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European Journal of Epidemiology

, Volume 22, Issue 12, pp 871–881 | Cite as

Modified Mediterranean diet and survival after myocardial infarction: the EPIC-Elderly study

  • A. Trichopoulou
  • C. Bamia
  • T. Norat
  • K. Overvad
  • E. B. Schmidt
  • A. Tjønneland
  • J. Halkjær
  • F. Clavel-Chapelon
  • M. -N. Vercambre
  • M. -C. Boutron-Ruault
  • J. Linseisen
  • S. Rohrmann
  • H. Boeing
  • C. Weikert
  • V. Benetou
  • T. Psaltopoulou
  • P. Orfanos
  • P. Boffetta
  • G. Masala
  • V. Pala
  • S. Panico
  • R. Tumino
  • C. Sacerdote
  • H. B. Bueno-de-Mesquita
  • M. C. Ocke
  • P. H. Peeters
  • Y. T. Van der Schouw
  • C. González
  • M. J. Sanchez
  • M. D. Chirlaque
  • C. Moreno
  • N. Larrañaga
  • B. Van Guelpen
  • J. -H. Jansson
  • S. Bingham
  • K. -T. Khaw
  • E. A. Spencer
  • T. Key
  • E. Riboli
  • D. Trichopoulos
Cardiovascular Disease

Abstract

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.

Keywords

Mediterranean diet Survival Elderly Myocardial infarction 

Abbreviations

EPIC

European Investigation into Cancer and nutrition

NA

Not Applicable

ACE

Angiotensin-Converting Enzyme

Notes

Acknowledgements

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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Copyright information

© Springer Science+Business Media B.V. 2007

Authors and Affiliations

  • A. Trichopoulou
    • 1
  • C. Bamia
    • 1
  • T. Norat
    • 2
  • K. Overvad
    • 3
  • E. B. Schmidt
    • 4
  • A. Tjønneland
    • 5
  • J. Halkjær
    • 5
  • F. Clavel-Chapelon
    • 6
  • M. -N. Vercambre
    • 6
  • M. -C. Boutron-Ruault
    • 6
  • J. Linseisen
    • 7
  • S. Rohrmann
    • 7
  • H. Boeing
    • 8
  • C. Weikert
    • 8
  • V. Benetou
    • 1
  • T. Psaltopoulou
    • 1
  • P. Orfanos
    • 1
  • P. Boffetta
    • 9
  • G. Masala
    • 10
  • V. Pala
    • 11
  • S. Panico
    • 12
  • R. Tumino
    • 13
  • C. Sacerdote
    • 14
  • H. B. Bueno-de-Mesquita
    • 15
  • M. C. Ocke
    • 15
  • P. H. Peeters
    • 16
  • Y. T. Van der Schouw
    • 16
  • C. González
    • 17
  • M. J. Sanchez
    • 18
  • M. D. Chirlaque
    • 19
  • C. Moreno
    • 20
  • N. Larrañaga
    • 21
  • B. Van Guelpen
    • 22
  • J. -H. Jansson
    • 23
  • S. Bingham
    • 24
  • K. -T. Khaw
    • 25
  • E. A. Spencer
    • 26
  • T. Key
    • 26
  • E. Riboli
    • 27
  • D. Trichopoulos
    • 1
    • 28
  1. 1.Department of Hygiene and EpidemiologyUniversity of Athens, Medical SchoolAthensGreece
  2. 2.Infections and Cancer Epidemiology GroupInternational Agency for Research on Cancer (IARC)LyonFrance
  3. 3.Department of Clinical Epidemiology, Aalborg HospitalAarhus University HospitalAarhusDenmark
  4. 4.Center for Cardiovascular Research, AalborgÅrhus University HospitalsAarhusDenmark
  5. 5.Institute of Cancer EpidemiologyDanish Cancer SocietyCopenhagenDenmark
  6. 6.Institut Gustave RoussyEquipe E3N-EPIC, INSERMParisFrance
  7. 7.Nutritional EpidemiologyGerman Cancer Research CenterHeidelbergGermany
  8. 8.Department of EpidemiologyGerman Institute of Human NutritionPotsdam-RehbruckeGermany
  9. 9.Genetics and Epidemiology ClusterInternational Agency for Research on Cancer (IARC)LyonFrance
  10. 10.Molecular and Nutritional Epidemiology Unit CSPO-Scientific Institute of TuscanyFlorenceItaly
  11. 11.Epidemiology UnitIstituto Nazionale per lo Studio e la Cura dei TumoriMilanItaly
  12. 12.Dipartimento di Medicina Clinica e SperimentaleFederico II, UniversityNaplesItaly
  13. 13.Cancer RegistryAzienda Ospedaliera “Civile M.P. Arezzo”RagusaItaly
  14. 14.Unit of Cancer Epidemiology, Department of Biomedical Sciences and Human OncologyUniversity of TurinTurinItaly
  15. 15.Centre for Nutrition and HealthNational Institute for Public Health and the EnvironmentBilthoven, UtrechtThe Netherlands
  16. 16.Julius Center for Health Sciences and Primary CareUniversity Medical CenterUtrechtThe Netherlands
  17. 17.Department of EpidemiologyCatalan Institute of OncologyBarcelonaSpain
  18. 18.Andalusian School of Public HealthGranada Cancer RegistryGranadaSpain
  19. 19.Epidemiology DepartmentMurcia Health CouncilMurciaSpain
  20. 20.Public Health InstitutePamplonaSpain
  21. 21.Department of Public Health of GipuzkoaSan SebastianSpain
  22. 22.Medical BiosciencesUmeå UniversityUmeåSweden
  23. 23.Department of Medicine, Skellefteå County Hospital and Publical Health and Clinical MedicineUmeå University HospitalUmeåSweden
  24. 24.MRC Dunn Human Nutrition UnitCambridgeUK
  25. 25.Institute of Public HealthUniversity of CambridgeCambridgeUK
  26. 26.Cancer Epidemiology UnitOxford UniversityOxfordUK
  27. 27.Department of Epidemiology & Public HealthImperial CollegeLondonUK
  28. 28.Department of EpidemiologyHarvard School of Public HealthBostonUSA

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