Matina Kouvari1,2, Thomas Tsiampalis1, Christina Chrysohoou3, Ekavi Georgousopoulou1,4,5, Venetia Notara1,6, Kyriakos Souliotis7, Theodora Psaltopoulou8, Mary Yannakoulia1, Christos Pitsavos3, Demosthenes B Panagiotakos9,10. 1. Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece. 2. Faculty of Health, University of Canberra, Canberra, Australia. 3. First Cardiology Clinic, School of Medicine, University of Athens, Athens, Greece. 4. School of Medicine, The University of Notre Dame, Sydney, Australia. 5. Medical School, Australian National University, Canberra, Australia. 6. Department of Public and Community Health, School of Public Health, University of West Attica, Athens, Greece. 7. Faculty of Social Sciences, University of Peloponnese, Korinthos, Greece. 8. Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, University of Athens, Athens, Greece. 9. Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece. dbpanag@hua.gr. 10. Faculty of Health, University of Canberra, Canberra, Australia. dbpanag@hua.gr.
Abstract
BACKGROUND/ OBJECTIVES: To quantify the changes in 10-year cardiovascular disease (CVD) onset, recurrence, and mortality, in relation to transitioning from low to a higher level of adherence to the Mediterranean diet. SUBJECTS/ METHODS: An individual-level microsimulation was created based on ATTICA (2002-2012, n = 3042 subjects free-of-CVD) and GREECS (2004-2014, n = 2172 patients with acute coronary syndrome (ACS)) studies (in total n = 5214). Eight scenarios regarding the proportion of participants and the size of improvement of the level of adherence to the Mediterranean diet (corresponding to one to ten point increases in MedDietScore) were compared in terms of relative change in CVD incidence and mortality, as well as, the number of preventable CVD events and deaths. RESULTS: Improving adherence to the Mediterranean diet in at least 10% of the population, a significant relative percentage reduction could be observed in 10-year CVD onset, recurrence, and mortality. At least 851 first CVD events, 374 recurrent CVD events, and 205 CVD deaths per 100,000 of the population could be averted or delayed. In addition, Mediterranean diet clustering revealed that scoring higher in fruits, vegetables, whole wheat products, and legumes was more important than achieving higher scores in low consumption of meat and full-fat dairy products against CVD (all HRs in the former cluster were lower than the latter, indicating a stronger protective effect). CONCLUSIONS: This microsimulation process confirms the added value of the Mediterranean diet in primary and secondary CVD prevention having great achievements even with modifications in a small part of the population (10%), while challenges the orientation of Mediterranean-diet interventions giving higher weights to plant-based part.
BACKGROUND/ OBJECTIVES: To quantify the changes in 10-year cardiovascular disease (CVD) onset, recurrence, and mortality, in relation to transitioning from low to a higher level of adherence to the Mediterranean diet. SUBJECTS/ METHODS: An individual-level microsimulation was created based on ATTICA (2002-2012, n = 3042 subjects free-of-CVD) and GREECS (2004-2014, n = 2172 patients with acute coronary syndrome (ACS)) studies (in total n = 5214). Eight scenarios regarding the proportion of participants and the size of improvement of the level of adherence to the Mediterranean diet (corresponding to one to ten point increases in MedDietScore) were compared in terms of relative change in CVD incidence and mortality, as well as, the number of preventable CVD events and deaths. RESULTS: Improving adherence to the Mediterranean diet in at least 10% of the population, a significant relative percentage reduction could be observed in 10-year CVD onset, recurrence, and mortality. At least 851 first CVD events, 374 recurrent CVD events, and 205 CVD deaths per 100,000 of the population could be averted or delayed. In addition, Mediterranean diet clustering revealed that scoring higher in fruits, vegetables, whole wheat products, and legumes was more important than achieving higher scores in low consumption of meat and full-fat dairy products against CVD (all HRs in the former cluster were lower than the latter, indicating a stronger protective effect). CONCLUSIONS: This microsimulation process confirms the added value of the Mediterranean diet in primary and secondary CVD prevention having great achievements even with modifications in a small part of the population (10%), while challenges the orientation of Mediterranean-diet interventions giving higher weights to plant-based part.