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A Mediterranean diet and risk of myocardial infarction, heart failure and stroke: A population-based cohort study.

Abstract

BACKGROUND AND AIMS

The Mediterranean diet, which is palatable and easily achievable, has been associated with lower all-cause and cardiovascular disease (CVD) incidence and mortality. Data on heart failure (HF) and stroke types are lacking. The aim was to examine a Mediterranean diet in relation to incidence of myocardial infarction (MI), HF and stroke types in a Swedish prospective cohort.

METHODS

In a population-based cohort of 32,921 women, diet was assessed through a self-administered questionnaire. The modified Mediterranean diet (mMED) score was created based on high consumption of vegetables, fruits, legumes, nuts, whole grains, fermented dairy products, fish and monounsaturated fat, moderate intakes of alcohol and low consumption of red meat, on a 0-8 scale. Relative risks (RR) with 95% confidence intervals (CI), adjusted for potential confounders, were estimated by Cox proportional hazards regression models.

RESULTS

During 10 y of follow-up (1998-2008), 1109 MIs, 1648 HFs, 1270 ischemic strokes and 262 total hemorrhagic strokes were ascertained. A high adherence to the mMED score (6-8), compared to low, was associated with a lower risk of MI (RR: 0.74, 95% CI: 0.61-0.90, p = 0.003), HF (RR: 0.79, 95% CI: 0.68-0.93, p = 0.004) and ischemic stroke (RR: 0.78, 95% CI: 0.65-0.93, p = 0.007), but not hemorrhagic stroke (RR: 0.88, 95% CI: 0.61-1.29, p = 0.53).

CONCLUSIONS

Better adherence to a Mediterranean diet was associated with lower risk of MI, HF and ischemic stroke. The Mediterranean diet is most likely to be beneficial in primary prevention of all major types of atherosclerosis-related CVD.

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  • Authors+Show Affiliations

    ,

    Unit of Nutritional Epidemiology, Institute of Environmental Medicine (IMM), Karolinska Institutet, Nobels väg 13, Box 210, SE-171 77, Stockholm, Sweden. Electronic address: thanasis.tektonidis@ki.se.

    ,

    Unit of Nutritional Epidemiology, Institute of Environmental Medicine (IMM), Karolinska Institutet, Nobels väg 13, Box 210, SE-171 77, Stockholm, Sweden. Electronic address: Agneta.Akesson@ki.se.

    ,

    Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd University Hospital, Stockholm, Sweden; Unit of Cardiovascular Epidemiology, Institute of Environmental Medicine (IMM), Karolinska Institutet, Nobels väg 13, Box 210, SE-171 77, Stockholm, Sweden. Electronic address: Bruna.Gigante@ki.se.

    ,

    Unit of Nutritional Epidemiology, Institute of Environmental Medicine (IMM), Karolinska Institutet, Nobels väg 13, Box 210, SE-171 77, Stockholm, Sweden. Electronic address: Alicja.Wolk@ki.se.

    Unit of Nutritional Epidemiology, Institute of Environmental Medicine (IMM), Karolinska Institutet, Nobels väg 13, Box 210, SE-171 77, Stockholm, Sweden. Electronic address: Susanna.Larsson@ki.se.

    Source

    Atherosclerosis 243:1 2015 Nov pg 93-8

    MeSH

    Aged
    Aged, 80 and over
    Atherosclerosis
    Diet, Mediterranean
    Female
    Follow-Up Studies
    Heart Failure
    Hemorrhage
    Humans
    Incidence
    Middle Aged
    Myocardial Infarction
    Primary Prevention
    Proportional Hazards Models
    Prospective Studies
    Risk Factors
    Stroke
    Surveys and Questionnaires
    Sweden

    Pub Type(s)

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

    Language

    eng

    PubMed ID

    26363438

    Citation

    Tektonidis, Thanasis G., et al. "A Mediterranean Diet and Risk of Myocardial Infarction, Heart Failure and Stroke: a Population-based Cohort Study." Atherosclerosis, vol. 243, no. 1, 2015, pp. 93-8.
    Tektonidis TG, Åkesson A, Gigante B, et al. A Mediterranean diet and risk of myocardial infarction, heart failure and stroke: A population-based cohort study. Atherosclerosis. 2015;243(1):93-8.
    Tektonidis, T. G., Åkesson, A., Gigante, B., Wolk, A., & Larsson, S. C. (2015). A Mediterranean diet and risk of myocardial infarction, heart failure and stroke: A population-based cohort study. Atherosclerosis, 243(1), pp. 93-8. doi:10.1016/j.atherosclerosis.2015.08.039.
    Tektonidis TG, et al. A Mediterranean Diet and Risk of Myocardial Infarction, Heart Failure and Stroke: a Population-based Cohort Study. Atherosclerosis. 2015;243(1):93-8. PubMed PMID: 26363438.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - A Mediterranean diet and risk of myocardial infarction, heart failure and stroke: A population-based cohort study. AU - Tektonidis,Thanasis G, AU - Åkesson,Agneta, AU - Gigante,Bruna, AU - Wolk,Alicja, AU - Larsson,Susanna C, Y1 - 2015/09/03/ PY - 2015/06/11/received PY - 2015/08/21/revised PY - 2015/08/28/accepted PY - 2015/9/13/entrez PY - 2015/9/13/pubmed PY - 2016/9/15/medline KW - Cardiovascular disease KW - Heart failure KW - Mediterranean diet KW - Myocardial infarction KW - Primary prevention KW - Prospective studies KW - Stroke SP - 93 EP - 8 JF - Atherosclerosis JO - Atherosclerosis VL - 243 IS - 1 N2 - BACKGROUND AND AIMS: The Mediterranean diet, which is palatable and easily achievable, has been associated with lower all-cause and cardiovascular disease (CVD) incidence and mortality. Data on heart failure (HF) and stroke types are lacking. The aim was to examine a Mediterranean diet in relation to incidence of myocardial infarction (MI), HF and stroke types in a Swedish prospective cohort. METHODS: In a population-based cohort of 32,921 women, diet was assessed through a self-administered questionnaire. The modified Mediterranean diet (mMED) score was created based on high consumption of vegetables, fruits, legumes, nuts, whole grains, fermented dairy products, fish and monounsaturated fat, moderate intakes of alcohol and low consumption of red meat, on a 0-8 scale. Relative risks (RR) with 95% confidence intervals (CI), adjusted for potential confounders, were estimated by Cox proportional hazards regression models. RESULTS: During 10 y of follow-up (1998-2008), 1109 MIs, 1648 HFs, 1270 ischemic strokes and 262 total hemorrhagic strokes were ascertained. A high adherence to the mMED score (6-8), compared to low, was associated with a lower risk of MI (RR: 0.74, 95% CI: 0.61-0.90, p = 0.003), HF (RR: 0.79, 95% CI: 0.68-0.93, p = 0.004) and ischemic stroke (RR: 0.78, 95% CI: 0.65-0.93, p = 0.007), but not hemorrhagic stroke (RR: 0.88, 95% CI: 0.61-1.29, p = 0.53). CONCLUSIONS: Better adherence to a Mediterranean diet was associated with lower risk of MI, HF and ischemic stroke. The Mediterranean diet is most likely to be beneficial in primary prevention of all major types of atherosclerosis-related CVD. SN - 1879-1484 UR - https://www.unboundmedicine.com/medline/citation/26363438/full_citation L2 - https://linkinghub.elsevier.com/retrieve/pii/S0021-9150(15)30102-7 DB - PRIME DP - Unbound Medicine ER -