Association of physical activity with body mass index, waist circumference and incidence of obesity in older adults.

Background: There is limited, and inconsistent, data on the prospective association between physical activity and surrogate markers of adiposity in older adults. We aim to determine the prospective association of leisure time physical activity (LTPA) with body mass index (BMI), waist circumference (WC) and the incidence of obesity. Methods: This prospective analysis included 7144 individuals with a mean age of 67 ± 6.2 years, from the PREvención con DIeta MEDiterránea (PREDIMED) study. BMI and WC were measured and LTPA was recorded using the Minnesota Leisure Time Physical Activity Questionnaire. Exposure and outcome variables were calculated as cumulative average of repeated measurements. Results: Total LTPA was inversely associated (P < 0.001) with BMI and WC. The difference in BMI and WC between extreme quintiles of LTPA (Q1-Q5) was 2.1 kg/m2 (95% confidence interval (CI) 1.68; 2.49, P < 0.001) and 4.8 cm (CI 2.28; 7.25, P < 0.001), respectively. Low-intensity LTPA was inversely associated with BMI but not with WC, while moderate/vigorous LTPA showed an inverse relationship with BMI and WC. The hazard of general and abdominal obesity incidence decreased across quintiles of total and moderate/vigorous LTPA (P < 0.001 for both), whereas low-intensity LTPA was inversely associated with the incidence of general obesity (P < 0.001). Conclusion: LTPA was inversely associated with BMI, WC and incidence of general and abdominal obesity. The finding that low-intensity LTPA was inversely related to BMI and the incidence of obesity is of particular importance because this level of physical activity could be a feasible option for many older adults.

Changes in ultrasound-assessed carotid intima-media thickness and plaque with a Mediterranean diet: a substudy of the PREDIMED trial.

OBJECTIVE: The Prevención con Dieta Mediterránea (PREDIMED) trial showed that a Mediterranean diet (MedDiet) supplemented with either extra virgin olive oil or 30 g/d of mixed nuts reduced incident cardiovascular events compared with a control (low fat) diet. The mechanisms of cardiovascular protection afforded by MedDiets remain to be uncovered. We assessed the effect of both supplemented MedDiets on internal carotid intima-media thickness (ICA-IMT) and plaque height, the ultrasound features that best predict future cardiovascular events, in subjects at high cardiovascular risk. APPROACH AND RESULTS: In a PREDIMED subcohort (n=175), plaque height and carotid IMT of 3 prespecified segments (ICA, bifurcation, and common) were sonographically assessed at baseline and after intervention for a mean of 2.4 years. We evaluated 164 subjects with complete data. In a multivariate model, mean ICA-IMT progressed in the control diet group (mean [95% confidence interval], 0.052 mm [-0.014 to 0.118 mm]), whereas it regressed in the MedDiet+nuts group (-0.084 mm [-0.158 to -0.010 mm]; P=0.024 versus control). Similar results were observed for maximum ICA-IMT (control, 0.188 mm [0.077 to 0.299 mm]; MedDiet+nuts, -0.030 mm [-0.153 to 0.093 mm]; P=0.034) and maximum plaque height (control, 0.106 mm [0.001 to 0.210 mm]; MedDiet+nuts, -0.091 mm [-0.206 to 0.023 mm]; P=0.047). There were no changes in ICA-IMT or plaque after the MedDiet+extra virgin olive oil. CONCLUSIONS: Compared with a control diet, consumption of a MedDiet supplemented with nuts is associated with delayed progression of ICA-IMT and plaque. The results contribute mechanistic evidence for the reduction of cardiovascular events observed in the PREDIMED trial. CLINICAL TRIAL REGISTRATION URL: http://www.controlled-trials.com. Unique identifier: ISRCTN35739639.

Dietary inflammatory index and all-cause mortality in large cohorts: The SUN and PREDIMED studies.

BACKGROUND: Inflammation is known to be related to the leading causes of death including cardiovascular disease, several types of cancer, obesity, type 2 diabetes, depression-suicide and other chronic diseases. In the context of whole dietary patterns, the Dietary Inflammatory Index (DII®) was developed to appraise the inflammatory potential of the diet. OBJECTIVE: We prospectively assessed the association between DII scores and all-cause mortality in two large Spanish cohorts and valuated the consistency of findings across these two cohorts and results published based on other cohorts. DESIGN: We assessed 18,566 participants in the "Seguimiento Universidad de Navarra" (SUN) cohort followed-up during 188,891 person-years and 6790 participants in the "PREvencion con DIeta MEDiterránea" (PREDIMED) randomized trial representing 30,233 person-years of follow-up. DII scores were calculated in both cohorts from validated FFQs. Higher DII scores corresponded to more proinflammatory diets. A total of 230 and 302 deaths occurred in SUN and PREDIMED, respectively. In a random-effect meta-analysis we included 12 prospective studies (SUN, PREDIMED and 10 additional studies) that assessed the association between DII scores and all-cause mortality. RESULTS: After adjusting for a wide array of potential confounders, the comparison between extreme quartiles of the DII showed a positive and significant association with all-cause mortality in both the SUN (hazard ratio [HR] = 1.85; 95% CI: 1.15, 2.98; P-trend = 0.004) and the PREDIMED cohort (HR = 1.42; 95% CI: 1.00, 2.02; P-trend = 0.009). In the meta-analysis of 12 cohorts, the DII was significantly associated with an increase of 23% in all-cause mortality (95% CI: 16%-32%, for the highest vs lowest category of DII). CONCLUSION: Our results provide strong and consistent support for the hypothesis that a pro-inflammatory diet is associated with increased all-cause mortality. The SUN cohort and PREDIMED trial were registered at clinicaltrials.gov as NCT02669602 and at isrctn.com as ISRCTN35739639, respectively.

