title: The Mediterranean-style dietary pattern and mortality among men and women with cardiovascular disease.
abstract: BACKGROUND
  The role of the Mediterranean diet among individuals with previous cardiovascular disease (CVD) is uncertain.
  
  
  OBJECTIVE
  The aim of this study was to assess the association between the Alternate Mediterranean Diet (aMED) score and all-cause, cardiovascular, and cancer mortality in men and women with CVD from the Health Professionals Follow-Up Study and the Nurses' Health Study.
  
  
  METHODS
  This study included 6137 men and 11,278 women with myocardial infarction, stroke, angina pectoris, coronary bypass, and coronary angioplasty. Diet was first assessed in 1986 for men and in 1980 for women with a food-frequency questionnaire (FFQ) and then repeatedly every 2-4 y. Cumulative consumption was calculated with all available FFQs from the diagnosis of CVD to the end of the follow-up in 2008.
  
  
  RESULTS
  During a median follow-up of 7.7 y (IQR: 4.2-11.8) for men and 5.8 y (IQR: 3.8-8.0) for women, we documented 1982 deaths (1142 from CVD and 344 from cancer) among men and 1468 deaths (666 from CVD and 197 from cancer) among women. In multivariable Cox regression models, the pooled RR of all-cause mortality from a comparison of the top with the bottom quintiles of the aMED score was 0.81 (95% CI: 0.72, 0.91; P-trend < 0.001). The corresponding pooled RR for CVD mortality was 0.85 (95% CI: 0.67, 1.09; P-trend = 0.30), for cancer mortality was 0.85 (95% CI: 0.65, 1.11; P-trend = 0.10), and for other causes was 0.79 (95% CI: 0.65, 0.97; P-trend = 0.01). A 2-point increase in adherence to the aMED score was associated with a 7% (95% CI: 3%, 11%) reduction in the risk of total mortality.
  
  
  CONCLUSIONS
  Adherence to a Mediterranean-style dietary pattern was associated with lower all-cause mortality in individuals with CVD.
authors.affiliation: Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain (EL-G and FR-A); CIBER of Epidemiology and Public Health (EL-G and FR-A) and the Departments of Nutrition (TYL, TTF, SL, WCW, EBR, and FBH) and Epidemiology (WCW, EBR, and FBH), Harvard School of Public Health, Boston, MA; the Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (TYL, WCW, EBR, and FBH); and the Programs in Nutrition, Simmons College, Boston, MA (TTF).
authors.forename: Esther
authors.initials: E
authors.lastname: Lopez-Garcia
authors.forename: Fernando
authors.initials: F
authors.lastname: Rodriguez-Artalejo
authors.forename: Tricia Y
authors.initials: TY
authors.lastname: Li
authors.forename: Teresa T
authors.initials: TT
authors.lastname: Fung
authors.forename: Shanshan
authors.initials: S
authors.lastname: Li
authors.forename: Walter C
authors.initials: WC
authors.lastname: Willett
authors.forename: Eric B
authors.initials: EB
authors.lastname: Rimm
authors.forename: Frank B
authors.initials: FB
authors.lastname: Hu
mesh_terms: D000328:Adult; D000368:Aged; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000401:mortality* / Q000517:prevention & control*; D038441:Diet, Mediterranean; D005247:Feeding Behavior; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009369:Neoplasms / Q000401:mortality / Q000517:prevention & control; D015596:Nutrition Assessment; D010349:Patient Compliance; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011795:Surveys and Questionnaires