title: Mediterranean diet and the incidence of cardiovascular disease: a Spanish cohort.
abstract: OBJECTIVE
  The Mediterranean diet is considered a model for healthy eating. However, prospective evidence in Mediterranean countries evaluating the relationship between this dietary pattern and non-fatal cardiovascular events is scarce. The aim of the present study was to evaluate the association between the adherence to the Mediterranean diet and the incidence of fatal and non-fatal cardiovascular events among initially healthy middle-aged adults from the Mediterranean area.
  
  
  RESULTS
  We followed-up 13,609 participants (60 percent women, mean age: 38 years) initially free of cardiovascular disease (CVD) during 4.9 years. Participants were part of a prospective cohort study of university graduates from all regions of Spain. Baseline diet was assessed using a validated 136-item food-frequency questionnaire. A 9-point score was used to appraise adherence to the Mediterranean diet. Incident clinical events were confirmed by a review of medical records. We observed 100 incident cases of CVD. In multivariate analyses, participants with the highest adherence to the Mediterranean diet (score>6) exhibited a lower cardiovascular risk (hazard ratio=0.41, 95% confidence interval [CI]: 0.18-0.95) compared to those with the lowest score (<3). For each 2-point increment in the score, the adjusted hazard ratios were 0.80 (95% CI: 0.62-1.02) for total CVD and 0.74 (0.55-0.99) for coronary heart disease.
  
  
  CONCLUSIONS
  There is an inverse association between adherence to the Mediterranean diet and the incidence of fatal and non-fatal CVD in initially healthy middle-aged adults.
authors.affiliation: Department of Preventive Medicine and Public Health, Medical School-Clinica Universitaria, University of Navarra, c/ Irunlarrea, 1 Ed. Investigacion, 31080 Pamplona, Navarra, Spain. mamartinez@unav.es
authors.forename: M A
authors.initials: MA
authors.lastname: Martínez-González
authors.forename: M
authors.initials: M
authors.lastname: García-López
authors.forename: M
authors.initials: M
authors.lastname: Bes-Rastrollo
authors.forename: E
authors.initials: E
authors.lastname: Toledo
authors.forename: E H
authors.initials: EH
authors.lastname: Martínez-Lapiscina
authors.forename: M
authors.initials: M
authors.lastname: Delgado-Rodriguez
authors.forename: Z
authors.initials: Z
authors.lastname: Vazquez
authors.forename: S
authors.initials: S
authors.lastname: Benito
authors.forename: J J
authors.initials: JJ
authors.lastname: Beunza
mesh_terms: D000328:Adult; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000517:prevention & control; D015331:Cohort Studies; D003327:Coronary Disease / Q000453:epidemiology / Q000517:prevention & control; D038441:Diet, Mediterranean; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D010349:Patient Compliance; D016016:Proportional Hazards Models; D011446:Prospective Studies; D013030:Spain / Q000453:epidemiology; D011795:Surveys and Questionnaires; D055815:Young Adult