Evaluating the role of Mediterranean diet and eating behaviors on the likelihood of having a non-fatal acute coronary syndrome, under the context of stress perception: a case-control study.
OBJECTIVE
Mediterranean diet and perceived stress have long been associated with the likelihood of having an acute coronary syndrome (ACS). The aim of this study was to evaluate whether the Mediterranean diet and other eating behaviors mediate and/or moderate the unfavorable impact of perceived stress on the likelihood of having a non-fatal ACS.


METHODS
This is a case-control study with individuals matched by age and sex. A total of 250 consecutive patients (60±11 years, 78% men) with a first ACS and 250 population-based, control subjects (60±8.6 years, 77.6% men) were enrolled. Perceived stress levels were evaluated with the Perceived Stress Scale (PSS-14; range 0-14), and adherence to the Mediterranean diet was assessed by the MedDietScore (range 0-55). Stress eating, eating heavy meals and eating alone were also evaluated.


RESULTS
For each unit increase in the PSS-14, the likelihood of having an ACS increased by 14% (95% confidence interval (CI)=1.10, 1.18). Stratified analysis by Mediterranean diet adherence level revealed a similar association of PSS-14 with ACS likelihood between the low-to-moderate and moderate-to-high adherence groups (that is, odds ratio (OR)=1.15, 95% CI=1.09, 1.21 and OR=1.13, 95% CI=1.07, 1.80, respectively). Stress eating and eating alone were positively associated with the likelihood of having an ACS (OR=1.31, 95% CI=0.97, 1.77 and OR=1.36, 95% CI=1.08, 1.69, respectively). Eating heavy meals was not associated with ACS (OR=1.08, 95% CI=0.82, 1.41); no mediating or moderating effect of these behaviors on perceived stress ACS was observed.


CONCLUSIONS
The highly significant impact of perceived stress on ACS likelihood was not mediated or moderated by the level of adherence to the Mediterranean diet or other eating behaviors, underlying the strong effect of this psychological disorder on ACS.
Department of Cardiology, School of Medicine, University of Thessaly, Larissa, Greece.
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Katsarou
Department of Cardiology, School of Medicine, University of Thessaly, Larissa, Greece.
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Triposkiadis
Department of Cardiology, School of Medicine, University of Thessaly, Larissa, Greece.
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Skoularigis
First Department of Psychiatry, Eginition Hospital, School of Medicine, University of Athens, Athens, Greece.
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Papageorgiou
Department of Nutrition and Dietetics, Harokopio, University, Athens, Greece.
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Panagiotakos
D054058:Acute Coronary Syndrome / Q000209:etiology* / Q000517:prevention & control; D000368:Aged; D016022:Case-Control Studies; D038441:Diet, Mediterranean; D002149:Energy Intake; D005247:Feeding Behavior; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012307:Risk Factors; D013315:Stress, Psychological / Q000150:complications*