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

  • Cardiovascular Disease
  • Published:
European Journal of Epidemiology Aims and scope Submit manuscript

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.

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Abbreviations

EPIC:

European Investigation into Cancer and nutrition

NA:

Not Applicable

ACE:

Angiotensin-Converting Enzyme

References

  1. Keys A. Seven countries. A multivariate analysis of death, coronary heart disease. Cambridge MA: Harvard University Press; 1980.

    Google Scholar 

  2. Trichopoulou A, Kouris-Blazos A, Wahlqvist ML, et al. Diet and overall survival in the elderly. BMJ 1995;311:1457–60.

    PubMed  CAS  Google Scholar 

  3. Osler M, Schroll M. Diet and mortality in a cohort of elderly people in a north European community. Int J Epidemiol 1997;26:155–9.

    Article  PubMed  CAS  Google Scholar 

  4. Lasheras C, Fernandez S, Patterson AM. Mediterranean diet and age with respect to overall survival in institutionalised, nonsmoking elderly people. Am J Clin Nutr 2000;71:987–92.

    PubMed  CAS  Google Scholar 

  5. Trichopoulou A, Costacou T, Bamia C, et al. Adherence to Mediterranean diet and survival in a Greek population. N Engl J Med 2003;348:2599–608.

    Article  PubMed  Google Scholar 

  6. Fidanza F, Alberti A, Lanti M, et al. Mediterranean diet score: correlation with 25-year mortality from coronary heart disease in the Seven Countries Study. Nutr Metab Cardiovasc Dis 2004;14:397.

    Article  PubMed  CAS  Google Scholar 

  7. Knoops KT, de Groot LC, Kromhout D, et al. Mediterranean diet, lifestyle factors, and 10-year mortality in elderly European men and women: the HALE project. JAMA 2004;292:1433–9.

    Article  PubMed  Google Scholar 

  8. Trichopoulou A, Orfanos P, Norat T, et al. Modified Mediterranean diet and survival: EPIC-elderly prospective cohort study. BMJ 2005;330:991-; DOI 10.1136/bmj.38415.644155.8F.

    Article  PubMed  Google Scholar 

  9. de Lorgeril M, Renaud S, Mamelle N, et al. Mediterranean alpha-linolenic acid-rich diet in secondary prevention of coronary heart disease. Lancet 1994;343:1454–9.

    Article  PubMed  Google Scholar 

  10. de Lorgeril M, Salen P, Martin JL, et al. Mediterranean diet, traditional risk factors, and the rate of cardiovascular complications after myocardial infarction: final report of the Lyon Diet Heart Study. Circulation 1999;99:779–85.

    PubMed  Google Scholar 

  11. Singh RB, Dubnov G, Niaz MA, et al. Effect of an Indo-Mediterranean diet on progression of coronary artery disease in high risk patients (Indo-Mediterranean diet heart study): a randomised single-blind trial. Lancet 2002;360:1455–61.

    Article  PubMed  Google Scholar 

  12. Kris-Etherton P, Eckel RH, Howard BV, et al. Nutrition committee population science committee and clinical science committee of the American heart association. AHA science advisory: Lyon diet heart study. benefits of a mediterranean-style, National cholesterol education program/American heart association step I dietary pattern on cardiovascular disease. Circulation 2001;103:1823–5.

    PubMed  CAS  Google Scholar 

  13. Horton R. Expression of concern: Indo-Mediterranean diet heart study. Lancet 2005;366:354–6.

    Article  PubMed  Google Scholar 

  14. Mann J. The Indo-Mediterranean diet revisited. Lancet 2005;366:353–4.

    Article  PubMed  Google Scholar 

  15. Trichopoulou A, Bamia C, Trichopoulos D. Mediterranean diet and survival among patients with coronary heart disease in Greece. Arch Intern Med 2005;165:929–35.

    Article  PubMed  Google Scholar 

  16. Riboli E, Hunt KJ, Slimani N, et al. European Prospective Investigation into Cancer and Nutrition (EPIC): study populations and data collection. Public Health Nutr 2002;5:1113–24.

