title: Mediterranean Alcohol-Drinking Pattern and the Incidence of Cardiovascular Disease and Cardiovascular Mortality: The SUN Project.
abstract: BACKGROUND
  We assessed the still unclear effect of the overall alcohol-drinking pattern, beyond the amount of alcohol consumed, on the incidence of cardiovascular clinical disease (CVD).
  
  
  METHODS
  We followed 14,651 participants during up to 14 years. We built a score assessing simultaneously seven dimensions of alcohol consumption to capture the conformity to a traditional Mediterranean alcohol-drinking pattern (MADP). It positively scored moderate alcohol intake, alcohol intake spread out over the week, low spirit consumption, preference for wine, red wine consumption, wine consumed during meals and avoidance of binge drinking.
  
  
  RESULTS
  During 142,177 person-years of follow-up, 127 incident cases of CVD (myocardial infarction, stroke or cardiovascular mortality) were identified. Compared with the category of better conformity with the MADP, the low-adherence group exhibited a non-significantly higher risk (HR) of total CVD ((95% CI) = 1.55 (0.58-4.16)). This direct association with a departure from the traditional MADP was even stronger for cardiovascular mortality (HR (95% CI) = 3.35 (0.77-14.5)). Nevertheless, all these associations were statistically non-significant.
  
  
  CONCLUSIONS
  Better conformity with the MADP seemed to be associated with lower cardiovascular risk in most point estimates; however, no significant results were found and more powered studies are needed to clarify the role of the MADP on CVD.
authors.affiliation: Department of Cardiology, Clínica Universidad de Navarra, 31009 Pamplona, Spain. aitorhernandez86@gmail.com.|Department of Preventive Medicine and Public Health, School of Medicine, University of Navarra, 31008 Pamplona, Spain. aitorhernandez86@gmail.com.
authors.forename: Aitor
authors.initials: A
authors.lastname: Hernandez-Hernandez
authors.affiliation: Department of Preventive Medicine and Public Health, School of Medicine, University of Navarra, 31008 Pamplona, Spain. ageas@unav.es.|CIBER Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, 28029 Madrid, Spain. ageas@unav.es.|IdiSNA, Navarra Institute for Health Research, 31008 Pamplona, Navarra, Spain. ageas@unav.es.
authors.forename: Alfredo
authors.initials: A
authors.lastname: Gea
authors.affiliation: Department of Preventive Medicine and Public Health, School of Medicine, University of Navarra, 31008 Pamplona, Spain. mbes@unav.es.|CIBER Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, 28029 Madrid, Spain. mbes@unav.es.|IdiSNA, Navarra Institute for Health Research, 31008 Pamplona, Navarra, Spain. mbes@unav.es.
authors.forename: Miguel
authors.initials: M
authors.lastname: Ruiz-Canela
authors.affiliation: Department of Preventive Medicine and Public Health, School of Medicine, University of Navarra, 31008 Pamplona, Spain. etoledo@unav.es.|CIBER Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, 28029 Madrid, Spain. etoledo@unav.es.|IdiSNA, Navarra Institute for Health Research, 31008 Pamplona, Navarra, Spain. etoledo@unav.es.
authors.forename: Estefania
authors.initials: E
authors.lastname: Toledo
authors.affiliation: Department of Clinical Sciences, School of Biomedical and Health Sciences, Universidad Europea de Madrid, Laureate International Universities, 28029 Madrid, Spain. jjbeunza@unav.es.
authors.forename: Juan-José
authors.initials: JJ
authors.lastname: Beunza
authors.affiliation: Department of Preventive Medicine and Public Health, School of Medicine, University of Navarra, 31008 Pamplona, Spain. mbes@unav.es.|CIBER Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, 28029 Madrid, Spain. mbes@unav.es.|IdiSNA, Navarra Institute for Health Research, 31008 Pamplona, Navarra, Spain. mbes@unav.es.
authors.forename: Maira
authors.initials: M
authors.lastname: Bes-Rastrollo
authors.affiliation: Department of Preventive Medicine and Public Health, School of Medicine, University of Navarra, 31008 Pamplona, Spain. mamartinez@unav.es.|CIBER Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, 28029 Madrid, Spain. mamartinez@unav.es.|IdiSNA, Navarra Institute for Health Research, 31008 Pamplona, Navarra, Spain. mamartinez@unav.es.
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Martinez-Gonzalez
mesh_terms: D000328:Adult; D000428:Alcohol Drinking; D000434:Alcoholic Beverages; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000209:etiology / Q000401:mortality*; D038441:Diet, Mediterranean; D000431:Ethanol / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D006801:Humans; D015994:Incidence; D008019:Life Style; D008297:Male; D008875:Middle Aged; D012307:Risk Factors
chemical_list: D000431:Ethanol
keywords: Mediterranean drinking pattern; alcohol; cardiovascular disease; cardiovascular mortality; cohort studies