Wednesday, April 03, 2024

Majority of people with heart disease consume too much sodium


Study finds patients on average consume more than twice the recommended daily amount of sodium with little variation across socioeconomic groups



AMERICAN COLLEGE OF CARDIOLOGY





Individuals with heart disease stand to gain the most from a low-sodium diet but, on average, consume over twice the recommended daily sodium intake, according to a study being presented at the American College of Cardiology’s Annual Scientific Session.

Sodium is an essential nutrient, but consuming too much can raise blood pressure, which damages blood vessels and forces the heart to work harder. Excess sodium can also cause the body to retain fluid, exacerbating conditions like heart failure. The current U.S. Dietary Guidelines put out by the U.S. Department of Agriculture recommends most adults limit their sodium intake to less than 2,300 mg/day, which is equivalent to about 1 teaspoon of table salt. For individuals with cardiovascular diseases, the limit is even lower at 1,500 mg/day, according to guideline recommendations from the ACC and the American Heart Association.

This new study found that among a sample of more than 3,100 people with heart disease, 89% consumed more than the recommended daily maximum of 1,500 mg of sodium and, on average, study participants consumed more than twice this amount. Limiting sodium intake is a fundamental lifestyle modification shown to reduce the likelihood of subsequent major adverse cardiovascular events, researchers said. Their findings underscore the challenges many people face in keeping within recommended sodium limits, regardless of other factors such as socioeconomic status.

“Estimating sodium quantities in a meal can be challenging,” said Elsie Kodjoe, MD, MPH, an internal medicine resident at Piedmont Athens Regional Hospital in Athens, Georgia and the study’s lead author. “Food labels aid in dietary sodium estimation by providing sodium quantities in packaged food. Yet, adhering to a low sodium diet remains challenging even for individuals with cardiovascular disease who have a strong incentive to adhere.”

The study used data from patients diagnosed with a heart attack, stroke, heart failure, coronary artery disease or angina who participated in the National Health and Nutrition Examination Survey (NHANES) between 2009–2018.

Researchers estimated sodium intake based on questionnaires in which participants were asked to report everything they had consumed in 24 hours. According to the results, study participants with cardiovascular disease consumed an average of 3,096 mg of sodium per day, which is slightly lower than the national average of 3,400 mg/day reported by the U.S. Centers for Disease Control and Prevention.

“The relatively small difference in sodium intake suggests that people with cardiovascular disease are not limiting their intake very much compared with the general population and are also consuming more than double what is recommended,” Kodjoe said. “To make it easier for patients to adhere to dietary guidelines, we need to find more practical ways for the general public to estimate dietary sodium levels or perhaps consider a reduction in the sodium content of the food we consume right from the source.”

The researchers also compared sodium intake among people in different socioeconomic groups, but they did not find any significant differences between wealthier and less affluent participants after accounting for age, sex, race and educational attainment.

Individuals can take proactive measures to lower their sodium intake, Kodjoe said. This includes preparing more meals at home where they have greater control over the sodium content and paying close attention to food labels, particularly targeting foods with sodium levels of 140 mg or less per serving. Researchers suggested that better education around the benefits of limiting sodium could also help motivate more people to follow the recommendations.

“Cardiovascular disease is real, and it is the number one cause of morbidity and mortality worldwide according to the World Health Organization,” Kodjoe said. “Adhering to sodium guidelines is one of the easier strategies individuals could readily adopt to reduce hospitalizations, health care costs, morbidity and mortality associated with cardiovascular disease.”

One limitation of the study is that sodium intake was estimated based on food recall questionnaires, rather than 24-hour urine sodium measurements, which is considered the gold standard method. NHANES has included 24-hour urine sodium measurements in its data gathering methods in recent survey cycles, so future studies using this data could provide a more accurate assessment of sodium intake among people with cardiovascular disease.  

For more information on reducing sodium, visit CardioSmart.org/Sodium.

Kodjoe will present the study, “The Impact of Income to Poverty Ratio on Sodium Intake Among Adults with Cardiovascular Disease,” on Sunday, April 7, 2024, at 3:15 p.m. ET / 19:15 UTC in Hall B4-5.

ACC.24 will take place April 6-8, 2024, in Atlanta, bringing together cardiologists and cardiovascular specialists from around the world to share the newest discoveries in treatment and prevention. Follow @ACCinTouch@ACCMediaCenter and #ACC24 for the latest news from the meeting.


Want to cut US heart risks? Get more people into primary care, study suggests


Most care to address the “Essential Eight” risk factors for heart disease and stroke happens in general-care settings, but many with high risk don’t go



MICHIGAN MEDICINE - UNIVERSITY OF MICHIGAN





When someone has a heart attack or a stroke, specialized care can give them the best chance of surviving.

