Major dietary patterns and risk of coronary heart disease in middle-aged persons from a Mediterranean country: the EPIC-Spain cohort study.
OBJECTIVE
No previous study has assessed the association between major dietary patterns and the risk of coronary heart disease (CHD) in a large cohort from a Mediterranean country.


RESULTS
We studied prospectively 40,757 persons, aged 29-69 years, participating in the Spanish cohort of the EPIC study. Food consumption was collected between 1992 and 1996 with a validated history method. Individuals were followed-up until 2004 through record linkage with hospital discharge registers, population-based registers of myocardial infarction, and mortality registers to ascertain CHD events (fatal and non-fatal acute myocardial infarction or angina requiring revascularization). Two major dietary patterns were identified from factor analysis. The first pattern was labeled as Westernized, because of the frequent consumption of refined cereals and red meat; the second was called the evolved Mediterranean pattern, because of the frequent intake of plant-based foods and olive oil. During a median follow-up of 11 years, 606 CHD events were ascertained. No association was found between the Westernized pattern and CHD risk. In contrast, the score for the evolved Mediterranean pattern was inversely associated with CHD risk (p for trend = 0.0013); when compared with the lowest quintile of the evolved Mediterranean pattern score, the multivariable hazard ratios for CHD were 0.77 (95% confidence interval 0.61-0.98) for the second quintile, 0.64 (95% CI 0.50-0.83) for the third quintile, 0.56 (95% CI 0.43-0.73) for the fourth quintile, and 0.73 (95% CI 0.57-0.94) for the fifth quintile.


CONCLUSIONS
A Mediterranean diet, as consumed in this study population, was associated with a lower risk of CHD.
Guallar-Castillón
P
P
Department of Preventive Medicine and Public Health, School of Medicine. Universidad Autónoma de Madrid, IdiPAZ, Avda. Arzobispo Morcillo, 28029 Madrid. Spain. mpilar.guallar@uam.es
Rodríguez-Artalejo
F
F
Tormo
M J
MJ
Sánchez
M J
MJ
Rodríguez
L
L
Quirós
J R
JR
Navarro
C
C
Molina
E
E
Martínez
C
C
Marín
P
P
Lopez-Garcia
E
E
Larrañaga
N
N
Huerta
J M
JM
Dorronsoro
M
M
Chirlaque
M D
MD
Buckland
G
G
Barricarte
A
A
Banegas
J R
JR
Arriola
L
L
Ardanaz
E
E
González
C A
CA
Moreno-Iribas
C
C
D000328:Adult; D000367:Age Factors; D000368:Aged; D003327:Coronary Disease / Q000453:epidemiology* / Q000401:mortality / Q000517:prevention & control*; D038441:Diet, Mediterranean; D005163:Factor Analysis, Statistical; D005247:Feeding Behavior; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D008498:Medical Record Linkage; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012042:Registries; D012111:Residence Characteristics; D018570:Risk Assessment; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D013997:Time Factors