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. 

In This Article

Results

Basic Characteristics of the Participants

Characteristics of the participants are presented in Table I. Compared with the patients with stroke, the patients with ACS were mostly male and younger. All control subjects reported healthier dietary habits (higher MedDietScore) and were more physically active, satisfied with their financial status, and less frequently smokers than the patients (P < .05). Furthermore, lower prevalence of hypertension, diabetes mellitus, and CVD family history was observed in the controls compared with the patients (P < .05).

Compared with the patients with stroke, the patients with ACS were more likely to be physically active (P < .001), smokers (P < .001), and obese (P = .02) and had better education status (P < .001), higher financial satisfaction (P < .001), and lower ZUNG-DRS levels (P < .001); however, the patients with ACS were less likely to have hypertension (P < .001) (Table I).

Modeling the Role of Mediterranean Diet on the Presence of ACS

Unadjusted analysis showed that adherence to the Mediterranean diet had a beneficial effect regarding the likelihood of having ACS (model 1) (Table II). Further data analysis revealed that the association of the Mediterranean diet with the development of ACS remained significant (ie, 9% lower likelihood of ACS per 1/55-unit increase in the MedDietScore), even after controlling for several other potential confounders (models 2 and 3) (Table II). The results were slightly mediated after controlling for education years, financial satisfaction, and depression status (models 4 and 5). Furthermore, stratified analyses on treated and nontreated (for hypertension, hypercholesterolemia, and diabetes) participants did not alter the effect size measures of MedDietScore on ACS outcome (data not shown). In addition, the participants in the highest tertile of the MedDietScore had a 68% (95% CI 40%-83%) lower likelihood of having an ACS, compared with those in the first tertile, after adjusting for the factors included in model 3. The bias of the odds ratio as regards the MedDietScore from the bootstrap procedure was very low, that is, −0.005 (with 95% CI for the bootstrap estimates for 1/55-unit increase, ie, log(odds ratio): −0.167, −0.044).

Modeling the Role of Mediterranean Diet on the Presence of Stroke

Regarding stroke, a greater adherence to the Mediterranean diet was also associated with a lower likelihood of having an event, in the unadjusted model and even after controlling for various potential confounding factors (Table III). Specifically, each 1-of-55-unit increase of the MedDietScore was associated with a 12% lower likelihood of stroke. Results were slightly mediated after controlling for additional factors (models 4 and 5). Stratified analyses on treated and nontreated (for hypertension, hypercholesterolemia, and diabetes) participants did not alter the previous effect size measures on stroke outcome (data not shown). Further analysis showed that the participants in the highest tertile of adherence to the Mediterranean dietary pattern had a 78% (95% CI 54%-90%) lower likelihood of developing a stroke, compared with those in the first tertile, after taking into account potential confounders (used in model 3). The bias of the odds ratio as regards the MedDietScore from the bootstrap procedure was very low, −0.005 (with 95% CI for the bootstrap estimates for 1/55-unit increase: −0.224, −0.064).

Based on the previous models, adherence to the Mediterranean diet seems to exert a slightly stronger effect size measure on stroke outcome as compared with ACS (Wald test: 12.93 vs 11.70; comparisons were made for similarly adjusted logistic regression models).

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