Mediterranean diet improves cognition: the PREDIMED-NAVARRA randomised trial.

OBJECTIVE: Previous observational studies reported beneficial effects of the Mediterranean diet (MedDiet) on cognitive function, but results were inconsistent. We assessed the effect on cognition of a nutritional intervention using MedDiets in comparison with a low-fat control diet. METHODS: We assessed 522 participants at high vascular risk (44.6% men, age 74.6 ± 5.7 years at cognitive evaluation) enrolled in a multicentre, randomised, primary prevention trial (PREDIMED), after a nutritional intervention comparing two MedDiets (supplemented with either extra-virgin olive oil (EVOO) or mixed nuts) versus a low-fat control diet. Global cognitive performance was examined by Mini-Mental State Examination (MMSE) and Clock Drawing Test (CDT) after 6.5 years of nutritional intervention. Researchers who assessed the outcome were blinded to group assignment. We used general linear models to control for potential confounding. RESULTS: After adjustment for sex, age, education, Apolipoprotein E genotype, family history of cognitive impairment/dementia, smoking, physical activity, body mass index, hypertension, dyslipidaemia, diabetes, alcohol and total energy intake, participants allocated to the MedDiet+EVOO showed higher mean MMSE and CDT scores with significant differences versus control (adjusted differences: +0.62 95% CI +0.18 to +1.05, p=0.005 for MMSE, and +0.51 95% CI +0.20 to +0.82, p=0.001 for CDT). The adjusted means of MMSE and CDT scores were also higher for participants allocated to the MedDiet+Nuts versus control (adjusted differences: +0.57 (95% CI +0.11 to +1.03), p=0.015 for MMSE and +0.33 (95% CI +0.003 to +0.67), p=0.048 for CDT). These results did not differ after controlling for incident depression. CONCLUSIONS: An intervention with MedDiets enhanced with either EVOO or nuts appears to improve cognition compared with a low-fat diet. ISRCTN:35739639.

[Smoking cessation and risk of myocardial reinfarction in coronary patients: a nested case-control study]. / Abandono del tabaco y riesgo del nuevo infarto en pacientes coronarios: estudio de casos y controles anidados.

INTRODUCTION AND OBJECTIVES: Smoking cessation reduces mortality in coronary patients. The aim of this study was to estimate association measures between the risk of occurrence of fatal or non-fatal reinfarction in patients who either continue to smoke or stop after a first infarction and are treated with secondary prevention measures. PATIENTS AND METHOD: The study was a case-control (1:1) design nested in a cohort of 985 coronary patients under the age of 76 years who were not treated with invasive procedures and survived more than 6 months after the first acute myocardial infarction. Cases were all patients who suffered reinfarction (n = 137) between 1997 and 2000. A control patient was matched with each case by gender, age, hospital, interviewer, and the secondary prevention timeframe. RESULTS: Patients who smoke after the first acute myocardial infarction had an Odds ratio (OR) of 2.83 (95% CI, 1.47-5.47) for a new acute myocardial infarction. Adjustment for lifestyle, drug treatment, and risk factors (family history of coronary disease, high blood pressure, hypercholesterolemia, and diabetes mellitus) did not change the OR (2.80 [95% CI, 1.35-5.80]). Patients who quit smoking had an adjusted OR of 0.90 (95% CI, 0.47-1.71) compared with non-smokers before the first acute myocardial infarction. Continued smoking had an adjusted OR of 2.90 (95% CI, 1.35-6.20) compared to quitting after the first acute myocardial infarction. CONCLUSION: The risk of acute myocardial infarctions is three times higher in patients who continue to smoke after an acute coronary event compared with patients who quit. The risk of reinfarction in patients who stop smoking is similar to the risk of non-smokers before the first infarction.

Abandono del tabaco y riesgo de nuevo infarto en pacientes coronarios: estudio de casos y controles anidado / Smoking cessation and risk of myocardial reinfarction in coronary patients: a nested case control study

Introducción y objetivos. Dejar de fumar reduce la mortalidad en pacientes coronarios. El objetivo de esta investigación fue estimar las medidas de asociación entre la aparición de un reinfarto fatal o no fatal y el mantenimiento o el abandono del hábito tabáquico tras un primer infarto, en pacientes sometidos a medidas de prevención secundaria. Pacientes y método. Estudio de casos y controles (1:1) anidados en una cohorte de 985 pacientes coronarios, menores de 76 años, no tratados con procedimientos invasivos o quirúrgicos, que sobrevivieron más de 6 meses tras el primer infarto. Los casos (n = 137) fueron todos los pacientes con un reinfarto entre 1997 y 2002, emparejados con los controles por sexo, edad, hospital, entrevistador y tiempo de prevención secundaria. Resultados. El hábito de fumar después del primer IAM presentó una odds ratio (OR) de 2,83 (intervalo de confianza [IC] del 95 por ciento, 1,47-5,47) para un nuevo IAM. El ajuste del modelo por otros estilos de vida, tratamientos farmacológicos y factores de riesgo (antecedentes familiares de enfermedad coronaria, hipertensión arterial, hipercolesterolemia y diabetes mellitus) mantuvo la OR (2,80 [IC del 95 por ciento, 1,35-5,80]). Los que dejaron de fumar presentaron una OR ajustada de 0,90 (IC del 95 por ciento, 0,47-1,71) respecto a los no fumadores, mientras que los que continuaron fumando presentaron una OR ajustada para un nuevo IAM de 2,90 (IC del 95 por ciento, 1,35-6,20) respecto a los que dejaron de fumar. Conclusiones. El mantenimiento del tabaquismo después de un IAM se asocia con un riesgo triple de padecer otro infarto respecto a los pacientes que dejan de fumar. El abandono del hábito tabáquico equipara el riesgo al de los no fumadores antes del primer infarto (AU)