Executive summary of the Hellenic Atherosclerosis Society guidelines for the diagnosis and treatment of dyslipidemias - 2023.

Atherosclerotic cardiovascular disease (ASCVD) remains the main cause of death worldwide, and thus its prevention, early diagnosis and treatment is of paramount importance. Dyslipidemia represents a major ASCVD risk factor that should be adequately managed at different clinical settings. 2023 guidelines of the Hellenic Atherosclerosis Society focus on the assessment of ASCVD risk, laboratory evaluation of dyslipidemias, new and emerging lipid-lowering drugs, as well as diagnosis and treatment of lipid disorders in women, the elderly and in patients with familial hypercholesterolemia, acute coronary syndromes, heart failure, stroke, chronic kidney disease, diabetes, autoimmune diseases, and non-alcoholic fatty liver disease. Statin intolerance is also discussed.

Mediterranean diet is inversely associated with steatosis and fibrosis and decreases ten-year diabetes and cardiovascular risk in NAFLD subjects: Results from the ATTICA prospective cohort study.

BACKGROUND AND AIMS: We assessed the association of Mediterranean diet with NAFLD and their interaction in predicting ten-year diabetes onset and first fatal/non-fatal cardiovascular disease (CVD) incidence. METHODS: The ATTICA prospective observational study in Athens, Greece included 1,514 men and 1,528 women (>18 years old) free-of-CVD at baseline. Liver steatosis and fibrosis indices were calculated. Mediterranean diet adherence was assessed through MedDietScore. At the ten-year follow-up visit, CVD evaluation was performed in an a priori specified subgroup of n = 2,020 participants and diabetes onset in n = 1,485 free-of-diabetes participants. RESULTS: MedDietScore was inversely associated with steatosis and fibrosis; e.g. in the case of the TyG index the Odds Ratio (OR) of the 3rd vs. 1st MedDietScore tertile was = 0·53, [95% Confidence Interval (95% CI) (0·29, 0·95)] and the associations persisted in multi-adjusted models. NAFLD predicted incident diabetes prospectively over a ten year period [HR = 1·87, 95% CI (0·75, 4·61)] and the association remained significant only in subjects with low MedDietScore (below median) whereas diabetes onset among subjects with higher MedDietScore was not influenced by NAFLD. Similarly, NAFLD predicted CVD [Hazard Ratio (HR) = 3·01, 95%CI(2·28, 3·95)]; the effect remained significant only in subjects with MedDietScore below median [HR = 1·38, 95% CI (1·00, 1·93)] whereas it was essentially null [HR = 1·00,95% CI (0·38, 2·63)] among subjects with higher score. Mediation analysis revealed that adiponectin and adiponectin-to-leptin ratio were the strongest mediators. CONCLUSIONS: We report an inverse association between Mediterranean diet and NAFLD. Mediterranean diet protected against diabetes and CVD prospectively among subjects with NAFLD.

The influence of socio-environmental determinants on hypertension. A spatial analysis in Athens metropolitan area, Greece.

INTRODUCTION: While epidemiological and pathophysiological aspects of hypertension are still being investigated, there is an increased global interest between hypertension and social health determinants and environmental factors that this study aims to examine. METHODS: The sample size used in this work included 2,445 individuals, from Athens metropolitan area, who were randomly enrolled in ATTICA study, during 2001 to 2002. Principal component analysis (PCA), Poisson regression modeling and geographical analysis, based on Geographic Information Systems (GIS) technology, were applied. RESULTS: Geographical analysis and thematic mapping revealed that the West municipalities of Athens had the lowest socio-environmental status. Three components were derived from PCA: high, low and mixed socio-environmental status. Poisson regression analysis showed that high socio-environmental status, educational and economic level were negatively correlated with hypertension in some sectors of Athens (p < 0.05, for all). CONCLUSIONS: Through the use of geospatial surveillance the underlying epidemiology of hypertension, and those at greater risk, can be more precisely determined. This study underlines the need to account for environmental factors when developing public health policies and programs for effective hypertension prevention or reduction.

Dietary vitamin D intake, cardiovascular disease and cardiometabolic risk factors: a sex-based analysis from the ATTICA cohort study.

