Ekavi Georgousopoulou

Ten-year (2002–2012) cardiovascular disease incidence and all-cause mortality, in urban Greek population: The ATTICA Study

AIM The 10-year incidence of cardiovascular disease (CVD) and all-cause mortality, as well as its determinants, in a sample of men and women from Greece, was evaluated. METHODS From May 2001 to December 2002, 1514 men and 1528 women (>18y) without any clinical evidence of CVD or any other chronic disease, at baseline, living in greater Athens area, in Greece, were enrolled. In 2011-12, the 10-year follow-up was performed in 2583 participants (15% of the participants were lost to follow-up). Incidence of fatal or non-fatal CVD (coronary heart disease, acute coronary syndromes, stroke, or other CVD) was defined according to World Health Organization (WHO)-International Coding Diseases (ICD)-10 criteria. RESULTS The 10-year CVD incidence was 19.7% in men and 11.7% in women (p<0.001). Multi-adjusted analysis revealed that the determinants of CVD events were increased age (Hazard ratio (HR) per year=1.06, 95%Confidence Interval (CI): 1.04, 1.08), male sex (HR=1.40, 95%CI: 0.90, 2.19), smoking (HR=1.53, 95%CI: 1.03, 2.27), C-reactive protein levels (HR per 1mg/L=1.06, 95%CI: 1.02, 1.15), as well as adherence to Mediterranean diet (protective) (HR per 1/55 units=0.98, 95%CI: 0.95, 1.01). CONCLUSION The burden of CVD and its related risk factors is at emerging rates, in Greece, making the need for effective public health actions, more necessary than ever before.

Adherence to Mediterranean diet and 10-year incidence (2002–2012) of diabetes: correlations with inflammatory and oxidative stress biomarkers in the ATTICA cohort study

The purpose of this work was to investigate the links between oxidative stress, inflammation and coagulation and their effect on Mediterranean diet–diabetes relationship.

Effects of alcohol consumption and the metabolic syndrome on 10-year incidence of diabetes: the ATTICA study.

AIM The purpose of this prospective study was to investigate the effect of alcohol consumption on the 10-year diabetes incidence. METHODS In 2001-2002, a random sample of 1514 men (18-89 years old) and 1528 women (18-87 years old) was selected to participate in the ATTICA study (Athens metropolitan area, Greece). Among various other characteristics, average daily alcohol intakes (abstention, low, moderate, high) and type of alcoholic drink were evaluated. Diabetes was defined according to American Diabetes Association criteria. During 2011-2012, the 10-year follow-up was performed. RESULTS The 10-year incidence of diabetes was 13.4% in men and 12.4% in women. After making various adjustments, those who consumed up to 1 glass/day of alcohol had a 53% lower diabetes risk (RR=0.47; 95% CI: 0.26, 0.83) compared with abstainers, while trend analysis revealed a significant U-shaped relationship between quantity of alcohol drunk and diabetes incidence (P<0.001 for trend). Specific types of drinks were not associated with diabetes incidence; however, a one-unit increase in ratio of wine/beer/vodka vs. other spirits was associated with an 89% lower risk of diabetes (RR=0.11; 95% CI: 0.02, 0.67). The protective effect of low alcohol consumption on diabetes incidence was more prominent among individuals with stricter adherence to the Mediterranean diet (RR=0.08; 95% CI: 0.011, 0.70) and without the metabolic syndrome (RR=0.34; 95% CI: 0.16, 0.70). CONCLUSION This work revealed the protective effect of modest alcohol consumption of particularly wine and beer against the long-term incidence of diabetes, possibly due to their pleiotropic health effects.

Metabolic syndrome, adherence to the Mediterranean diet and 10-year cardiovascular disease incidence: The ATTICA study

BACKGROUND AND AIMS To better understand the metabolic syndrome (MS) spectrum through principal components analysis and further evaluate the role of the Mediterranean diet on MS presence. METHODS During 2001-2002, 1514 men and 1528 women (>18 y) without any clinical evidence of CVD or any other chronic disease, at baseline, living in greater Athens area, Greece, were enrolled. In 2011-2012, the 10-year follow-up was performed in 2583 participants (15% of the participants were lost to follow-up). Incidence of fatal or non-fatal CVD was defined according to WHO-ICD-10 criteria. MS was defined by the National Cholesterol Education Program Adult Treatment panel III (revised NCEP ATP III) definition. Adherence to the Mediterranean diet was assessed using the MedDietScore (range 0-55). RESULTS Five principal components were derived, explaining 73.8% of the total variation, characterized by the: a) body weight and lipid profile, b) blood pressure, c) lipid profile, d) glucose profile, e) inflammatory factors. All components were associated with higher likelihood of CVD incidence. After adjusting for various potential confounding factors, adherence to the Mediterranean dietary pattern for each 10% increase in the MedDietScore, was associated with 15% lower odds of CVD incidence (95%CI: 0.71-1.06). For the participants with low adherence to the Mediterranean diet all five components were significantly associated with increased likelihood of CVD incidence. However, for the ones following closely the Mediterranean pattern positive, yet not significant associations were observed. CONCLUSION Results of the present work propose a wider MS definition, while highlighting the beneficial role of the Mediterranean dietary pattern.

