Predicted Skeletal Muscle Mass and 4-Year Cardiovascular Disease Incidence in Middle-Aged and Elderly Participants of IKARIA Prospective Epidemiological Study: The Mediating Effect of Sex and Cardiometabolic Factors.

The sex-specific effect of skeletal muscle mass (SMM) index (SMI) on 4-year first fatal/non-fatal cardiovascular disease (CVD) event in free-of-disease individuals was examined. In 2009, n = 1411 inhabitants (mean age = 64(12)) from Ikaria were selected. Follow-up was performed in 2013. SMI was created to reflect SMM through appendicular skeletal muscle mass (indirectly calculated through formulas) divided by body mass index (BMI). Fifteen and six tenths percent of participants exhibited CVD (19.8% in men/12% in women, p = 0.002). Significant U-shape trends were observed in participants >65 years old and women irrespective to age confirmed through multi-adjusted Cox regression analysis; in age >65 years, Hazard Ratio (HR)(2nd vs. 1st SMI tertile) = 0.80, 95% Confidence Interval (95%CI) (0.45, 0.96) and in women HR(2nd vs. 1st SMI tertile) = 0.71, 95% CI (0.33, 0.95), while, as for the 3rd SMI tertile, no significant trends were observed. Mediation analysis revealed that mediators of the aforementioned associations in men were the arterial distensibility and total testosterone, while, in women, inflammation, insulin resistance, and arterial distensibility. High SMM accompanied by obesity may not guarantee lower CVD risk. Specific cardiometabolic factors seem to explain this need for balance between lean and fat mass.

Breakfast association with arterial stiffness and carotid atherosclerotic burden. Insights from the 'Corinthia' study.

BACKGROUND AND AIMS: The role of dietary patterns, in cardiovascular diseases has been challenged. The role of breakfast as an element of balance energy intake has gained research interest. However, the effects of dietary patterns related to breakfast consumption on vascular function are unknown. We explored the association of breakfast consumption habits with arterial wall elastic properties and carotid atherosclerosis. METHODS AND RESULTS: In this cross-sectional study we enrolled 2043 inhabitants of the Corinthia region in Greece. Carotid-femoral pulse wave velocity (cf-PWV) was used to assess arterial stiffness. Carotid intima-media thickness (cIMT) was measured and the mean and the maximum cIMT were calculated. According to food frequency questionnaires, breakfast contribution in total daily energy intake (>20%; 5-20% and <5%) was estimated. Subjects were categorized as high-energy breakfast consumers (HeBC), low-energy breakfast consumers (LeBC) and those skipping breakfast (SBf) respectively. From the study population 240 subjects were categorized as HeBC, 897 as LeBC, and 681 as SBf. The mean cf-PWV was significantly higher in subjects SBf compared to LeBC and HeBC (9.35 ± 2.82 m/s vs. 9.09 ± 2.77 m/s vs. 8.76 ± 2.69 m/s, p = 0.02). The mean cIMT was significantly higher in subjects SBf compared to LeBC and HeBC (1.04 ± 0.46 mm vs. 0.99 ± 0.43 mm vs. 0.92 ± 0.39 mm, p = 0.01). Even after adjustment for potential confounders and cardiovascular risk factors SBf subjects have significantly increased mean cIMT and cf-PWV. CONCLUSION: Skipping breakfast has an adverse effect on arterial stiffness and carotid atheromatic burden. Increased breakfast total energy intake may act protectively against atherosclerosis, a finding worth of further pathophysiologic exploration with potential clinical implications.

Cardiovascular effects of electronic cigarettes: A systematic review and meta-analysis.

AIMS: The electronic cigarette is marketed as a safe alternative to tobacco smoking, but electronic cigarette cardiovascular effects remain largely unknown. We systematically reviewed and meta-analysed published literature to investigate the cardiovascular effects and associated risk from electronic cigarette use. METHODS AND RESULTS: We searched PubMed from January 2000 to November 2017 for published studies assessing the cardiovascular effects of the electronic cigarette. Evidence suggests that the electronic cigarette negatively affects endothelial function, arterial stiffness and the long-term risk for coronary events, but these findings are from single study reports and have not been confirmed in additional studies. Conflicting evidence exists on the effects of the electronic cigarette on heart rate and blood pressure, which is mainly based on non-randomized clinical studies of moderate quality. The meta-analysis of 14 studies (N + 441 participants) suggested that despite the negative acute effects of the electronic cigarette on heart rate (pooled mean difference (MD) + 2.27, 95% confidence interval (CI): 1.64 to 2.89, p < 0.001), diastolic (pooled MD + 2.01 mmHg, 95% CI: 0.62 to 3.39, p + 0.004) and systolic blood pressure (pooled MD + 2.02 mmHg, 95% CI: 0.07 to 3.97, p + 0.042), benefits may be observed in terms of blood pressure regulation when switching from tobacco smoking to chronic electronic cigarette use (systolic blood pressure pooled MD + -7.00, 95% CI: -9.63 to -4.37, p < 0.001; diastolic blood pressure pooled MD + -3.65, 95% CI: -5.71 to -1.59, p + 0.001). CONCLUSIONS: The existing evidence on the cardiovascular effects of the electronic cigarette is concerning, with several unexplored issues. Unless supported by stronger evidence, the electronic cigarette should not be labelled as a cardiovascular safe product. Future studies should delineate whether electronic cigarette use is less hazardous to cardiovascular health than conventional cigarette smoking.

