title: Lifestyle, Mediterranean diet and survival in European post-myocardial infarction patients.
abstract: BACKGROUND
  The extent and benefits of adherence to lifestyle and dietary recommendations in secondary prevention are largely unknown.
  
  
  METHODS
  We examined the frequency of healthy dietary and lifestyle behaviours and their impact on survival in post-myocardial infarction (MI) patients in a prospective cohort study of elderly Europeans.
  
  
  METHODS
  Adherence to a Mediterranean-type diet was measured with a modified Mediterranean Diet Score (MDS) on an eight-point scale.
  
  
  RESULTS
  Participants were 426 men and women, aged 70 years or more, from 10 European countries, with a history of MI. During 10 years of follow-up mortality was 53%. Frequency of non-smoking behaviour (85%), moderate to vigorous physical activity (54%), moderate alcohol consumption (45%) and a Mediterranean-type diet (63%) in patients differed only marginally as compared with 'healthy' elderly. The median MDS in patients from northern Europe was two points lower than in southern Europe. Non-smoking [hazards ratio (HR) 0.62; 95% confidence interval (95% CI) 0.44-0.88], physical activity (HR 0.69; 95% CI 0.53-0.90), moderate alcohol consumption (HR 0.77; 95% CI 0.58-1.02) and a Mediterranean-type diet (HR 0.75; 95% CI 0.57-0.97) were associated with lower all-causes mortality. Presence of at least three healthy behaviours was associated with 40% lower mortality.
  
  
  CONCLUSIONS
  There is a strong relationship between lifestyle and dietary habits and mortality in post-MI patients. The findings implicate that substantial health gain can be obtained by better adherence to dietary and lifestyle recommendations.
authors.affiliation: Julius Center for Health Sciences and Primary Care, Department for Nutritional Sciences, University Medical Center Utrecht, Utrecht, The Netherlands. j.iestra@umcutrecht.nl
authors.forename: Jolein
authors.initials: J
authors.lastname: Iestra
authors.forename: Kim
authors.initials: K
authors.lastname: Knoops
authors.forename: Daan
authors.initials: D
authors.lastname: Kromhout
authors.forename: Lisette
authors.initials: L
authors.lastname: de Groot
authors.forename: Diederick
authors.initials: D
authors.lastname: Grobbee
authors.forename: Wija
authors.initials: W
authors.lastname: van Staveren
mesh_terms: D000368:Aged; D000428:Alcohol Drinking / Q000453:epidemiology; D016009:Chi-Square Distribution; D038441:Diet, Mediterranean; D005060:Europe / Q000453:epidemiology; D015444:Exercise; D005260:Female; D006801:Humans; D008019:Life Style; D008297:Male; D009203:Myocardial Infarction / Q000401:mortality* / Q000517:prevention & control*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D044465:White People