Mediterranean diet and carotid atherosclerosis in the Northern Manhattan Study.
OBJECTIVE
Adherence to a Mediterranean-style diet (MeDi) may protect against clinical vascular events by reducing atherosclerosis, but data is limited. This is the first observational study of the association between MeDi adherence and carotid plaque thickness and area.


METHODS
The study included 1374 participants of the population-based Northern Manhattan Study with diet assessed and carotid intima-media thickness (cIMT) and plaque measured using B-mode ultrasound (mean age 66 ± 9 years, 60% female, 60% Hispanic, 18% White, 19% Black). A MeDi adherence score (range = 0-9, 9 representing maximal adherence) was examined continuously and in quintiles (3/4/5/6-9 vs. 0-2).


RESULTS
Mean cIMT = 0.9 ± 0.1 mm and 57% had plaque (median plaque thickness = 1.5 mm, 75th percentile = 2.2; median plaque area = 4.2 mm(2), 75th percentile = 15.8). There was no association between MeDi and cIMT or plaque presence. MeDi adherence was inversely associated with the 75th percentile of plaque thickness and median of plaque area in quantile regression analyses. These associations persisted after controlling for demographics, smoking, physical activity, and total energy consumption (effect of a 1-point increase in MeDi score on the 75th percentile of plaque thickness = -0.049 mm, p = 0.03; median of plaque area = -0.371 mm(2), p = 0.03), and when additionally controlling for vascular disease biomarkers, medication use, BMI, and previous cardiac disease. The protective associations appeared strongest for those with a MeDi score of 5 (4th quintile) vs. 0-2 (bottom quintile). Differential effects of a MeDi on plaque thickness and area across race/ethnic groups was suggested.


CONCLUSIONS
Moderate and strict adherence to a MeDi may protect against a higher burden of carotid atherosclerotic plaque, which may mediate the protection against clinical vascular events. Efforts to improve adherence to a MeDi are critical to reducing the burden of atherosclerotic disease.
Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL, USA. Electronic address: hgardener@med.miami.edu.
Hannah
H
Gardener
Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL, USA.
Clinton B
CB
Wright
Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL, USA.
Digna
D
Cabral
Department of Neurology, Sergievsky Center, Taub Institute for Research in Alzheimer's Disease and the Aging Brain, Columbia University Medical Center, New York, NY, USA; Department of Social Medicine, Psychiatry, and Neurology, National and Kapodistrian University of Athens, Athens, Greece.
Nikolaos
N
Scarmeas
Department of Neurology, Sergievsky Center, Taub Institute for Research in Alzheimer's Disease and the Aging Brain, Columbia University Medical Center, New York, NY, USA.
Yian
Y
Gu
Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA.
Ken
K
Cheung
Department of Neurology, Columbia University College of Physicians and Surgeons, New York, NY, USA.
Mitchell S V
MS
Elkind
Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL, USA.
Ralph L
RL
Sacco
Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL, USA.
Tatjana
T
Rundek
D000368:Aged; D002339:Carotid Arteries / Q000000981:diagnostic imaging; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging / Q000208:ethnology / Q000517:prevention & control*; D059168:Carotid Intima-Media Thickness; D038441:Diet, Mediterranean; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009519:New York City / Q000453:epidemiology; D010349:Patient Compliance; D058226:Plaque, Atherosclerotic; D011237:Predictive Value of Tests; D065840:Protective Factors; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors
Carotid atherosclerosis; Intima-media thickness; Mediterranean diet; Plaque