Dietary electrolytes and cardiovascular disease.Continuing education continuing education: see adult education.continuing education or adult education Any form of learning provided for adults. In the U.S. the University of Wisconsin was the first academic institution to offer such programs (1904). and the APD APD atrial premature depolarization (see atrial premature complex, under complex ); pamidronate. program This quiz is an ideal activity for APD members to include in your CPD CPD citrate phosphate dextrose; see anticoagulant citrate phosphate dextrose solution, under solution. Cephalopelvic disproportion (CPD) log, where it relates to personal learning goals. Record the time taken, to the nearest hour, to complete the quiz and any associated research. INTRODUCTION A number of dietary electrolytes have been associated with a rise in blood pressure (BP). Raised BP is a major, preventable risk factor for cardiovascular disease Cardiovascular disease Disease that affects the heart and blood vessels. Mentioned in: Lipoproteins Test cardiovascular disease (CVD CVD Cardiovascular disease, see there ), including stroke, coronary heart disease coronary heart disease: see coronary artery disease. coronary heart disease or ischemic heart disease Progressive reduction of blood supply to the heart muscle due to narrowing or blocking of a coronary artery (see atherosclerosis). , heart failure, peripheral vascular disease Peripheral Vascular Disease Definition Peripheral vascular disease is a narrowing of blood vessels that restricts blood flow. It mostly occurs in the legs, but is sometimes seen in the arms. and kidney failure kidney failure or renal failure Partial or complete loss of kidney function. Acute failure causes reduced urine output and blood chemical imbalance, including uremia. Most patients recover within six weeks. . (1) The risk of CVD increases as the level of BP increases. In addition to the physiological effects resulting from variations in the intakes of electrolytes, there may be significant interactions between these electrolytes that affect CVD risk. This continuing education quiz refers to the findings of the Summary of Evidence review on dietary electrolytes, blood pressure and CVD conducted by the National Heart Foundation of Australia The National Heart Foundation of Australia (NHF) or Heart Foundation [1] is a non-profit organization with the stated mission "to improve the cardiac health of Australians". It was formed in 1959 by a group of cardiac physicians. in 2006. (2) The electrolytes considered were sodium, potassium, magnesium and calcium. 1. Which statement best describes the evidence relating to calcium and BP or CVD, and magnesium and BP or CVD? a. There is evidence for a relationship between magnesium and BP but not for calcium and BP b. There is no evidence to support an association between magnesium and BP or CVD, but evidence to support an association between calcium and BP c. There is no evidence to support a relationship between calcium and BP, or for an association between magnesium and BP or CVD d. There is evidence to support a relationship between magnesium and BP, and calcium and BP, but no evidence to support an association between magnesium and CVD 2. The National Heart Foundation of Australia recommends all Australians reduce their salt intake to less than 6 g of salt a day. This amount of salt is equal to a. 2000 mg of sodium b. 2300 mg of sodium c. 3200 mg of sodium d. 1600 mg of sodium 3. There is good evidence to show that a reduction in dietary sodium of approximately 1700 mg/day results in a fall of ___ mmHg in hypertensive hypertensive /hy·per·ten·sive/ (-ten´siv) 1. characterized by increased tension or pressure. 2. an agent that causes hypertension. 3. a person with hypertension. individuals (systolic Systolic The phase of blood circulation in which the heart's pumping chambers (ventricles) are actively pumping blood. The ventricles are squeezing (contracting) forcefully, and the pressure against the walls of the arteries is at its highest. BP [greater than or equal to]140 mmHg) and a fall of ___ mmHg in normotensive normotensive /nor·mo·ten·sive/ (-ten´siv) 1. characterized by normal tone, tension, or pressure, as by normal blood pressure. 