(24-02-09) Mediterranean Diet and Incidence of and Mortality From Coronary Heart Disease and Stroke in Women

Author(s): Fung TT, Rexrode KM, Mantzoros CS, Manson JE,
Willett WC, Hu FB.Citation: Circulation 2009;119:1093-1100.

Trial: The Nurses' Health Study Hypertension & Stroke Substudy (Nurses' Health Study Hypertension & Stroke Substudy) Trial: Women's Health Initiative (WHI)
Study Question: Does adherence to a Mediterranean-type diet reduce risk for cardiovascular disease (CVD) among women?
Methods: Participants from the Nurses? Health Study (NHS) cohort, who were apparently healthy at baseline and followed for the occurrence of coronary heart disease and stroke events, comprised the study population. Women with a history of diabetes or CVD at baseline were excluded. An alternative Mediterranean Diet Score based on self -reported dietary information was created. Points were counted if women reported consumption higher than the median for vegetables, fruits, nuts, whole grains, legumes, fish, and alcohol. The ratio of monounsaturated to saturated fats was also included. Red meat and processed meat consumption below the median was also included in the diet score. Dietary information was collected through a food frequency questionnaire at six different time points from 1984 to 2002.
Relative risks for coronary heart disease, stroke, and fatal CVD were
calculated in multivariate models adjusting for CV risk factors.
Results: A total of 74,886 women, ages 38-63, were included in this analysis. Over the 20 years of follow-up, 2,391 incident cases of coronary heart disease, 1,763 incident cases of stroke, and 1,077 incident cases of CVD deaths occurred.
Women in the top quintile for the Mediterranean Diet Score were at lower risk for coronary heart disease events (relative risk [RR], 0.71; 95% confidence interval [CI], 0.62-0.82) and stroke (RR, 0.87; 95% CI, 0.73-1.02) as compared to those in the bottom quintile. CVD mortality was also significantly lower among women in the top quintile for the Mediterranean Diet Score compared to those in the bottom quintile (RR, 0.61; 95% CI, 0.49-0.76). An interaction with body mass index (BMI) was observed for CHD but not stroke; women with a BMI <25 kg/m2 were observed to have a greater benefit than heavier women.
Conclusions: The investigators concluded that adherence to a Mediterranean-type diet is associated with a protective benefit for coronary heart disease and stroke among women.
Perspective: These findings add to current evidence that adoption
and adherence to a diet high in plant proteins and fish, and lower consumption of animal products and saturated fats, is associated with lower risk for CVD.
Still, this type of diet is often difficult for Americans to adhere to for
multiple reasons, including cost. Elizabeth A. Jackson, M.D., F.A.C.C.

Source: http://www.cardiosource.com

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