BACKGROUND: The present study aimed to evaluate the association between dietary vitamin D intake and 10-year first fatal/nonfatal cardiovascular disease (CVD), conventional CVD risk factors and surrogate markers related to inflammation, coagulation, insulin resistance, liver and renal function. METHODS: The ATTICA study was conducted during 2001-2012 including 1514 men and 1528 women (aged >18 years) from the greater Athens area, Greece. Dietary assessment was based on a validated semi-quantitative food frequency questionnaire. Daily intake of vitamin D was calculated using a standardised food database. Follow-up (2011-2012) was achieved in 2020 participants (n = 317 cases). RESULTS: Ranking from first to third vitamin D tertile, CVD events were 24%, 17% and 12% for men (P = 0.002) and 14%, 10% and 11% for women (P = 0.59). Inverse associations between vitamin D and CVD in total sample [hazard ratio (HR) = 0.76 95% confidence interval (CI) = 0.60-0.97] and in men (HR = 0.66 95% CI = 0.49-0.89) were observed, and lost after adjusting for inflammation/coagulation markers; for women, no significant trends were observed. Regarding 10-year onset of conventional risk factors, inverse associations of vitamin D with hypertension in men (HR = 0.62 95% CI = 0.39-0.99) and transition to metabolically unhealthy status in women (HR = 0.69 95% CI = 0.51-0.93) were observed. Significant inverse associations for C-reactive protein, interleukin-6 and fibrinogen in both sexes, whereas these were revealed only in women for insulin resistance. CONCLUSIONS: Contradicting the neutral/modest associations in vitamin-D supplementation trials, increased food-generated vitamin D may protect against hard and intermediate CVD endpoints, implying different paths between sexes.

Amino acid profile and metabolic syndrome in a male Mediterranean population: A cross-sectional study.

BACKGROUND AND AIMS: The metabolic syndrome (MetS) refers to a cluster of clinically relevant factors that increases the risk of cardiovascular diseases and all-cause mortality. Circulating levels of several amino acids and metabolites related to one-carbon metabolism have been associated with cardiometabolic risk factors and MetS. We aimed to identify the amino acid profile that is significantly associated with MetS among an all male Mediterranean population. METHODS AND RESULTS: One hundred middle-aged men (54.6 ± 8.9 years) participated in a cross-sectional study carried out during 2011-2012. The International Diabetes Federation (IDF) criteria were used to define MetS. Fasting plasma levels of 20 common amino acids and 15 metabolites related to amino acid and one-carbon metabolism were measured using gas chromatography (GC-MS/MS) and liquid chromatography tandem mass spectrometry (LC-MS/MS). Principal components analysis was applied. Fifty-six participants fulfilled the IDF criteria for defining MetS. Five factors were extracted from the 35 measured metabolites. The branched-chain amino acids/aromatic amino acids (BCAA/AAA) related pattern and the glutamine/glycine/serine/asparagine (Gln/Gly/Ser/Asn) related pattern were significantly associated with MetS (odds ratio, 95% confidence interval; 6.41, 2.43-16.91, and 0.47, 0.23-0.96, respectively) after adjustment for age, current smoking status, physical activity level and medical treatment for hypertension, dyslipidaemia, type 2 diabetes mellitus. Further adjustment for liver function markers (i.e. glutamic oxaloacetic transaminase, glutamic pyruvic transaminase, and γ-glutamyltransferase), and plasma adiponectin levels did not significantly affect the associations. CONCLUSION: The BCAA/AAA pattern was positively associated, while the Gln/Gly/Ser/Asn pattern was inversely associated with established cardiometabolic risk factors and MetS. Plasma adiponectin levels or markers of liver function did not significantly affect these associations.

Mediterranean diet and prognosis of first-diagnosed Acute Coronary Syndrome patients according to heart failure phenotype: Hellenic Heart Failure Study.