Mediterranean diet and risk of heart failure: results from the PREDIMED randomized controlled trial.

AIMS: The aim of this study was to evaluate the effect of the Mediterranean diet (MedDiet) on the incidence of heart failure (HF), a pre-specified secondary outcome in the PREDIMED (PREvención con DIeta MEDiterránea) primary nutrition-intervention prevention trial. METHODS AND RESULTS: Participants at high risk of cardiovascular disease were randomly assigned to one of three diets: MedDiet supplemented with extra-virgin olive oil (EVOO), MedDiet supplemented with nuts, or a low-fat control diet. Incident HF was ascertained by a Committee for Adjudication of events blinded to group allocation. Among 7403 participants without prevalent HF followed for a median of 4.8 years, we observed 29 new HF cases in the MedDiet with EVOO group, 33 in the MedDiet with nuts group, and 32 in the control group. No significant association with HF incidence was found for the MedDiet with EVOO and MedDiet with nuts, compared with the control group [hazard ratio (HR) 0.68; 95% confidence interval (CI) 0.41-1.13, and HR 0.92; 95% CI 0.56-1.49, respectively]. CONCLUSION: In this sample of adults at high cardiovascular risk, the MedDiet did not result in lower HF incidence. However, this pre-specified secondary analysis may have been underpowered to provide valid conclusions. Further randomized controlled trials with HF as a primary outcome are needed to better assess the effect of the MedDiet on HF risk. TRIAL REGISTRATION: ISRCTN35739639.

Obesity indexes and total mortality among elderly subjects at high cardiovascular risk: the PREDIMED study.

BACKGROUND: Different indexes of regional adiposity have been proposed for identifying persons at higher risk of death. Studies specifically assessing these indexes in large cohorts are scarce. It would also be interesting to know whether a dietary intervention may counterbalance the adverse effects of adiposity on mortality. METHODS: We assessed the association of four different anthropometric indexes (waist-to-height ratio (WHtR), waist circumference (WC), body mass index (BMI) and height) with all-cause mortality in 7447 participants at high cardiovascular risk from the PREDIMED trial. Forty three percent of them were men (55 to 80 years) and 57% were women (60 to 80 years). All of them were initially free of cardiovascular disease. The recruitment took place in 11 recruiting centers between 2003 and 2009. RESULTS: After adjusting for age, sex, smoking, diabetes, hypertension, intervention group, family history of coronary heart disease, and leisure-time physical activity, WC and WHtR were found to be directly associated with a higher mortality after 4.8 years median follow-up. The multivariable-adjusted HRs for mortality of WHtR (cut-off points: 0.60, 0.65, 0.70) were 1.02 (0.78-1.34), 1.30 (0.97-1.75) and 1.55 (1.06-2.26). When we used WC (cut-off points: 100, 105 and 110 cm), the multivariable adjusted Hazard Ratios (HRs) for mortality were 1.18 (0.88-1.59), 1.02 (0.74-1.41) and 1.57 (1.19-2.08). In all analyses, BMI exhibited weaker associations with mortality than WC or WHtR. The direct association between WHtR and overall mortality was consistent within each of the three intervention arms of the trial. CONCLUSIONS: Our study adds further support to a stronger association of abdominal obesity than BMI with total mortality among elderly subjects at high risk of cardiovascular disease. We did not find evidence to support that the PREDIMED intervention was able to counterbalance the harmful effects of increased adiposity on total mortality. TRIAL REGISTRATION: Controlled-Trials.com ISRCTN35739639.

Síndrome de Marfan causado por mosaicismo somático de una mutación en splicing en FBN1 / Marfan syndrome caused by somatic mosaicism in an FBN1 splicing mutation

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Indicaciones actuales de tratamiento médico / Current indications for medical therapy

La mortalidad cardiovascular se ha reducido en las últimas décadas. Este hecho, junto con el envejecimiento de la población, ha producido un aumento de las prevalencias de la cardiopatía isquémica crónica y la angina de pecho estable y, por lo tanto, un incremento de pacientes con comorbilidades relacionadas. Las comorbilidades más prevalentes son la hipertensión y la diabetes mellitus, aunque la vasculopatía periférica, la enfermedad obstructiva crónica, la insuficiencia cardiaca y la fibrilación auricular también son frecuentes. En este contexto, el tratamiento médico es cada vez más complejo por la necesidad de utilizar múltiples fármacos, aunque los nuevos antianginosos como la ranolazina y la ivabradina ofrecen nuevas posibilidades para controlar los síntomas. En cualquier caso, el tratamiento médico óptimo siguiendo las recomendaciones de las guías de práctica clínica es la primera opción terapéutica (AU)

Mortality associated with cardiovascular disease has decreased in recent decades. The occurrence of this decrease at a time when the population is aging has led to a rise in the prevalence of chronic ischemic heart disease and stable angina and, consequently, an increase in the number of patients with associated comorbidities. Although the most prevalent comorbidities are hypertension and diabetes mellitus, peripheral arterial disease, chronic obstructive pulmonary disease, heart failure, and atrial fibrillation are also common. In this setting, medical therapy is increasingly complex because of the number of drugs that have to be prescribed. Moreover, new antianginal drugs, such as ranolazine and ivabradine, have provided alternative ways of achieving symptom control. Nevertheless, first-line therapy still involves the administration of optimum medical treatment in accordance with clinical practice guidelines (AU)