06 May 2014 In Cardiovascular System

BACKGROUND: The Southern European Atlantic Diet (SEAD) is the traditional diet in northern Portugal and Galicia, a region in northwest Spain.

OBJECTIVE: The objective was to examine the association between adherence to the SEAD and the occurrence of nonfatal acute myocardial infarction (AMI).

DESIGN: This was a population-based case-control study in Porto, Portugal. Cases were patients aged > or =18 y who were hospitalized with an incident AMI (n = 820), and controls were individuals without AMI selected at random from the resident population of the participating hospitals' catchment area (n = 2196). A validated food-frequency questionnaire was administered in face-to-face interviews to assess dietary intake in the previous year. We developed an SEAD adherence index with 9 key components: fresh fish excluding cod, cod, red meat and pork products, dairy products, legumes and vegetables, vegetable soup, potatoes, whole-grain bread, and wine. A score of 1 or 0 was assigned to each food consumed and reflected consumption that was higher or lower, respectively, than the sex-specific median in controls.

RESULTS: After adjustment for the main confounders, a 1-point increment in the SEAD score was associated with a 10% reduced odds of AMI [odds ratio (OR): 0.90; 95% CI: 0.85, 0.96]. In comparison with individuals in the lower quartile of the SEAD index (lowest adherence), those in the upper quartile had a 33% lower likelihood of experiencing an AMI (OR: 0.67; 95% CI: 0.51, 0.88; P for trend = 0.003). An SEAD index calculated by reverse scoring for red meat and pork products and potatoes led to an even stronger inverse association between the SEAD and AMI (OR for the upper compared with the lower quartile of SEAD index: 0.40; 95% CI: 0.30, 0.52; P for trend < 0.001).

CONCLUSIONS: Adherence to the SEAD was associated with lower odds of nonfatal AMI. However, some but not all food components of the SEAD may contribute to the very low coronary mortality in northern Portugal and Galicia.

06 May 2014 In Cardiovascular System

BACKGROUND: Although moderate alcohol intake is associated with lower risk for myocardial infarction (MI), guidelines generally suggest that adults seek other lifestyle measures to reduce cardiovascular risk. We studied whether alcohol consumption is inversely associated with risk for coronary heart disease in men who report consistently favorable lifestyle behaviors.

METHODS: From 51 529 male participants of the Health Professionals Follow-up Study who have reported diet and other lifestyle factors in biennial questionnaires since 1986, we defined a cohort of 8867 men free of major illness to participate in a prospective study. All participants reported 4 healthy lifestyle behaviors, including a body mass index (calculated as weight in kilograms divided by height in meters squared) of less than 25, moderate to vigorous activity for 30 minutes or more per day, abstention from smoking, and a summary diet score in the top 50% for men. High dietary scores reflected a high intake of vegetables, fruits, cereal fiber, fish, chicken, nuts, soy, and polyunsaturated fat; low consumption of trans-fat, and red and processed meats; and multivitamin use. We ascertained the incidence of nonfatal MI and fatal coronary heart disease according to reported intake of beer, wine, and liquor every 4 years.

RESULTS: During 16 years of follow-up, we documented 106 incident cases of MI. Compared with abstention, the hazard ratios for MI were 0.98 (95% confidence interval, 0.55-1.74) for alcohol intake of 0.1 to 4.9 g/d, 0.59 (95% confidence interval, 0.33-1.07) for alcohol intake of 5.0 to 14.9 g/d, 0.38 (95% confidence interval, 0.16-0.89) for alcohol intake of 15.0 to 29.9 g/d, and 0.86 (95% confidence interval, 0.36-2.05) for alcohol intake of 30.0 g/d or more. In men who met 3 criteria, the lower risk associated with alcohol intake of 5.0 to 29.9 g/d tended to be similar to the lower risk associated with the remaining healthy lifestyle behavior.

CONCLUSION: Even in men already at low risk on the basis of body mass index, physical activity, smoking, and diet, moderate alcohol intake is associated with lower risk for MI.

06 May 2014 In Cardiovascular System

BACKGROUND: Although a wealth of literature links dietary factors and coronary heart disease (CHD), the strength of the evidence supporting valid associations has not been evaluated systematically in a single investigation.

METHODS: We conducted a systematic search of MEDLINE for prospective cohort studies or randomized trials investigating dietary exposures in relation to CHD. We used the Bradford Hill guidelines to derive a causation score based on 4 criteria (strength, consistency, temporality, and coherence) for each dietary exposure in cohort studies and examined for consistency with the findings of randomized trials.

RESULTS: Strong evidence supports valid associations (4 criteria satisfied) of protective factors, including intake of vegetables, nuts, and "Mediterranean" and high-quality dietary patterns with CHD, and associations of harmful factors, including intake of trans-fatty acids and foods with a high glycemic index or load. Among studies of higher methodologic quality, there was also strong evidence for monounsaturated fatty acids and "prudent" and "western" dietary patterns. Moderate evidence (3 criteria) of associations exists for intake of fish, marine omega-3 fatty acids, folate, whole grains, dietary vitamins E and C, beta carotene, alcohol, fruit, and fiber. Insufficient evidence (< or =2 criteria) of association is present for intake of supplementary vitamin E and ascorbic acid (vitamin C); saturated and polyunsaturated fatty acids; total fat; alpha-linolenic acid; meat; eggs; and milk. Among the dietary exposures with strong evidence of causation from cohort studies, only a Mediterranean dietary pattern is related to CHD in randomized trials.

CONCLUSIONS: The evidence supports a valid association of a limited number of dietary factors and dietary patterns with CHD. Future evaluation of dietary patterns, including their nutrient and food components, in cohort studies and randomized trials is recommended.

06 May 2014 In Cardiovascular System

BACKGROUND: Little is known about the role of diet in the development of venous thromboembolism (VTE). We explored the prospective relation of dietary patterns, food groups, and nutrients to incident VTE in older women.

METHODS: In 1986, Iowa women aged 55 to 69 years completed a mailed survey, including a 127-item food frequency questionnaire. These data were linked to Medicare data from 1986 to 2004, and International Classification of Diseases discharge codes were used to identify hospitalized VTE cases. Cox regression analyses evaluated relations of 2 principal components-derived dietary patterns, 11 food groups, and 6 nutrients to VTE, adjusted for age, education, smoking status, physical activity, and energy intake.

RESULTS: Over 19 years of follow-up, 1,950 of the 37,393 women developed VTE. Women consuming alcohol daily were at 26% (95% CI 11%-38%) lower risk of VTE as compared to nonconsumers. All alcoholic beverages types were in the direction of lower risk; however, only beer and liquor were statistically significant. After basic adjustments, coffee was inversely related to VTE, and diet soda and fish positively related. However, these associations were confounded and became nonsignificant after adjustment for body mass index and diabetes. No associations were observed with consumption of 'Western' or 'Prudent' dietary patterns, fruit, vegetables, dairy, meat, refined grains, whole grains, regular soda, vitamins E, vitamin B6, vitamin B12, folate, omega-3 fatty acids, or saturated fat.

CONCLUSIONS: In this cohort of older women, greater intake of alcohol was associated with a lower risk of incident VTE. No other independent associations were seen between diet and VTE.

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