Objective To evaluate the cross-sectional relationship between migraine and pre-gravid obesity; and to assess the risk of adult weight gain among women with history of a pediatric diagnosis of migraine. Background Obesity, comorbid with pain disorders including migraine, shares common pathophysiological characteristics including systemic inflammation, and derangements in adipose-tissue derived cytokines. Despite biochemical and epidemiological commonalities, obesity-migraine associations have been inconsistently observed. Methods A cohort of 3,733 women was interviewed during early pregnancy. We ascertained participants’ self-reported history of physician-diagnosed migraine and collected self-reported information about pre-gravid weight, adult height and net weight change from age 18 to the 3-monthsperiodpriorto pregnancy. Using pre-gravid body mass index, we categorized participants as follows: lean (<18.5 kg/m2); normal (18.5–24.9 kg/m2); overweight (25–29.9 kg/m2), obese (30–34.9 kg/m2), severely obese (35–39.9 kg/m2), and morbidly obese (≥ 40 kg/m2). Logistic regression procedures were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs). Results After adjusting for confounders, relative to normal weight women, obese women had a 1.48-fold increased odds of migraine(OR=1.48; 95%CI 1.12–1.96). Severely obese (OR=2.07; 95%CI 1.27–3.39) and morbidly obese (OR=2.75; 95%CI 1.60–4.70) had the highest odds of migraines. Women with a history of diagnosed pediatric migraine had a 1.67-fold higher odds of gaining ≥10.0 kg above their weight at age 18, as compared with non-migraineurs (OR=1.67; 95%CI 1.13–2.47). Conclusion These data support earlier observations of migraine-obesity association among women, and extend the literature to include evidence of adult weight gain among women with a history of pediatric migraine.

Background In contrast with the setting of acute myocardial infarction, there are limited data regarding the impact of diabetes mellitus on clinical outcomes in contemporary cohorts of patients with chronic coronary syndromes. We aimed to investigate the prevalence and prognostic impact of diabetes according to geographical regions and ethnicity. Methods and results CLARIFY is an observational registry of patients with chronic coronary syndromes, enrolled across 45 countries in Europe, Asia, America, Middle East, Australia, and Africa in 2009–2010, and followed up yearly for 5 years. Chronic coronary syndromes were defined by ≥1 of the following criteria: prior myocardial infarction, evidence of coronary stenosis &gt;50%, proven symptomatic myocardial ischaemia, or prior revascularization procedure. Among 32 694 patients, 9502 (29%) had diabetes, with a regional prevalence ranging from below 20% in Northern Europe to ∼60% in the Gulf countries. In a multivariable-adjusted Cox proportional hazards model, diabetes was associated with increased risks for the primary outcome (cardiovascular death, myocardial infarction, or stroke) with an adjusted hazard ratio of 1.28 (95% confidence interval 1.18, 1.39) and for all secondary outcomes (all-cause and cardiovascular mortality, myocardial infarction, stroke, heart failure, and coronary revascularization). Differences on outcomes according to geography and ethnicity were modest. Conclusion In patients with chronic coronary syndromes, diabetes is independently associated with mortality and cardiovascular events, including heart failure, which is not accounted by demographics, prior medical history, left ventricular ejection fraction, or use of secondary prevention medication. This is observed across multiple geographic regions and ethnicities, despite marked disparities in the prevalence of diabetes. ClinicalTrials identifier ISRCTN43070564

The aim of this study was to describe the clinical characteristics and mortality of patients with conflicting diastolic function during follow-up. Up to 30% of patients have conflicting diastolic function by echo Doppler and therefore cannot be classified into a distinct diastolic dysfunction category of stage 1, 2 or 3. Using our established echocardiography data base, we studied a cohort of 250 subjects with conflicting diastolic function. Each individual was compared to two controls with normal diastolic and systolic function. The pre-specified goal of the analysis was a 6-year follow-up. Patients with conflicting diastolic function were more likely to have diabetes, hypertension, and established coronary artery disease. The Cox proportional hazards model determined that the risk of death was significantly higher for conflicting patients compared to patients with normal diastolic parameters (HR: 1.83; 95% CI: 1.32-2.53), P < 0.001. After adjustment for covariates, the risk of death remained elevated for the conflicting group (HR: 1.56; 95% CI: 1.11-2.18), P = 0.009. Conflicting diastolic dysfunction is associated with an increased risk of death compared to individuals with normal function. In conclusion, this emphasizes the need to attain a more precise characterization and categorization for patients with diastolic dysfunction.