Modified Mediterranean diet and survival after myocardial infarction: the EPIC-Elderly study
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Mediterranean diet is associated with lower incidence of coronary heart disease, and two randomised trials indicated that it improves prognosis of coronary patients. These trials, however, relied on a total of 100 deaths and evaluated designer diets in the clinical context. We have evaluated the association of adherence to the modified Mediterranean diet, in which unsaturates were substituted for monounsaturates, with survival among elderly with previous myocardial infarction within the European Prospective Investigation into Cancer and nutrition (EPIC) study. As of December 2003, after a median follow-up of 6.7 years, 2671 EPIC participants from nine countries were 60 years or older and had prevalent myocardial infarction but no stroke or cancer at enrolment, complete information on dietary intakes and important covariates and known survival status. Adherence to the modified Mediterranean diet was assessed through a 10-unit-scale. Mortality ratio in relation to modified Mediterranean diet was estimated through Cox regression controlling for possible confounding. Increased adherence to modified Mediterranean diet by two units was associated with 18% lower overall mortality rate (95% confidence interval 7–27%, fixed effects model). There was no significant heterogeneity by sex, age at enrolment, or country, although the association tended to be less evident among northern Europeans. Associations between food groups contributing to the modified Mediterranean diet and mortality were generally weak. A diet inspired by the Mediterranean pattern that can be easily adopted by Western populations is associated with substantial reduction of total mortality of coronary patients in the community.
KeywordsMediterranean diet Survival Elderly Myocardial infarction
European Investigation into Cancer and nutrition
This study was supported by the “Quality of Life and Management of Living resources” Programme of the European Commission (DG Research, contract No QLK6-CT-2001–00241) for the project EPIC-Elderly, coordinated by the Department of Hygiene and Epidemiology, University of Athens Medical School; the European Commission: Public Health and Consumer Protection Directorate 1993–2004; Research Directorate-General 2005 for the project EPIC coordinated by the International Agency for Research on Cancer (WHO); Greek Ministry of Health and the Greek Ministry of Education (Greece); a fellowship honoring Vasilios and Nafsika Tricha (Greece); The Danish Cancer Society (Denmark); Ligue contre le Cancer (France); Société 3 M (France); Mutuelle Générale de l’Education Nationale (France); Institut National de la Santé et de la Recherche Médicale (INSERM) (France); Gustave Roussy Institute and several General Councils in France (France); German Cancer Aid (Germany); German Cancer Research Center (Germany); German Federal Ministry of Education and Research (Germany); EPIC Italy is supported by a generous grant from the Associazione Italiana per la Ricerca sul Cancro (AIRC, Milan); Associazione Italiana per la Ricerca contro il Cancro (AIRC) in Florence (Italy); Compagnia di San Paolo (Italy); Regione Sicilia, Associazione Italiana Ricerca Cancro and Avis-Ragusa (Italy); Dutch Ministry of Public Health,Welfare and Sports (the Netherlands); Health Research Fund (FIS) of the Spanish Ministry of Health (Spain); the Spanish Regional Governments of Andalucia, Asturias, Basque Country, Murcia and Navarra (Spain); the ISCIII Network Red de Centros RCESP (C03/09), (Spain); Swedish Cancer Society (Sweden); Swedish Scietific Council, City of Malmö, (Sweden); Regional Government of Skåne, (Sweden); Cancer Research, UK (UK); Medical Research Council UK.
The funding sources had no involvement in the study design, in the collection, analysis and interpretation of data, in the writing of the report and in the decision to submit the paper for publication. The author(s) is (are) solely responsible for the publication and the publication does not represent the opinion of the Community. The Community is not responsible for any use that might be made of data appearing in this work.
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