Mediterranean Diet, Lifestyle Factors, and 10-Year Mortality in Elderly European Men and Women

Knoops, K.T.B.; Groot, Lisette C. P. G. M. de; Kromhout, Daan; Perrin, A; Moreiras-varela, O.; Menotti, Alessandro; Staveren, W.A. van

doi:10.1001/jama.292.12.1433

Cited by 1,391 publications

(1,080 citation statements)

References 26 publications

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“…In agreement with our results, a Mediterranean dietary pattern was inversely associated with all‐cause mortality in the US Multiethnic Cohort,37 the US National Institutes of Health–AARP Diet and Health Study,38 Spanish cohorts,32, 39 an Italian cohort,40 the UK‐based EPIC (European Prospective Investigation of Cancer)–Norfolk study,41 a Danish cohort,42 and a cohort of elderly European men and women 43. However, there was no association of a Mediterranean‐type diet with all‐cause mortality in the UK‐based Whitehall II study 33.…”

Section: Discussionsupporting

confidence: 89%

Dietary Patterns and Mediterranean Diet Score and Hazard of Recurrent Coronary Heart Disease Events and All‐Cause Mortality in the REGARDS Study

Shikany

Safford

Bryan

et al. 2018

JAHA

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BackgroundPreviously, we reported on associations between dietary patterns and incident acute coronary heart disease (CHD) in the REGARDS (Reasons for Geographic and Racial Differences in Stroke) study. Here, we investigated the associations of dietary patterns and a dietary index with recurrent CHD events and all‐cause mortality in REGARDS participants with existing CHD.Methods and ResultsWe included data from 3562 participants with existing CHD in REGARDS. We used Cox proportional hazards regression to examine the hazard of first recurrence of CHD events—definite or probable MI or acute CHD death—and all‐cause mortality associated with quartiles of empirically derived dietary patterns (convenience, plant‐based, sweets, Southern, and alcohol and salads) and the Mediterranean diet score. Over a median 7.1 years (interquartile range, 4.4, 8.9 years) follow‐up, there were 581 recurrent CHD events and 1098 deaths. In multivariable‐adjusted models, the Mediterranean diet score was inversely associated with the hazard of recurrent CHD events (hazard ratio for highest score versus lowest score, 0.78; 95% confidence interval, 0.62–0.98; PT rend=0.036). The Southern dietary pattern was adversely associated with the hazard of all‐cause mortality (hazard ratio for Q4 versus Q1, 1.57; 95% confidence interval, 1.28–1.91; P Trend<0.001). The Mediterranean diet score was inversely associated with the hazard of all‐cause mortality (hazard ratio for highest score versus lowest score, 0.80; 95% confidence interval, 0.67–0.95; PT rend=0.014).ConclusionsThe Southern dietary pattern was associated with a greater hazard of all‐cause mortality in REGARDS participants. Greater adherence to the Mediterranean diet was associated with both a lower hazard of recurrent CHD events and all‐cause mortality.

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Section: Discussionsupporting

confidence: 89%

Dietary Patterns and Mediterranean Diet Score and Hazard of Recurrent Coronary Heart Disease Events and All‐Cause Mortality in the REGARDS Study

Shikany

Safford

Bryan

et al. 2018

JAHA

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“…In observational studies, adherence to healthy lifestyles has been associated with reduced CVD risk 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11. Our study confirms this association in a large and contemporaneous primary‐prevention trial; however, only 2% of study participants adhered to all 4 healthy lifestyle factors, and a third had <2 of these 4 factors.…”

Section: Discussionsupporting

confidence: 79%

“…Observational studies indicate that healthy lifestyles, defined as avoidance of tobacco, moderate or vigorous physical activities, optimal body weight, and healthy diet, are associated with lower mortality and cardiovascular disease (CVD) 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11. Both statins and blood pressure lowering (in those with elevated blood pressure) reduce the risk of CVD in randomized clinical trials, but no analyses of randomized trial data have evaluated whether the effects of statins or antihypertensive agents compared with placebo vary in patients who adhere or do not adhere to healthy lifestyles.…”

Section: Introductionmentioning

confidence: 99%

Effects of Lipid‐Lowering and Antihypertensive Treatments in Addition to Healthy Lifestyles in Primary Prevention: An Analysis of the HOPE‐3 Trial

