Type of myocardial infarction presentation in patients with chronic kidney disease.

BACKGROUND AND AIM: Association of coronary and renal disease has been frequently found in epidemiological studies. Whether ECG-graphic presentation of myocardial infarction [S-T Elevated MI (STEMI) or Non S-T Elevated MI (NSTEMI)] is related to the degree of renal dysfunction is still unclear. METHODS AND RESULTS: We examined 146 patients with acute myocardial infarction, consecutively entering the Coronary Care Unit of our ward. At entry, patients underwent clinical, ECG-graphic and echocardiographic examination, and blood samples were withdrawn for cardiac markers and general biochemistry. GFR was calculated using the CKD-EPI equation. STEMI was found in 71 cases and NSTEMI in 75 cases. Renal function was normal in 61 patients (stage 1), mildly impaired (<90 mL/min/1.73 m(2) and ≥ 60 mL/min/1.73 m(2)) in 60 (stage 2) and moderately to severely impaired (GFR <60 mL/min/1.73 m(2)) in 25 cases (stages 3-4). Patients were, thereafter, clustered into two groups (stages 1-2 and stages 3-4). Compared to stage 1-2 subjects, stages 3-4 patients were older, were more likely to be diabetic and had more frequently previous cardiovascular diseases. The probability of presentation of NSTEMI for stage 3-4 patients was 4-fold greater than for stage 1-2 patients (p = 0.02). CONCLUSIONS: These data support the evidence that 1) NSTEMI is associated with more severe kidney dysfunction, likely due to more severe and/or longer lasting exposition to risk factors; 2) cardiac and renal impairment are strongly associated. ClinicalTrials.gov Identifier: NCT01636427.

Low-lipid diet reduces frequency and severity of acute migraine attacks.

BACKGROUND AND AIM: There is uncertainty regarding the prevention of migraine crises by changing the lifestyle of patients. The aim of this randomized, crossover intervention trial was to evaluate the effects of a low lipid intake on the incidence and severity of migraine crises, in comparison to a diet with moderate lipid intake. METHODS AND RESULTS: After a 2-month run-in when patients received preventive medication but were left on their habitual diet, a low-lipid or a normal-lipid diet was randomly prescribed for 3 months and thereafter diets were crossed over for the following 3 months. Headache was diagnosed based on the International Classification of Headache Disorders (IHCD) III criteria. The number and severity of attacks were assessed using a self-reported calendar. Adherence to the diet was assessed by a food frequency questionnaire. An analysis was performed on the 83 episodic or chronic migraineurs (63 female and 20 male), in the age range of 18-57 years, who completed both intervention periods. Obese subjects had a significantly higher number of attacks than those overweight or with normal body weight (24.7 ± 8, 16.3 ± 12, and 15.6 ± 11, respectively, p < 0.03) with a significant relationship between the body mass index (BMI) and the number of monthly attacks (r = 0.238, p < 0.03). The number (2.9 ± 3.7 vs. 6.8 ± 7.5, p < 0.001) and severity (1.2 + 0.9 vs. 1.7 ± 0.9, p < 0.01) of attacks significantly decreased during both intervention periods, with a significant difference in favour of the low-lipid diet. CONCLUSIONS: In this group of patients, the low-lipid diet significantly affected the number and severity of migraine attacks in comparison to a normal-lipid diet. ClinicalTrials.gov Identifier: NCT 01917474.