BACKGROUND/OBJECTIVES: Nutrition in secondary prevention of Acute Coronary Syndrome (ACS) is inadequately investigated. We sought to evaluate the role of Mediterranean diet in prognosis of first-diagnosed ACS patients, according to heart failure type. SUBJECTS/METHODS: in 2006-2009, 1000 consecutive patients hospitalized at First Cardiology Clinic of Athens with ACS diagnosis were enrolled in the study. In 2016, 10-year follow-up was performed (75% participation rate). Only n=690 (69%) first-diagnosed ACS patients were included. Adherence to Mediterranean diet was assessed through MedDietScore (range 0-55). Heart failure phenotypes were reduced, mid-range and preserved ejection fraction (that is, HFrEF, HFmrEF and HFpEF, respectively). RESULTS: Ranking from first to third MedDietScore tertile, fewer 1, 2 and 10-year fatal/non-fatal ACS events were observed. Multivariate logistic regression analysis highlighted a significantly inverse association between MedDietScore and long-term ACS prognosis in 1 year (odds ratio (OR)=0.84, 95% confidence interval (CI) (0.71, 1.00), P=0.05), 2 year (OR=0.91, 95% CI (0.82, 1.00), P=0.04) and 10 year (OR=0.93, 95% CI (0.85, 1.00), P=0.05) follow-up. Further analysis revealed that MedDietScore differentially affected patients' prognosis according to heart failure phenotype, with short-term impact in HFrEF and HFmrEF patients yet longer positive outcomes in HFpEF and C-reactive protein potentially mediated these relations. CONCLUSIONS: Mediterranean diet seemed to protect against recurrent cardiac episodes in coronary patients with major ACS complications. Results were more encouraging with regard to patients with preserved left ventricle function. Such findings may possess a cost-effective, supplementary-to-medical, treatment approach in this patient category where evidence concerning their management are inconclusive.European Journal of Clinical Nutrition advance online publication, 23 August 2017; doi:10.1038/ejcn.2017.122.

Visceral adiposity index and 10-year cardiovascular disease incidence: The ATTICA study.

BACKGROUND AND AIMS: Visceral adiposity index (VAI) has been proposed as a marker of visceral adipose tissue accumulation/dysfunction. Our aim was to evaluate potential associations between the VAI and the 10-year cardiovascular disease (CVD) incidence. METHODS AND RESULTS: During 2001-2002, 3042 Greek adults (1514 men; age: ≥18 years) without previous CVD were recruited into the ATTICA study, whilst the 10-year study follow-up was performed in 2011-2012, recording the fatal/non-fatal CVD incidence in 2020 (1010 men) participants. The baseline VAI scores for these participants were calculated based on anthropometric and lipid variables, while VAI tertiles were extracted for further analyses. During the study follow-up a total of 317 CVD events (15.7%) were observed. At baseline, the participants' age and the prevalence of hypertension, diabetes, hypercholesterolemia and metabolic syndrome increased significantly across the VAI tertiles. After adjusting for multiple confounders, VAI exhibited a significantly independent positive association with the 10-year CVD incidence (OR = 1.05, 95%CI: 1.01, 1.10), whereas the association of the body mass index (HR = 1.03, 95%CI: 0.99, 1.08), or the waist circumference (HR = 1.01, 95%CI: 0.99, 1.02) was less prominent. Sex-specific analysis further showed that VAI remained significantly predictive of CVD in men alone (HR = 1.06, 95%CI: 1.00, 1.11) but not in women (HR = 1.06, 95%CI: 0.96, 1.10). CONCLUSIONS: Our findings show for the first time in a large-sample, long-term, prospective study in Europe that the VAI is independently associated with elevated 10-year CVD risk, particularly in men. This suggests that the VAI may be utilized as an additional indicator of long-term CVD risk for Caucasian/Mediterranean men without previous CVD.

Arterial aging mediates the effect of TNF-α and ACE polymorphisms on mental health in elderly individuals: insights from IKARIA study.

BACKGROUND: Aging is characterized by an insidious decline in cognitive function. Several genetic and lifestyle factors have been implicated in the increased risk or early onset of dementia. AIM: We sought to assess the role of tumor necrosis factor (TNF) and angiotensin-converting enzyme (ACE) polymorphisms on the development of impaired mental health in respect to indices of arterial aging in nonagenarian individuals. DESIGN: 178 consecutive subjects above 75 years that permanently inhabit in the island of IKARIA, Greece were recruited. METHODS: Aortic distensibility (AoD) was calculated and genetic evaluation was performed on the ACE Insertion/Deletion gene polymorphism (intron 16) and the G/A transition (position -308) of the TNF gene. Cognitive function was evaluated using the Mini-mental State Examination (MMSE). RESULTS: The DD genotype for ACE was independently associated ( b = -0.44, P = 0.007) with AD while AoD remained an independent determinant of mental status (OR = 1.82, P = 0.036). Interestingly though, when a combined genetic index (GI) was calculated for both genes (ACE and TNF), subjects being double homozygous (DD for ACE and GG for TNF) for these loci presented significantly decreased MMSE (adjusted OR = 0.259, P = 0.033). This GI independently associated with AD (beta coefficient = -0.785, P = 0.002). When AoD was included, GI lost its predictive role (OR = 0.784, P = 0.783) towards MMSE. AoD has marginal indirect mediating effect in the association of the GI with MMSE ( P = 0.07). CONCLUSION: Vascular aging may modulates the genetic substrate of elderly subjects on the risk for developing dementia.

