To what extent are the effects of diet on coronary heart disease lipid-mediated?

BACKGROUND: Cohort and case-control studies support the effect of diet on coronary heart disease. The objective of this study was to analyze the strength of the influence of dietary fat subtypes and other nutrients on serum lipids levels in patients with a first acute myocardial infarction. METHODS: We studied 139 patients with a first myocardial infarction and no previous history of vascular disease. Serum lipids were determined, and nutrient intake was analyzed using a validated 118-food item questionnaire. RESULTS: Multiple regression models found weak but significant associations between the intake of different fatty acids and total to HDL cholesterol ratio (atherogenic index) when we adjusted for age, gender and body mass index (BMI). Positive associations with serum HDL cholesterol concentration were observed for energy-adjusted intake of red wine, alcohol intake, and omega-3 fatty acids intake. However, these nutrients explained less than 12% of the variability in the atherogenic index, and less than 17% in the variability of HDL. CONCLUSIONS: Our results suggest only a modest contribution of the investigated nutrients on serum lipids (atherogenic index and HDL cholesterol) in coronary patients. Alternative mechanisms of dietary factors not directly related with serum lipids or, more likely, a global effect of diet on inflammatory and antioxidant parameters should be studied in order to better understand the nature of dietary habits' influence on cardiovascular disease.

Type of alcoholic beverage and first acute myocardial infarction: a case-control study in a Mediterranean country.

BACKGROUND: Although international comparisons have consistently found an inverse association between wine and coronary heart disease, few epidemiologic studies are available in Southern Europe. We assessed the association of wine, red wine, and the pattern of drinking wine during meals with the risk of myocardial infarction. HYPOTHESIS: We specifically evaluated three hypotheses: (1) Is the protection against incidence of nonfatal myocardial infarction stronger for wine than for other alcoholic beverages? (2) Does the wine consumed during meals represent a more beneficial pattern of alcohol consumption? (3) Is red wine more advantageous than other types of wine? METHODS: A case-control study (171 cases, 171 matched controls) was conducted in Spain. Multiple dietary and nondietary potential confounders were assessed. RESULTS: Exposure to wine, red wine, and wine during meals was associated with risk reductions similar to those of other alcoholic beverages (point estimates of the odds ratio for low and high intake were 0.48 and 0.38 for wine; 0.42 and 0.55 for other beverages). However, after controlling for total alcohol intake, wine consumption (g/day) improved the prediction of a myocardial infarction. CONCLUSIONS: Our data showed that red wine or drinking wine during meals was similar to alcohol from other sources for reducing coronary risk. However, an additional benefit of wine, keeping constant overall alcohol intake, deserves further research.

Role of fibre and fruit in the Mediterranean diet to protect against myocardial infarction: a case-control study in Spain.

OBJECTIVE: To assess the association between a first acute myocardial infarction and the consumption of fibre and fruit. DESIGN: Hospital-based case-control study with incident cases. A validated semi-quantitative food frequency questionnaire (136 items) was used to assess food intake. SETTING: Three third-level university hospitals in Pamplona (Spain). SUBJECTS: Cases were subjects aged under 80, newly diagnosed with acute myocardial infarction. Each case patient (n=171) was matched to a control subject of the same gender and age (5 y bands) admitted to the same hospital. RESULTS: An inverse association was apparent for the three upper quintiles of fibre intake. After adjustment for non-dietary and dietary confounders, an inverse linear trend was clearly significant, showing the highest relative reduction of risk (86%) for the fifth quintile (OR=0.14, 95% confidence interval: 0.03-0.67). An inverse association was also apparent for fruit intake, but not for vegetables or legumes. CONCLUSIONS: Our data suggest that a substantial part of the postulated benefits of the Mediterranean diet on coronary risk might be attributed to a high intake of fibre and fruit.

Risk of first non-fatal myocardial infarction negatively associated with olive oil consumption: a case-control study in Spain.

BACKGROUND: Olive oil is the main source of dietary lipids in most Mediterranean countries where mortality and incidence rates for coronary heart disease (CHD) are the lowest in Europe. Although international comparisons and mechanistic reasons support the hypothesis that a high olive oil intake may prevent CHD, limited data from studies of individuals are available. METHODS: A hospital-based case-control study was conducted in Pamplona (Spain) recruiting 171 patients (81% males, age <80 years) who suffered their first acute myocardial infarction and 171 age-, gender- and hospital-matched controls (admitted to minor surgery, trauma or urology wards). A validated semi-quantitative food frequency questionnaire (136 items) was used to appraise previous long-term dietary exposures. The same physician conducted the face-to-face interview for each case patient and his/her matched control. Conditional logistic regression modelling was used to take into account potential dietary and non-dietary confounders. RESULTS: The exposure to the upper quintile of energy-adjusted olive oil (median intake: 54 g/day) was associated with a statistically significant 82% relative reduction in the risk of a first myocardial infarction (OR = 0.18; 95% CI : 0.06-0.63) after adjustment for dietary and non-dietary confounders. CONCLUSIONS: Our data suggest that olive oil may reduce the risk of coronary disease. These findings require confirmation in further observational studies and trials.

