Lipid accumulation product in relation to 10-year cardiovascular disease incidence in Caucasian adults: The ATTICA study

Background and aims The lipid accumulation product (LAP) is an index describing lipid over-accumulation based on waist circumference (WC) and fasting triglycerides, and can outperform the body mass index (BMI) in recognizing cardiovascular disease (CVD) risk. We aimed to explore the association of LAP with long-term CVD risk and compare its CVD-predictive value against common anthropometric indices/ratios of obesity. Methods ATTICA is a prospective, population-based cohort that recruited 3042 adults without pre-existing CVD from the Greek general population (age 18–89 years; 1514 men). The 10-year study follow-up (2011–2012) captured the fatal/non-fatal CVD incidence in 2020 participants (50% men). Baseline LAP (cm⋅mmol/L) was calculated and analyzed in relation to the 10-year CVD incidence. Results In total, 317 CVD cases (15.7%) were documented during the follow-up. Baseline LAP showed a significant positive association with the 10-year CVD incidence, even after adjusting for hypertension, diabetes, hypercholesterolemia, smoking, physical activity, Mediterranean diet adherence, and key pro-inflammatory biomarkers (Hazard Ratios per 10 cm mmol/L of LAP ranging from 1.1 to 1.21, p = 0.04). Moreover, LAP predicted the 10-year CVD study incidence better than common obesity indices (BMI, WC, waist-to-hip, waist-to-height ratio). Conclusions These findings support and independent positive association between LAP and long-term CVD incidence in CVD-free Caucasian adults from the general population

Olive oil consumption and 10-year (2002–2012) cardiovascular disease incidence: the ATTICA study

Olive oil, being rich in mono-unsaturated fatty acids and anti-inflammatory compounds, may have protective effects against cardiovascular disease (CVD). The aim of the present work was to examine the association of olive oil consumption with the 10-year CVD incidence in adults without pre-existing CVD. After controlling for various covariates, an inverse association between exclusive olive oil use and the risk of developing CVD was observed (relative risk 0.07, 95% CI: 0.01-0.66) compared to those not consuming olive oil. Further adjustment for fibrinogen plasma levels (among various inflammatory markers) showed a significant mediation effect on the previous association. These findings support exclusive olive oil consumption, a key component of the Mediterranean diet, for the primary CVD prevention, in adults without pre-existing disease. Circulating fibrinogen levels appear to play a mediating role in this relationship

Impact of physical activity category on incidence of cardiovascular disease:Results from the 10-year follow-up of the ATTICA Study (2002–2012)

The aim of the study was to examine the effects of physical activity (PA) level on 10-year cardiovascular disease (CVD) incidence, taking into consideration several clinical and lifestyle risk factors along with the potential moderating role of gender. An analysis was undertaken on data from the ATTICA prospective cohort study (10-year follow-up, 2002–2012), which followed a Greek adult population (aged 18–89 years). A total n = 317 of fatal and nonfatal CVD events occurred among the 2020 participants. After adjusting for the lifestyle and clinical risk factors as potential confounders, odds ratio (ORs) of CVD risk of individuals who reported being sufficiently active and highly active were decreased by 58% (95% CI: 0.30, 0.58) and 70% (95% CI: 0.15, 0.56), when compared to those who were inactive/insufficiently active, respectively. Men had nearly two-fold increase in risk of CVD (95% CI: 1.62, 2.18) versus women. Stratified analysis by gender, revealed that sufficiently active men, had 52% (95% CI: 0.24, 0.97) reduced risk of CVD incidence when compared to inactive males, while, for women, the role of PA lost significance following adjusting for lifestyle factors. The current data suggests a beneficial effect of even moderate physical activity levels on 10-year incidence of CVD, reinforcing the importance of physically activity, especially for men

Modeling anthropometric indices in relation to 10-year (2002-2012) incidence of cardiovascular disease, among apparently healthy individuals:the ATTICA study

