Department of Epidemiology and Prevention, IRCCS Neuromed, Via dell'Elettronica, 86077 Pozzilli, IS, Italy.
Department of Epidemiology and Prevention, IRCCS Neuromed, Via dell'Elettronica, 86077 Pozzilli, IS, Italy.
Int J Cardiol. 2019 Feb 1;276:248-254. doi: 10.1016/j.ijcard.2018.11.117. Epub 2018 Nov 24.
Statins are prescribed for patients with cardiovascular disease (CVD), along with the recommendation of adopting healthy diets. We evaluated the independent and the combined effect of statins and Mediterranean diet (MD) towards mortality risk in patients with previous CVD by using real-life data from a population-based prospective cohort.
Longitudinal analysis on 1180 subjects (mean age 67.7 ± 10) with prior CVD at enrollment in the Moli-sani Study and followed up for 7.9 y (median). Adherence to MD was appraised by a Mediterranean diet score. Hazard ratios (HR) with 95% confidence intervals (95% CI) were calculated by multivariable Cox regression and competing risk models.
Multivariable risk estimates associated with a 2-point increase in MD score were 0.84 (95% CI 0.70-1.00), 0.77 (0.61-0.97) and 0.70 (0.52-0.93) for overall, cardiovascular and coronary artery disease (CAD)/cerebrovascular deaths, respectively. Statins were not associated with death risk. Subjects combining statins and average-high adherence to MD had much lower than expected risk of cardiovascular and CAD/cerebrovascular mortality (p for interaction = 0.045 and 0.0015, respectively) as compared to those neither using statins nor having average-high MD. The combination of average-high MD and statins was associated in a likely synergistic way with reduced low-grade inflammation, but not with blood cholesterol.
MD lowered the risk of all-cause, cardiovascular and CAD/cerebrovascular mortality CVD patients, net of statins. In the same population, statins reduced CVD death risk only in combination with MD. Low-grade inflammation, rather than lipids, is likely to be on the pathway of the interaction between MD and statins towards mortality risk.
他汀类药物被开给患有心血管疾病（CVD）的患者，并建议他们采用健康饮食。我们利用来自基于人群的前瞻性队列研究的真实数据，评估了他汀类药物和地中海饮食（MD）对既往 CVD 患者死亡率风险的独立和联合影响。
对 Moli-sani 研究中登记时患有既往 CVD 的 1180 名受试者（平均年龄 67.7±10 岁）进行纵向分析，随访时间为 7.9 年（中位数）。通过地中海饮食评分评估 MD 的依从性。通过多变量 Cox 回归和竞争风险模型计算危险比（HR）和 95%置信区间（95%CI）。
与 MD 评分增加 2 分相关的多变量风险估计值分别为 0.84（95%CI 0.70-1.00）、0.77（0.61-0.97）和 0.70（0.52-0.93），用于全因、心血管和冠状动脉疾病（CAD）/脑血管死亡。他汀类药物与死亡风险无关。与既不使用他汀类药物也不具有平均高 MD 依从性的患者相比，同时使用他汀类药物和平均高 MD 依从性的患者的心血管和 CAD/脑血管死亡率的风险明显低于预期（交互作用的 p 值分别为 0.045 和 0.0015）。平均高 MD 和他汀类药物的组合与降低低度炎症呈可能协同作用，但与血液胆固醇无关。
MD 降低了 CVD 患者全因、心血管和 CAD/脑血管死亡率的风险，他汀类药物除外。在同一人群中，他汀类药物仅在与 MD 联合使用时降低 CVD 死亡风险。低度炎症而不是脂质可能是 MD 和他汀类药物对死亡率风险相互作用的途径。
