Nutritional screening a potential tool for determining heart attack, angina prognosis

August 10, 2020

In a study published today in the Journal of the American College of Cardiology of more than 5,000 acute coronary syndromes (ACS) patients, 71.8% were considered malnourished by at least one nutrition screening test, and worsening malnutrition status was associated with higher mortality and major adverse cardiovascular events (MACE), such as another heart attack or stroke.

"Screening for malnutrition scores may be an easy way to determine which ACS patients are at high risk of adverse outcomes and has the added benefit of being a very simple calculation, as many of the variables are taken through routine testing in the emergency setting," said Sergio Raposeiras Roubín, MD, PhD, a clinical cardiologist at University Hospital Álvaro Cunqueiro and researcher at the Centro Nacional de Investigaciones Cardiovasculares in Spain. "Malnutrition is also a potentially modifiable risk factor for these patients, as clinicians could start nutritional interventions during hospitalization and continue after discharge by coordinating with rehabilitation centers and programs."

In this retrospective study, researchers used the Registry of Acute Coronary Syndrome from University Hospital of Vigo to identify 6,023 patients with ACS admitted between January 2010 and September 2017. ACS is an umbrella term for medical conditions impacting blood flow to the heart muscle, including heart attacks--both non ST-segment Elevation Myocardial Infarction (NSTEMI) and ST-segment Elevation Myocardial Infarction (STEMI)--and unstable angina or chest pain. Patients with incomplete data for admissions or follow-up and patients diagnosed with leukemia or lymphoma were excluded. The final study cohort included 5,062 patients who were 74.5% men, all white race and had a median age of 66.2 years. Among the enrolled patients 10.6% had unstable angina, 49% had NSTEMI and 40.4% had STEMI.

Patients were classified as underweight, normal weight, overweight or obese, according to body mass index. All patients were screened for malnutrition using three calculators: Malnutrition ranged from 8.9% with the PNI, 49.8% with the CONUT and 59.5% with the NRI score, while 38.5% (CONUT) and 20% (NRI) had mild malnutrition, which PNI does not calculate. Moderate to severe malnutrition was calculated in 11.2% (CONUT), 39.5% (NRI) and 8.9% (PNI) of patients. Using any degree of malnutrition, 8.9% were classified as malnourished by all three scores and 28.2% were not malnourished by any score.

Patients with malnutrition, as measured by any of the three scores were older, more likely to be women, and more likely to have atrial fibrillation, anemia and reduced left ventricular ejection fraction. The highest prevalence of malnutrition was found in patients with a body mass index considered underweight or normal weight. However, a significant proportion of patients considered overweight or obese were malnourished.

Over 3.6 years of follow-up, 16.4% of patients died and 20.7% had MACE, which includes cardiovascular mortality, another heart attack or stroke. The researchers found worsening malnutrition status was associated with increased risk of poor outcomes regardless of the malnutrition score used. While the CONUT and PNI outperformed the NRI at predicting mortality and MACE, the CONUT had higher success than the PNI for both outcomes.

"Many clinical cardiologists are not aware of the prevalence of malnutrition, leading it to go unrecognized and untreated," Raposeiras said. "Our study demonstrates the importance in screening for malnutrition in all patients admitted for ACS regardless of body mass index. By doing so we may be able to improve risk assessment in these patients and subsequent interventions for secondary prevention."

In an accompanying editorial, Andrew M. Freeman, MD, of National Jewish Health in Denver, said, "It's time for the CVD professional to arm itself with the most cost-effective and powerful tool in the battle against CVD: nutrition and lifestyle medicine."

Study limitations include the single-center retrospective nature, as well as the lack of comparison of the prognostic value of nutritional screening tools with more complex comprehensive nutritional assessments such as questionnaires or food diaries.

The American College of Cardiology envisions a world where innovation and knowledge optimize cardiovascular care and outcomes. As the professional home for the entire cardiovascular care team, the mission of the College and its 54,000 members is to transform cardiovascular care and to improve heart health. The ACC bestows credentials upon cardiovascular professionals who meet stringent qualifications and leads in the formation of health policy, standards and guidelines. The College also provides professional medical education, disseminates cardiovascular research through its world-renowned JACC Journals, operates national registries to measure and improve care, and offers cardiovascular accreditation to hospitals and institutions. For more, visit acc.org.
-end-
The Journal of the American College of Cardiology ranks among the top cardiovascular journals in the world for its scientific impact. JACC is the flagship for a family of journals--JACC: Cardiovascular Interventions, JACC: Cardiovascular Imaging, JACC: Heart Failure, JACC: Clinical Electrophysiology, JACC: Basic to Translational Science, JACC: Case Reports and JACC: CardioOncology--that prides themselves in publishing the top peer-reviewed research on all aspects of cardiovascular disease. Learn more at JACC.org.

American College of Cardiology

Related Heart Attack Articles from Brightsurf:

Top Science Tip Sheet on heart failure, heart muscle cells, heart attack and atrial fibrillation results
Newly discovered pathway may have potential for treating heart failure - New research model helps predict heart muscle cells' impact on heart function after injury - New mass spectrometry approach generates libraries of glycans in human heart tissue - Understanding heart damage after heart attack and treatment may provide clues for prevention - Understanding atrial fibrillation's effects on heart cells may help find treatments - New research may lead to therapy for heart failure caused by ICI cancer medication

Molecular imaging identifies link between heart and kidney inflammation after heart attack
Whole body positron emission tomography (PET) has, for the first time, illustrated the existence of inter-organ communication between the heart and kidneys via the immune system following acute myocardial infarction.

Muscle protein abundant in the heart plays key role in blood clotting during heart attack
A prevalent heart protein known as cardiac myosin, which is released into the body when a person suffers a heart attack, can cause blood to thicken or clot--worsening damage to heart tissue, a new study shows.

New target identified for repairing the heart after heart attack
An immune cell is shown for the first time to be involved in creating the scar that repairs the heart after damage.

Heart cells respond to heart attack and increase the chance of survival
The heart of humans and mice does not completely recover after a heart attack.

A simple method to improve heart-attack repair using stem cell-derived heart muscle cells
The heart cannot regenerate muscle after a heart attack, and this can lead to lethal heart failure.

Mount Sinai discovers placental stem cells that can regenerate heart after heart attack
Study identifies new stem cell type that can significantly improve cardiac function.

Fixing a broken heart: Exploring new ways to heal damage after a heart attack
The days immediately following a heart attack are critical for survivors' longevity and long-term healing of tissue.

Heart patch could limit muscle damage in heart attack aftermath
Guided by computer simulations, an international team of researchers has developed an adhesive patch that can provide support for damaged heart tissue, potentially reducing the stretching of heart muscle that's common after a heart attack.

How the heart sends an SOS signal to bone marrow cells after a heart attack
Exosomes are key to the SOS signal that the heart muscle sends out after a heart attack.

Read More: Heart Attack News and Heart Attack Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.