title: Association between behavior-dependent cardiovascular risk factors and asymptomatic carotid atherosclerosis in a general population.
abstract: OBJECTIVE
  Physical inactivity and unfavorable dietary and lifestyle patterns are related to cardiovascular disease and premature death. Their relationship to atherosclerosis of the carotid arteries and subsequent stroke is unclear. The objective of this study was to investigate the association between those behavioral cardiovascular risk factors and asymptomatic atherosclerosis of the carotid arteries in a population of former East Germany.
  
  
  METHODS
  The Study of Health in Pomerania (SHIP) is a cross-sectional survey in northeast Germany. In 1632 individuals aged 45 to 70 years, high-resolution B-mode ultrasound was used to assess the mean intima-media thickness of the right and left common carotid arteries. Carotid plaques and stenosis were recorded. Physical activity, dietary patterns, and cardiovascular risk factors were assessed in interviews with the use of standardized scales. Physically active participants with optimal dietary patterns were classified in the optimal lifestyle group, and those inactive with unfavorable diet were classified in the unfavorable group.
  
  
  RESULTS
  After adjustment for sex and age, significant decreasing trends were found for both intima-media thickness and severe asymptomatic atherosclerosis from unfavorable to optimal lifestyle patterns in never smokers but not in smokers. Regression analysis revealed an increased risk of severe asymptomatic atherosclerosis in subjects with an unfavorable lifestyle pattern compared with those with an optimal pattern (odds ratio 2.68; 95% CI, 1.13 to 6.37), following a significant linear trend.
  
  
  CONCLUSIONS
  Physical activity and optimal diet are associated with reduced risk of early atherosclerosis in subjects who never smoked, while no benefit of an otherwise optimal lifestyle is observed in smokers.
authors.affiliation: Institute of Epidemiology and Social Medicine, Department of Neurology, Ernst-Moritz-Arndt University of Greifswald, Germany.
authors.forename: Jan
authors.initials: J
authors.lastname: Luedemann
authors.forename: Ulf
authors.initials: U
authors.lastname: Schminke
authors.forename: Klaus
authors.initials: K
authors.lastname: Berger
authors.forename: Marion
authors.initials: M
authors.lastname: Piek
authors.forename: Stefan N
authors.initials: SN
authors.lastname: Willich
authors.forename: Angela
authors.initials: A
authors.lastname: Döring
authors.forename: Ulrich
authors.initials: U
authors.lastname: John
authors.forename: Christof
authors.initials: C
authors.lastname: Kessler
mesh_terms: D000368:Aged; D001519:Behavior / Q000145:classification; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology*; D017536:Carotid Artery, Common / Q000000981:diagnostic imaging; D015984:Causality; D015897:Comorbidity; D003430:Cross-Sectional Studies; D004032:Diet / Q000706:statistics & numerical data*; D015444:Exercise; D005247:Feeding Behavior / Q000145:classification; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010809:Physical Fitness; D018570:Risk Assessment; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology*; D017539:Tunica Intima / Q000000981:diagnostic imaging; D017540:Tunica Media / Q000000981:diagnostic imaging; D014463:Ultrasonography