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Mata-Fernández A, Hershey MS, Pastrana-Delgado JC, Sotos-Prieto M, Ruiz-Canela M, Kales SN, Martínez-González MA, Fernandez-Montero A. A Mediterranean lifestyle reduces the risk of cardiovascular disease in the "Seguimiento Universidad de Navarra" (SUN) cohort. Nutr Metab Cardiovasc Dis 2021; 31:1728-1737. [PMID: 33895077 DOI: 10.1016/j.numecd.2021.02.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 01/20/2021] [Accepted: 02/16/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUND AND AIMS A healthy lifestyle is essential to prevent cardiovascular disease (CVD). However, beyond dietary habits, there is a scarcity of studies comprehensively assessing the typical traditional Mediterranean lifestyle with a multi-dimensional index. We assessed the association between the Mediterranean lifestyle (measured with the MEDLIFE index including diet, physical activity, and other lifestyle factors) and the incidence of CVD. METHODS AND RESULTS The "Seguimiento Universidad de Navarra" (SUN) project is a prospective, dynamic and multipurpose cohort of Spanish university graduates. We calculated a MEDLIFE score, composed of 28 items on food consumption, dietary habits, physical activity, rest, social habits, and conviviality, for 18,631 participants by assigning 1 point for each typical Mediterranean lifestyle factor achieved, for a theoretically possible final score ranging from 0 to 28 points. During an average follow-up of 11.5 years, 172 CVD cases (myocardial infarction, stroke or cardiovascular death) were observed. An inverse association between the MEDLIFE score and the risk of primary cardiovascular events was observed, with multivariable-adjusted hazard ratio (HR) = 0.50; (95% confidence interval, 0.31-0.81) for the highest MEDLIFE scores (14-23 points) compared to the lowest scores (0-9 points), p (trend) = 0.004. CONCLUSION A higher level of adherence to the Mediterranean lifestyle was significantly associated with a lower risk of CVD in a Spanish cohort. Public health strategies should promote the Mediterranean lifestyle to preserve cardiovascular health.
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Affiliation(s)
- Arancha Mata-Fernández
- University of Navarra, Emergency Department, Clínica Universidad de Navarra, Pamplona, Spain
| | - Maria S Hershey
- University of Navarra, Department of Preventive Medicine and Public Health, Pamplona, Spain; Department of Environmental Health, Harvard T.H Chan School of Public Health, Boston, MA, USA
| | - Juan C Pastrana-Delgado
- University of Navarra, Department of Internal Medicine, Clínica Universidad de Navarra, Pamplona, Spain
| | - Mercedes Sotos-Prieto
- Department of Environmental Health, Harvard T.H Chan School of Public Health, Boston, MA, USA; Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, IdiPaz (Instituto de Investigación Sanitaria Hospital Universitario La Paz), and CIBERESP (CIBER of Epidemiology and Public Health), Madrid, Spain; IMDEA-Food Institute, CEI UAM+CSIC, Madrid, Spain
| | - Miguel Ruiz-Canela
- University of Navarra, Department of Preventive Medicine and Public Health, Pamplona, Spain; Biomedical Research Network Centre for Pathophysiology of Obesity and Nutrition (CIBEROBN), Carlos III Health Institute, Madrid, Spain; Navarra Institute for Health Research (IdisNa), Pamplona, Spain
| | - Stefanos N Kales
- Department of Environmental Health, Harvard T.H Chan School of Public Health, Boston, MA, USA; Department of Occupational Medicine, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, USA
| | - Miguel A Martínez-González
- University of Navarra, Department of Preventive Medicine and Public Health, Pamplona, Spain; Biomedical Research Network Centre for Pathophysiology of Obesity and Nutrition (CIBEROBN), Carlos III Health Institute, Madrid, Spain; Navarra Institute for Health Research (IdisNa), Pamplona, Spain; Department of Nutrition, Harvard T.H Chan School, Boston, MA, USA
| | - Alejandro Fernandez-Montero
- Department of Environmental Health, Harvard T.H Chan School of Public Health, Boston, MA, USA; Navarra Institute for Health Research (IdisNa), Pamplona, Spain; University of Navarra, Department of Occupational Medicine, Pamplona, Spain.
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