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Prediction of Cardiovascular Disease by the Framingham‐REGICOR Equation in the High‐Risk PREDIMED Cohort: Impact of the Mediterranean Diet Across Different Risk Strata

2017; Wiley; Volume: 6; Issue: 3 Linguagem: Inglês

10.1161/jaha.116.004803

2047-9980

Antonio J. Amor, Mercè Serra‐Mir, Miguel Ángel Martínez‐González, Dolores Corella, Jordi Salas‐Salvadó, Montserrat Fitó, Ramón Estruch, Lluís Serra‐Majem, Fernando Arós, Nancy Babió, Emilio Ros, Emilio Ortega, Ana Pérez-Heras, Carles Viñas, Rosa Casas, Luigi Santa-Maria, Sonia Lidia Romero Vela, Emilio Sacanella, G. Chiva, Patricio Valderas, Sara Arranz, Jacinto Baena, Montse García, M. Oller, Jordi Delás, I. Duaso, Y. García, Carmen Iglésias, C. Simón, Ll. Quinzavos, L. Parra, M. Liroz, Jaume Benavent, J. Clos, Indira Plá, M. Amorós, Mercedes Bonet, Michelle T. Martin, M.S. Sánchez, J. Altirriba, E. Manzano, A. Altés, Aleix Sala‐Vila, Montserrat Cofán, Cinta Valls‐Pedret, Tania M. Freitas-Simoes, Mónica Doménech, Rosa Gilabert, Núria Bargalló, Mònica Bulló, Josep Basora, R. González, Andrés Díaz‐López, C. Molina, Guillermo Mena, Francisco Carlos López-Márquez, Pablo Pérez‐Martínez, Nerea Pérez Ibarrola, M.L. Sorli, J Roselló, Francisco Martín‐Luján, N. Tort, A. Isach, Albert Salas‐Huetos, Nerea Becerra‐Tomás, Núria Rosique Esteban, Joan Vila, Gaspar Mestres, Francesco Paris, M. Llauradó, Roser Pedret, J. Basells, Jesús Vizcaíno, Rafael Segarra, Pablo Hernández‐Alonso, Simona Giardina, Cíntia Ferreira‐Pêgo, Christopher Papandreou, Laura Camacho, Estefanía Toledo, Pilar Buil‐Cosiales, Miguel Ruiz‐Canela, J. Alfredo Martínéz, B. Sanjulián, Ana Sánchez‐Tainta, Javier Díez‐Espino, Cristina Razquín, Ana García‐Arellano, Elisabetta Goni, Zenaida Vázquez‐Ruiz, N. Berrade, V. Extremera‐Urabayen, Sonia Eguaras, Amelia Martí, C. Arroyo‐Azpa, Luis‐Emilio García‐Pérez, J. Villanueva Telleria, F. Cortés Ugalde, T. Sagredo Arce, Mathieu Montoy, M. D. Vigata López, M. T. Arceiz Campo, A Samper, Ma Victoria Güeto Rubio, A. Pérez Sola, Nicolás Goñi, Óscar Lecea, Susana Tello, Joan Vila, Rafael de la Torre, Daniel Muñoz‐Aguayo, Roberto Elosúa, Jaume Marrugat, Helmut Schröder, Nerea M. Molina, Elena Moreno, Olga Castañer, Adela Rovira, Magı́ Farré, José V. Sorlí, Vicente Zanón‐Moreno, Paula Carrasco, Carolina Ortega‐Azorín, Maximiliano Asensio, R. Osma, Rocío Barragán, F. Francés, Marisa Guillén, José I. González, Carmen Sáiz, Olga Portolés, François Gimenez†, Óscar Coltell, Patricia Guillem‐Sáiz, Laura Quiles, Vicente Pascual, Cristina Riera, M Pagès, Daniela Godoy, Arturo Carratalá, M. J. Martín‐Rillo, E. Llopis‐Osorio, J. Ruiz‐Baixauli, A. Bertolín‐Muñoz, Itziar Salaverria‐Lete, T. del Hierro, Jaime Algorta, Saionara Cristina Francisco, Ángel M. Alonso‐Gómez, E. Sanz, Javier Rekondo, María C. Belló, A Loma-Osorio, Enrique Gómez‐Gracia, Julia Wärnberǵ, R. Benítez Pont, Maria Alba, Ricardo Gómez‐Huelgas, Javier Martínez, Vanessa Garcia, J. de Diego Salas, Alvaro Osorio, J. Gil Zarzosa, Juan José Sánchez Luque, E. Vargas López, Valentina Ruiz‐Gutiérrez, Javier S. Perona, E. Romero, M. García‐García, Enrique Jurado‐Ruiz, Miquel Fiol, M. García‐Valdueza, Manuel Moñino, Ana M. Proenza, Rafael Prieto, Guillem Frontera, M. Ginard, Francisca Fiol, A. Jover, Dora Romaguera, José García-Sánchez, José Lapetra, José Manuel Santos‐Lozano, Manuel Ortega‐Calvo, L. Mellado, Mariano Leal Hernández, E. Martínez, Fernando García, P. Román, Pablo Iglesias, Y. Corchado, Lluïsa Miró, César Domínguez, J.M. Lozano, E. Mayoral, Rosa M. Lamuela‐Raventós, M. Carmen López‐Sabater, A.I. Castellote-Bargalló, Anna Tresserra‐Rimbau, Jacqueline Álvarez-Pérez, Elena María Díaz-Benítez, Inmaculada Bautista-Castaño, Almudena Sánchez‐Villegas, María Fernández-Rodríguez, T. Casanas Quintana, J. Pérez‐Cabrera, Mariela Nissensohn, Vanessa Díaz-González, Cristina Ruano-Rodríguez, Adriana Ortiz‐Andrellucchi, Bastián Gutiérrez, Ángel Julio Santana-Santana, Xavier Pintó, E. de la Cruz, A. Galera, Y. Soler, F. Trias, I. Sarasa, E. Padres, Emili Corbella, Carmen Cabezas, Ernest Vinyoles, M.A. Rovira, Lorena García, Guillermo Moreno Flores, José María Verdú-Rotellar, Poornima Baby, Ángel Mazón, Lourdes Mengual, Pere Roura‐Poch, María Concepción Ayuso Yuste, A. Guarner, Adela Rovira, Milton Santamaría, Manel Mata‐Cases, C. de Juan, Antonio Sanz Brau, Josep A. Tur, María P. Portillo, Guillermo T. Sáez, Mikel Aldámiz, Álvaro Alonso, Jesús Berjón, Luis Forga, Juanita Mena Gallego, Amparo Larrauri, J. Portu, Juan Timiraos, Manuel Serrano-Martínez,