L-Carnitine/Simvastatin Reduces Lipoprotein (a) Levels Compared with Simvastatin Monotherapy: A Randomized Double-Blind Placebo-Controlled Study.

Lipoprotein (a) [Lp(a)] is an independent risk factor for cardiovascular disease. There are currently limited therapeutic options to lower Lp(a) levels. L-Carnitine has been reported to reduce Lp(a) levels. The aim of this study was to compare the effect of L-carnitine/simvastatin co-administration with that of simvastatin monotherapy on Lp(a) levels in subjects with mixed hyperlipidemia and elevated Lp(a) concentration. Subjects with levels of low-density lipoprotein cholesterol (LDL-C) >160 mg/dL, triacylglycerol (TAG) >150 mg/dL and Lp(a) >20 mg/dL were included in this study. Subjects were randomly allocated to receive L-carnitine 2 g/day plus simvastatin 20 mg/day (N = 29) or placebo plus simvastatin 20 mg/day (N = 29) for a total of 12 weeks. Lp(a) was significantly reduced in the L-carnitine/simvastatin group [-19.4%, from 52 (20-171) to 42 (15-102) mg/dL; p = 0.01], but not in the placebo/simvastatin group [-6.7%, from 56 (26-108) to 52 (27-93) mg/dL, p = NS versus baseline and p = 0.016 for the comparison between groups]. Similar significant reductions in total cholesterol, LDL-C, apolipoprotein (apo) B and TAG were observed in both groups. Co-administration of L-carnitine with simvastatin was associated with a significant, albeit modest, reduction in Lp(a) compared with simvastatin monotherapy in subjects with mixed hyperlipidemia and elevated baseline Lp(a) levels.

Metabolic syndrome and 10-year cardiovascular disease incidence: The ATTICA study.

AIMS: To evaluate the influence of metabolic syndrome (MetS) as well as inflammatory and renal markers on cardiovascular disease (CVD) incidence. METHODS AND RESULTS: During 2001-2002, 1514 men and 1528 women (>18 y) without any clinical evidence of CVD or any other chronic disease, at baseline, living in greater Athens area, Greece, were enrolled. In 2011-2012, the 10-year follow-up was performed in 2583 participants (15% of the participants were lost to follow-up). Incidence of fatal or non-fatal CVD was defined according to WHO-ICD-10 criteria. MetS was defined using three definitions, provided by the National Cholesterol Education Program Adult Treatment panel III (revised NCEP ATP III), the International Diabetes Federation (IDF) or the Harmonized definition. Furthermore, the contributory predictive role of C-reactive protein (CRP), inteleukin-6, uric acid and estimated glomerular filtration rate in the aforementioned models was evaluated. History of MetS-NCEP was positively associated with CVD, adjusting for potential confounding factors (OR:1.83, 95%CI:1.24-2.72). Not statistically significant associations with CVD incidence were observed when using the IDF or the Harmonized definition. Additionally, none of the added inflammatory and renal function markers mediated the influence of MetS on CVD incidence (all p's from Sobel test >0.40). C-statistic values for the MetS definitions used exceeded 0.789 (CI:0.751-0.827), indicating fair-to-good predictive probability of the models. CONCLUSION: Results of the present work revealed the negative impact of MetS-NCEP, but not of the other MetS definitions, on CVD incidence, a key-point that may help in better understanding the role of IDF and Harmonized MetS definitions on CVD.

Adherence to Mediterranean diet and 10-year incidence (2002-2012) of diabetes: correlations with inflammatory and oxidative stress biomarkers in the ATTICA cohort study.

