Georgia-Maria Kouli

Modeling anthropometric indices in relation to 10-year (2002-2012) incidence of cardiovascular disease, among apparently healthy individuals: the ATTICA study

AIMS Body fat accumulation is implicated in the development of cardiovascular disease (CVD). Our objective was to explore potential associations between anthropometric indices and the 10-year CVD incidence in Greek adults without previous CVD. METHODS During 2001-2, we enrolled 3042 adults without CVD from the general population of Attica, Greece. In 2011-2, the 10-year study follow-up was performed, recording the CVD incidence in 1958 participants with baseline body mass index (BMI) ≥18.5kg/m2. RESULTS The study 10-year CVD incidence was 15.8%, exhibiting a gradual increase according to the baseline body mass index (BMI) category. Baseline BMI ≥30kg/m2 was related with significantly higher 10-year CVD risk compared to BMI <25kg/m2, even after adjustment for age and other known CVD risk factors. Baseline BMI, waist circumference, waist-to-hip ratio, waist-to-height ratio and waist-to-hip-to-height ratio were independently associated with the 10-year CVD risk in multi-adjusted models. Gender-specific analyses showed that these associations were more evident in men compared to women, with baseline BMI exhibiting an independent association with the 10-year CVD incidence in men. CONCLUSIONS Our results indicate that even simple anthropometric indices exhibit independent associations with CVD risk in a representative sample of the Greek general population without previous CVD.

Beer, wine consumption, and 10-year CVD incidence: the ATTICA study

Background/objectivesLow/moderate alcohol consumption seems to be protective against cardiovascular disease (CVD). This study aimed to investigate the association of wine/beer consumption with the 10-year CVD incidence.Subjects/methodsDuring 2001–2002, 3042 CVD-free adults consented to participate in the ATTICA study; of them 2583 completed the 10-year follow-up (85% participation rate), but precise information about fatal/nonfatal CVD incidence (myocardial infarction, angina pectoris, cardiac ischemia, heart failure, chronic arrhythmias, and stroke) was available in 2020 participants (overall retention rate 66%). Alcohol/ethanol intake and the alcoholic beverages consumed were assessed; participants were categorized into three groups (no use; ≤1 glass/week; >1 glass/week).ResultsAlcohol drinking was reported by 56% of the participants who did not develop a CVD event and 49% of those who had (p = 0.04); whereas ethanol intake was 14 ± 16 g among those who did not had an event vs. 21 ± 18 g among those who had a CVD event (p < 0.001). A strong inverse and similar association between low wine/beer intake (≤1 glass/week) and the risk of developing CVD was observed [HR: 0.40, 95% confidence interval (CI): 0.17–0.98; and HR: 0.43, 95% CI: 0.20–0.93, respectively], as compared to abstention. No significant association was found in participants exceeding drinking 1 glass/week compared with abstainers. Compared to <2 g/day ethanol intake, participants who reported 2–10, 10–20, and >20 g/day had CVD-risk HRs (95% CI) of 0.60 (0.40–0.98), 1.22 (0.60–1.14), and 1.81 (0.70–4.61), respectively.ConclusionsThis study revealed similar results of low wine/beer consumption against CVD incidence, mainly due to its implication on low-grade chronic inflammation.

Lipid accumulation product in relation to 10-year cardiovascular disease incidence in Caucasian adults: The ATTICA study

BACKGROUND AND AIMS The lipid accumulation product (LAP) is an index describing lipid over-accumulation based on waist circumference (WC) and fasting triglycerides, and can outperform the body mass index (BMI) in recognizing cardiovascular disease (CVD) risk. We aimed to explore the association of LAP with long-term CVD risk and compare its CVD-predictive value against common anthropometric indices/ratios of obesity. METHODS ATTICA is a prospective, population-based cohort that recruited 3042 adults without pre-existing CVD from the Greek general population (age 18-89 years; 1514 men). The 10-year study follow-up (2011-2012) captured the fatal/non-fatal CVD incidence in 2020 participants (50% men). Baseline LAP (cm·mmol/L) was calculated and analyzed in relation to the 10-year CVD incidence. RESULTS In total, 317 CVD cases (15.7%) were documented during the follow-up. Baseline LAP showed a significant positive association with the 10-year CVD incidence, even after adjusting for hypertension, diabetes, hypercholesterolemia, smoking, physical activity, Mediterranean diet adherence, and key pro-inflammatory biomarkers (Hazard Ratios per 10 cm·mmol/L of LAP ranging from 1.1 to 1.21, p = 0.04). Moreover, LAP predicted the 10-year CVD study incidence better than common obesity indices (BMI, WC, waist-to-hip, waist-to-height ratio). CONCLUSIONS These findings support a positive association between LAP and long-term CVD incidence in CVD-free Caucasian adults from the general population.

Reply to Letter to the Editor to J-shaped relationship between habitual coffee consumption and 10-year (2002–2012) cardiovascular disease incidence: the ATTICA study

does not provide any essential macro or micro-nutrients, that caffeine intake has been often associated with harmful health effects and coffee drinking is often considered as a component of unhealthy behaviours, including smoking and sedentary lifestyle, we strongly believe that abstinence should be the value of reference in such analyses. We definitely agree that continuous variables compared to categorical ones allow better degrees of freedom in many, but not all types of analyses. Especially for coffee consumption and CVD risk, it has been reported that they do not have a linear relationship; thus, the classification in common drinking groups is the optimal way to test this research hypothesis. In addition, and from a public health perspective, providing real intake-based analyses, it makes the conclusions more comprehensible in daily life. Moreover, in this paper, consistently with all the ATTCA study papers, a composite CVD endpoint due to the relatively low 10-year incidence observed of specific CVD manifestations was generated (i.e., acute myocardial infarction, stroke, unstable angina, heart failure) [5]. This should not be seen as a limitation, but as strength of the study, especially from a methodological point of view, where the number of events is a key player in establishing robust effect estimates through statistical analyses. Finally, the fact that only baseline measurements were used in the analysis, as risk factors or potential mediators between the exposure and the 10-year CVD incidence, is a very common approach in prospective studies. It would be great if in epidemiologic studies we had continuous monitoring of participants’ characteristics, but this was not the case. Nevertheless, this has already been acknowledged as a limitation in the discussion section of the paper [1]. Conclusively, coffee consumption seems to play complex and multiple roles in CVD risk that may partially explain the contradictory findings reported by previous Dear Editor,