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Improvement of nutritional status contributes to the long-term risk reduction as well as fitness improvement in cardiovascular patients

Session Poster Session 6

Speaker Mariko Ehara

Event : ESC Congress 2018

  • Topic : preventive cardiology
  • Sub-topic : Nutrition, Malnutrition and Heart Disease
  • Session type : Poster Session

Authors : M Ehara (Nagoya,JP), K Shibata (Nagoya,JP), M Kameshima (Nagoya,JP), H Fujiyama (Nagoya,JP), M Terai (Nagoya,JP), M Horibe (Nagoya,JP), A Shimada (Nagoya,JP), R Sakai (Nagoya,JP), S Yamada (Nagoya,JP), Y Ohkawa (Nagoya,JP), T Suzuki (Toyohashi,JP)

Authors:
M. Ehara1 , K. Shibata2 , M. Kameshima2 , H. Fujiyama2 , M. Terai2 , M. Horibe2 , A. Shimada2 , R. Sakai2 , S. Yamada3 , Y. Ohkawa4 , T. Suzuki5 , 1Nagoya Heart Center, Cardiology - Nagoya - Japan , 2Nagoya Heart Center, Rehabilitation - Nagoya - Japan , 3Nagoya University Graduate School of Medicine (Health Sciences) - Nagoya - Japan , 4Nagoya Heart Center - Nagoya - Japan , 5Toyohashi Heart Center - Toyohashi - Japan ,

Citation:
European Heart Journal ( 2018 ) 39 ( Supplement ), 1113

Background: Nutritional sufficiency is an essential issue for low-fitness cardiovascular patients, although in what extent nutritional improvement during recovery phase may impact on the future prognosis.

Purpose: To investigate whether the recovery phase nutritional improvement can contribute to the long-term cardiovascular risk reduction as well as fitness improvement.

Methods: We studied 244 consecutive patients (average age 68, range 25–88) who participated in phase II comprehensive cardiac rehabilitation program (CR) at least for 3 months (median 232 days). The program included 1–3 times a week aerobic exercise and resistance training, combined with monthly individual guidance for diet and nutrition. Peak oxygen consumption (PVO2) by cardiopulmonary exercise test was obtained at both the pre- and post-CR periods, and the difference between periods (ΔPVO2) was used as the indicator of fitness improvement. The geriatric nutritional risk index (GNRI) was calculated as following: 14.89 × serum albumin level (g/dl) + 41.7 × body mass index (kg/m2)/22. The difference of GNRI between pre-and post-CR (ΔGNRI) was used as the indicator of nutritional improvement. Baseline PVO2 <15.4 ml/kg/min (the median) was defined as “poor baseline fitness”. Cases were divided in 4 groups by the medians of ΔPVO2 and ΔGNRI (1.0 and 6.0, respectively). The Cox proportional hazards regression analysis was used to assess the independent predictors of cardiovascular events. Long-term cardiovascular event rate was compared between groups.

Results: At the observation period (median 648 days), poor baseline fitness cases had significantly higher incidence of cardiovascular event compared with normal cases (24.6% vs. 17.2%, p=0.043). With GNRI improvement, poor baseline fitness cases showed 38% reduction of event rate, whereas 29% reduction in normal cases. Multivariate analysis showed that low-ΔGNRI (hazard ratio (HR) 2.25, 95% confidence interval (CI) 1.26–4.00, p=0.006) and low-ΔPVO2 (HR 2.88, 95% CI 1.63–5.10, p<0.001) were both independent predictors of the future cardiovascular event. Kaplan-Meier analysis revealed that those who had no improvement in both ΔPVO2 and ΔGNRI showed significantly lower event-free rate in poor baseline fitness cases (Log rank p<0.001).

Conclusion: Improvement of nutritional status may contribute to the long-term risk reduction as well as the fitness improvement in cardiovascular patients. Nutritional intervention should be indispensable especially among poor fitness patients for better future outcome.

Long-term cardiovascular event rate

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