Dietary patterns and 5-year incidence of cardiovascular disease: a multivariate analysis of the ATTICA study

Nutr Metab Cardiovasc Dis. 2009 May;19(4):253-63. doi: 10.1016/j.numecd.2008.06.005. Epub 2008 Aug 21.


Background and aims: The 5-year incidence of cardiovascular disease (CVD) in relation to dietary habits, among men and women from Greece, was evaluated.

Methods and results: From May 2001 to December 2002, 1514 men and 1528 women (>18 years) without any clinical evidence of CVD, living in the Attica area, Greece, were enrolled in the ATTICA study. In 2006, a group of experts performed the 5-year follow-up (941 of the 3042 participants were lost). Development of CVD (coronary heart disease, acute coronary syndromes, stroke, or other CVD) during the follow-up period was defined according to WHO ICD-10 criteria. Principal components analysis was applied, and 15 dietary patterns were extracted (71% of total information explained) from 26 foods or food groups. The 5-year incidence of CVD was 11.0% in men and 6.1% in women (p<0.001); the case fatality rate was 1.6%. Multi-adjusted analysis revealed that the dietary pattern that was mainly characterized by cereals, small fish, hardtack and olive oil intake, was associated with lower CVD risk (HR per 1 unit=0.72, 95% CI 0.52-1.00); the pattern that was characterized by fruits, vegetables intake and olive oil use in daily cooking was associated with lower CVD risk (HR per 1 unit=0.80, 95% CI 0.66-0.97); while patterns that were mainly characterized by sweets, red meat, margarine, salty nuts intake, and hard cheese, as well as alcohol intake, were associated with higher CVD risk (HR per 1 unit=1.26, 95% CI 1.01-1.56, and HR per 1 unit=1.32, 95% CI 1.05-1.66, respectively).

Conclusions: Multivariate statistical methods revealed dietary patterns based on empirical epidemiological data which were associated with the development of CVD.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Cardiovascular Diseases / ethnology*
  • Cardiovascular Diseases / etiology*
  • Cardiovascular Diseases / mortality
  • Diet, Mediterranean / adverse effects*
  • Diet, Mediterranean / ethnology*
  • Feeding Behavior / ethnology*
  • Female
  • Follow-Up Studies
  • Greece / epidemiology
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Principal Component Analysis
  • Risk Assessment
  • Risk Factors
  • Risk Reduction Behavior
  • Time Factors