[Differences between young and elderly patients in a protocol for the diagnosis and follow-up of arterial hypertension] . / Diferencias entre pacientes jóvenes y ancianos en un protocolo de diagnóstico y seguimiento de hipertensión arterial.

OBJECTIVE: To determine possible differences between the control of hypertension in elderly patients and in young patients. DESIGN: Retrospective observation study of the differences between initial and final systolic and diastolic blood pressure, of their relationship to inclusion in medical treatment, and of the control obtained with different kinds of, and changes in, treatment, of drug association, periodic check-ups, vascular disease and risk factors. SETTING: The urban Azpilagaña Health District in Pamplona. PATIENTS: 389 hypertense patients were studied retrospectively: 196 of 70 or over and 193 between 45 and 60. MAIN RESULTS: More older patients were treated medically (91.8% vs 84.5%, p = 0.024), and received combined two-drug treatment (30.1% vs 19.7%, p < 0.001), although the young people received more than two hypertension drugs more often (11.4% vs 2.5%, p < 0.001). Final control (< 140/90) was achieved more often among young people (39.9% vs 26.5%, p = 0.005). In the older patients group initial higher diastolic pressure was related to final pressure control. More older patients had periodic check-ups at the health centre (73.3% vs 63.7%, p < 0.001), but this practice only improved relative control (< or = 140/90) in young people (p = 0.001). Older patients used more diuretics (p < 0.001) and less beta-blockers (p < 0.001), with no differences for other hypertension drugs. CONCLUSIONS: There are differences based on age in treatment and control of hypertension patients. Older patients with diastolic hypertension are controlled more easily. Altogether and in both groups analysed, the percentage of people with normal pressure after treatment was higher than in other studies.

Diferencias entre pacientes jóvenes y ancianos en un protocolo de diagnóstico y seguimiento de hipertensión arterial / Differences between young and elderly patients in a protocol for diagnosis and follow-up of hypertension

Objetivo. Determinar la posible existencia de diferencias en el control de la hipertensión en sujetos ancianos en comparación con hipertensos jóvenes. Diseño. Estudio observacional retrospectivo de las diferencias entre las tensiones arteriales sistólica (TAS) y diastólica (TAD) iniciales y finales, y su relación con la inclusión en tratamiento farmacológico, así como el control obtenido según tipo y cambios de tratamiento, asociación farmacológica, revisiones periódicas, enfermedad vascular o factores de riesgo. Emplazamiento. Zona Básica de Salud de Azpilagaña en Pamplona, con características urbanas. Pacientes. Se estudiaron retrospectivamente 389 hipertensos: 196 de 70 o más años y 193 de 45-60 años. Resultados principales. Más pacientes mayores fueron tratados con fármacos (91,8 frente a 84,5 por ciento, p = 0,024) y recibían tratamiento combinado con 2 fármacos (30,1 frente a 19,7 por ciento, p < 0,001), aunque son los jóvenes los que con mayor frecuencia reciben más de 2 antihipertensivos (11,4 frente a 2,5 por ciento, p < 0,001). El control final (< 140/90) se consiguió con más frecuencia entre los jóvenes (39,9 frente a 26,5 por ciento, p = 0,005). En el grupo de pacientes mayores la mayor tensión diastólica inicial se relacionó con el control tensional final. Más pacientes mayores siguieron las revisiones periódicas en el centro de salud (73,3 frente a 63,7 por ciento, p < 0,001), pero esta práctica sólo mejoró el control relativo (ó 140/90) en los jóvenes (p = 0,001). En pacientes mayores se emplearon más diuréticos (p < 0,001) y menos bloqueadores beta (p < 0,001), sin diferencias en otros antihipertensivos. Conclusiones. Hay diferencias en el tratamiento y control de los pacientes hipertensos en relación a su edad. Los pacientes mayores con hipertensión diastólica se controlan más fácilmente. En conjunto, y en ambos grupos analizados, el porcentaje de sujetos normotensos tras tratamiento es superior al reseñado en otros estudios (AU)