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  • 1
    Online Resource
    Online Resource
    Abstract 3695: Obesity-mediated Vascular Injury Stimulates Progenitor Cell Mobilization
    Ovid Technologies (Wolters Kluwer Health) ; 2007
    In:  Circulation Vol. 116, No. suppl_16 ( 2007-10-16)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 116, No. suppl_16 ( 2007-10-16)
    Abstract: Recent data suggest that bone marrow derived endothelial progenitor cells contribute to endothelial repair after damage. We investigated whether obesity modulates the number and function of progenitor cells, and whether lifestyle intervention with a healthy diet influences this effect. We hypothesized that obesity-mediated vascular injury stimulates progenitor cell mobilization. Methods Peripheral blood mononuclear cells were cultured on fibronectin plates for 7 days and the number of colony forming units (CFUs) with endothelial-type cells at their periphery were counted. 28 lean healthy subjects were compared with 30 overweight/obese age-and sex-matched non-smokers on a high saturated fat ( 〉 10%) American style diet. Twenty obese subjects were then randomized to receive either a Mediterranean-style (MED) diet (n=11) or the control regular American diet (n=9) for 2 months. Endothelium-dependent and -independent function was measured by brachial reactivity testing at baseline, 1 and 2 months. Results CFUs were significantly higher in overweight/obese compared to lean subjects (74±42 vs 23±10, p 〈 0.001), even after adjustment for other risk factors. When overweight/obese subjects were treated with a MED diet, CFUs reduced significantly, a change that was not observed in the controls (Table ). There was a simultaneous improvement in brachial flow-mediated vasodilation but not endothelium-independent function in the MED group. No changes were observed in controls(Table ). Conclusion Endothelial precursors are stimulated in obese compared to lean subjects. Dietary alteration to a MED diet resulted in improvement in endothelial function and reduced mobilization of endothelial precursors. These observations suggest that endothelial injury in obesity provokes a compensatory mobilization of endothelial progenitor cell population that may help repair damage to the endothelial lining.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.116.suppl_16.II_839
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2007
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  • 2
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    Abstract 2849: Family Variables in Early Recovery Predict Stroke Survivor Quality of Life in 12 months
    Ovid Technologies (Wolters Kluwer Health) ; 2007
    In:  Circulation Vol. 116, No. suppl_16 ( 2007-10-16)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 116, No. suppl_16 ( 2007-10-16)
    Abstract: Purpose : Quality of life (QOL) after stroke may be influenced by the family context in addition to the stroke survivor’s physical ability. The purpose of this study was to determine whether baseline caregiver (CG) and family characteristics (age, physical function, depressive symptoms, and family communication) predict stroke survivor (SS) QOL: physical function, memory/thinking, social activities, communication, and mood at 1 year follow-up. Methods : Data were collected on 132 SS-CG dyads. SSs were 3–9 months post stroke, 30 to 83 years old ( M = 62.2 ± 12.6), male (64%), Caucasian (74 %), and had an ischemic stroke (88%). CGs were age 25 to 85 years ( M = 56.7 ± 13.7), female (74 %), well-educated (73 %), and spouses (80 %) enrolled in a multi-site caregiving study complementary to a clinical trial testing constraint-induced movement therapy in SSs. Measures included CG physical function (SF-36), CG depressive symptoms (CES-D), family communication (McMaster Family Assessment Device), and SS QOL (Stroke Impact Scale). Pearson’s correlations and hierarchal multiple regression analyses (n = 107) controlling for SS gender, the EXCITE intervention group, and SS functional level were used for analysis. Results : Baseline CG depressive symptoms were negatively related to both SS mood ( r = -.24, p 〈 .01) and social activities ( r = -.26, p = .01) at 1 year. Better family communication was related to higher SS memory/thinking ( r = -.24, p = .01). CG age and physical function were not associated with any SS QOL domains. In the regression models, CGs with more depressive symptoms (β = -.28, p = .007) at baseline predicted poorer SS mood ( F = 2.56, p = .02; R 2 = .13) and worse social participation (β = -.27, p = .01; F = 1.61, p = .15; R 2 = .09). Although the overall model was not significant ( F = 1.20, p = .31; R 2 = .07), worse family communication (β = -.22; p = .04) predicted poorer SS memory and thinking at 1 year. No CG or family characteristics were associated with SS physical or communication QOL domains. Conclusions : Early recognition and intervention of CG depressive symptoms may have profound effects on both CG and aspects of SS QOL in the early and chronic stroke recovery periods. Family interventions focusing on improving communication early may also improve long term stroke recovery.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.116.suppl_16.II_634
