Predictors of omega-3 index in patients with acute myocardial infarction

OBJECTIVE: To identify the patient and dietary characteristics associated with low omega-3 levels in patients with acute myocardial infarction (AMI) and determine whether these characteristics are useful to identify patients who may benefit from omega-3 testing and treatment.PATIENTS AND METHODS: Dietary habits of 1487 patients in the 24-center Translational Research Investigating Underlying disparities in acute Myocardial infarction Patients'' Health status (TRIUMPH) registry between April 11, 2005, and September 28, 2007, were assessed by asking about the frequency of fast food and nonfried fish consumption. All patients had erythrocyte omega-3 index measured at the time of hospital admission for AMI. We used multivariable linear regression to identify independent correlates of the omega-3 index and modified Poisson regression to predict risk of a low omega-3 index (<4%).RESULTS: The proportion of patients with a low omega-3 index increased with more frequent fast food intake (18.9% for <1 time monthly, 28.6% for 1-3 times monthly, 28.8% for 1-2 times weekly, and 37.6% for ≥3 times weekly; P<.001). In contrast, a low omega-3 index was less common among patients with more frequent fish intake (35.1% for <1 time monthly, 24.9% for 1-3 times monthly, 16.1% for 1-2 times weekly, and 21.1% for ≥3 times weekly; P<.001). Fish intake, older age, race other than white, and omega-3 supplementation were independently associated with a higher omega-3 index, whereas frequent fast food intake, smoking, and diabetes mellitus were associated with a lower omega-3 index.CONCLUSION: Potentially modifiable factors, such as patient-reported fast food intake, fish intake, and smoking, are independently associated with the omega-3 index in patients with AMI. These characteristics may be useful to identify patients who would benefit most from omega-3 supplementation and lifestyle modification.AMI = acute myocardial infarction; DHA = docosahexaenoic acid; EPA = eicosapentaenoic acid; RBC = red blood cell; TRIUMPH = Translational Research Investigating Underlying disparities in acute Myocardial infarction Patients'' Health statusA low red blood cell (RBC) omega-3 index (the sum of eicosapentaenoic acid [EPA] and docosahexaenoic acid [DHA]) is associated with greater long-term mortality in patients with coronary artery disease.^1,2 Because omega-3 supplementation reduces mortality in patients with cardiovascular disease,^3-5 it is possible that augmenting omega-3 levels in those with the lowest omega-3 indices would yield the greatest treatment benefit. Accordingly, routine assessment of patients'' omega-3 index could identify the highest-risk patients who are ideal targets for dietary modification and aggressive omega-3 supplementation. Despite these potential benefits and the availability of well-tolerated, affordable omega-3 supplements, routine testing of omega-3 fatty acid levels has been limited in acute myocardial infarction (AMI) populations because of its cost and limited availability at the point of care. Therefore, simple and inexpensive screening mechanisms are needed to identify patients who are likely to have a low omega-3 index and who may experience greater benefit from omega-3 index testing and treatment than those with a higher omega-3 index.Studies in asymptomatic patients, many of whom had no coronary artery disease, identified several patient characteristics associated with omega-3 levels. Specifically, omega-3 supplements, age, body mass index, diabetes, and smoking were independently associated with the omega-3 index.^6,7 To our knowledge, the patient characteristics and dietary behaviors associated with the omega-3 index have not been described in patients with incident AMI, a particularly high-risk population. Moreover, although poor dietary habits, such as frequent consumption of fast food, may influence omega-3 levels, no studies have examined the association between fast food intake and the omega-3 index. Therefore, we studied patients enrolled in a contemporary registry of AMI treatment and outcomes, the Translational Research Investigating Underlying disparities in acute Myocardial infarction Patients'' Health status (TRIUMPH) study, to describe the association between patient characteristics and omega-3 levels at the time of AMI. Our goal was to identify the independent predictors of omega-3 levels so that patients likely to have low levels of omega-3 could be recognized and considered for further testing and treatment.     