2. a person with normal blood pressure. individuals (systolic BP <120 mmHg). a. 4-5, 2 b. 2, 2-3 c. 2-3, 1 d. 5-6, 4 4. There is good evidence in the scientific literature to indicate that a general reduction in sodium intake could be best achieved by a reduction in the sodium content of manufactured foods rather than by dietary advice alone because the sodium added to processed food contributes about ___ of dietary sodium. a. 50% b. 30% c. 80% d. 65% 5. There is good evidence in the scientific literature to indicate that an increased intake of dietary potassium of approximately 2100 mg/day is associated with a fall in systolic BP of ___ mmHg in hypertensive individuals and a fall in systolic BP of ___ mmHg in normotensive individuals. a. 5-6, 3 b. 4-8, 2 c. 2-3, 1 d. 2-5, 2 6. There is moderate evidence in the scientific literature to indicate that: a. A high dietary sodium intake is associated with increased stroke incidence, and mortality from coronary heart disease and CVD b. A high potassium high potassium Vox populi Hyperkalemia; often also, hyperpotassemia intake is associated with decreased stroke mortality c. Reducing dietary sodium and increasing dietary potassium intake is associated with a reduced risk of CVD d. Both a and b 7. When advising patients or clients with high BP or those at risk of CVD, the Heart Foundation recommends: a. Advising patients to reduce their salt intake to less than 6 g of salt (2300 mg of sodium) a day b. Advising patients to reduce their salt intake to less than 4 g of salt (1550 mg of sodium) a day c. Advising patients to reduce dietary sodium intake along with weight loss for greater benefits in reduction of BP d. Advising patients to reduce their salt intake to 1.2-1.6 g of salt (460-920 mg of sodium) a day For more information about the Heart Foundation Position Statement regarding the relationship between dietary electrolytes and CVD, visit http://www.heartfoundation.org.au and click on Professional Information then Nutrition. ANSWERS 1. c. The evidence obtained from a systematic review of all relevant randomised Adj. 1. randomised - set up or distributed in a deliberately random way randomized irregular - contrary to rule or accepted order or general practice; "irregular hiring practices" controlled trials is considered to be the most robust and good-quality evidence. (3) The Heart Foundation has based its conclusions on the highest-quality evidence available after assessing each paper individually. The criteria used to appraise the evidence were based on consistency across a range of study designs, the quality of each study and consideration of measurement bias, the size of the effects and the demonstration of a biologically plausible mechanism. The terms 'good', 'moderate' and 'weak' evidence were used to assess the strength of the scientific evidence. The scientific literature review undertaken by the National Heart Foundation of Australia found there is limited evidence currently available regarding the impact of dietary magnesium and calcium on BP and CVD. The review found no evidence to support an association between calcium and BP, and weak evidence that high calcium intake reduces the risk of ischaemic stroke. (4-8) The review also found no evidence to support an association between magnesium and BP or magnesium and CVD. 2. b. Australian adults eat about 9 g of salt a day. (9,10) The National Heart Foundation recommends that Australians reduce their intake to less than 6 g of salt a day These recommendations are consistent with the 2006 National Health and Medical Research Council The National Health and Medical Research Council (NHMRC) is Australia's peak funding body for medical research, with a budget of nearly A$500M a year . The Council was established to develop and maintain health standards and is responsible for implementing the Nutrient Reference Values ref·er·ence values pl.n. A set of laboratory test values obtained from an individual or from a group in a defined state of health. for Australia and New Zealand New Zealand (zē`lənd), island country (2005 est. pop. 4,035,000), 104,454 sq mi (270,534 sq km), in the S Pacific Ocean, over 1,000 mi (1,600 km) SE of Australia. The capital is Wellington; the largest city and leading port is Auckland. . (11) Six grams of salt contains approximately 100 mmol of sodium or 2300 milligrams of sodium. In order to know how much salt is in food, advise patients to look at the Nutrition Information Panel on food packages. Salt is not shown on the label, so the patient must look for the figure for sodium in milligrams per 100 g. Australians can reduce their sodium/salt intake by eating plenty of fresh fruit and vegetables, choosing 'no added salt', 'low salt' or 'reduced salt' if lower-salt options are not available, avoiding high-salt foods particularly processed meats, commercial sauces, commercial soups and stocks, high-salt take-away take·a·way n. 1. A concession, as in a lower level of health benefits, made by a labor union to a company in negotiating a new contract. 2. and snack foods, and avoiding adding salt while cooking and at the table. 