Adherence to the Mediterranean Diet in Relation to Acute Coronary Syndrome or Stroke Nonfatal Events

A Comparative Analysis of a Case/Case-Control Study

Christina-Maria Kastorini, MSc; Haralampos J. Milionis, MD, PhD; Aggeliki Ioannidi, MSc; Kallirroi Kalantzi, MD; Vassilios Nikolaou, MD; Konstantinos N. Vemmos, MD; John A. Goudevenos, MD, PhD; Demosthenes B. Panagiotakos, PhD

Disclosures

Am Heart J. 2011;162(4):717-724.

Abstract and Introduction

Abstract

Background Although the role of Mediterranean diet on cardiovascular disease prevention has long been evaluated and understood, its association with the development of stroke has been rarely examined. The aim of the present work was to comparatively evaluate the association between adherence to the Mediterranean diet and the development of an acute coronary syndrome (ACS) or ischemic stroke.
Methods During the period from 2009 to 2010, 1,000 participants were enrolled; 250 were consecutive patients with a first ACS, 250 were consecutive patients with a first ischemic stroke, and 500 population-based, control subjects, 1-for-1 matched to the patients by age and sex. Sociodemographic, clinical, psychological, dietary, and other lifestyle characteristics were measured. Adherence to the Mediterranean diet was assessed by the validated MedDietScore (theoretical range 0–55).
Results After various adjustments were made, it was observed that for each 1-of-55-unit increase of the MedDietScore, the corresponding odds ratio for having an ACS was 0.91 (95% CI 0.87–0.96), whereas regarding stroke, it was 0.88 (95% CI 0.82–0.94).
Conclusions The present work extended the current knowledge about the cardioprotective benefits from the adoption of the Mediterranean diet by showing an additional protective effect on ischemic stroke development.

Introduction

According to the World Health Organization, 17.1 million people died from cardiovascular disease (CVD) in 2004; 7.2 million, from coronary heart disease (CHD); and 5.7 million, from stroke. Also, there is an increasing trend globally.^[1] Thus, prevention of CVD is considered of major public health importance, not only because of its increasing prevalence but also because of its negative impact on quality of life.^[2]

Lifestyle changes and, especially, dietary interventions are cost-effective means for the prevention of CVD and the reduction of the social and economic burden of this condition.^[1,3,4] The Mediterranean dietary pattern is one of the most well-known dietary patterns regarding its cardioprotective effects.^[5] This pattern is characterized by high consumption of monounsaturated fatty acids, primarily from olives and olive oil. It encourages daily consumption of fruits, vegetables, whole grain cereals, and low-fat dairy products; weekly consumption of fish, poultry, tree nuts, and legumes; monthly consumption of red meat; and a moderate daily consumption of alcohol, normally with meals. The beneficial role of the Mediterranean diet regarding mortality from all causes, CHD, some types of cancer, and metabolic disorders, has already been reported.^[6–9] In a recent meta-analysis of 530,000 participants from 50 studies, greater adherence to the Mediterranean diet was associated with a lower risk for metabolic syndrome and its constituents.^[10] The main mechanism for this cardiometabolic protection is the antioxidant and anti-inflammatory effects that the aforementioned pattern has.^[11,12] However, despite the fact that many studies have underlined the beneficial role of the Mediterranean diet regarding the development of CHD, the role of this diet on the development of stroke has not been thoroughly examined.^[13,14] To the best of our knowledge, only one study has evaluated and attempted to compare the effect of the Mediterranean diet on the development of both acute coronary syndromes (ACS) and stroke.^[13]

Thus, the aims of the present work were to evaluate the role of adherence to the Mediterranean dietary pattern on the likelihood of developing an ACS or stroke and to perform a comparative analysis between these 2 outcomes as regards the effect size of this potential cardioprotection. The significance of this work is of major importance for public health care planners, since it would test the Mediterranean diet–stroke hypothesis at population basis and may provide an additional, non pharmacologic means for the prevention of ischemic stroke.

1 2 3 4 5

Next Section

Cite this: Adherence to the Mediterranean Diet in Relation to Acute Coronary Syndrome or Stroke Nonfatal Events - Medscape - Oct 01, 2011.