Effect of living alone on patient outcomes after hospitalization for acute myocardial infarction

Considerable attention has been devoted to the effect of social support on patient outcomes after acute myocardial infarction (AMI). However, little is known about the relation between patient living arrangements and outcomes. Thus, we used data from PREMIER, a registry of patients hospitalized with AMI at 19 United States centers from 2003 through 2004, to assess the association of living alone with outcomes after AMI. Outcome measurements included 4-year mortality, 1-year readmission, and 1-year health status using the Seattle Angina Questionnaire (SAQ) and the Short Form-12 Physical Health Component scales. Patients who lived alone had higher crude 4-year mortality (21.8% vs 14.5%, p <0.001) but comparable rates of 1-year readmission (41.6% vs 38.3%, p = 0.79). Living alone was associated with lower unadjusted quality of life (mean SAQ -2.40, 95% confidence interval [CI] -4.44 to -0.35, p = 0.02) but had no impact on Short Form-12 Physical Health Component (-0.45, 95% CI -1.65 to 0.76, p = 0.47) compared to patients who did not live alone. After multivariable adjustment, patients who lived alone had a comparable risk of mortality (hazard ratio 1.35, 95% CI 0.94 to 1.93) and readmission (hazard ratio 0.99, 95% CI 0.76 to 1.28) as patients who lived with others. Mean quality-of-life scores remained lower in patients who lived alone (SAQ -2.91, 95% CI -5.56 to -0.26, p = 0.03). In conclusion, living alone may be associated with poorer angina-related quality of life 1 year after MI but is not associated with mortality, readmission, or other health status measurements after adjusting for other patient and treatment characteristics.     

Therapie der Osteoporose beim geriatrischen Patienten

Due to the demographic changes of the last few decades, there has been a significant increase in the number of osteoporotic fractures. After a fracture, geriatric patients are at particularly high risk for an increase of their functional impairments as well as a loss of independence and quality of life. In spite of the severe medical and socioeconomic consequences of fragility fractures, osteoporotic treatment and prevention are still insufficient. Based on the current literature, the pharmacological and nonpharmacological treatment options as well as new surgical techniques for geriatric patients are reviewed.     

Mechanisms of hypotonic inhibition of the sodium, proton exchanger type 1 (NHE1) in a biliary epithelial cell line (Mz-Cha-1)

Aim: To elucidate the cellular events that results in inhibition of Na⁺, H⁺ exchanger type 1 (NHE1) by hypotonicity. Methods: Intracellular pH (pH_i) was measured in biliary epithelial cells, with the pH‐sensitive fluorochrome 2′,7′‐bis‐(carboxyethyl)‐5(6)‐carboxyfluorescein (BCECF) using a spectrophotometer. Regulatory volume decrease (RVD) was analysed from confocal images. Changes in NHE1 membrane content were visualized by confocal laser scanning microscopy after transfection of Mz‐Cha‐1 cells with a NHE1–cMyc fusion protein. Results: In Mz‐Cha‐1 cells hypotonicity (?80 mmol L^?1 NaCl) inhibited endogenous Na⁺, H⁺ exchange. Tyrosine and serine kinase inhibitors were incapable to prevent inhibition. As several signalling pathways influence Na⁺, H⁺ exchange, we tested the effect of the Ca⁺⁺, Calmodulin, protein kinase C or the cAMP, protein kinase A system on inhibition of Na⁺, H⁺ exchange by hypotonic challenge, but neither system was involved. In contrast, cytoskeleton did influence the effect of hypotonicity. Inhibition of microtubule polymerization by colchicine prevented inhibition of NHE1, and also restored Na⁺, H⁺ exchange kinetics. Specific inhibition of Src kinases with PP2, attenuated pH_i recovery rate from 1.93 ± 0.16 pH units min^?1 (normotonic environment) to 1.02 ± 0.50 pH units min^?1 (hypotonic environment). Membrane staining of NHE1–cMyc fusion protein was maintained after hypotonic exposure in colchicine pre‐treated cells as was RVD. Microfilament inhibition by cytochalasin preserved NHE1 activity. Inhibition of phosphatidylinositol‐3′‐kinase was unable to restore Na⁺, H⁺ exchange activity. Conclusion: We conclude that regulation of Na⁺, H⁺ exchange during RVD is mediated by cytoskeletal elements. This receptor independent pathway is regulated by Src.