The Mediterranean-style dietary pattern and mortality among men and women with cardiovascular disease123

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ABSTRACT

Background:

The role of the Mediterranean diet among individuals with previous cardiovascular disease (CVD) is uncertain.

Objective:

The aim of this study was to assess the association between the Alternate Mediterranean Diet (aMED) score and all-cause, cardiovascular, and cancer mortality in men and women with CVD from the Health Professionals Follow-Up Study and the Nurses’ Health Study.

Design:

This study included 6137 men and 11,278 women with myocardial infarction, stroke, angina pectoris, coronary bypass, and coronary angioplasty. Diet was first assessed in 1986 for men and in 1980 for women with a food-frequency questionnaire (FFQ) and then repeatedly every 2–4 y. Cumulative consumption was calculated with all available FFQs from the diagnosis of CVD to the end of the follow-up in 2008.

Results:

During a median follow-up of 7.7 y (IQR: 4.2–11.8) for men and 5.8 y (IQR: 3.8–8.0) for women, we documented 1982 deaths (1142 from CVD and 344 from cancer) among men and 1468 deaths (666 from CVD and 197 from cancer) among women. In multivariable Cox regression models, the pooled RR of all-cause mortality from a comparison of the top with the bottom quintiles of the aMED score was 0.81 (95% CI: 0.72, 0.91; P-trend < 0.001). The corresponding pooled RR for CVD mortality was 0.85 (95% CI: 0.67, 1.09; P-trend = 0.30), for cancer mortality was 0.85 (95% CI: 0.65, 1.11; P-trend = 0.10), and for other causes was 0.79 (95% CI: 0.65, 0.97; P-trend = 0.01). A 2-point increase in adherence to the aMED score was associated with a 7% (95% CI: 3%, 11%) reduction in the risk of total mortality.

Conclusion:

Adherence to a Mediterranean-style dietary pattern was associated with lower all-cause mortality in individuals with CVD.

Cited by (0)

1

From the Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain (EL-G and FR-A); CIBER of Epidemiology and Public Health (EL-G and FR-A) and the Departments of Nutrition (TYL, TTF, SL, WCW, EBR, and FBH) and Epidemiology (WCW, EBR, and FBH), Harvard School of Public Health, Boston, MA; the Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA (TYL, WCW, EBR, and FBH); and the Programs in Nutrition, Simmons College, Boston, MA (TTF).

2

Supported by NIH research grants HL60712, P01 CA87969, and P01 CA055075 and by ‘Fondo de Investigacion Sanitaria’ research grant 09/00104 from the Ministry of Health in Spain (to EL-G).

3

Address correspondence to E Lopez-Garcia, Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, Avda Arzobispo Morcillo 4, 28029 Madrid, Spain. E-mail: [email protected].

4

Abbreviations used: aMED, Alternate Mediterranean Diet; CVD, cardiovascular disease; FFQ, food frequency questionnaire; ICD-8, International Classification of Diseases, 8th Revision; IHD, ischemic heart disease.