TY - JOUR
T1 - Interaction between Mediterranean diet and statins on mortality risk in patients with cardiovascular disease
T2 - Findings from the Moli-sani Study
AU - Moli-sani Study Investigators
AU - Bonaccio, Marialaura
AU - Di Castelnuovo, Augusto
AU - Costanzo, Simona
AU - Persichillo, Mariarosaria
AU - De Curtis, Amalia
AU - Cerletti, Chiara
AU - Donati, Maria Benedetta
AU - de Gaetano, Giovanni
AU - Iacoviello, Licia
N1 - Copyright © 2018 Elsevier B.V. All rights reserved.
PY - 2019/2/1
Y1 - 2019/2/1
N2 - BACKGROUND: Statins are prescribed for patients with cardiovascular disease (CVD), along with the recommendation of adopting healthy diets. We evaluated the independent and the combined effect of statins and Mediterranean diet (MD) towards mortality risk in patients with previous CVD by using real-life data from a population-based prospective cohort.METHODS: Longitudinal analysis on 1180 subjects (mean age 67.7 ± 10) with prior CVD at enrollment in the Moli-sani Study and followed up for 7.9 y (median). Adherence to MD was appraised by a Mediterranean diet score. Hazard ratios (HR) with 95% confidence intervals (95% CI) were calculated by multivariable Cox regression and competing risk models.RESULTS: Multivariable risk estimates associated with a 2-point increase in MD score were 0.84 (95% CI 0.70-1.00), 0.77 (0.61-0.97) and 0.70 (0.52-0.93) for overall, cardiovascular and coronary artery disease (CAD)/cerebrovascular deaths, respectively. Statins were not associated with death risk. Subjects combining statins and average-high adherence to MD had much lower than expected risk of cardiovascular and CAD/cerebrovascular mortality (p for interaction = 0.045 and 0.0015, respectively) as compared to those neither using statins nor having average-high MD. The combination of average-high MD and statins was associated in a likely synergistic way with reduced low-grade inflammation, but not with blood cholesterol.CONCLUSIONS: MD lowered the risk of all-cause, cardiovascular and CAD/cerebrovascular mortality CVD patients, net of statins. In the same population, statins reduced CVD death risk only in combination with MD. Low-grade inflammation, rather than lipids, is likely to be on the pathway of the interaction between MD and statins towards mortality risk.
AB - BACKGROUND: Statins are prescribed for patients with cardiovascular disease (CVD), along with the recommendation of adopting healthy diets. We evaluated the independent and the combined effect of statins and Mediterranean diet (MD) towards mortality risk in patients with previous CVD by using real-life data from a population-based prospective cohort.METHODS: Longitudinal analysis on 1180 subjects (mean age 67.7 ± 10) with prior CVD at enrollment in the Moli-sani Study and followed up for 7.9 y (median). Adherence to MD was appraised by a Mediterranean diet score. Hazard ratios (HR) with 95% confidence intervals (95% CI) were calculated by multivariable Cox regression and competing risk models.RESULTS: Multivariable risk estimates associated with a 2-point increase in MD score were 0.84 (95% CI 0.70-1.00), 0.77 (0.61-0.97) and 0.70 (0.52-0.93) for overall, cardiovascular and coronary artery disease (CAD)/cerebrovascular deaths, respectively. Statins were not associated with death risk. Subjects combining statins and average-high adherence to MD had much lower than expected risk of cardiovascular and CAD/cerebrovascular mortality (p for interaction = 0.045 and 0.0015, respectively) as compared to those neither using statins nor having average-high MD. The combination of average-high MD and statins was associated in a likely synergistic way with reduced low-grade inflammation, but not with blood cholesterol.CONCLUSIONS: MD lowered the risk of all-cause, cardiovascular and CAD/cerebrovascular mortality CVD patients, net of statins. In the same population, statins reduced CVD death risk only in combination with MD. Low-grade inflammation, rather than lipids, is likely to be on the pathway of the interaction between MD and statins towards mortality risk.
KW - Adult
KW - Aged
KW - Cardiovascular Diseases/mortality
KW - Diet, Mediterranean
KW - Female
KW - Follow-Up Studies
KW - Humans
KW - Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use
KW - Italy/epidemiology
KW - Male
KW - Middle Aged
KW - Population Surveillance/methods
KW - Prospective Studies
KW - Risk Assessment/methods
KW - Risk Factors
KW - Secondary Prevention/methods
KW - Survival Rate/trends
KW - Time Factors
U2 - 10.1016/j.ijcard.2018.11.117
DO - 10.1016/j.ijcard.2018.11.117
M3 - Article
C2 - 30527993
VL - 276
SP - 248
EP - 254
JO - International Journal of Cardiology
JF - International Journal of Cardiology
SN - 0167-5273
ER -