Aims: Body fat accumulation is implicated in the development of cardiovascular disease (CVD). Our objective was to explore potential associations between anthropometric indices and the 10-year CVD incidence in Greek adults without previous CVD. Methods: During 2001–2, we enrolled 3042 adults without CVD from the general population of Attica, Greece. In 2011–2, the 10-year study follow-up was performed, recording the CVD incidence in 1958 participants with baseline body mass index (BMI) ≥18.5 kg/m2. Results: The study 10-year CVD incidence was 15.8%, exhibiting a gradual increase according to the baseline body mass index (BMI) category. Baseline BMI ≥30 kg/m2 was related with significantly higher 10-year CVD risk compared to BMI <25 kg/m2, even after adjustment for age and other known CVD risk factors. Baseline BMI, waist circumference, waist-to-hip ratio, waist-to-height ratio and waist-to-hip-to-height ratio were independently associated with the 10-year CVD risk in multi-adjusted models. Gender-specific analyses showed that these associations were more evident in men compared to women, with baseline BMI exhibiting an independent association with the 10-year CVD incidence in men. Conclusions: Our results indicate that even simple anthropometric indices exhibit independent associations with CVD risk in a representative sample of the Greek general population without previous CVD

J-shaped relationship between habitual coffee consumption and 10-year (2002–2012) cardiovascular disease incidence:the ATTICA study

Purpose: The purpose of this work was to evaluate the association between coffee consumption and 10-year cardiovascular disease (CVD) incidence in the ATTICA study, and whether this is modified by the presence or absence of metabolic syndrome (MetS) at baseline. Methods: During 2001–2002, 3042 healthy adults (1514 men and 1528 women) living in the greater area of Athens were voluntarily recruited to the ATTICA study. In 2011–2012, the 10-year follow-up was performed in 2583 participants (15% of the participants were lost to follow-up). Coffee consumption was assessed by a validated food-frequency questionnaire at baseline (abstention, low, moderate, heavy). Incidence of fatal or non-fatal CVD event was recorded using WHO-ICD-10 criteria and MetS was defined by the National Cholesterol Education Program Adult Treatment panel III (revised) criteria. Results: Overall, after controlling for potential CVD risk factors, the multivariate analysis revealed a J-shaped association between daily coffee drinking and the risk for a first CVD event in a 10-year period. Particularly, the odds ratio for low (250 ml/day), compared to abstention, were 0.44 (95% CI 0.29–0.68), 0.49 (95% CI 0.27–0.92) and 2.48 (95% CI 1.56–1.93), respectively. This inverse association was also verified among participants without MetS at baseline, but not among participants with the MetS. Conclusions: These data support the protective effect of drinking moderate quantities of coffee (equivalent to approximately 1–2 cups daily) against CVD incidents. This protective effect was only significant for participants without MetS at baseline

Association between metabolic syndrome, clinical and dietary parameters towards the ten-year cvd incidence: ten-year follow - up of the Attica study (2002 - 2012)