Abstract and Introduction
Methods
Results
Discussion
Conclusion
References

Table I. Sociodemographic, lifestyle, and clinical characteristics of the study's participants
	Patients with ACS (n = 250)	Controls with ACS (n = 250)	Patients with stroke ( n = 250)	Controls with stroke (n = 250)
Age (y)	60 ± 12	60 ± 12	77 ± 9	73 ± 9
Male gender	208 (83.2)	208 (83.2)	139 (55.6)	139 (55.6)
Smoking habits
Never smoker	56 (22.4)^†	108 (43.2)	151 (60.4)	139 (55.8)
Current smoker	127 (50.8)	63 (25.2)	49 (19.6)	47 (18.9)
Former smoker	67 (26.8)	79 (31.6)	50 (20)	63 (25.3)
Physical activity	150 (64.1)^†	203 (82.5)	99 (47.1)^†	181 (74.8)
Education years	10 ± 4.3*	11 ± 5.0	8 ± 4.6	8 ± 4.9
Financial status satisfaction
Not satisfied	50 (22.7)^†	19 (8.1)	74 (35.9)^†	35 (14.6)
Satisfied	118 (53.6)	154 (65.3)	114 (55.3)	157 (65.7)
Very satisfied	52 (23.6)	63 (26.7)	18 (8.7)	47 (19.7)
Family history of CVD	81 (36.2)^†	39 (16.7)	51 (31.3)^†	38 (16.7)
Hypertension	148 (62.2)^†	90 (37.7)	206 (84.4)^†	137 (56.8)
Hypercholesterolemia	165 (71.4)^†	100 (45.5)	159 (68.5)*	119 (54.1)
Diabetes mellitus	58 (26.1)^†	29 (12.4)	71 (32.9)*	50 (21.5)
BMI (kg/m²)	27.82 ± 4.29	27.23 ± 3.50	26.72 ± 3.57	27.35 ± 4.24
Normal weight (18.5–24.9)	57 (24.9)	63 (26.3)	79 (33.1)	73 (30)
Overweight (25–29.9)	116 (50.7)	132 (55)	124 (51.9)	120 (49.4)
Obese (>30)	56 (24.5)	45 (18.8)	36 (15.0)	50 (20.6)
MedDietScore (range 0–55)	30.67 ± 5.02^†	32.50 ± 4.41	29.99 ± 3.79^†	32.03 ± 4.08
1st tertile (0–29)	86 (41.1)^†	50 (21.9)	94 (49.5)†	60 (26.8)
2nd tertile (30–33)	66 (31.6)	79 (34.6)	64 (33.7)	82 (36.6)
3rd tertile (34–55)	57 (27.3)	99 (43.4)	32 (16.8)	82 (36.6)
ZUNG-DRS (range 20–80)	38.50 ± 8.50^†	35.07 ± 7.90	46.30 ± 8.23^†	38.01 ± 8.57
20–49: normal	203 (89.4)	233 (94.7)	121 (57.1)†	224 (91.8)
50–59: mild depression	22 (9.7)	12 (4.9)	86 (40.6)	18 (7.4)
60–69: moderate-marked depression	2 (0.9)	1 (0.4)	5 (2.4)	2 (0.8)
70–80: severe depression	0 (0)	0 (0)	0 (0)	0 (0)

Data are expressed as mean ± SD or frequencies (n [%]). P values were derived from Student t test or the χ² test.
* P < .05 compared with the control group with ACS.
† P < .001 compared with the control group with stroke.