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2007
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  • 3
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    Abstract 4606: Appetite Ratings on Single-item Visual Analog Scale Identify Patients with Heart Failure at Risk for Malnutrition
    Ovid Technologies (Wolters Kluwer Health) ; 2008
    In:  Circulation Vol. 118, No. suppl_18 ( 2008-10-28)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 118, No. suppl_18 ( 2008-10-28)
    Abstract: Background : Patients with heart failure (HF) are at risk for malnutrition due to multiple factors. A simple, clinically feasible tool to identify risk for malnutrition is needed. Visual analog scales have been used in studies on appetite but it is unknown whether an appetite scale can be used to identify patients with HF at risk for malnutrition. Purpose : To determine whether differences in kcal and protein intake could be identified in patients with HF grouped by their appetite rating. Method : A total of 137 patients (63% male, 60 ± 12 years, 56% NYHA class III/IV, ejection fraction (39 ± 14%) were recruited from outpatient HF clinics in the Midwest and South. Patients provided detailed 4-day food diaries that were reviewed by a registered dietitian to verify serving sizes and preparation methods and to obtain missing information. Patients were also asked to rate their appetite over the 4 days of diet recording on a 10 mm visual analog with anchors of “no appetite” and “extremely good appetite” Diaries were analyzed by Nutrition Data Systems software. Three series of between-group comparisons of kcal and protein (total and referenced to kg body weight) were made by t-tests using 4 mm (below midpoint), 5 mm (mid-point), and 6 mm (above mid-point) cut-points. Results : Significant differences in kcal and protein intake were identified between groups using the 6 mm cut point. A total of 36% of the patients had low appetite ratings ( 〈 6mm). Patients with low appetite ratings consumed 20% fewer total kcals (1555 vs. 1936 kcal, p = .001) and 23% fewer kcal/kg (18 vs. 22 kcal, p = .005) than those with high ratings. The low appetite group also consumed 24% less protein than the high appetite group (62 g vs. 82 g, p = .001). The .71 g/kg protein intake of the low appetite group was below the recommended .8 g/kg protein intake for adults. In contrast, the .91 g/kg protein intake of the high appetite group was above the recommended level. Conclusion : Patients with lower appetite ratings had kcal and protein intakes below recommended levels while those with high appetite ratings had adequate intake. These results provide evidence that rating appetite on a visual analog scale may be a simple tool that could be used clinically to identify patients with HF at risk for malnutrition. This research has received full or partial funding support from the American Heart Association, AHA Great Rivers Affiliate (Delaware, Kentucky, Ohio, Pennsylvania & West Virginia).
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.118.suppl_18.S_920-a
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2008
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  • 4
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    Abstract 2092: Heart Failure Patients with Diabetes Have More Comorbidities and Self Care Problems
    Ovid Technologies (Wolters Kluwer Health) ; 2008
    In:  Circulation Vol. 118, No. suppl_18 ( 2008-10-28)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 118, No. suppl_18 ( 2008-10-28)