    Article  PubMed  CAS  Google Scholar 

  17. Margetts BM, Pietinen P. European Prospective Investigation into Cancer and Nutrition: validity studies on dietary assessment methods. Int J Epidemiol 1997;26(Suppl 1):S1–5.

    Article  PubMed  Google Scholar 

  18. Deharveng G, Charrondiere UR, Slimani N, et al. Comparison of nutrients in the food composition tables available in the nine European countries participating in EPIC. European Prospective Investigation into Cancer and Nutrition. Eur J Clin Nutr 1999;53:60–79.

    Article  PubMed  CAS  Google Scholar 

  19. Marmot MG. Alcohol and coronary heart disease. Int J Epidemiol 2001;30:724–9.

    Article  PubMed  CAS  Google Scholar 

  20. Britton A, Marmot M. Different measures of alcohol consumption and risk of coronary heart disease and all-cause mortality: 11-year follow-up of the Whitehall II Cohort Study. Addiction 2004;99:109–16.

    Article  PubMed  Google Scholar 

  21. James WPT, Schofield EC. Human energy requirements: a manual for planners and nutritionists. Oxford/New York/Tokyo: Oxford University Press;1990.

    Google Scholar 

  22. Jacques PF, Tucker KL. Are dietary patterns useful for understanding the role of diet in chronic disease? Am J Clin Nutr 2001;73:1–2.

    PubMed  CAS  Google Scholar 

  23. Trichopoulos D, Lagiou P. Mediterranean diet and cardiovascular epidemiology. Eur J Epidemiol 2004;19:1–2.

    Google Scholar 

  24. Ascherio A, Rimm EB, Giovannucci EL, et al. Dietary fat and risk of coronary heart disease in men: cohort follow up study in the United States. BMJ 1996;313:84–90.

    PubMed  CAS  Google Scholar 

  25. Esposito K, Marfella R, Ciotola M, et al. Effect of a Mediterranean-style diet on endothelial dysfunction and markers of vascular inflammation in the metabolic syndrome: a randomized trial. JAMA 2004;292:1440–6.

    Article  PubMed  CAS  Google Scholar 

  26. Ambring A, Johansson M, Axelsen M, et al. Mediterranean-inspired diet lowers the ratio of serum phospholipid n-6 to n-3 fatty acids, the number of leukocytes and platelets, and vascular endothelial growth factor in healthy subjects. Am J Clin Nutr 2006;83:575–81.

    PubMed  CAS  Google Scholar 

  27. Siemiatycki J, Wacholder S, Dewar R, et al. Degree of confounding bias related to smoking, ethnic group, and socioeconomic status in estimates of the associations between occupation and cancer. J Occup Med 1988;30:617–25.

    Article  PubMed  CAS  Google Scholar 

  28. MacMahon B, Trichopoulos D. Epidemiology: Principles and Methods, 2nd ed. Boston: Little Brown; 1996.

    Google Scholar 

Download references

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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Authors and Affiliations

  1. Department of Hygiene and Epidemiology, University of Athens, Medical School, 75 Mikras Asias st, 115 27, Athens, Greece