3. a. Reducing dietary sodium is associated with a fall in blood pressure in hypertensive and normotensive individuals. There is good evidence in the scientific literature to indicate that a reduction in dietary sodium of approximately 1700 mg/day (75 mmol/day) results in a fall in systolic blood pressure Systolic blood pressure Blood pressure when the heart contracts (beats). Mentioned in: Hypertension of 4-5 mmHg in hypertensive individuals (systolic BP [greater than or equal to]140 mmHg) and a fall in systolic blood pressure of 2 mmHg in normotensive individuals (systolic BP <120 mmHg).12,13 4. c. A reduction in sodium intake could be better achieved by a general reduction in the sodium content of manufactured food products than by dietary advice alone, and whole foods have a greater effect on BP than supplements. (8,14) The greater impact of reducing sodium in manufactured food products results from the finding that processed foods contribute to 80% of dietary sodium. (15) 5. b. Australian men eat about 2800-3200 mg of potassium per day and women about 2600-2900 mg of potassium per day. (9,10) The National Health and Medical Research Council recommend that men eat 3800 mg of potassium per day and women eat 2800 mg of potassium per day in order to prevent deficiency. (11) To prevent chronic disease (including CVD), the recommended intake is 4700 mg per day. The National Heart Foundation found good evidence in the scientific literature to make recommendations to increase potassium for normotensive (systolic BP <120 mmHg) and hypertensive (systolic BP >140 mmHg) individuals. (16-18) The National Heart Foundation found less evidence that focused on mildly hypertensive individuals (systolic BP = 120-139 mmHg), and has not made recommendations for this group. For individuals with high blood pressure, at high risk or with existing CVD, the National Heart Foundation recommends increasing potassium intake to at least 4700 mg a day by eating vegetables, fruits, nuts, legumes Legumes A family of plants that bear edible seeds in pods, including beans and peas. Mentioned in: Cholesterol, High legumes (l and wholegrain cereals regularly (Note: people with renal impairment should check with their doctor before changing potassium intake.) 6. d. The scientific literature review undertaken by the National Heart Foundation found that high dietary sodium intake is associated with increased stroke incidence, and mortality from coronary heart disease and CVD. (19,20) A high potassium intake is associated with decreased stroke mortality. (21-25) Further studies are needed to clarify the evidence that reducing dietary sodium and increasing potassium intake is associated with a reduced risk of CVD. 7. b. The National Heart Foundation recommends that patients or clients with high BP, or those with or at risk of CVD, reduce their salt intake to less than 4 g of salt a day (approximately 1550 mg of sodium). These recommendations are consistent with the National Health and Medical Research Council's Nutrient Reference Values for Australia and New Zealand, which recommend a Suggested Dietary Target sodium intake of 1600 mg per day. (11) Further studies are needed to clarify the evidence that reductions in dietary sodium intake, along with weight loss, facilitate greater benefits in reduction of BP. REFERENCES 1 Australian Institute of Health and Welfare. Australia's Health. Canberra: Australian Institute of Health and Welfare, 2006. 2 National Heart Foundation of Australia. Summary of Evidence on the Relationships between Dietary Electrolytes and Cardiovascular Disease. Sydney: National Heart Foundation of Australia, December 2006. (Cited 24 Jul 2007.) Available from URL URL in full Uniform Resource Locator Address of a resource on the Internet. The resource can be any type of file stored on a server, such as a Web page, a text file, a graphics file, or an application program. : http://www.heartfoundation.org.au/Professional_Information/Lifestyle_Risk/Nutrition.htm. 3 National Health and Medical Research Council. A Guide to the Development, Implementation and Evaluation of Clinical Practice Guidelines clinical practice guidelines Clinical policies, practice guidelines, practice parameters, practice policies Medtalk Systematically developed statements to assist practitioner and Pt decisions about appropriate health care for specific clinical circumstances. See Psychology. . Canberra: NHMRC NHMRC National Health and Medical Research Council , 1999. 4 Abbott R, Curb J, Rodriguez B, Sharp D, Burchfiel C, Yano K. Effect of dietary calcium and milk consumption on risk of thromboembolic thromboembolic pertaining to or emanating from thromboembolism. thromboembolic meningoencephalitis see hemophilosis. thromboembolic parasitism see thromboembolic colic. stroke in older middle-aged men. Honolulu Heart Program Stroke 1996; 27: 813-18. 5 Elwood P, Strain J, Robson P et al. Milk consumption, stroke, and heart attack risk: evidence from the Caerphilly Caerphilly (kīrfĭl`ē, kär–), Welsh Caerffili, town (1981 pop. 42,376) and county borough, 108 sq mi (279 sq km), S Wales. cohort of older men. J Epidemiol Community Health 2005; 59: 502-5. 