Conference News Update—ESC Congress 2014
Over the seven-year follow up period, there were 19,300 cases of IHD and 19,689 strokes, including 14,688 ischemic strokes and 3,562 hemorrhagic strokes. Approximately 18% of participants consumed fruit daily, and 6.3% never consumed fruit. The average amount of fruit eaten by the daily consumers was 1.5 portions, or approximately 150 g.
The researchers found that, compared with people who never ate fruit, those who ate fruit daily decreased their CVD risks by 25% to 40% (approximately 15% for IHD, approximately 25% for ischemic stroke, and 40% for hemorrhagic stroke). There was a dose-response relationship between the frequency of fruit consumption and the risk of CVD.
“Our data clearly show that eating fresh fruit can reduce the risk of cardiovascular disease, including ischemic heart disease and stroke, particularly hemorrhagic stroke,” said Dr. Du. “And not only that, the more fruit you eat, the more your CVD risk goes down. It does suggest that eating more fruit is beneficial, compared to less or no fruit.”
The researchers also found that people who consumed fruit more often had significantly lower blood pressure. Eating fruit daily was associated with 3.4–4.1 mm Hg lower systolic–diastolic blood pressure, compared with those who never ate fruit. “Our data show that eating fresh fruit was associated with lower baseline blood pressure,” said Dr. Du. “We also found that the beneficial effect of fruit on the risk of CVD was independent of its impact on baseline blood pressure.”
In a separate analysis, the researchers examined the association of fruit consumption with total mortality and CV mortality in more than 61,000 patients from the China Kadoorie Biobank who had CVD or hypertension at baseline. They found that, compared with people who never ate fruit, daily consumers of fruit decreased their overall risk of death by 32%. They also reduced their risks of dying from IHD by 27% and of dying from stroke by around 40%.
“Patients with CVD and hypertension should also be encouraged to consume more fresh fruit,” said Zhengming Chen, MBBS, the principal investigator of the China Kadoorie Biobank. “Many Western populations have experienced a rapid decrease in CVD mortality during the past several decades, especially stroke mortality since the early 1950s, for reasons that are not yet fully explained. Improved access to fresh fruit may well have contributed importantly to that decline.”
“Our results show the benefit of eating fruit in the healthy general population and in patients with CVD and hypertension. Fruit consumption is an effective way to cut CVD risk and should not only be regarded as ‘might be useful.’ Policies are needed to promote the availability, affordability, and acceptability of fresh fruit through educational and regulatory measures,” the researchers concluded.
Iron Deficiency May Be an Attractive Therapeutic Target in Heart Failure
Treating symptomatic patients with heart failure and iron deficiency with IV ferric carboxymaltose may result in sustained improvements in functional capacity, symptoms, and quality of life, according to results of the CONFIRM study.
“Iron deficiency has recently been reported as a frequent comorbidity in heart failure and has been associated with impaired functional capacity, poor quality of life, and increased mortality, irrespective of the presence of anemia,” explained Piotr Ponikowski, Project Leader at the Medical University in Wroclaw, Poland. Correction of iron deficiency is “an attractive therapeutic target,” he said, adding that it affects approximately 50% of patients with heart failure.
In the Ferric Carboxymaltose Evaluation on Performance in Patients With Iron Deficiency in Combination With Chronic Heart Failure (CONFIRM) study, 304 patients from 41 centers in nine countries were randomized to ferric carboxymaltose or a saline placebo for 52 weeks. The researchers defined iron deficiency as a serum ferritin level of less than 100 ng/mL, or a level between 100 and 300 ng/mL if transferring saturation was less than 20%. Overall, 75% of the patients required a maximum of two injections of ferric carboxymaltose to correct and maintain their iron parameters.
At week 24, patients randomized to ferric carboxymaltose improved their performance on six-minute walk tests by 18 m, in comparison with patients receiving placebo, whose performance decreased by 16 m. Secondary end points of changes in patient global assessment scores and in New York Heart Association functional class also improved. In all, 10 patients in the ferric carboxymaltose group were hospitalized for worsening heart failure, in comparison with 32 in the placebo group (hazard ratio, 0.39).
“If you ask whether the magnitude of the effect is robust and clinically meaningful, I can only say that similar effects regarding the improvement in exercise capacity have only been seen before in cardiac resynchronization therapy,” said Mr. Ponikowski.