BACKGROUND: The purpose of this work was to investigate the links between oxidative stress, inflammation and coagulation and their effect on Mediterranean diet-diabetes relationship. METHODS: In 2001-2002, a random sample of 1514 men (18-87 years old) and 1528 women (18-89 years old) was selected to participate in the ATTICA study, where Athens is the major metropolis. A validated questionnaire was used to assess lifestyle and dietary factors. Adherence to Mediterranean diet was recorded using MedDietScore. Among others, oxidative stress and inflammatory biomarkers were recorded. During 2011-2012, the 10-year follow-up was performed. Diabetes incidence was defined according to the American Diabetes Association criteria. RESULTS: A total of 191 incident cases of diabetes were documented, yielding an incidence of 12.9% (13.4% in men and 12.4% in women). Medium and high adherence was found to decrease diabetes risk by 49% (95% CI: 0.30, 0.88) and 62% (95% CI: 0.16, 0.88), respectively, compared with low adherence. A logarithmic trend between Mediterranean diet and diabetes incidence was also revealed (p for trend = 0.042). Individuals with abnormal waist circumference (>94 for men, >80 for women) were benefited the most. Wholegrain cereals, fruits and legumes had the greatest predictive ability. The anti-diabetic effect of Mediterranean diet correlated with measurements of tumour necrosis factor-α, homocysteine and total antioxidant capacity. CONCLUSIONS: The reported results support the role of Mediterranean diet as a promising dietary tool for the primary prevention of diabetes, by attenuating inflammation and fostering total antioxidant capacity. This dietary pattern may have therapeutic potential for many cardiometabolic disorders associated with inflammation and/or oxidative stress.

Exclusive olive oil consumption and 10-year (2004-2014) acute coronary syndrome incidence among cardiac patients: the GREECS observational study.

BACKGROUND: The present study evaluated the association between long-term, exclusive olive oil consumption, in cooking preparation or as a dressing, and the 10-year (2004-2014) incidence of acute coronary syndrome (ACS) among cardiac patients. METHODS: From October 2003 to September 2004, a sample of 2172 ACS consecutive patients from six major Greek hospitals were enrolled. During 2013-2014, the 10-year follow-up was performed in 1918 patients (88% participation rate). The development of fatal or nonfatal ACS was recorded through medical records or hospital registries. Among other dietary components, added fats (i.e. olive oil, butter, margarine and seed oils) consumption at baseline examination was assessed using a semi-quantitative food frequency questionnaire. RESULTS: Non-exclusive olive oil consumption on a daily basis was associated with an adverse effect on the ACS incidence after taking into account various potential confounders [odds ratio (OR) = 1.40, 95% confidence interval (CI) = 1.05-1.86, P = 0.024]. However, significant interactions between olive oil consumption and body mass index (BMI) (P = 0.082) and educational level (P = 0.054) led to further stratified analysis. Using BMI as strata (i.e. ≤29.9 versus >29.9 kg m(-2)), the above association remained significant only in obese patients (OR = 1.80, 95% CI = 1.03-3.12, P = 0.038), whereas, on examining the education status (i.e. ≤9 versus >9 years of school), a significant association was observed only among the higher educated patients (OR = 1.83, 95% CI = 1.01-3.32, P = 0.047). CONCLUSIONS: Exclusive use of olive oil, either as a salad dressing or in cooking, should be promoted through the dietary management of ACS patients, with the aim of reducing the likelihood of recurrent cardiac episodes.

The evaluation of inflammatory and oxidative stress biomarkers on coffee-diabetes association: results from the 10-year follow-up of the ATTICA Study (2002-2012).