    A. Trichopoulou, C. Bamia, V. Benetou, T. Psaltopoulou, P. Orfanos & D. Trichopoulos

  2. Infections and Cancer Epidemiology Group, International Agency for Research on Cancer (IARC), Lyon, France

    T. Norat

  3. Department of Clinical Epidemiology, Aalborg Hospital, Aarhus University Hospital, Aarhus, Denmark

    K. Overvad

  4. Center for Cardiovascular Research, Aalborg, Århus University Hospitals, Aarhus, Denmark

    E. B. Schmidt

  5. Institute of Cancer Epidemiology, Danish Cancer Society, Copenhagen, Denmark

    A. Tjønneland & J. Halkjær

  6. Institut Gustave Roussy, Equipe E3N-EPIC, INSERM, Paris, France

    F. Clavel-Chapelon, M. -N. Vercambre & M. -C. Boutron-Ruault

  7. Nutritional Epidemiology, German Cancer Research Center, Heidelberg, Germany

    J. Linseisen & S. Rohrmann

  8. Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbrucke, Germany

    H. Boeing & C. Weikert

  9. Genetics and Epidemiology Cluster, International Agency for Research on Cancer (IARC), Lyon, France

    P. Boffetta

  10. Molecular and Nutritional Epidemiology Unit CSPO-Scientific Institute of Tuscany, Florence, Italy

    G. Masala

  11. Epidemiology Unit, Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan, Italy

    V. Pala

  12. Dipartimento di Medicina Clinica e Sperimentale, Federico II, University, Naples, Italy

    S. Panico

  13. Cancer Registry, Azienda Ospedaliera “Civile M.P. Arezzo”, Ragusa, Italy

    R. Tumino

  14. Unit of Cancer Epidemiology, Department of Biomedical Sciences and Human Oncology, University of Turin, Turin, Italy

    C. Sacerdote

  15. Centre for Nutrition and Health, National Institute for Public Health and the Environment, Bilthoven, Utrecht, The Netherlands

    H. B. Bueno-de-Mesquita & M. C. Ocke

  16. Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, The Netherlands

    P. H. Peeters & Y. T. Van der Schouw

  17. Department of Epidemiology, Catalan Institute of Oncology, Barcelona, Spain

    C. González

  18. Andalusian School of Public Health, Granada Cancer Registry, Granada, Spain

    M. J. Sanchez

  19. Epidemiology Department, Murcia Health Council, Murcia, Spain

    M. D. Chirlaque

  20. Public Health Institute, Pamplona, Navarra, Spain

    C. Moreno

  21. Department of Public Health of Gipuzkoa, San Sebastian, Spain

    N. Larrañaga

  22. Medical Biosciences, Umeå University, Umeå, Sweden

    B. Van Guelpen

  23. Department of Medicine, Skellefteå County Hospital and Publical Health and Clinical Medicine, Umeå University Hospital, Umeå, Sweden

    J. -H. Jansson

  24. MRC Dunn Human Nutrition Unit, Cambridge, UK

    S. Bingham

  25. Institute of Public Health, University of Cambridge, Cambridge, UK

    K. -T. Khaw

  26. Cancer Epidemiology Unit, Oxford University, Oxford, UK

    E. A. Spencer & T. Key

  27. Department of Epidemiology & Public Health, Imperial College, London, UK

    E. Riboli

  28. Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA

    D. Trichopoulos

Authors
  1. A. Trichopoulou
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  2. C. Bamia
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  3. T. Norat
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  4. K. Overvad
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  5. E. B. Schmidt
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  6. A. Tjønneland
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  7. J. Halkjær
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  8. F. Clavel-Chapelon
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  9. M. -N. Vercambre
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  10. M. -C. Boutron-Ruault
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  11. J. Linseisen
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  12. S. Rohrmann
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  13. H. Boeing
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  14. C. Weikert
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  15. V. Benetou
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  16. T. Psaltopoulou
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  17. P. Orfanos
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  18. P. Boffetta
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  19. G. Masala
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  20. V. Pala
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  21. S. Panico
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  22. R. Tumino
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  23. C. Sacerdote
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  24. H. B. Bueno-de-Mesquita
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  25. M. C. Ocke
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  26. P. H. Peeters
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  27. Y. T. Van der Schouw
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  28. C. González
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  29. M. J. Sanchez
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  30. M. D. Chirlaque
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  31. C. Moreno
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  32. N. Larrañaga
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  33. B. Van Guelpen
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  34. J. -H. Jansson
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  35. S. Bingham
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  36. K. -T. Khaw
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  37. E. A. Spencer
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  38. T. Key
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  39. E. Riboli
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  40. D. Trichopoulos
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Corresponding author

Correspondence to D. Trichopoulos.

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Trichopoulou, A., Bamia, C., Norat, T. et al. Modified Mediterranean diet and survival after myocardial infarction: the EPIC-Elderly study. Eur J Epidemiol 22, 871–881 (2007). https://doi.org/10.1007/s10654-007-9190-6

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  • DOI: https://doi.org/10.1007/s10654-007-9190-6

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