title: A Mediterranean diet and risk of myocardial infarction, heart failure and stroke: A population-based cohort study.
abstract: OBJECTIVE
  The Mediterranean diet, which is palatable and easily achievable, has been associated with lower all-cause and cardiovascular disease (CVD) incidence and mortality. Data on heart failure (HF) and stroke types are lacking. The aim was to examine a Mediterranean diet in relation to incidence of myocardial infarction (MI), HF and stroke types in a Swedish prospective cohort.
  
  
  METHODS
  In a population-based cohort of 32,921 women, diet was assessed through a self-administered questionnaire. The modified Mediterranean diet (mMED) score was created based on high consumption of vegetables, fruits, legumes, nuts, whole grains, fermented dairy products, fish and monounsaturated fat, moderate intakes of alcohol and low consumption of red meat, on a 0-8 scale. Relative risks (RR) with 95% confidence intervals (CI), adjusted for potential confounders, were estimated by Cox proportional hazards regression models.
  
  
  RESULTS
  During 10 y of follow-up (1998-2008), 1109 MIs, 1648 HFs, 1270 ischemic strokes and 262 total hemorrhagic strokes were ascertained. A high adherence to the mMED score (6-8), compared to low, was associated with a lower risk of MI (RR: 0.74, 95% CI: 0.61-0.90, p = 0.003), HF (RR: 0.79, 95% CI: 0.68-0.93, p = 0.004) and ischemic stroke (RR: 0.78, 95% CI: 0.65-0.93, p = 0.007), but not hemorrhagic stroke (RR: 0.88, 95% CI: 0.61-1.29, p = 0.53).
  
  
  CONCLUSIONS
  Better adherence to a Mediterranean diet was associated with lower risk of MI, HF and ischemic stroke. The Mediterranean diet is most likely to be beneficial in primary prevention of all major types of atherosclerosis-related CVD.
authors.affiliation: Unit of Nutritional Epidemiology, Institute of Environmental Medicine (IMM), Karolinska Institutet, Nobels väg 13, Box 210, SE-171 77, Stockholm, Sweden. Electronic address: thanasis.tektonidis@ki.se.
authors.forename: Thanasis G
authors.initials: TG
authors.lastname: Tektonidis
authors.affiliation: Unit of Nutritional Epidemiology, Institute of Environmental Medicine (IMM), Karolinska Institutet, Nobels väg 13, Box 210, SE-171 77, Stockholm, Sweden. Electronic address: Agneta.Akesson@ki.se.
authors.forename: Agneta
authors.initials: A
authors.lastname: Åkesson
authors.affiliation: Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd University Hospital, Stockholm, Sweden; Unit of Cardiovascular Epidemiology, Institute of Environmental Medicine (IMM), Karolinska Institutet, Nobels väg 13, Box 210, SE-171 77, Stockholm, Sweden. Electronic address: Bruna.Gigante@ki.se.
authors.forename: Bruna
authors.initials: B
authors.lastname: Gigante
authors.affiliation: Unit of Nutritional Epidemiology, Institute of Environmental Medicine (IMM), Karolinska Institutet, Nobels väg 13, Box 210, SE-171 77, Stockholm, Sweden. Electronic address: Alicja.Wolk@ki.se.
authors.forename: Alicja
authors.initials: A
authors.lastname: Wolk
authors.affiliation: Unit of Nutritional Epidemiology, Institute of Environmental Medicine (IMM), Karolinska Institutet, Nobels väg 13, Box 210, SE-171 77, Stockholm, Sweden. Electronic address: Susanna.Larsson@ki.se.
authors.forename: Susanna C
authors.initials: SC
authors.lastname: Larsson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D050197:Atherosclerosis / Q000175:diagnosis / Q000517:prevention & control; D038441:Diet, Mediterranean; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000175:diagnosis* / Q000517:prevention & control; D006470:Hemorrhage; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000517:prevention & control; D011322:Primary Prevention; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis* / Q000517:prevention & control; D011795:Surveys and Questionnaires; D013548:Sweden
keywords: Cardiovascular disease; Heart failure; Mediterranean diet; Myocardial infarction; Primary prevention; Prospective studies; Stroke