BACKGROUND/OBJECTIVES: The purpose of this work was to investigate the association between coffee drinking and diabetes development and potential mediation by oxidative stress and inflammatory biomarkers. SUBJECTS/METHODS: In 2001-2002, a random sample of 1514 men (18-87 years old) and 1528 women (18-89 years old) were selected to participate in the ATTICA study (Athens metropolitan area, Greece). A validated food-frequency questionnaire was used to assess coffee drinking (abstention, casual, habitual) and other lifestyle and dietary factors. Evaluation of oxidative stress and inflammatory markers was also performed. During 2011-2012, the 10-year follow-up of the ATTICA study was carried out. The outcome of interest in this work was incidence of type 2 diabetes, defined according to American Diabetes Association criteria. RESULTS: During follow-up, 191 incident cases of diabetes were documented (incidence 13.4% in men and 12.4% in women). After various adjustments, individuals who consumed ⩾250 ml of coffee (≈1.5cup) had 54% lower odds of developing diabetes (95% confidence interval: 0.24, 0.90), as compared with abstainers. A dose-response linear trend between coffee drinking and diabetes incidence was also observed (P for trend=0.017). When controlling for several oxidative stress and inflammatory biomarkers, the inverse association between habitual coffee drinking and diabetes was found to be mediated by serum amyloid-A levels. CONCLUSIONS: This work highlights the significance of long-term habitual coffee drinking against diabetes onset. The anti-inflammatory effect of several coffee components may be responsible for this protection.

Effects of alcohol consumption and the metabolic syndrome on 10-year incidence of diabetes: the ATTICA study.

AIM: The purpose of this prospective study was to investigate the effect of alcohol consumption on the 10-year diabetes incidence. METHODS: In 2001-2002, a random sample of 1514 men (18-89 years old) and 1528 women (18-87 years old) was selected to participate in the ATTICA study (Athens metropolitan area, Greece). Among various other characteristics, average daily alcohol intakes (abstention, low, moderate, high) and type of alcoholic drink were evaluated. Diabetes was defined according to American Diabetes Association criteria. During 2011-2012, the 10-year follow-up was performed. RESULTS: The 10-year incidence of diabetes was 13.4% in men and 12.4% in women. After making various adjustments, those who consumed up to 1 glass/day of alcohol had a 53% lower diabetes risk (RR=0.47; 95% CI: 0.26, 0.83) compared with abstainers, while trend analysis revealed a significant U-shaped relationship between quantity of alcohol drunk and diabetes incidence (P<0.001 for trend). Specific types of drinks were not associated with diabetes incidence; however, a one-unit increase in ratio of wine/beer/vodka vs. other spirits was associated with an 89% lower risk of diabetes (RR=0.11; 95% CI: 0.02, 0.67). The protective effect of low alcohol consumption on diabetes incidence was more prominent among individuals with stricter adherence to the Mediterranean diet (RR=0.08; 95% CI: 0.011, 0.70) and without the metabolic syndrome (RR=0.34; 95% CI: 0.16, 0.70). CONCLUSION: This work revealed the protective effect of modest alcohol consumption of particularly wine and beer against the long-term incidence of diabetes, possibly due to their pleiotropic health effects.

Exploring the path of Mediterranean diet on 10-year incidence of cardiovascular disease: the ATTICA study (2002-2012).

BACKGROUND AND AIMS: A Mediterranean diet has been associated with lower all-cause and cardiovascular disease (CVD) morbidity and mortality, but the clinical and behavioral pathway has not been well understood and appreciated. The aim of this work was to explore the path between adherence to a Mediterranean-type diet, lifestyle behaviors, clinical status, and a 10-year incidence of CVD. METHODS AND RESULTS: The ATTICA study was carried out in the Athens area during 2001-2002 and included 3042 participants free of CVD at baseline (49.8% men, aged 18-89). Adherence to a Mediterranean diet was assessed using the MedDietScore (range 0-55). During 2011-2012, 2583 out of the 3042 participants were found during the 10-year follow-up (15% lost to follow-up). Adherence to a Mediterranean diet decreased CVD risk (relative Risk (RR) per 1/55 unit = 0.96, 95% confidence interval (CI): 0.93, 1.00), independently of various sociodemographic, lifestyle, and clinical factors. Subgroup analyses revealed that participants with an unhealthy lifestyle (i.e., smokers, and obese and sedentary persons) remained protected from CVD through a greater adherence to a Mediterranean diet (RR for smokers = 0.92, 95%CI: 0.88, 0.97; RR for obese participants = 0.90, 95%CI: 0.82, 0.979; and RR for sedentary participants = 0.95, 95%CI: 0.90, 0.99). Path analysis revealed that adherence to a Mediterranean diet not only decreases the levels of C-reactive protein and interleukin-6 but also has an independent protective role against CVD risk per se (total effect of the MedDietScore on CVD = -0.003, 95%CI: -0.005 to 0.000). CONCLUSION: Adherence to a Mediterranean diet confers a considerable reduction on CVD risk, independent of various factors. Therefore, even subjects with unhealthy lifestyle behaviors may benefit from adherence to this diet, suggesting another dimension to prevention strategies.

