Impact of cardiovascular treatments and systolic dysfunction on nutritional risk in patients with ischemic and valvular heart disease.

OBJECTIVE

There is a limited knowledge about connections existing between impaired systolic function and nutritional risk. The aim of our study was to evaluate nutritional risk in patients recently treated for valvular or ischemic heart disease, depending on the impairment of left ventricle systolic function and chronic cardiovascular therapy.

METHODS

Nutritional risk screening was applied using a nutritional risk screening (NRS)-2002 [ 1 ] tool in cross-sectional study settings on patients scheduled for cardiovascular rehabilitation. There were 105 patients with impairment of left ventricle systolic function (LVEF ≤ 40) vs 145 consecutive matching peers with preserved LVEF. Percentage weight loss history (WLH) from preceding cardiovascular treatments was available for more than 85% of studied patients.

RESULTS

Mean WLH was 7.7 ± 4.6%, and NRS-2002 was 3.6 ± 1.5. Significant differences in percentage WLH and NRS-2002 were found for age groups (p < 0.001, p < 0.001, respectively), cardiovascular treatments (p < 0.001, p < 0.001, respectively), and grades of renal function (p < 0.001, p < 0.001, respectively), whereas there was no difference on the basis of systolic function preservation (both p > 0.05, respectively). Utilization of proton pump inhibitors, loop diuretics, and calcium channel antagonists increased the odds for pronounced nutritional risk, 2.60 (95% confidence interval [CI], 1.23-5.47), p = 0.012, vs 2.15 (95% CI, 1.00-4.62), p = 0.049, vs 2.18 (95% CI, 1.01-4.68), p = 0.046, respectively. Conversely, angiotensin-converting enzyme (ACE) inhibitors exhibited protective effects to the nutritional risk, 0.20 (95% CI, 0.05-0.89), p = 0.035.

CONCLUSION

Clinically, most evocative connections of nutritional risk screening and unintentional weight loss were found in relation to invasiveness of preceding cardiovascular treatments, rather than preservation of systolic function. Protective effects on nutritional risk were found for ACE inhibitors, whereas loop diuretics and proton pump inhibitors increased the nutritional risk and unintentional loss of weight.