    Abstract: Background : Approximately 30 – 47% of heart failure (HF) patients have diabetes mellitus (DM) which is associated with increased risk for rehospitalization and death. Little data exist on psychological factors, physical symptoms, and comorbidities that could affect self care and outcomes in this population. Purpose : To compare HF patients with and without diabetes on demographic, clinical and psychosocial factors associated with self-care and outcomes. Methods : Participants (N = 212, 61 ±11 years old, 62% male, 25% African-American, 62% NYHA functional class III/IV, 37% with DM) from a larger study on nutrition and Body Mass Index (BMI) in HF completed clinical assessments, interviews and questionnaires. Variables and measures were: comorbidities; psychosocial factors of anxiety (Brief Symptom Inventory), depressive symptoms (Beck Depression Inventory-II), and social support (Perceived Social Support Scale); frequency and severity of HF symptoms (Symptom Status Questionnaire); and outcomes of functional status (Duke Activity Status Index; DASI ) and quality of life (MLHFQ). Hospitalizations after 12 months were obtained from medical record review and patient/family interview in a subset. Data were analyzed by t-tests, Chi-Square and nonparametric statistics. Results : Patients with DM were older (63 ± 9 vs 60±12 years, p=.02), had higher BMI (32 ± 6.4 vs 29.4 ± 6.7 kg/m 2 , p=.003), and a greater proportion had coronary artery disease, stroke, and renal dysfunction (p=.01) than those without DM. Thirty-seven percent were receiving insulin therapy. Although no differences in psychosocial factors were found, those with DM reported greater symptom severity (13.7 ±6.7 vs 10.7 ± 6.9 p=.003), and exhibited lower DASI scores (11.4 ± 10.8 vs 15.8 ± 13, p=.001), and MLHFQ scores (45.1 ± 22 vs 38.5 ± 23, p=.04) as well as more total hospitalizations at 12 months (1.5 ± 2.8 vs .55 ± 1.1 p=.04, n=122) than those without DM. Conclusion : HF patients with concomitant DM are at risk for more complex self care regimens due to increased comorbidities and symptom severity, and reduced functional status and quality of life with increased hospitalizations. These data may be useful in designing a comorbidity model of self management interventions to improve outcomes.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.118.suppl_18.S_668
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2008
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  • 5
    Online Resource
    Online Resource
    Abstract 4609: Evidence of Need for a More Comprehensive Approach to Dietary Self-Management for Patients with Heart Failure and Diabetes
    Ovid Technologies (Wolters Kluwer Health) ; 2008
    In:  Circulation Vol. 118, No. suppl_18 ( 2008-10-28)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 118, No. suppl_18 ( 2008-10-28)
    Abstract: Background: Type 2 diabetes (DM) is a common comorbidity in patients with heart failure (HF). Nutritional management is a key strategy in achieving blood glucose control and decreasing the risk of microvascular complications. The ability of patients with HF to nutritionally self-manage multiple comorbidities is unknown. Purpose: To compare nutritional intake of a group of patients with HF and DM with a group without DM. Methods: A total of 174 patients (66 with DM, age 60± 12 yrs, 35% female, 57% NYHA class III/IV) recruited from HF clinics completed detailed 4-day food diaries that were reviewed by a registered dietitian. Nutrition Data System software was used to determine carbohydrate (total and subtype), protein, fat, cholesterol, and sodium intake. Fasting blood glucose was obtained on a subset of 123 patients. Between-group comparisons were made using independent sample t-tests. Results: Patients with DM consumed a lower percentage of calories from carbohydrate (44% vs. 49%, p=.003) and a greater percentage of calories from protein (19% vs. 16%, p 〈 .001) and fat (38% vs. 35%, p=.049) compared to patients without DM. With respect to carbohydrate subtypes, patients with DM consumed 30% less sucrose (29g vs. 42g, p 〈 .001) and 39% less fructose (14g vs. 23g, p 〈 .001) than patients without DM, but a similar amount of starch (93g vs. 95g). There were no differences in sodium (3472mg vs. 3209mg), cholesterol (321mg vs. 285mg) or saturated fat (12% vs. 11% of kcal) intake between groups with and without DM. A total of 60% of patients with DM had fasting blood glucose levels 〉 120mg/dl and 40% had a fasting levels 〉 140mg/dl. Conclusions: Patients with HF and DM primarily limited dietary sugar intake, with only moderate success. Nutritional management of HF has focused on the single nutrient sodium with limited success; these data suggest that teaching for DM may be similarly focused on the single nutrient sugar. This indicates that new, more comprehensive, approaches are needed to help patients meet the challenge of nutritionally managing multiple comorbidities. This research has received full or partial funding support from the American Heart Association, AHA Great Rivers Affiliate (Delaware, Kentucky, Ohio, Pennsylvania & West Virginia).
