In nutritional guidance to prevent the development of arteriosclerosis, keep the calorie intake appropriate, suppress the intake of unsaturated fatty acids, refrain from sugar and salt, and limited alcoholic beverages consumption are advised. In recent years, in addition to these diets for preventing arteriosclerosis, as the number of undernourished elderly cardiovascular disease patients increases, more complicated nutritional guidance considering malnutrition is required. Many elderly patients with heart failure are undernourished, which is a cause of further deterioration of mental and physical function. It is useful to accurately evaluate this malnutrition and to perform appropriate interventions such as diet and exercise therapy. In the mini-review, we will summarize the nutritional assessment of elderly patients with cardiovascular disease as the end stage of atherosclerotic diseases and the nutritional assessment tools, which are useful for the evaluation. The nutritional status can be evaluated more accurately by combining several evaluation items. In the mini-review, we introduce MNA® (Mini Nutritional Assessment), GNRI (Geriatric Nutritional Risk Index), CONUT (Controlling Nutritional Status), and the GLIM criteria. These nutritional assessment tools are useful for elderly patients with atherosclerosis and cardiovascular diseases to evaluate their nutritional conditions.
Although the coronavirus disease 2019 (COVID-19) pandemic is still ongoing, the path towards a better future is finally becoming clear as a result of the initiation of COVID-19 vaccination. While pneumonia was initially emphasized as the only complication of COVID-19, it has become clear that fatal complications, such as a thromboembolism, are also likely to occur. In the era of recurring coronavirus infections, it is important to identify the causes and risk factors regarding exacerbations in patients who may develop severe COVID-19. This review describes how to prevent COVID-19 exacerbations in the context of cardiovascular disease, especially exacerbations related to the vascular endothelium.
Purpose: The circulating level of B-type Natriuretic Peptide (BNP) is recognized as a biomarker of ventricular dysfunction. In the field of primary prevention, BNP is a useful predictor of cardiac death, heart failure, cerebral infarction, and atrial fibrillation. On the other hand, the predictive value of BNP has not been fully elucidated in patients with coronary artery disease and/or those who are prone to atherosclerosis. Methods: We analyzed 679 patients (average age, 65.3 years; 29.2% women) with asymptomatic heart failure (ACC/AHA stage A to B) undergoing total risk management for cardiovascular disease prevention in the Kitasato Registry for Cardiovascular Disease Prevention. The mean follow-up period was 8.4 years (range, 73–3686 days) for all study patients. Results: Among all patients, 54.0% had coronary artery disease, 54.2% had hypertension, 55.7% had dyslipidemia, 31.2% had diabetes mellitus, and 15.5% had atrial fibrillation. The baseline level of plasma BNP was 47.5 (63.8) [mean (SD)] pg/mL. The plasma BNP level correlated with age and the serum creatinine level. The presence of coronary artery disease or atrial fibrillation significantly affected the plasma level of BNP (P <0.05, P <0.01; respectively). Plasma BNP levels were significantly higher in the event group than in the event-free group [80.4 (123.3) vs. 43.4 (50.8) pg/mL, P <0.0001]. Of all patients, 59 experienced cardiac events and 10 died during the study period. In the multivariate analysis, plasma BNP level, age, and diabetes mellitus were identified as predictive factors. The Cox proportional hazards model showed that the plasma BNP level was an independent predictor of cardiac death. The event-free rate was significantly higher in patients with BNP of 40 pg/mL or less than in those with BNP of 40pg/mL or more. Conclusions: In the present long-term follow-up study, we found that the plasma level of BNP of patients who are in a stable condition was a useful prognostic marker. Circulating levels of plasma BNP could be an independent predictor of cardiac events in patients with asymptomatic heart failure.
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