET≥4), moderate (MPA; MET between 4 and 6.5) and vigorous PA (VPA; MET≥6.5). Body weight was objectively measured, and changes were standardized to a 4-year period. Separate analyses, adjusted for age, educational level, diet, smoking, alcohol consumption and changes in creatinine excretion (a marker of muscle mass), were performed for men and women.
The average weight gain was + 0.45 ± 0.03 kg in women. Relative to each reference groups (No-MVPA, No-MPA and No-VPA), MVPA (Beta (95%CI): - 0.34 kg (- 0.56;-0.13)), MPA (- 0.32 kg (- 0.54;-0.10)) and VPA (- 0.30 kg (- 0.43;-0.18)) were associated with less gain in body weight in women after adjusting for potential confounders, described above. These associations were dose-dependent when physically active individuals were divided in tertiles. Beta-coefficients (95%CI) for the lowest, middle, and highest MVPA tertiles relative to the 'No-MVPA' were, respectively, - 0.24 (- 0.47;-0.02), - 0.31 (- 0.53;-0.08), and - 0.38 (- 0.61;-0.16) kg. The average weight gain in men was + 0.13 ± 0.03 kg, and only VPA, not MPA was associated with less body weight gain. Beta-coefficients (95%CI) for the VPA tertiles relative to the 'No-VPA' group were, respectively, - 0.25 (- 0.42;-0.09), - 0.19 (- 0.38;-0.01) and - 0.20 (- 0.38;-0.02) kg. However, after adjusting for potential confounders, the association was no longer significant in men. The potential benefits of leisure-time PA were age-stratified and mainly observed in younger adults (men < 35 years) or stronger with younger age (women < 55 years).
Higher leisure-time MVPA, MPA, and VPA were associated with less weight gain in women < 55 years. In younger men (< 35 years), only VPA was associated with less weight gain.
Aims Important changes in cardiovascular and all-cause mortality rates are occurring in Western and Eastern Europe, each with their own dynamics. Differences in trends will be analysed and possible ...causes are discussed. Methods and results Mortality data for cardiovascular and all-cause mortality rates from different countries were obtained from WHO and were analysed for the period 1970–2000. The annual changes in cause-specific mortality rates were calculated using linear and polynomial regression models. Mortality rates declined almost linearly for ischaemic heart disease, stroke, and total cardiovascular diseases between 1970 and 2000 in Western Europe. In both men and women, the decline for these diseases varied between 50 and 65% or ∼2%/year in this period. In contrast, in Eastern Europe cardiovascular mortality rates reached a maximum in the period 1990–94, followed by a decline of ∼3%/year in Poland, 2%/year in Hungary, and 5%/year in the Baltic states. The changes in cardiovascular mortality rates were reflected in all-cause mortality rates in both Western and Eastern Europe. Conclusion Over the past 30 years, mortality rates in cardiovascular diseases increased or decreased very rapidly. The causes are complex but changes in diet appear to play a major role. The more recent declines in Western Europe also reflect improvements in modern cardiovascular treatment.
Abstract Background Epidemiological studies suggest a protective effect of n-3 fatty acids derived from fish (eicosapentaenoic acid EPA and docosahexaenoic acid DHA) against cognitive decline. For ...α-linolenic acid (ALA) obtained from vegetable sources, the effect on cognitive decline is unknown. We examined the effect of n-3 fatty acid supplementation on cognitive decline in coronary heart disease patients. Methods The analysis included 2911 coronary patients (78% men) aged 60 to 80 years who participated in a double-blind placebo-controlled trial of n-3 fatty acids and cardiovascular diseases (Alpha Omega Trial). By using a 2 × 2 factorial design, patients were randomly assigned to margarines that provided 400 mg/d of EPA–DHA, 2 g/d of ALA, both EPA–DHA and ALA, or placebo for 40 months. Cognitive function was assessed by the Mini-Mental State Examination (MMSE) at baseline and after 40 months. The effect of n-3 fatty acids on change in MMSE score was assessed using analysis of variance. Logistic regression analysis was used to examine the effects on risk of cognitive decline, defined as a decrease of 3 or more points in MMSE score or incidence of dementia. Results Patients in the active treatment groups had an additional intake of 384 mg of EPA–DHA, 1.9 g of ALA, or both. The overall MMSE score in this cohort was 28.3 ± 1.6 points, which decreased by 0.67 ± 2.25 points during follow-up. Changes in MMSE score during intervention did not differ significantly between EPA–DHA and placebo (−0.65 vs −0.69 points, P = .44) or between ALA and placebo (−0.60 vs −0.74 points, P = .12). The risk of cognitive decline was 1.03 (95% confidence interval: 0.84–1.26, P = .80) for EPA–DHA (vs placebo) and 0.90 (0.74–1.10, P = .31) for ALA (vs placebo). Conclusion This large intervention study showed no effect of dietary doses of n-3 fatty acids on global cognitive decline in coronary heart disease patients.
The food supply and dietary preferences have changed in recent decades.
We studied time- and age-related individual and population-wide changes in a dietary quality score and food groups during ...1985-2006.
The Coronary Artery Risk Development in Young Adults (CARDIA) study of 5115 black and white men and women aged 18-30 y at year 0 (1985-1986) assessed diet at examinations at study years 0, 7 (1992-1993), and 20 (2005-2006). The dietary quality score, which was validated by its inverse association with cardiovascular disease risk, summed 46 food groups rated by investigators as positive or negative on the basis of hypothesized health effects. We used repeated-measures regression to estimate time-specific mean diet scores and servings per day of food groups.
In 2652 participants with all 3 diet assessments, the mean (±SD) dietary quality score increased from 64.1 ± 13.0 at year 0 to 71.1 ± 12.6 at year 20, which was mostly attributable to increased age. However, the secular trend, which was estimated from differences of dietary quality scores across time at a fixed age (age-matched time trend) decreased. The diet score was higher in whites than in blacks and in women than in men and increased with education, but demographic gaps in the score narrowed over 20 y. There tended to be increases in positively rated food groups and decreases in negatively rated food groups, which were generally similar in direction across demographic groups.
The CARDIA study showed many age-related, desirable changes in food intake over 20 y of observation, despite a secular trend toward a lower diet quality. Nevertheless, demographic disparities in diet persist.
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