Mediterranean Diet and cardio-vascular health: an historical perspective

The first investigation of dietary intake in the Mediterranean region was undertaken at the initiative of the government of Greece in 1948. Plant foods (cereals, pulses, nuts, potatoes, vegetables and fruits) accounted for 61% of total energy intake (TEI), animal foods (meat, eggs, fish, and dairy products) for 7% of TEI, and olive oil was the main oil used. In 1950s, Ancel Keys undertook studies in USA, Italy, Spain, England, Japan, Australia, Canada leading him to hypothesize that a link could exist between diet, plasma cholesterol and coronary heart disease (CHD). Between 1958 and 1964, Keys and co-workers carried out the Seven Countries Study, which enrolled men aged 40-59 years in one of 16 cohorts from seven countries (Finland, Greece, Italy, Yugoslavia, Japan, USA and Italy), After 15-y, 25-y and 50-y follow up, a strong positive relation was observed between saturated fat intake and CHD mortality, and a negative one with Mediterranean Dietary Index. In 1975, Keys and his wife published a book intitled: “How to eat well and stay well. The Mediterranean way”, which popularized Mediterranean Diet (MedDiet). After 45-y follow-up longevity without CHD death was 12.9 years higher in Crete than in Finland. Protecting effect of MedDiet towards CHD incidence and risk is now confirmed by PREDIMED Study and by cohorts’ studies gathered in several recent meta-analysis. MedDiet is sustainable and recognized by UNESCO as an Intangible Cultural Heritage, which is the most beautiful homage that can be paid to Ancel Keys and all his co-workers.

Metabolic syndrome and mortality prediction in the seven countries' study: single or multifactorial

Introduction The metabolic syndrome (Met Sy) is a known cluster of risk factors (HTA, HLP, DM, BMI) that promotes overall vascular disease, however its real impact on overall, ischemic heart disease (IHD) and cerebrovascular disease (CVD) mortality remains debated. Material and methods The Seven Countries Study encompassed 12,763 participants who were healthy men over 40y at baseline and who underwent regular check ups every 5 years throughout over a 4 decades' span. Morbidity and mortality was adjudicated according to valid ICD and LPH coding. Results Using the IDF definition of the Metabolic Syndrome, 9,09% of participants were identified. In a multivariate analysis predictors for overall Mt were hypertension (p<0.0001) and BMI (p<0.029), while HLP had a weak prediction value (p=0.083), where as MetSy and DM had not at all. Hypertension (p<0.0001) remained a strong predictor for IHD mortality together with HLP (p<0.0001), while diabetes was of weak predictive value (p=0.065), whereas MetSy failed to. Although HTA was a strong predictor for CVD mortality, so did MetSy (p<0.050), while DM and HLP haven't while BMI had a low impact (p=0.070). Conclusion Metabolic syndrome's role in atherosclerotic burden remains important, however whether its power is due to its respective components or their interactions remains to be an issue. The described results belong to an era where both IHD and CVD were considered a “male disease” women were spared of, so, further validation in the described cohorts is needed in an offspring fashion, however hypertension remains the driving force of both overall mortality as well as specific IHD and CVD ones, also previously demonstrated in the very same cohort to be more important in the setting of maternal family history of hypertension, than paternal one. MetSy in the SCS Funding Acknowledgement Type of funding source: None

Abstract P123: Metabolic Syndrome Risk Factors' Aggregation Within the Seven Countries' Study: 45 Years Follow Up Results

Introduction: Components of the metabolic syndrome (MetSy) have gone through myriad of changes ever since the initial cluster was defined. The Seven Countries Study taught us the basics of classical risk factors for atherosclerotic artery disease and their influence on both cardiovascular and cerebrovascular morbidity and mortality. Material and Methods: In a 3-continent, 7-country (USA, Japan, Greece, the Netherlands, Finland, Italy, and former Yugoslavia then, now Croatia and Serbia) sample of 12,763 participants -- all healthy men over 40 at entry -- systematic, quinquennial checkups were conducted over 4 decades and MetSy was defined using the IDF definition. ResultS: A total of 9,09% of participants were identified to have MetSy, while the detailed description of risk factors' combination is shown in Table 1 and Figure 1, below. Conclusion: The leading combination was hypertension (HTA), diabetes (DM) and dyslipidemia (HLP), while hypertension was the hallmark risk factor irrelevant of presence or absence of MetSy. The results of this study call for a contemporary comprehensive research involving both sexes that could elucidate better real life risk factors' relationships in aforementioned countries.

Energy-adjusted Dietary Inflammatory Index scores predict long-term cardiovascular disease mortality and other causes of death in an ecological analysis of the Seven Countries Study

Using data from the Seven Countries Study of Cardiovascular Diseases, the first study to conduct international comparisons of men in different European, USA, and Japanese cohorts, we examined the effect of diet-associated inflammation on prediction of coronary heart disease-, other major cardiovascular disease- and all-cause mortality after 50-years of follow-up. The energy-adjusted Dietary Inflammatory Index was used to quantify the effect of diet on systemic inflammation. Positive linear correlations were observed between the cohort-average energy-adjusted Dietary Inflammatory Index score and both overall death rates ( R = 0.61, p = 0.0114) and major cardiovascular disease mortality rates ( R = 0.51, p = 0.0337) but not cancer. Correlations for all-cause mortality were higher when the Belgrade outlier cohort was omitted ( R = 0.72, p = 0.0024) or when analyses were adjusted for socioeconomic status ( R = 0.67, p = 0.0065). There was also a significant reverse correlation between energy-adjusted Dietary Inflammatory Index score and age at death ( R = –0.50 to –0.68, p = 0.0480 to 0.0012). Adjusting for systolic blood pressure, cholesterol, and smoking habits did not modify these correlations that were still significant. With control for these covariates a significant correlation emerged for coronary heart disease. Results obtained using a 25-year follow-up to allow unprojected data from all cohorts were similar. Results from this long-term follow-up study are consistent with a recommendation to increase consuming an anti-inflammatory diet characterized by high concentrations of fruits and vegetables and low consumption of simple carbohydrates and fats.

Impact of Sex on Office White Coat Effect Tail: Investigating Two Italian Residential Cohorts

To assess the impact of sex on office white-coat effect tail (OWCET), the waning of systolic blood pressure (SBP) after its waxing during office visit, on the incidence of long-term major fatal and non-fatal events in two Italian residential cohorts [from the Gubbio Study and the Italian Rural Areas of the Seven Countries Study (IRA)]. There were 3565 persons (92 with missing data, 44% men, 54 ± 11 years) included in the Gubbio and 1712 men (49 ± 5 years) in the IRA studies. OWCET was defined as a decrease of ≥10 mmHg in SBP between successive measurements with slight measurement differences between the two cohorts. Cardiovascular (CVD), coronary heart disease (CHD) and stroke (STR) incidences were considered. Over an approximately 20-year follow-up, women with OWCET had an increased risk of CVD [HR: 1.591 (95%CI: 1.204–2.103)], CHD [HR: 1.614 (95%CI: 1.037–2.512)] and STR [HR: 1.696 (95%CI: 1.123–2.563)] events independently of age, serum and HDL cholesterol, cigarettes, BMI and SBP in the Gubbio study. However, there was no increased risk of CVD, CHD or STR in men with OWCET neither in the Gubbio 20-year follow-up nor in the IRA 50-year follow-up. These results were not modified significantly by the correction of the regression dilutions bias between the first and the subsequent SBP measurements. Thus, in primary care, OWCET should be actively evaluated in women as it can improve stratification of long-term CVD, CHD and STR risks.