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American Journal of Epidemiology Advance Access published online on November 10, 2009
American Journal of Epidemiology, doi:10.1093/aje/kwp282
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American Journal of Epidemiology © The Author 2009. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org.

Original Contribution

Adherence to the Mediterranean Diet and Risk of Coronary Heart Disease in the Spanish EPIC Cohort Study

Genevieve Buckland, Carlos A. González*, Antonio Agudo, Mireia Vilardell, Antoni Berenguer, Pilar Amiano, Eva Ardanaz, Larraitz Arriola, Aurelio Barricarte, Mikel Basterretxea, María Dolores Chirlaque, Lluís Cirera, Miren Dorronsoro, Nerea Egües, José María Huerta, Nerea Larrañaga, Pilar Marin, Carmen Martínez, Esther Molina, Carmen Navarro, José Ramón Quirós, Laudina Rodriguez, María-José Sanchez, María-José Tormo and Conchi Moreno-Iribas

* Correspondence to Carlos A. González, Unit of Nutrition, Environment and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology (ICO), Avda Gran Via 199-203, Barcelona 08907, Spain (e-mail: cagonzalez{at}iconcologia.net).

Received for publication June 4, 2009. Accepted for publication August 11, 2009.

No known cohort study has investigated whether the Mediterranean diet can reduce incident coronary heart disease (CHD) events in a Mediterranean population. This study examined the relation between Mediterranean diet adherence and risk of incident CHD events in the 5 Spanish centers of the European Prospective Investigation into Cancer and Nutrition. Analysis included 41,078 participants aged 29–69 years, recruited in 1992–1996 and followed up until December 2004 (mean follow-up:10.4 years). Confirmed incident fatal and nonfatal CHD events were analyzed according to Mediterranean diet adherence, measured by using an 18-unit relative Mediterranean diet score. A total of 609 participants (79% male) had a fatal or nonfatal confirmed acute myocardial infarction (n = 468) or unstable angina requiring revascularization (n = 141). After stratification by center and age and adjustment for recognized CHD risk factors, high compared with low relative Mediterranean diet score was associated with a significant reduction in CHD risk (hazard ratio = 0.60, 95% confidence interval: 0.47, 0.77). A 1-unit increase in relative Mediterranean diet score was associated with a 6% reduced risk of CHD (95% confidence interval: 0.91, 0.97), with similar risk reductions by sex. Mediterranean diet adherence was associated with a significantly reduced CHD risk in this Mediterranean country, supporting its role in primary prevention of CHD in healthy populations.

cohort studies; coronary disease; diet, Mediterranean; incidence; Mediterranean region; primary prevention

Abbreviations: CHD, coronary heart disease; EPIC, European Prospective Investigation into Cancer and Nutrition; rMED, relative Mediterranean diet


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