Exploring the path of Mediterranean diet on 10-year incidence of cardiovascular disease: The ATTICA study (2002–2012)

BACKGROUND AND AIMS A Mediterranean diet has been associated with lower all-cause and cardiovascular disease (CVD) morbidity and mortality, but the clinical and behavioral pathway has not been well understood and appreciated. The aim of this work was to explore the path between adherence to a Mediterranean-type diet, lifestyle behaviors, clinical status, and a 10-year incidence of CVD. METHODS AND RESULTS The ATTICA study was carried out in the Athens area during 2001-2002 and included 3042 participants free of CVD at baseline (49.8% men, aged 18-89). Adherence to a Mediterranean diet was assessed using the MedDietScore (range 0-55). During 2011-2012, 2583 out of the 3042 participants were found during the 10-year follow-up (15% lost to follow-up). Adherence to a Mediterranean diet decreased CVD risk (relative Risk (RR) per 1/55 unit = 0.96, 95% confidence interval (CI): 0.93, 1.00), independently of various sociodemographic, lifestyle, and clinical factors. Subgroup analyses revealed that participants with an unhealthy lifestyle (i.e., smokers, and obese and sedentary persons) remained protected from CVD through a greater adherence to a Mediterranean diet (RR for smokers = 0.92, 95%CI: 0.88, 0.97; RR for obese participants = 0.90, 95%CI: 0.82, 0.979; and RR for sedentary participants = 0.95, 95%CI: 0.90, 0.99). Path analysis revealed that adherence to a Mediterranean diet not only decreases the levels of C-reactive protein and interleukin-6 but also has an independent protective role against CVD risk per se (total effect of the MedDietScore on CVD = -0.003, 95%CI: -0.005 to 0.000). CONCLUSION Adherence to a Mediterranean diet confers a considerable reduction on CVD risk, independent of various factors. Therefore, even subjects with unhealthy lifestyle behaviors may benefit from adherence to this diet, suggesting another dimension to prevention strategies.

10-year incidence of diabetes and associated risk factors in Greece: the ATTICA study (2002-2012).

BACKGROUND The incidence of diabetes in the general population is increasing world-wide. The increase is attributed to the consumption of saturated fatty acids, obesity, lack of physical activity, genetic predisposition, and other factors, but knowledge about the reasons, biological mechanisms, and late complications is insufficient. It is therefore important to clarify the reasons more exactly through long-term clinical trials to stop the rise of diabetes and its complications. AIM To evaluate the 10-year incidence of type 2 diabetes in apparently healthy Greek adults. METHODS In 2001-2002, a random sample of 1514 men (18-87 years old) and 1528 women (18-89 years old) was selected to participate in the ATTICA study. During 2011-2012, the 10-year follow-up was performed. Patients diagnosed with diabetes at baseline (n = 210) and those lost at the 10-year follow-up (n = 1347) were excluded, yielding a final sample of 1485 participants. RESULTS During the period of investigation, diabetes was diagnosed in 191 cases corresponding to a 12.9% incidence (95%CI: 10.4-15.4), with 13.4% (95%CI: 10.8-16) in men and 12.4% (95%CI: 10.1-14.7) in women. A relative increase was observed in the second half of the 10-year follow-up when age became significant. Multiple logistic regression analysis revealed that age (OR = 1.14, 95%CI: 1.09-1.19), abnormal waist-to-height ratio (OR = 3.27, 95%CI: 1.07-10.0), fasting blood glucose (OR per 1 mg/dl = 0.05, 95%CI: 1.02-1.08), energy intake (OR per 500 kcal = 1.02, 95%CI: 1.01-1.35), and family history of diabetes (OR = 2.8, 95%CI: 1.30-6.03) were the most significant baseline predictors for diabetes, after adjusting for potential confounders. Waist-to-height ratio showed the best explanatory power of all anthropometric variables. Physical activity exerts an effect on risk factors. Being active was found to eliminate the aggravating effect of diabetes family history and fasting blood glucose. CONCLUSIONS The findings confirm the escalating increase of type 2 diabetes incidence in Greece, which is in line with global trends. A lifestyle change in individuals at risk of developing diabetes towards healthier eating and increased physical activity would be an effective and inexpensive means of reducing diabetes.