Gender-specific distribution of selenium to serum selenoproteins: associations with total selenium levels, age, smoking, body mass index, and physical activity.

The epidemiology of selenium (Se) is mainly based on the determination of total serum selenium levels (TSe) which by many aspects is an inadequate marker of Se status. In this study we applied a recently developed LC-ICP-MS method, for the determination of the selenium content of the three main serum selenium-containing proteins, in a subcohort of the ATTICA study. This enables us to investigate whether the selenium distribution to selenoproteins may correlate with demographic (age, gender) and lifestyle variables (smoking, physical activity) that are crucial for the development of chronic diseases. A sub-sample from the ATTICA Study, consisted of 236 males (40 ± 11 years) and 163 females (38 ± 12 years), was selected. The selenium content of glutathione peroxidase (GPx-3), selenoprotein P (SelP) and selenoalbumin (SeAlb) was determined in serum by LC-ICP/MS method. We found that 26% of TSe is found in GPx-3, 61% in SelP and 13% in SeAlb. We have assessed the different ratios of selenoproteins' selenium content (Se-GPX-3/Se-SelP, Se-GPX-3/Se-SeAlb, Se-SelP/Se-SeAlb), showing that people with similar TSe may have different distribution of this selenium to selenoproteins. Total selenium levels and gender are the variables that mostly affect selenium distribution to selenoproteins while age, smoking, physical activity and BMI do not significantly influence selenium distribution. In conclusion, the simultaneous determination of the selenium content of serum selenium-containing selenoproteins is necessary for a thorough estimation of selenium status. The ratio of the Se content between selenoproteins may be proven a novel, valid marker of selenium status.

High intensity, interval exercise improves quality of life of patients with chronic heart failure: a randomized controlled trial.

BACKGROUND: The aim of this study was to evaluate the effect of high intensity, interval exercise on quality of life (QoL) and depression status, in chronic heart failure (CHF) patients. METHODS: A randomized controlled trial (phase III). Of the 100 consecutive CHF patients (NYHA classes II-IV, ejection fraction ≤ 50%) that were randomly allocated to exercise intervention (n = 50, high-intensity intermittent endurance training 30 s at 100% of max workload, 30 s at rest, for 45 min/day-by-12 weeks) or no exercise advice (n = 50), 72 (exercise group, n = 33, 63 ± 9 years, 88% men, 70% ischemic CHF and control group, n = 39, 56 ± 11 years, 82% men, 70% ischemic CHF) completed the study. QoL was assessed using the validated and translated Minnesota Living with Heart Failure questionnaire. Depressive symptomatology was evaluated using the validated and translated Zung Depression Rating Scale (ZDRS). Maximal oxygen uptake (VO(2max)) and carbon dioxide production (VCO(2max)) were also measured breath-by-breath. RESULTS: Data analysis demonstrated that in the intervention group MLHFQ score was reduced by 66% (P = 0.003); 6-min-walk distance increased by 13% (P < 0.05), VO(2max) level increased by 31% (P = 0.001), VCO(2max) level increased by 28% (P = 0.001) and peak power output increased by 25% (P = 0.001), as compared with the control group. CONCLUSION: High intensity, systematic aerobic training, could be strongly encouraged in CHF patients, since it improves QoL, by favorably modifying their fitness level.

Association between periodontitis and acute myocardial infarction: a case-control study of a nondiabetic population.

BACKGROUND AND OBJECTIVE: Periodontitis and acute myocardial infarction (AMI) are two diseases that share common risk factors. The role of periodontitis as an independent risk factor for cardiovascular disease has been under debate. The aim of this study was to investigate whether an association exists between periodontitis and AMI in a nondiabetic population, using multiple periodontal case definitions. MATERIAL AND METHODS: Periodontal examination was performed in 204 patients with AMI. The control group comprised 102 healthy subjects, without significant coronary disease, confirmed angiographically. Periodontitis was assessed using measurements of clinical attachment loss (CAL), probing depth and number of missing teeth. From these measurements, five different case definitions of periodontitis were generated. RESULTS: Using the continuous forms of periodontal measurements, the odds ratio (95% confidence interval) of the association with incident AMI was 1.74 (1.26-2.50), 1.83 (1.10-3.17) and 1.08 (1.06-1.13) for mean CAL, probing depth and number of missing teeth, respectively. A consistent positive association was observed regardless of the case definition of periodontitis. CONCLUSION: In this nondiabetic population, the association between periodontitis and AMI was consistent across different measurements and/or definitions of periodontitis. The strength of the association increased concomitantly with the robustness of the criteria used to define periodontitis.

