Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, Osaka 565-0871, Japan.
Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing 100191, China.
Nutrients. 2021 Jul 29;13(8):2623. doi: 10.3390/nu13082623.
The association of the Mediterranean diet (MD) with mortality among people with a history of cardiovascular disease (CVD) has not been systematically examined. Hereby, our objective was to investigate the association of MD with all-cause and cardiovascular mortality in people with a history of CVD. We searched five electronic databases including Embase, PubMed, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials to screen eligible studies published before 31 August 2020. A random-effect model was used to examine the association of a 2-unit increment in MD score with the risk of all-cause and cardiovascular mortality. We conducted sensitivity and subgroup analyses and examined potential publication bias by Egger's and Begg's tests. Seven cohort studies (eight datasets) with a total of 37,879 participants who had a history of CVD were eligible for the main analysis. The pooled hazard ratios were 0.85 (95% CIs: 0.78-0.93; n = 8) for all-cause mortality and 0.91 (95% CIs; 0.82-1.01; n = 4) for cardiovascular mortality for each 2-unit increment in a score of adherence to MD. Subgroup analyses for all-cause mortality showed that the association appeared relatively stronger in Mediterranean areas (HR = 0.76 [0.69-0.83]) than non-Mediterranean areas (HR = 0.95 [0.93-0.98]) and in studies with a shorter duration (HR = 0.75 [0.66-0.84] for <7 years vs. HR = 0.94 [0.91-0.98] for ≥7 years). No evidence of publication bias was observed. The present meta-analysis of prospective cohort studies provided evidence that adherence to MD improved survival in people with a history of CVD.
地中海饮食（MD）与心血管疾病（CVD）病史人群的死亡率之间的关联尚未得到系统研究。因此，我们的目的是研究 MD 与 CVD 病史人群的全因和心血管死亡率之间的关系。我们在五个电子数据库中进行了搜索，包括 Embase、PubMed、Scopus、Web of Science 和 Cochrane 中央对照试验注册库，以筛选截至 2020 年 8 月 31 日发表的合格研究。使用随机效应模型来检验 MD 评分每增加 2 个单位与全因和心血管死亡率风险之间的关系。我们进行了敏感性和亚组分析，并通过 Egger 和 Begg 检验检查了潜在的发表偏倚。共有 7 项队列研究（8 个数据集）纳入了 37879 名 CVD 病史患者，符合主要分析的条件。每增加 2 个单位的 MD 评分，全因死亡率的合并危险比为 0.85（95%CI：0.78-0.93；n=8），心血管死亡率的合并危险比为 0.91（95%CI：0.82-1.01；n=4）。全因死亡率的亚组分析表明，在地中海地区（HR=0.76[0.69-0.83]），该关联似乎比非地中海地区（HR=0.95[0.93-0.98]）更强，且在随访时间较短的研究中（HR=0.75[0.66-0.84]，<7 年 vs. HR=0.94[0.91-0.98]，≥7 年）关联更强。未发现发表偏倚的证据。本项前瞻性队列研究的荟萃分析提供了证据，表明遵循 MD 可改善 CVD 病史人群的生存。