6 Iso H, Stampfer M, Manson J et al. Prospective study of calcium, potassium and magnesium intake and risk of stroke in women. Stroke 1999; 30: 1772-9. 7 Umesawa M, Iso H, Date C et al. Dietary intake of calcium in relation to mortality from cardiovascular disease: the JACC JACC Journal of the American College of Cardiology JACC Java Authorization Contract for Containers JACC Joint Automatic Control Conference JACC Journal Access Core Collection JACC Joint Ambulatory Care Clinic JACC joint airspace control center Study. Stroke 2006; 37: 20-26. 8 Griffith L, Guyatt G, Cook R, Bucher H, Cook D. The influence of dietary and non-dietary calcium supplementation calcium supplementation Metabolism The addition of Ca2+ to the diet, usually in the form of calcium carbonate on blood pressure: an updated meta-analysis of randomized controlled trials. Am J Hypertens 1999; 12: 84-92. 9 Beard T, Woodward D, Ball PJ, Hornsby H, von Witt RJ, Dwyer T. The Hobart Salt Study 1995: few meet national sodium intake target. Med J Aust 1997; 166: 404-7. 10 Notowidjojo L, Truswell AS. Urinary sodium and potassium in a sample of healthy adults in Sydney, Australia. Asia Pacific J Clin Nutr 1993; 2: 25-33. 11 National Health and Medical Research Council. Nutrient Reference Values for Australia and New Zealand Including Recommended Dietary Intakes. Canberra: NHMRC, 2006. 12 He F, MacGregor G. Effect of modest salt reduction on blood pressure: a meta-analysis of randomised trials. Implications for public health. J Hum Hypertens 2002; 16: 761-70. 13 Cutler J, Follmann D, Allender P. Randomized ran·dom·ize tr.v. ran·dom·ized, ran·dom·iz·ing, ran·dom·iz·es To make random in arrangement, especially in order to control the variables in an experiment. trials of sodium reduction: an overview. Am J Clin Nutr 1997; 65: 643S-51S. 14 Hooper L, Bartlett C, Davey Smith G, Ebrahim S. Systematic review of long term effects of advice to reduce dietary salt in adults. BMJ BMJ n abbr (= British Medical Journal) → vom BMA herausgegebene Zeitschrift 2002; 325: 628. 15 Sacks F, Svetkey L, Vollmer W et al. Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension Dietary Approaches to Stop Hypertension or the DASH diet is a diet promoted by the National Heart, Lung, and Blood Institute (part of the NIH) to control hypertension. (DASH) diet. DASH-Sodium Collaborative Research Group. N Engl J Med 2001; 344: 3-10. 16 Whelton P, He J, Cutler J et al. Effects of oral potassium on blood pressure: meta-analysis of randomised controlled clinical trials controlled clinical trial, n a research strategy that calls for two samples: an experimental sample of patients receiving a pharmaceutical, and a second sample of control patients receiving a placebo. . JAMA JAMA abbr. Journal of the American Medical Association 1997; 277: 1624-32. 17 Geleijnse J, Kok F, Grobbee D. Blood pressure response to changes in sodium and potassium intake: a metaregression analysis of randomised trials. J Hum Hypertens 2003; 17: 471-80. 18 Cappuccio F, Markandu N, Carney C, Sagnella G, MacGregor G. Double-blind randomised trial of modest salt restriction in older people. Lancet 1997; 350: 850-54. 19 He J, Ogden L, Vupputuri S, Bazzano L, Loria C, Whelton P. Dietary sodium intake and subsequent risk of cardiovascular disease in overweight adults. JAMA 1999; 282: 2027-34. 20 Tuomilehto J, Jousilahti P, Rastenyte D et al. Urinary sodium excretion and cardiovascular mortality in Finland: a prospective study. Lancet 2001; 357: 848-51. 21 Ascherio A, Rimm E, Hernan M et al. Intake of potassium, magnesium, calcium, and fiber and risk of stroke among US men. Circulation 1998; 98: 1198-204. 22 Chang H, Hu Y, Yue C et al. Effect of potassium-enriched salt on cardiovascular mortality and medical expenses of elderly men. Am J Clin Nutr 2006; 83: 1289-96. 23 Fang J, Madhavan S, Alderman M. Dietary potassium intake and stroke mortality. Stroke 2000; 31: 1532-7. 24 Khaw KT, Barrett-Connor E. Dietary potassium and stroke-associated mortality. A 12-year prospective population study. N Engl J Med 1987; 316: 235-40. 25 Xie J, Sasaki S, Joossens J, Kesteloot H. The relationship between urinary actions obtained from the INTERSALT study and cerebrovascular cer·e·bro·vas·cu·lar adj. Relating to the blood supply to the brain, particularly with reference to pathological changes. cerebrovascular pertaining to the blood vessels of the cerebrum or brain. mortality. J Hum Hypertens 1992; 6: 17-21. This quiz has been prepared by Christina Black, Shanthi Thuraisingam and Barbara Eden, of the National Heart Foundation of Australia. Correspondence should be directed to Heartline 1300 36 27 87 or Barbara Eden, Executive Officer, National Nutrition Program, Heart Foundation, babara.eden@heartfoundation.com.au |
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