Metabolic syndrome and 10-year cardiovascular disease incidence: The ATTICA study

AIMS To evaluate the influence of metabolic syndrome (MetS) as well as inflammatory and renal markers on cardiovascular disease (CVD) incidence. METHODS AND RESULTS During 2001-2002, 1514 men and 1528 women (>18 y) without any clinical evidence of CVD or any other chronic disease, at baseline, living in greater Athens area, Greece, were enrolled. In 2011-2012, the 10-year follow-up was performed in 2583 participants (15% of the participants were lost to follow-up). Incidence of fatal or non-fatal CVD was defined according to WHO-ICD-10 criteria. MetS was defined using three definitions, provided by the National Cholesterol Education Program Adult Treatment panel III (revised NCEP ATP III), the International Diabetes Federation (IDF) or the Harmonized definition. Furthermore, the contributory predictive role of C-reactive protein (CRP), inteleukin-6, uric acid and estimated glomerular filtration rate in the aforementioned models was evaluated. History of MetS-NCEP was positively associated with CVD, adjusting for potential confounding factors (OR:1.83, 95%CI:1.24-2.72). Not statistically significant associations with CVD incidence were observed when using the IDF or the Harmonized definition. Additionally, none of the added inflammatory and renal function markers mediated the influence of MetS on CVD incidence (all ps from Sobel test >0.40). C-statistic values for the MetS definitions used exceeded 0.789 (CI:0.751-0.827), indicating fair-to-good predictive probability of the models. CONCLUSION Results of the present work revealed the negative impact of MetS-NCEP, but not of the other MetS definitions, on CVD incidence, a key-point that may help in better understanding the role of IDF and Harmonized MetS definitions on CVD.

The role of dietary patterns’ assessment in the predictive ability of cardiovascular disease risk estimation models: a review

Abstract Risk prediction scores have received much attention the past few years, especially in the primary prevention of cardiovascular disease (CVD). Although diet has been independently associated with CVD risk, its role in the accuracy of the developed scores has rarely been studied. Thus, in this review, the role of diet assessment on the performance of CVD risk scores and models was critically discussed. A computer-assisted literature search retrieved 15 relevant studies, but only two out of them evaluated the role of diet on the accuracy of the developed models; the inclusion of diet assessment improved significantly the accuracy of CVD risk models. The remaining studies suggested an independent, protective effect of healthy dietary habits on CVD risk, with an attributable risk varying from 9 to 37%. Inclusion of diet component in CVD risks scores, may increase the accuracy of the models, and better identify people at high risk.

Association of depression and anxiety status with 10-year cardiovascular disease incidence among apparently healthy Greek adults: The ATTICA Study.

Background Chronic stress frequently manifests with anxiety and/or depressive symptomatology and may have detrimental cardiometabolic effects over time. As such, recognising the potential links between stress-related psychological disorders and cardiovascular disease (CVD) is becoming increasingly important in cardiovascular epidemiology research. The primary aim of this study was to explore prospectively potential associations between clinically relevant depressive symptomatology and anxiety levels and the 10-year CVD incidence among apparently healthy Greek adults. Design A population-based, health and nutrition prospective survey. Methods In the context of the ATTICA Study (2002–2012), 853 adult participants without previous CVD history (453 men (45 ± 13 years) and 400 women (44 ± 18 years)) underwent psychological evaluations through validated, self-reporting depression and anxiety questionnaires. Results After adjustment for multiple established CVD risk factors, both reported depression and anxiety levels were positively and independently associated with the 10-year CVD incidence, with depression markedly increasing the CVD risk by approximately fourfold (adjusted odds ratio (95% confidence interval) 3.6 (1.3, 11) for depression status; 1.03 (1.0, 1.1) for anxiety levels). Conclusions Our findings indicate that standardised psychological assessments focusing on depression and anxiety should be considered as an additional and distinct aspect in the context of CVD preventive strategies that are designed and implemented by health authorities at the general population level.

Assessment of diet quality improves the classification ability of cardiovascular risk score in predicting future events: The 10-year follow-up of the ATTICA study (2002–2012):

Background In past years the prediction of cardiovascular disease (CVD) risk has received special attention; however, the presented risk models have so far not been very successful or appreciated. Design The aim of the present work was to examine whether the inclusion of a diet quality evaluation in a CVD risk prediction model is associated with the accuracy of estimating future events. Methods The working sample consisted of the 2009 ATTICA study participants (aged 18–89 years). The HellenicSCORE (a calibration of the European Society of Cardiology SCORE, based on age, gender, smoking habits, systolic blood pressure and total cholesterol) was calculated as a proxy of heart disease risk, while assessment of diet quality was based on the MedDietScore, which evaluates adherence to a Mediterranean diet. Fatal or non-fatal incidence of CVD (i.e., development of acute coronary syndromes, stroke or other CVD according to WHO-ICD-10 criteria) was calculated using the 10-year follow-up (2002–2012) data of the ATTICA study participants. Results The MedDietScore and the HellenicSCORE were significant predictors of CVD events (p < 0.05). The estimating bias (i.e., misclassification rate of cases) of the model that included only the HellenicSCORE was significantly reduced by the inclusion of MedDietScore in the risk model (Harrell’s C = 0.027, p = 0.012), improving the classification ability of the risk model by 56%. Conclusion The inclusion of dietary evaluation increased the accuracy of HellenicSCORE risk estimation and, thus, its incorporation into CVD risk prediction scores might help clinicians and public health professionals to better allocate future CVD candidates.