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.118.suppl_18.S_921
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2008
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  • 6
    Online Resource
    Online Resource
    Abstract 4605: Increased Body Mass Index is Protective against Low Bone Mineral Density in Patients with Heart Failure
    Ovid Technologies (Wolters Kluwer Health) ; 2008
    In:  Circulation Vol. 118, No. suppl_18 ( 2008-10-28)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 118, No. suppl_18 ( 2008-10-28)
    Abstract: Patients with heart failure (HF) may be at greater risk for decreased bone mineral density (BMD) than similarly-aged healthy adults due to limited activity and medications. Being overweight or obese may protect against decreased BMD due to greater weight bearing and hormonal differences. However, these assumptions have never been tested. The purposes were to compare BMD between patients with HF and similarly-aged healthy adults, compare BMD among normal weight, overweight, and obese patients with HF, and determine whether body mass index (BMI) is a predictor of BMD in patients with HF. A total of 119 patients with HF (preserved or non-preserved systolic function, age = 61 ± 12 yrs, 61% NYHA Class III/IV) and 58 community-dwelling older adults free of cardiovascular disease (age = 70 ± 7 yrs) underwent total body dual-energy x-ray absorptiometry scans. Bone mineral density Z-scores (matched for sex, age, weight, and ethnicity) were compared between patients with HF and healthy elders. Patients with HF were divided into four BMI categories to compare differences in total body BMD by BMI. Multiple linear regression was used to test whether BMI predicted BMD in patients with HF after controlling for age, sex, and NYHA class. Patients with HF had lower total body area BMD Z-scores (0.32 ± 1.20) than the healthy elders (0.88 ± 1.30, p = 0.005). Within the HF group, those with a BMI 〈 25 kg/m 2 had lower total body BMD (1.13 ± 0.13 g/cm 2 ) compared to those with BMIs of 25–29.9 kg/m 2+ (1.24 ± 0.13 g/cm 2 , p = 0.002), 30 –34 kg/m 2+ (1.23 ± 0.12 g/cm 2 , p = 0.019), and 〉 34 kg/m 2 (1.26 ± 0.13 g/cm 2 , p 〈 0.001). In the multiple linear regression, BMI was a significant predictor of BMD in patients with HF (β= 0.337, p 〈 0.001), explaining an additional 11% of the variance beyond age, sex, and NYHA class (R 2 = 0.40, p 〈 0.001). These results suggest that while HF is associated with decreased BMD, being overweight or obese may be protective against low BMD. This may be another example of better outcomes in overweight and obese patients with HF. This research has received full or partial funding support from the American Heart Association, AHA Great Rivers Affiliate (Delaware, Kentucky, Ohio, Pennsylvania & West Virginia).
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.118.suppl_18.S_920
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2008
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  • 7
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    Online Resource
    Abstract 2233: Biobehavioral Factors and Heart Failure Medication Adherence
    Ovid Technologies (Wolters Kluwer Health) ; 2007
    In:  Circulation Vol. 116, No. suppl_16 ( 2007-10-16)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 116, No. suppl_16 ( 2007-10-16)
    Abstract: Background: Medication adherence in heart failure (HF) patients reduces hospitalizations and improves outcomes, yet it is variable. This study evaluated adherence rates and associated biobehavioral factors for two HF medications using objective (Medication Event Monitoring System; MEMS) and self-report approaches. Methods: The sample (n = 87) was primarily male (64.4%), Black (64.7%), NYHA class II (71%), married (56.9%) with left ventricular ejection fraction (LVEF) 26.6±14.2, age 55.5±10.4 years. Adherence for a HF medication and diuretic was monitored for 19.6 ±5.7 days using the MEMS. Relationships among clinical variables (NYHA class, LVEF, six-minute walk test [6MWT]; objective (MEMs) and self-reported (Morisky Medication Adherence Scale) medication adherence; medication self-efficacy (Perceived Self-Efficacy [SE] for Medication Compliance); medication taking self-regulation (Treatment Self-Regulation for Medication Taking); and HF knowledge (HF Knowledge Questionnaire) were analyzed using correlation coefficients and hierarchical multiple regression. Results: Adherence was 85.42% for the HF medication (n=74) and 83.42% (n=67) for daily diuretic. MEMS and Morisky scores were correlated for the HF medication (r=.389, p=.002) and diuretic (r=.392, p=.002). Medication SE was related to adherence for HF medication (r=.283, p=.025) and diuretic (r=.294, p=.028). Higher HF Knowledge Questionnaire scores were related to greater adherence for the HF medication (r=.316, p=.012) and diuretic (r=.359, p=.007). The model (marital status, HF knowledge, medication SE and 6MWT) yielded adj. R 2 =.26 (F =6.7, p 〈 .001;) with medication SE (p 〈 .001) and 6MWT (p=.053) as independent predictors of medication adherence. Clinical, demographic and medication self-regulation variables were not significant. Conclusions: Medication adherence in HF patients is related to modifiable factors of medication self-efficacy and HF knowledge. Improving medication self-efficacy, knowledge and showing patients tangible evidence of improvement in physical function such as increased 6MWT distance may lead to enhanced medication adherence.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.116.suppl_16.II_486-a
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2007
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