But when it comes to preventing those problems in the first place, most essential care happens in general primary care clinics, a new study suggests. Or it doesn’t happen at all, if someone can’t, won’t or doesn’t take the time to see a primary care doctor or nurse practitioner.

The study finds that a majority of people with any of these key measures for improving and maintaining cardiovascular health, and the majority of those taking medication to control four of those measures, saw only a primary care clinician in the past year, compared with those who saw a cardiologist alone or in addition to seeing a primary care provider.

The study focuses on seven of what the American Heart Association calls “Life’s Essential Eight” controllable risk factors for cardiovascular disease: high cholesterol, high blood pressure, diabetes, very high body mass index, tobacco use, low exercise and sleep problems such as insomnia. The data source used in the study doesn’t include information about the eighth risk factor, healthy food intake.

The study also finds that large percentages of people with these major cardiovascular risk factors didn’t see either type of health care provider in the past year, even if they said they were taking medications to control their blood pressure, cholesterol, blood sugar or stop smoking.

More than 50% of all tobacco users, 44% of those who say they have low levels of physical activity, and 38% of those with severe obesity said they hadn’t seen a primary care provider or cardiologist in the last year. Even among those taking medication to control cardiovascular risk factors, 15% to 20% said they hadn’t seen any provider in the past year.

The study is published in Circulation: Quality and Outcomes by a team from Michigan Medicine, the University of Michigan’s academic medical center, OhioHealth, and Weill Cornell Medicine.

 They used data from more than 66,000 adults interviewed in-depth about their health and health care in the last year, through the nationally representative Medical Expenditure Panel Survey conducted by the federal government.

Lead author Jeremy Sussman, M.D., M.Sc., and co-author Madeline Sterling, M.D., M.P.H., serve on the American Heart Association’s Primary Care Science Committee, which is working on a report on the role of primary care in cardiovascular health.

“As a society we need to recognize that preventing common conditions requires providers who can see patients often, and see the whole patient, which is the role of primary care,” said Sussman, a general internist and associate professor in the U-M Department of Internal Medicine. “While cardiovascular care guidelines are often written by specialists and subspecialists, this study shows that access to primary care is crucial to preventing or delaying some of the most common causes of death in the nation.”

The current crisis in access to primary care for American adults does not bode well for making inroads on the “Essential Eight,” Sussman notes. That crisis is caused by both a shortage of, and uneven distribution of, physicians, nurse practitioners and physician assistants who choose to practice general internal medicine, family medicine and geriatrics.

Long waits for appointments, and inability to find a provider who is accepting new patients, could delay identification and management of cardiovascular risk factors, including starting new preventive medications or adjusting doses to control risk factors appropriately.

People who should make sure to see a primary care provider at least once a year – even just via a telehealth appointment – include those who have already been prescribed an antihypertensive medication to bring down high blood pressure, a diabetes drug to bring down blood sugar, a statin to control cholesterol or a prescription quit-smoking medication.

Regular checkups can help ensure they’re getting the most preventive power out of these medicines.

But even if they’re not taking medication, most adults with at least one cardiovascular risk factor on the “Essential Eight” list should be seeing a primary care provider regularly, Sussman said.

“Primary care providers today can manage high blood pressure, high cholesterol, most cases of diabetes, and tobacco cessation without having to refer to a specialist, though of course specialists play a key role in more complex prevention cases and post-incident care,” he said. “They can also be important entry routes to nutrition counseling, weight management and exercise programs, and sleep disorders diagnosis and treatment.”

Policy measures to enhance access to primary care by training more providers and incentivizing them to practice in shortage areas, and efforts to support primary care providers in managing cardiovascular risk factors, will be important, the authors say. But in the immediate timeframe, they urge individuals with any of these risk factors to request an appointment with their clinic or seek one out if they don’t have a regular primary care provider.

In addition to Sussman and Sterling, who is a general internist and researcher at Weill Cornell, the study team includes author Michael Johansen, M.D., a family medicine physician with OhioHealth who trained at U-M.

Sussman is a member of the U-M Institute for Healthcare Policy and Innovation, the VA Center for Clinical Management Research, and the Division of General Medicine.

The AHA committee that Sussman and Sterling serve on is a joint subcommittee of the Council on Quality of Care and Outcomes Research, and the Council on Cardiovascular and Stroke Nursing.

Clinical Care for Life’s Essential 8 by Medical Specialty in the United States, an Observational Cohort Study, Circulation: Cardiovascular Quality and Outcomes, DOI:10.1161/CIRCOUTCOMES.123.010498  https://www.ahajournals.org/doi/10.1161/CIRCOUTCOMES.123.010498

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