Jung

Lonn

Bogaty

et al. 2018

JAHA

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BackgroundIt is not clear whether the effects of lipid‐lowering or antihypertensive medications are influenced by adherence to healthy lifestyle factors. We assessed the effects of both drug interventions in subgroups by the number of healthy lifestyle factors in participants in the HOPE‐3 (Heart Outcomes Prevention Evaluation) trial.Methods and ResultsIn this primary prevention trial, 4 healthy lifestyle factors (nonsmoking status, physical activity, optimal body weight, and healthy diet) were recorded in 12 521 participants who were at intermediate risk of cardiovascular disease (CVD) and were randomized to rosuvastatin, candesartan/hydrochlorothiazide, their combination, or matched placebos. Median follow‐up was 5.6 years. The outcome was a composite of CVD events. Adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox regression models. Participants with ≥2 healthy lifestyle factors had a lower rate of CVD compared with those with fewer factors (HR: 0.85; 95% CI, 0.73–1.00). Rosuvastatin reduced CVD events in participants with ≥2 healthy lifestyle factors (HR: 0.74; 95% CI, 0.62–0.90) and in participants with <2 factors (HR: 0.79; 95% CI, 0.61–1.01). Consistent results were observed with combination therapy (≥2 factors: HR: 0.74; 95% CI, 0.57–0.97; <2 factors: HR: 0.61; 95% CI, 0.43–0.88). Candesartan/hydrochlorothiazide tends to reduce CVD only in participants with <2 healthy lifestyle factors (HR: 0.78; 95% CI, 0.61–1.00).ConclusionsHealthy lifestyles are associated with lower CVD. Rosuvastatin alone and combined with candesartan/hydrochlorothiazide is beneficial regardless of healthy lifestyle status; however, the benefit of antihypertensive treatment appears to be limited to patients with less healthy lifestyles.Clinical Trial Registration URL: https://www.clinicaltrials.gov. Unique identifier: NCT00239681.

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“…To simplify the interpretation, it was decided to combine the Deficiency Score and Excess Score into one score by subtracting the Excess Score from the Deficiency Score, now called the Adapted Thiele Score. This principle of being 'penalized' for non-preferable dietary intakes is used in most DQS (31)(32)(33) . The original HDI score was adapted for the present study by first using the more recent WHO prevention of CVD guidelines (34) for the cut-off points and second by changing the scoring system from a dichotomous variable (1 or 0) to a continuous score in order to provide a more sensitive scoring range, instead of using very strict cut-offs.…”

Section: Methodsmentioning

confidence: 99%

The use of predefined diet quality scores in the context of CVD risk during urbanization in the South African Prospective Urban and Rural Epidemiological (PURE) study

Dolman

Wentzel-Viljoen

Jerling

et al. 2013

Public Health Nutr.

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Objective: Urbanization is generally associated with increased CVD risk and accompanying dietary changes. Little is known regarding the association between increased CVD risk and dietary changes using approaches such as diet quality. The relevance of predefined diet quality scores (DQS) in non-Western developing countries has not yet been established. Design: The association between dietary intakes and CVD risk factors was investigated using two DQS, adapted to the black South African diet. Dietary intake data were collected using a quantitative FFQ. CVD risk was determined by analysing known CVD risk factors. Setting: Urban and rural areas in North West Province, South Africa. Subjects: Apparently healthy volunteers from the South African Prospective Urban and Rural Epidemiological (PURE) study population (n 1710). Results: CVD risk factors were significantly increased in the urban participants, especially women. Urban men and women had significantly higher intakes of both macro-and micronutrients with macronutrient intakes well within the recommended CVD guidelines. While micronutrient intakes were generally higher in the urban groups than in the rural groups, intakes of selected micronutrients were low in both groups. Both DQS indicated improved diet quality in the urban groups and good agreement was shown between the scores, although they seemed to measure different aspects of diet quality. Conclusions: The apparent paradox between improved diet quality and increased CVD risk in the urban groups can be explained when interpreting the cut-offs used in the scores against the absolute intakes of individual nutrients. Predefined DQS as well as current guidelines for CVD prevention should be interpreted with caution in non-Western developing countries.

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Mediterranean Diet, Lifestyle Factors, and 10-Year Mortality in Elderly European Men and Women

Cited by 1,391 publications

References 26 publications

Dietary Patterns and Mediterranean Diet Score and Hazard of Recurrent Coronary Heart Disease Events and All‐Cause Mortality in the REGARDS Study

Dietary Patterns and Mediterranean Diet Score and Hazard of Recurrent Coronary Heart Disease Events and All‐Cause Mortality in the REGARDS Study

Effects of Lipid‐Lowering and Antihypertensive Treatments in Addition to Healthy Lifestyles in Primary Prevention: An Analysis of the HOPE‐3 Trial

The use of predefined diet quality scores in the context of CVD risk during urbanization in the South African Prospective Urban and Rural Epidemiological (PURE) study

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