Cardiovascular Health and Risk Factors

The usefulness of cardiovascular disease (CVD) predictive equations in different populations is debatable. We assessed the efficacy of the Framingham-REGICOR scale, validated for the Spanish population, to identify future CVD in participants, who were predefined as being at high-risk in the PREvención con DIeta MEDiterránea (PREDIMED) study-a nutrition-intervention primary prevention trial-and the impact of adherence to the Mediterranean diet on CVD across risk categories.In a post hoc analysis, we assessed the CVD predictive value of baseline estimated risk in 5966 PREDIMED participants (aged 55-74 years, 57% women; 48% with type 2 diabetes mellitus). Major CVD events, the primary PREDIMED end point, were an aggregate of myocardial infarction, stroke, and cardiovascular death. Multivariate-adjusted Cox regression was used to calculate hazard ratios for major CVD events and effect modification from the Mediterranean diet intervention across risk strata (low, moderate, high, very high). The Framingham-REGICOR classification of PREDIMED participants was 25.1% low risk, 44.5% moderate risk, and 30.4% high or very high risk. During 6-year follow-up, 188 major CVD events occurred. Hazard ratios for major CVD events increased in parallel with estimated risk (2.68, 4.24, and 6.60 for moderate, high, and very high risk), particularly in men (7.60, 13.16, and 15.85, respectively, versus 2.16, 2.28, and 3.51, respectively, in women). Yet among those with low or moderate risk, 32.2% and 74.3% of major CVD events occurred in men and women, respectively. Mediterranean diet adherence was associated with CVD risk reduction regardless of risk strata (P>0.4 for interaction).Incident CVD increased in parallel with estimated risk in the PREDIMED cohort, but most events occurred in non-high-risk categories, particularly in women. Until predictive tools are improved, promotion of the Mediterranean diet might be useful to reduce CVD independent of baseline risk.URL: http://www.Controlled-trials.com. Unique identifier: ISRCTN35739639.