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Mediterranean style diet and 12-year incidence of cardiovascular diseases: the EPIC-NL cohort study.
PLoS One 2012; 7(9):e45458Plos

Abstract

BACKGROUND

A recent meta-analysis showed that a Mediterranean style diet may protect against cardiovascular diseases (CVD). Studies on disease-specific associations are limited. We evaluated the Mediterranean Diet Score (MDS) in relation to incidence of total and specific CVDs.

METHODS

The EPIC-NL Study is a cohort of 40,011 men and women aged 20-70 years, examined between 1993 and 1997, with 10-15 years of follow-up. Diet was assessed with a validated food frequency questionnaire and the MDS was based on the daily intakes of vegetables, fruits, legumes and nuts, grains, fish, fatty acids, meat, dairy, and alcohol. Cardiovascular morbidity and mortality were ascertained through linkage with national registries. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CI) adjusted for age, sex, cohort, smoking, physical activity, total energy intake, and educational level.

RESULTS

In 34,708 participants free of CVD at baseline, 4881 CVD events occurred, and 487 persons died from CVD. A two unit increment in MDS (range 0-9) was inversely associated with fatal CVD (HR: 0.78; 95%CI: 0.69-0.88), total CVD (HR: 0.95 (0.91-0.98)), myocardial infarction (HR: 0.86 (0.79-0.93)), stroke (HR: 0.88 (0.78-1.00)), and pulmonary embolism (HR: 0.74 (0.59-0.92)). The MDS was not related to incident angina pectoris, transient ischemic attack and peripheral arterial disease.

CONCLUSION

Better adherence to a Mediterranean style diet was more strongly associated with fatal CVD than with total CVD. Disease specific associations were strongest for incident myocardial infarction, stroke and pulmonary embolism.

Authors+Show Affiliations

Centre for Prevention and Health Services Research, National Institute for Public Health and the Environment, Bilthoven, The Netherlands. marieke.hoevenaar@rivm.nlNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

23029021

Citation

Hoevenaar-Blom, Marieke P., et al. "Mediterranean Style Diet and 12-year Incidence of Cardiovascular Diseases: the EPIC-NL Cohort Study." PloS One, vol. 7, no. 9, 2012, pp. e45458.
Hoevenaar-Blom MP, Nooyens AC, Kromhout D, et al. Mediterranean style diet and 12-year incidence of cardiovascular diseases: the EPIC-NL cohort study. PLoS ONE. 2012;7(9):e45458.
Hoevenaar-Blom, M. P., Nooyens, A. C., Kromhout, D., Spijkerman, A. M., Beulens, J. W., van der Schouw, Y. T., ... Verschuren, W. M. (2012). Mediterranean style diet and 12-year incidence of cardiovascular diseases: the EPIC-NL cohort study. PloS One, 7(9), pp. e45458. doi:10.1371/journal.pone.0045458.
Hoevenaar-Blom MP, et al. Mediterranean Style Diet and 12-year Incidence of Cardiovascular Diseases: the EPIC-NL Cohort Study. PLoS ONE. 2012;7(9):e45458. PubMed PMID: 23029021.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Mediterranean style diet and 12-year incidence of cardiovascular diseases: the EPIC-NL cohort study. AU - Hoevenaar-Blom,Marieke P, AU - Nooyens,Astrid C J, AU - Kromhout,Daan, AU - Spijkerman,Annemieke M W, AU - Beulens,Joline W J, AU - van der Schouw,Yvonne T, AU - Bueno-de-Mesquita,Bas, AU - Verschuren,W M Monique, Y1 - 2012/09/28/ PY - 2012/06/08/received PY - 2012/08/22/accepted PY - 2012/10/3/entrez PY - 2012/10/3/pubmed PY - 2013/3/7/medline SP - e45458 EP - e45458 JF - PloS one JO - PLoS ONE VL - 7 IS - 9 N2 - BACKGROUND: A recent meta-analysis showed that a Mediterranean style diet may protect against cardiovascular diseases (CVD). Studies on disease-specific associations are limited. We evaluated the Mediterranean Diet Score (MDS) in relation to incidence of total and specific CVDs. METHODS: The EPIC-NL Study is a cohort of 40,011 men and women aged 20-70 years, examined between 1993 and 1997, with 10-15 years of follow-up. Diet was assessed with a validated food frequency questionnaire and the MDS was based on the daily intakes of vegetables, fruits, legumes and nuts, grains, fish, fatty acids, meat, dairy, and alcohol. Cardiovascular morbidity and mortality were ascertained through linkage with national registries. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CI) adjusted for age, sex, cohort, smoking, physical activity, total energy intake, and educational level. RESULTS: In 34,708 participants free of CVD at baseline, 4881 CVD events occurred, and 487 persons died from CVD. A two unit increment in MDS (range 0-9) was inversely associated with fatal CVD (HR: 0.78; 95%CI: 0.69-0.88), total CVD (HR: 0.95 (0.91-0.98)), myocardial infarction (HR: 0.86 (0.79-0.93)), stroke (HR: 0.88 (0.78-1.00)), and pulmonary embolism (HR: 0.74 (0.59-0.92)). The MDS was not related to incident angina pectoris, transient ischemic attack and peripheral arterial disease. CONCLUSION: Better adherence to a Mediterranean style diet was more strongly associated with fatal CVD than with total CVD. Disease specific associations were strongest for incident myocardial infarction, stroke and pulmonary embolism. SN - 1932-6203 UR - https://www.unboundmedicine.com/medline/citation/23029021/Mediterranean_style_diet_and_12_year_incidence_of_cardiovascular_diseases:_the_EPIC_NL_cohort_study_ L2 - http://dx.plos.org/10.1371/journal.pone.0045458 DB - PRIME DP - Unbound Medicine ER -