Mediterranean diet associated with lower risk of mortality over follow-up in men and women with cardiovascular disease
Friday, November 8, 2013. An article published online on October 30, 2013 in the American Journal of Clinical Nutrition reports a protective effect for the Mediterranean diet against the risk of premature death from all causes in cardiovascular disease patients. The diet, which is characterized by a relatively high amount of fruit and vegetables, legumes, nuts, fish and monounsaturated fatty acids, and a lower intake of meat and meat products, has been associated with several long-term benefits, including protection against cardiovascular disease, however, its effects in individuals with established disease had not been well studied.
The current study included 6,137 men enrolled in the Health Professionals Follow-Up Study initiated in 1986 and 11,278 women participating in the Nurses' Health Study established in 1976. Subjects in the current study were limited to those who had experienced a nonfatal cardiovascular event, including heart attack, stroke, angina, or coronary bypass or angioplasty. Dietary questionnaire responses provided by the participants in 1980, 1984, 1986, 1990, 1994, 1998, 2002 and 2006 were used to score adherence to the Mediterranean diet.
Over a median follow-up period of 7.7 years, 1,982 deaths occurred among the men. Among the women, 1,468 deaths occurred over a 5.8 year median. Pooled analysis of the subjects revealed a 19% lower risk of death from any cause among those whose adherence to the Mediterranean diet was among the top one-fifth of participants in comparison with those whose adherence was among the lowest fifth. Among those in the top fifth, the risk of dying from cancer or heart disease was 15% lower than those whose diet adherence was lowest, and the risk of death from other causes was 21% less than the risk experienced by those in the lowest group.
"These results are of interest because they show that a healthy diet can still be beneficial at an advanced stage of the atherosclerotic process and that following a Mediterranean-style diet pattern may be of benefit for populations outside the Mediterranean area," write Esther Lopez-Garcia of the Universidad Autónoma de Madrid and her colleagues. They note that the diet has been associated with reductions in such factors as weight, blood pressure and unfavorable lipid levels.
"A Mediterranean-style diet pattern was associated with a reduced risk of mortality in men and women with cardiovascular disease," the authors conclude. "These results support the adoption of a Mediterranean-style diet in patients with cardiovascular disease to prevent premature death."
The April 30, 2013 issue of the journal Neurology® published the findings of a large study of older men and women which revealed a reduced risk of dementia in association with greater adherence to a Mediterranean diet. In comparison with a standard Western diet, a Mediterranean diet provides relatively high amounts of omega-3 fatty acids which have been linked with a protective effect on cognitive function.
The current study included 17,478 African American and Caucasian participants in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study, who did not have stroke or impairment of cognition upon enrollment. Dietary questionnaire responses were scored for adherence to a Mediterranean diet, which is characterized by an abundance of vegetables, fruit, legumes, nuts, fish, and olive oil. Cognitive status was evaluated at the beginning of the study and yearly thereafter over a four year average period.
Cognitive impairment was identified in 1,248 participants over follow-up. Those with greater adherence to a Mediterranean diet experienced an 11% lower risk of cognitive impairment than those whose adherence was low. Further analysis of the data confined the reduction in risk to those without diabetes, who had a 19 percent lower risk of impairment than nondiabetics with low adherence to the diet.
"Since there are no definitive treatments for most dementing illnesses, modifiable activities, such as diet, that may delay the onset of symptoms of dementia are very important," stated lead author Georgios Tsivgoulis, MD, of the University of Athens in Greece. "Diet is an important modifiable activity that could help in preserving cognitive functioning in late life. However, it is only one of several important lifestyle activities that might play a role in late-life mental functioning. Exercise, avoiding obesity, not smoking cigarettes and taking medications for conditions like diabetes and hypertension are also important."
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