Table II. Results from the multiple logistic regression analysis that was developed to evaluate the likelihood of having an ACS (outcome), according to the level of adherence to the Mediterranean diet (main effect), among 250 ACS cases and 250 controls
Independent variables	Model 1	Model 2	Model 3	Model 4	Model 5
MedDietScore (per 1/55 unit)	0.92 (0.88–0.96)	0.91 (0.86–0.96)	0.91 (0.87–0.96)	0.94 (0.89–1.00)	0.95 (0.90–1.02)
Physical activity (yes/no)		0.36 (0.19–0.66)	0.34 (0.18–0.64)	0.38 (0.18–0.80)	0.40 (0.19–0.85)
Ever smoker vs no smoker		3.24 (1.84–5.69)	3.53 (1.98–6.29)	3.23 (1.69–6.16)	3.50 (1.81–6.80)
Family history of CVD (yes/no)		2.14 (1.18–3.88)	2.11 (1.15–3.87)	2.46 (1.23–4.90)	2.42 (1.20–4.88)
Hypertension (yes/no)		2.58 (1.50–4.41)	2.71 (1.55–4.74)	3.17 (1.69–5.96)	2.90 (1.53–5.49)
Hypercholesterolemia (yes/no)		2.98 (1.81–4.90)	2.83 (1.71–4.69)	2.86 (1.63–5.03)	2.85 (1.60–5.05)
Diabetes mellitus (yes/no)		1.95 (0.98–3.88)	2.08 (1.03–4.23)	2.27 (1.03–4.98)	1.94 (0.86–4.35)
BMI (per 1 kg/m²)			0.99 (0.93–1.06)	0.98 (0.91–1.05)	0.99 (0.92–1.07)
Education years (per 1 y)				0.96 (0.90–1.03)	0.98 (0.91–1.05)
Financial status satisfaction
Not satisfied				1.00	1.00
Satisfied				0.30 (0.13–0.71)	0.39 (0.16–0.94)
Very satisfied				0.35 (0.13–0.89)	0.47 (0.18–1.28)
ZUNG-DRS (per 1/80 unit)					1.06 (1.02–1.11)

Results are presented as odds ratio (95% CI) obtained from multiple conditional logistic regression.

Table III. Results from the multiple conditional logistic regression analysis that was developed to evaluate the likelihood of having a stroke (outcome) according to the level of adherence to the Mediterranean diet (main effect), among 250 stroke cases and 250 controls
Independent variables	Model 1	Model 2	Model 3	Model 4	Model 5
MedDietScore (per 1/55 unit)	0.87 (0.83–0.92)	0.87 (0.82–0.94)	0.88 (0.82–0.94)	0.91 (0.83–1.00)	0.94 (0.85–1.04)
Physical activity (yes/no)		0.57 (0.31–1.05)	0.54 (0.29–1.02)	0.59 (0.26–1.31)	0.66 (0.26–1.67)
Ever smoker vs no smoker		0.95 (0.51–1.75)	0.84 (0.45–1.58)	0.60 (0.28–1.31)	0.41 (0.17–0.99)
Family history of CVD (yes/no)		3.15 (1.68–5.92)	3.21 (1.69–6.09)	4.16 (1.86–9.32)	3.27 (1.30–8.24)
Hypertension (yes/no)		1.82 (1.00–3.28)	1.85 (1.01–3.38)	1.88 (0.86–4.12)	2.47 (0.95–6.44)
Hypercholesterolemia (yes/no)		1.92 (1.08–3.40)	1.88 (1.05–3.35)	1.70 (0.81–3.53)	1.53 (0.67–3.48)
Diabetes mellitus (yes/no)		1.18 (0.64–2.18)	1.26 (0.67–2.38)	1.68 (0.75–3.75)	1.62 (0.66–3.96)
BMI (per 1 kg/m²)			0.96 (0.89–1.02)	0.89 (0.81–0.99)	0.92 (0.83–1.02)
Education years (per 1 y)				0.99 (0.92–1.08)	1.02 (0.99–1.12)
Financial status satisfaction
Not satisfied				1.00	1.00
Satisfied				0.37 (0.16–0.89)	0.28 (0.11–0.74)
Very satisfied				0.14 (0.04–0.45)	0.16 (0.04–0.59)
ZUNG-DRS (per 1/80 unit)					1.05 (1.00–1.11)

Results are presented as odds ratio (95% CI) obtained from multiple conditional logistic regression.

Comments

Commenting is limited to medical professionals. To comment please Log-in.

Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.

processing....

Adherence to the Mediterranean Diet in Relation to Acute Coronary Syndrome or Stroke Nonfatal Events

A Comparative Analysis of a Case/Case-Control Study

Abstract and Introduction

Abstract

Introduction

Tables

Tables

Tables

References

Authors and Disclosures

Authors and Disclosures

Comments

Email This

Feedback