Long-term fish intake preserves kidney function in elderly individuals: the Ikaria study.

OBJECTIVES: The aim of this work was to evaluate the correlation between the amount of weekly fish intake and kidney function as measured by creatinine clearance (CCr) rate among elderly inhabitants of Ikaria Island, a place that has been related to an increased rate of longevity. METHODS: From June to October of 2009, 673 males and females, aged 65-100 years and long-term residents of Ikaria Island were enrolled. Of those, 328 (75 ± 7 years) were males and 339 (75 ± 6 years) were females. Nutritional habits, including fish intake, were evaluated using a validated, semi-frequent food questionnaire and the MedDietScore. Urea and creatinine were measured, and CCr rate was estimated by the Cockcroft-Gault formula. RESULTS: Eighty-four percent of participants reported fish consumption of more than 150 g/week; 35% had moderate to severe CCr (<60 mL). Crude analysis revealed that CCr rate was positively associated with fish intake (b ± SE per 100 g/day: 24 ± 9, P = .007); multiple linear regression analysis confirmed the previous finding (b ± SE per 100 g/day: 11 ± 2, P = .001) after adjusting for overall dietary habits through the MedDietScore and other potential confounders. Fish intake was positively associated with CCr. Furthermore, multi-adjusted logistic regression analysis showed that fish consumption of 100 g/day increased the likelihood by 121% of having a CCr greater than 60 mL (95% confidence interval 10%-343%). CONCLUSIONS: Long-term fish consumption was independently associated with improved kidney function among elderly individuals, a finding that extends the current knowledge regarding the benefits of fish intake on human health.

Long-term adherence to the Mediterranean diet reduces the prevalence of hyperuricaemia in elderly individuals, without known cardiovascular disease: the Ikaria study.

BACKGROUND: The purpose of this study was to evaluate the impact of adherence to Mediterranean diet on serum uric acid (UA) levels in elderly individuals, without known cardiovascular disease. METHODS: During 2009, 281 females (75±6 years old) and 257 males (75±7 years old) permanent inhabitants of the island, were voluntarily enrolled. A diet score that assesses the inherent characteristics of the Mediterranean diet (MedDietScore, range 0-55) was applied. Serum levels of UA were determined using an enzymatic colorimetric test through the uricase-peroxidase method. Hyperuricaemia was defined as UA>7 mg/dL in males and 6 mg/dL in females. RESULTS: Prevalence of hyperuricaemia was 34% in males and 25% in females (p=0.02). Mean level of adherence to the Mediterranean diet was 35±2. Linear regression analysis revealed that MedDietScore was inversely associated with UA levels (b±SE: -1.48±0.17, p<0.001) in the overall sample, after controlling for hypertension, hypercholesterolemia, diabetes mellitus, creatinine clearance, physical activity, and coffee consumption. When the analysis was stratified by gender, MedDietScore was inversely associated with UA levels in males (b±SE: -1.10±0.42, p=0.009), but not in females (b±SE: 0.04±0.41, p=0.92). CONCLUSION: Another cardioprotective effect of Mediterranean diet was revealed, through the modification of UA levels in elderly individuals. The potential different effect size as regards the relationship between diet and UA levels between genders, deserves further investigation.

Fish Consumption Moderates Depressive Symptomatology in Elderly Men and Women from the IKARIA Study.

Background. The aim was to examine the association of depressive symptoms with fish eating habits, in elderly individuals. Methods. From June to October of 2009, we studied 330 men and 343 women, aged 65 to 100 years, permanent inhabitants of Ikaria Island. Among several characteristics, depression was assessed with the Geriatric Depression scale (GDS range 0-15), while dietary habits through a valid semiquantitative food frequency questionnaire. Results. Women had significantly higher values of the GDS compared to men (4.8 ± 3.5 versus 3.3 ± 3.1, P = .001). Participants in the upper tertile of depression scale ate less frequent fish and consumed higher quantities of alcohol, compared to those in the lowest tertile (all P < .05). Regarding fish consumption, 50% of the individuals reported consuming 1-2 times weekly, 32% 3 to 5 times weekly, 11% 2-3 times monthly, while the rest reported rare (4.5%) and everyday (1.2%) consumption. Logistic regression showed that increased fish consumption (>3 times/week versus never/rare) was inversely associated with the odds of having GDS greater the median value (i.e., 4) (odds ratio = 0.34, 95% CI: 0.19, 0.61), after controlling for several cofounders. Conclusion. Frequent fish consumption in elderly seems to moderate depression mood.