Aim: to investigate the impact of various metabolic indices and nutritional parameters towards the ten-year incidence of cardiovascular disease (CVD). Materials and methods: from May 2001 to December 2002, 1514 men and 1528 women (>18 y) without any clinical evidence of CVD, living in the greater Athens area, in Greece were recruited. In 2011-12, the ten-year follow-up was performed in 2583 participants (15% were lost to follow-up). The fatal/ non-fatal ten-year CVD incidence was calculated according to WHO-ICD-10 criteria in 2020 participants. Many clinical/biochemical/lifestyle features were measured in the study’s sample while dietary characteristics were evaluated through a validated semi-quantitative food frequency questionnaire. To recognize the malfunction of adipose tissue two recent metabolic indices VAI, LAP were measured for both sexes. Results: 15.7% of the subjects that were followed-up developed CVD event. Α relative increase of the D-AII (12%), reflecting an anti-inflammatory diet, was related to 19% decrease of the ten-year CVD risk. Interestingly, low to moderate consumption of coffee (150-250 ml/ day adjusted for 28% caffeine containment) and moderate consumption of alcohol (≤1 glass of wine or beer/ week, <12 g. ethanol) compared to abstention revealed a J-shaped association with ten-year CVD incidence, while exclusive olive oil use/ consumption was inversely related to ten-year CVD risk. The calculation of metabolic indices showed a positive and independent correlation of VAI index with ten-year CVD incidence in men, while LAP appeared as an independent predictive index for CVD risk. Conclusions: adhering to an anti-inflammatory diet by following healthier habits (moderate consumption of coffee/ alcohol and exclusive olive oil use) seems to be protective towards the development of CVD. The present work also identified that VAI, LAP are independent predictive tools for CVD risk, easily applied in clinical practice.Σκοπός: να εξεταστεί η επίδραση κλινικών/μεταβολικών δεικτών μαζί με διατροφικούς παράγοντες (τρόφιμα και πρότυπα διατροφής) στην εξέλιξη της καρδιαγγειακής νόσου (ΚΝ). Υλικό-Μέθοδος: από το Μάιο του 2001 έως το Δεκέμβριο 2002, 1514 άνδρες και 1528 γυναίκες άνω των 18 ετών, που κατοικούσαν στην ευρύτερη περιοχή της Αθήνας, χωρίς καμία κλινική εκδήλωση ΚΝ συμφώνησαν εθελοντικά να συμμετέχουν στη μελέτη ΑΤΤΙΚΗ. Το 2011-12 πραγματοποιήθηκε ο δεκαετής επανέλεγχος σε 2583 άτομα (15% χάθηκαν μέχρι το follow-up). Η επίπτωση θανατηφόρου ή μη ΚΝ προσδιορίστηκε με τα κριτήρια WHO-ICD-10 σε 2020 άτομα. Στο δείγμα αποτιμήθηκαν κλινικά/βιοχημικά/συμπεριφοριστικά χαρακτηριστικά ενώ η αξιολόγηση των διατροφικών χαρακτηριστικών του δείγματος έγινε με έγκυρο ημιποσοτικό ερωτηματολόγιο συχνότητας κατανάλωσης τροφίμων. Για την αναγνώριση της δυσλειτουργίας του λιπώδους ιστού που αποθηκεύεται σπλαχνικά χρησιμοποιήθηκαν οι μεταβολικοί δείκτες VAI, LAP που υπολογίστηκαν και για τα δύο φύλα. Αποτελέσματα: η δεκαετής επίπτωση ΚΝ αποτιμήθηκε στο 15.7%. Αύξηση του δείκτη D-AII (που αντικατοπτρίζει μια αντιφλεγμονώδη δίαιτα) κατά 12% συσχετίστηκε με 19% μείωση του καρδιαγγειακού κινδύνου μέσα στη δεκαετία. Μειωμένη προς μέτρια κατανάλωση καφέ (150-250 ml/ ημέρα προσαρμοσμένο για το 28% της καφεΐνης) και μέτρια κατανάλωση αλκοόλ (≤1 ποτήρι κρασιού ή μπύρας / εβδομάδα, έως 12 g. αιθανόλης) σε σχέση με την πλήρη αποχή φάνηκε να εμφανίζει παραβολική συσχέτιση με τη δεκαετή επίπτωση ΚΝ, ενώ και η αποκλειστική χρήση ελαιόλαδου φάνηκε να σχετίζεται αντίστροφα με τον καρδιαγγειακό κίνδυνο. Όσο αφορά στους μεταβολικούς δείκτες, ο δείκτης VAI παρουσίασε μία ανεξάρτητη και θετική συσχέτιση με τη δεκαετή επίπτωση ΚΝ στους άνδρες ενώ ο δείκτης LAP αναδείχθηκε ως ανεξάρτητος προβλεπτικός παράγοντας καρδιαγγειακού κινδύνου. Συμπεράσματα: η προσκόλληση σε μία αντιφλεγμονώδη διατροφή μαζί με την υιοθέτηση πιο υγιεινών συνηθειών όπως μέτρια κατανάλωση αλκοόλ/ καφέ και η αποκλειστική καθημερινή χρήση ελαιόλαδου φαίνεται να παρέχουν προστασία έναντι της ΚΝ. Τέλος, οι δείκτες VAI, LAP αναγνωρίστηκαν ως ανεξάρτητα διαγνωστικά εργαλεία ανίχνευσης καρδιαγγειακού κινδύνου

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