Highlights
- •Mediterranean diet (MD) is associated with lower risk of death in CVD patients.
- •Statins reduce CVD death risk only in combination with Mediterranean diet.
- •Inflammation is likely to be on the pathway of the interaction of MD and statins.
- •Combination of MD and statins may be an optimal option for secondary prevention.
Abstract
Background
Statins are prescribed for patients with cardiovascular disease (CVD), along with
the recommendation of adopting healthy diets. We evaluated the independent and the
combined effect of statins and Mediterranean diet (MD) towards mortality risk in patients
with previous CVD by using real-life data from a population-based prospective cohort.
Methods
Longitudinal analysis on 1180 subjects (mean age 67.7 ± 10) with prior CVD at enrollment
in the Moli-sani Study and followed up for 7.9 y (median). Adherence to MD was appraised
by a Mediterranean diet score. Hazard ratios (HR) with 95% confidence intervals (95%
CI) were calculated by multivariable Cox regression and competing risk models.
Results
Multivariable risk estimates associated with a 2-point increase in MD score were 0.84
(95% CI 0.70–1.00), 0.77 (0.61–0.97) and 0.70 (0.52–0.93) for overall, cardiovascular
and coronary artery disease (CAD)/cerebrovascular deaths, respectively. Statins were
not associated with death risk. Subjects combining statins and average-high adherence
to MD had much lower than expected risk of cardiovascular and CAD/cerebrovascular
mortality (p for interaction = 0.045 and 0.0015, respectively) as compared to those
neither using statins nor having average-high MD.
The combination of average-high MD and statins was associated in a likely synergistic
way with reduced low-grade inflammation, but not with blood cholesterol.
Conclusions
MD lowered the risk of all-cause, cardiovascular and CAD/cerebrovascular mortality
CVD patients, net of statins. In the same population, statins reduced CVD death risk
only in combination with MD. Low-grade inflammation, rather than lipids, is likely
to be on the pathway of the interaction between MD and statins towards mortality risk.
Keywords
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Article info
Publication history
Published online: November 24, 2018
Accepted:
November 23,
2018
Received in revised form:
November 7,
2018
Received:
June 13,
2018
Identification
Copyright
© 2018 Elsevier B.V. All rights reserved.