A multicomponent lifestyle intervention produces favourable changes in diet quality and cardiometabolic risk indices in hypercholesterolaemic adults.

BACKGROUND: To date, there are no dietary intervention studies available jointly examining the changes produced in cardiometabolic risk indices and diet quality assessed with the Healthy Eating Index 2005 (HEI-2005). The present study aimed to evaluate the effect of a 3-month multicomponent lifestyle intervention on several cardiometabolic risk indices, physical activity levels and diet quality. METHODS: A total sample of 108 hypercholesterolaemic adults (40-60 years old) were randomised to two intervention groups provided with and instructed to consume daily: (i) plain milk (n = 37) or (ii) enriched milk (n = 40) respectively; both groups were attending a 3-month dietary counselling programme. For the needs of the present study both intervention groups were analysed together IG: n = 77) and were compared against a control group following usual diet (CG: n = 31). RESULTS: Regarding diet quality HEI scores for 'milk' (P = 0.021), 'dark green/orange vegetables and legumes' (P = 0.050) and 'total HEI score' (P = 0.045) were improved in the IG compared to the CG. The IG also improved 'whole grains' and 'calories from solid fats, alcoholic beverages and added sugars' scores compared to their baseline values. Both groups improved the 'total vegetable' HEI score. Regarding physical activity levels and cardiometabolic risk indices, the IG significantly increased the daily number of steps (P = 0.005) and decreased body weight (P = 0.021), body mass index (P = 0.019) and waist circumference (P = 0.027) to a higher extent compared to the changes observed in the CG. Moreover, the IG significantly decreased systolic (P = 0.001) and diastolic blood pressure (P = 0.050) compared to baseline values. CONCLUSIONS: The present study revealed that this 3-month lifestyle and nutrition counselling intervention programme appears to have favourable effects on diet quality, physical activity levels, anthropometric and certain cardiometabolic risk indices.

Adherence to the Mediterranean diet and serum uric acid: the ATTICA study.

OBJECTIVE: The present study aimed to explore potential associations between adherence to a Mediterranean diet and serum uric acid (UA) levels. METHODS: The sample consisted of 2380 men and women free of cardiovascular or renal disease who participated in the ATTICA study. Dietary intake was assessed using a food frequency questionnaire (FFQ) and adherence to the Mediterranean diet was evaluated with the MedDietScore. Serum UA was measured and hyperuricaemia was defined as UA concentration > 7.0 mg/dL in men or > 6.0 mg/dL in women. RESULTS: MedDietScore was inversely associated with UA levels (b-coefficient per quartile of the score = -0.07 ± 0.03, p = 0.02) independently of sex, presence of overweight, hypertension, or abnormal glucose metabolism, and alcohol or coffee intake. Those at the fourth quartile of MedDietScore had a 70% lower likelihood of having hyperuricaemia [odds ratio (OR) 0.30, 95% confidence interval (CI) 0.11-0.82] compared to those at the first quartile, after adjustment for several confounders. According to stratified analyses by sex, body mass index (BMI) status, hypertension, abnormal glucose, alcohol and coffee intake, the inverse association between serum UA and MedDietScore remained significant in women (b-coefficient = -0.194 ± 0.055, p < 0.001), overweight subjects (b-coefficient = -0.103 ± 0.047, p = 0.02), in those with normal glucose metabolism (b-coefficient = -0.074 ± 0.037, p = 0.04), and in those abstaining from alcohol (b-coefficient = -0.212 ± 0.073, p = 0.004) and coffee (b-coefficient = -0.221 ± 0.096, p = 0.02). CONCLUSION: Adherence to the Mediterranean diet is associated with lower serum UA levels and lower likelihood of hyperuricaemia. These findings support a potential role of this dietary pattern in the prevention and treatment of hyperuricaemia and gout.