Nonobstructive Coronary Artery Disease Associated With Increased Risk of Heart Attack, Death

In a study that included nearly 38,000 patients, those diagnosed with nonobstructive coronary artery disease (CAD) had a significantly increased risk of heart attack or death one year after diagnosis, according to a study in the November 5 issue of JAMA.

Nonobstructive coronary artery disease (CAD) is atherosclerotic plaque that would not be expected to obstruct blood flow or result in anginal symptoms (such as chest pain). Although such lesions are relatively common, occurring in 10 percent to 25 percent of patients undergoing coronary angiography, their presence has been characterized as “insignificant” or “no significant CAD" in the medical literature. However, this perception of nonobstructive CAD may be incorrect, because prior studies have noted that the majority of plaque ruptures and resultant myocardial infarctions (MIs; heart attacks) arise from nonobstructive plaques. Despite the prevalence of nonobstructive CAD identified by coronary angiography, little is known about its risk of adverse outcomes, according to background information in the article.

Thomas M. Maddox, M.D., M.Sc., of the VA Eastern Colorado Health Care System, Denver, and colleagues compared heart attack and mortality rates among patients with nonobstructive CAD, obstructive CAD, and no apparent CAD. The patients included in the study were all U.S. veterans who underwent elective coronary angiography for CAD between October 2007 and September 2012 in the Veterans Affairs health care system. Patients with prior CAD events were excluded. CAD extent was defined by degree of vessel narrowing and distribution (1, 2, or 3 vessel).

During the study period, 37,674 patients underwent elective coronary angiography for indications related to CAD; of those, 22.3 percent had nonobstructive CAD and 55.4 percent had obstructive CAD. Within 1 year, 845 patients died and 385 were rehospitalized for MI. The researchers found that the 1-year MI risk progressively increased by the extent of CAD, rather than abruptly increasing between nonobstructive and obstructive CAD. Patients with nonobstructive CAD had an associated risk of MI that was 2-to 4.5-fold greater than among those with no apparent CAD. Similar observations were seen with 1-year mortality and the combined outcome of 1-year MI and death.

“These findings highlight a need to recognize that nonobstructive CAD is associated with significantly increased risk for MI, consistent with prior biologic studies indicating that a majority of MIs are related to nonobstructive stenosis [narrowing of an artery]. Correspondingly, these results reveal the limitations of a dichotomous [divided into two parts] characterization of angiographic CAD into ‘obstructive’ and ‘nonobstructive’ to predict MI and highlight the importance of preventive strategies such as pharmacotherapy treatments and lifestyle modifications to mitigate these risks,” the authors write.

(doi:10.1001/jama.2014.14681)

Are you paying for health or disease at the grocery store?

Choosing the right food prevents disease

SPOTSYLVANIA, VIRGINIA – (October 20, 2014) – According to the United States Census Bureau, supermarkets and grocery stores are a $466 billion industry. With nearly 65,000 stores nationwide, supermarkets are designed to meet the needs of those looking for the convenient foods to those who want to cook everything from scratch, and everything in between. With so many choices people can become overwhelmed and lose sight of the fact that what they put in their grocery cart can directly impact their overall health. Dr. Nimali Fernando, a pediatrician who founded The Doctor Yum Project, names five things you may be putting in your cart when you opt for unhealthy, processed foods.

“When it comes to feeding a family, there are choices we can make at the grocery store that can make us healthier AND save us money,” explains Dr. Nimali Fernando. “It’s time for us to stop considering the price per calorie of our food choices. Of course junk food may seem like the better value. But most Americans these days should consider the value of the nutrients per dollar and how full their food makes them feel. A banana has fewer calories than a bag of chips but delivers more satiation and nutrition at a similar price. Stocking your grocery cart with healthy fruits and vegetables doesn’t have to be expensive, and it’ll be worth it health-wise for both you and your children.”

When you reach for many quick, pre-packaged foods, you may be choosing foods that will be detrimental to your health. In fact, Dr. Fernando advises that you may be adding these five things:

1. Early onset of diabetes. The Centers for Disease Control and Prevention reports that around 16 percent of caloric intake for children and adults comes from added sugars. A typical teenager in America is ingesting 35-45 teaspoons of added sugar a day, and many pre-packaged foods and beverages they eat and drink contain high amounts of sugar. We are now seeing record numbers of type 2 diabetes in children, which can be much harder to manage than diabetes in adults.
2. Obesity. With the one third of children now overweight or obese, we should be less worried about how many calories our dollars buy and more focused on how many nutrients we can buy. Extra calories are leading to weight gain in children, leading them to have back pain, flat feet, and poor self image.
3. Constipation. Most processed and convenience foods are devoid of fiber, which could lead to trouble in the bathroom. Today, many children suffer from constipation that lasts for months or even years. Constipation can even lead to problems like bedwetting and chronic urinary tract infections.
4. Early coronary artery disease. The consumption of all the added sugars, according to the CDC, has been associated with cardiovascular disease, even among adolescents. In one study almost 100 percent of 10 year-olds in America already had fatty streaks in their coronary arteries. When we choose healthier options we are not just preventing heart disease in kids, we may be reversing the disease they already have.
5. Shortened lifespan. Some experts predict that this generation of children will be the first have a shorter life expectancy than their parents. This is due to the nature of their diet and sedentary lifestyle, which leads to illness. For instance, obesity now is the number one risk factor for cancer, and so much of our risk factor for cancer in adulthood is established in the first two to three decades of our life. If we can teach kids to make healthy choices from a young age, we are ultimately giving them the best chance for a long, productive life.
    

“The simple act of choosing healthy foods that contain vital nutrients and vitamins can make a serious impact in your long-term health and your children’s health,” affirms Dr. Fernando. “Teaching your children how to shop healthy will be essential to helping them maintain a long, healthy lifestyle.”

For more information or to make a donation, visit the site at www.doctoryum.com.

About The Doctor Yum Project

The Doctor Yum Project is a nonprofit organization that was founded by Dr. Nimali Fernando, a pediatrician. The mission of the organization is to raise awareness about the benefits of feeding children healthy foods and encouraging healthy lifestyles, thereby reducing childhood obesity and diet-related illnesses. They offer kids cooking classes, a cooking club, a preschool nutrition program, and more. For more information on The Doctor Yum Project, visit the website at:www.doctoryum.com.