title: Relationship between Mediterranean diet and time in therapeutic range in atrial fibrillation patients taking vitamin K antagonists.
abstract: OBJECTIVE
  It is unclear if atrial fibrillation (AF) patients treated with oral vitamin K antagonists (VKAs) must follow a specific diet to avoid interference with anticoagulation. The aim of this study was to assess if Mediterranean diet (Med-Diet) may affect quality of anticoagulation, as expressed by the time in therapeutic range (TTR).
  
  
  RESULTS
  A prospective observational study including 553 non-valvular AF patients. Time in therapeutic range was calculated for all patients treated with VKAs, and adherence to Med-Diet was evaluated with a validated nine-item dietary questionnaire. Cardiovascular events (CVEs), such as cardiovascular death and fatal/non-fatal stroke or myocardial infarction, and bleedings were recorded. The median follow-up was 31.6 months. The median number of international normalized ratios for each patient was 63.0 (35.0-98.0) and 38 730 blood samples were analysed. In the whole cohort, the mean TTR was 65.5 ± 17.8%. The mean Med-Diet score was 5.19 ± 1.6, with frequent use of olive oil (90.1%), fruits (88.4%), and vegetables (69.3%) and low meat intake (71.2%). There were no differences among tertiles of Med-Diet score regarding TTR. A multivariable linear regression analysis showed that diabetes (β: -0.105, P = 0.015) and the use of angiotensin converting enzyme inhibitor/angiotensin receptor blockers (β: 0.153, P < 0.001) were associated with TTR. Compared with those without, AF patients with a CVE had significantly lower TTR (65.9 ± 17.9 vs. 59.6 ± 15.9, P = 0.029) and Med-Diet score (5.2 ± 1.5 vs. 4.4 ± 1.9, P = 0.004). A reduction of CVE was observed for each point of the Med-Diet score (hazard ratio 0.790, P = 0.017).
  
  
  CONCLUSIONS
  In our cohort of AF patients, Med-Diet is not associated with changes in TTR, and thus can be recommended for AF patients who are taking VKAs.
authors.affiliation: Center of Atherothrombosis, I Medical Clinic, Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Umberto I Policlinic of Rome, I Clinica Medica, Viale del Policlinico 155, Rome 00161, Italy.
authors.forename: Pasquale
authors.initials: P
authors.lastname: Pignatelli
authors.affiliation: Center of Atherothrombosis, I Medical Clinic, Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Umberto I Policlinic of Rome, I Clinica Medica, Viale del Policlinico 155, Rome 00161, Italy.
authors.forename: Daniele
authors.initials: D
authors.lastname: Pastori
authors.affiliation: Center of Atherothrombosis, I Medical Clinic, Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Umberto I Policlinic of Rome, I Clinica Medica, Viale del Policlinico 155, Rome 00161, Italy.
authors.forename: Tommasa
authors.initials: T
authors.lastname: Vicario
authors.affiliation: Center of Atherothrombosis, I Medical Clinic, Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Umberto I Policlinic of Rome, I Clinica Medica, Viale del Policlinico 155, Rome 00161, Italy.
authors.forename: Tommaso
authors.initials: T
authors.lastname: Bucci
authors.affiliation: Center of Atherothrombosis, I Medical Clinic, Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Umberto I Policlinic of Rome, I Clinica Medica, Viale del Policlinico 155, Rome 00161, Italy.
authors.forename: Maria
authors.initials: M
authors.lastname: Del Ben
authors.affiliation: Center of Atherothrombosis, I Medical Clinic, Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Umberto I Policlinic of Rome, I Clinica Medica, Viale del Policlinico 155, Rome 00161, Italy.
authors.forename: Roberta
authors.initials: R
authors.lastname: Russo
authors.affiliation: Center of Atherothrombosis, I Medical Clinic, Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Umberto I Policlinic of Rome, I Clinica Medica, Viale del Policlinico 155, Rome 00161, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Tanzilli
authors.affiliation: Center of Atherothrombosis, I Medical Clinic, Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Umberto I Policlinic of Rome, I Clinica Medica, Viale del Policlinico 155, Rome 00161, Italy.
authors.forename: Maria Lavinia
authors.initials: ML
authors.lastname: Nardoni
authors.affiliation: Center of Atherothrombosis, I Medical Clinic, Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Umberto I Policlinic of Rome, I Clinica Medica, Viale del Policlinico 155, Rome 00161, Italy.
authors.forename: Simona
authors.initials: S
authors.lastname: Bartimoccia
authors.affiliation: Center of Atherothrombosis, I Medical Clinic, Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Umberto I Policlinic of Rome, I Clinica Medica, Viale del Policlinico 155, Rome 00161, Italy.
authors.forename: Cristina
authors.initials: C
authors.lastname: Nocella
authors.affiliation: Center of Atherothrombosis, I Medical Clinic, Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Umberto I Policlinic of Rome, I Clinica Medica, Viale del Policlinico 155, Rome 00161, Italy.
authors.forename: Domenico
authors.initials: D
authors.lastname: Ferro
authors.affiliation: Center of Atherothrombosis, I Medical Clinic, Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Umberto I Policlinic of Rome, I Clinica Medica, Viale del Policlinico 155, Rome 00161, Italy.
authors.forename: Mirella
authors.initials: M
authors.lastname: Saliola
authors.affiliation: Center of Atherothrombosis, I Medical Clinic, Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Umberto I Policlinic of Rome, I Clinica Medica, Viale del Policlinico 155, Rome 00161, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Cangemi
authors.affiliation: University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, UK.
authors.forename: Gregory Y H
authors.initials: GY
authors.lastname: Lip
authors.affiliation: Center of Atherothrombosis, I Medical Clinic, Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Umberto I Policlinic of Rome, I Clinica Medica, Viale del Policlinico 155, Rome 00161, Italy francesco.violi@uniroma1.it.
authors.forename: Francesco
authors.initials: F
authors.lastname: Violi
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage*; D001281:Atrial Fibrillation / Q000401:mortality* / Q000628:therapy*; D015897:Comorbidity; D038441:Diet, Mediterranean / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D015995:Prevalence; D012307:Risk Factors; D015996:Survival Rate; D013923:Thromboembolism / Q000401:mortality / Q000517:prevention & control*; D016896:Treatment Outcome; D014812:Vitamin K / Q000037:antagonists & inhibitors*
chemical_list: D000925:Anticoagulants; D014812:Vitamin K
keywords: Atrial fibrillation; Cardiovascular events; Food–drug interaction; Mediterranean diet; Time in therapeutic range; Vitamin K