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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 (<150 ml/day), moderate (150-250 ml/day) and heavy coffee consumption (>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. [ABSTRACT FROM AUTHOR]

Aim: Ikaria Island (North-East Aegean, Greece) has been recognized as one of the places with the highest life expectancy around the world (the Blues Zones). Risk factors in relation to 4-year all-cause mortality and cardiovascular disease (CVD) incidence in elders were studied. Methods: From June to October 2009, 330 men and 343 women, aged 65 to 100 years, were enrolled, and in June to July 2013, they were reevaluated. Results: Age-standardized, gender-specific, all-cause mortality rate was 790 deaths per 10 000 inhabitants, and causes of death were CVD (36%), cancer (21%), infection (10%), respiratory disease (2%), and other (31%). Incidence of CVDwas 520 cases per 10 000 men inhabitants and 320 cases per 10 000 women (P = .03). Age, male gender, heart rate, urea levels, left atrial maximum volume, left ventricular hypertrophy, thyroid-stimulating hormone, and moderate to severe depression were positively associated with mortality, whereas left ventricular ejection fraction as well as coffee and tea drinking, fruit intake, and exclusive olive oil use were inversely associated with CVD. Conclusion: Heart function markers in addition to antioxidant dietary factors were placed in this puzzle of CVD morbidity. [ABSTRACT FROM AUTHOR]

Cardiovascular disease ( CVD) remains the leading cause of morbidity and mortality worldwide, and educational level seems to be an important determinant of the disease occurrence. The aim of this work was to investigate the association between education status and 10-year incidence of CVD, controlling for various socio-demographic lifestyle and clinical factors. From May 2001 to December 2002, 1514 men and 1528 women (>18 years) without any clinical evidence of CVD or any other chronic disease, at baseline, living in greater Athens area, Greece, were enrolled. In 2011-2012, the 10-year follow-up was performed in 2583 participants (15% of the participants were lost to follow-up). Incidence of fatal or non-fatal CVD was defined according to WHO- ICD-10 criteria. Education status was measured in years of schooling. The 10-year incidence of CVD was 15.7% [95% confidence intervals ( CI) 14.1%-17.4%], 19.7% in men and 11.7% in women ( Pgender < 0.001). Age-and gender-adjusted analyses revealed that those with low education (<9 years of schooling) were 1.52 times more likely (95% CI 1.03-2.23%) to have CVD compared with those with high education (>12 years of schooling). People in the low education group had higher prevalence of hypertension, diabetes and dyslipidaemias, were more likely to be smokers and sedentary, had less healthy dietary habits, as compared with those in the high education group. When controlling for participants' medical history, smoking, dietary and lifestyle habits, low education was no longer significantly associated with CVD, illustrating the mediating effect of clinical and behavioural factors in the link between education and disease. It was of interest that low education status interacted with alcohol drinking, enhancing the adverse effect of low education on CVD risk (relative risk 1.44, 95% CI 0.94%-2.20%), after various adjustments made. In this study, it was concluded that low educational level was associated with increased CVD risk. This was mainly explained by the intermediate association of low education with unhealthy choices that consequently worsen clinical status. [ABSTRACT FROM AUTHOR]

Aims: Arrhythmogenic right-ventricular cardiomyopathy (ARVC) is a genetically determined disorder, mostly caused by mutations in genes encoding desmosomal proteins. We evaluated phenotype/genotype characteristics to predict the risk for the first major arrhythmic event in desmosomal-mutation-associated ARVC families.Methods and Results: A cohort of 105 desmosomal-mutation carriers belonging to 39 consecutive ARVC families was evaluated. Serial clinical work-up consisting of history, physical examination, 12-lead/signal-averaged/24 h ambulatory ECG, and two-dimensional echocardiography was performed every 6-12 months. The predictive value of gender and genotype for the first major arrhythmic event was investigated within the cohort using time-to-event analysis. ECG/echocardiographic features were evaluated at the time of event and associated with the outcome using an age-matched nested case-control study within the cohort. Forty-three (41%) participants experienced the primary arrhythmic outcome at median age of 29 (21-46) years. The first event was sustained ventricular tachycardia in 31 and sudden cardiac death in 12. Definite diagnosis according to the 2010 Task Force criteria, showed 57% positive and 100% negative predictive value for the occurrence of arrhythmic outcome. Male gender (hazard ratio = 3.26, 95%CI, 1.63-6.51), predicted the first major arrhythmic event, independently of genotype, on multivariable analysis. Repolarization abnormalities and left-ventricular dysfunction independently associated with clinical disease profile at the time of event.Conclusion: Male gender, independently of genotype is an arrhythmic risk predictor in ARVC-associated desmosomal-mutation carriers. Repolarization abnormalities and left-ventricular dysfunction are important components of the first event-associated clinical disease profile. [ABSTRACT FROM AUTHOR]

Background and Objectives: Risk evaluation of patients hospitalized with acute coronary syndrome (ACS) may contribute to their short-term prognosis improvement. The aim of this work was to develop a prediction index (score) for the risk assessment of 30-day death of ACS patients, using clinical and biological measurements at hospital admission. Methods: A sample of 6 Greek hospitals was selected, and almost all consecutive 2172 ACS patients from October 2003 to September 2004 were enrolled. Sociodemographic, biochemical, clinical, and lifestyle characteristics were recorded. Using as components age, systolic blood pressure, white blood cell count, creatine kinase-MB, and creatinine levels at the time of admission and the time between the onset of symptoms and presentation at hospital, a risk score (Greek Acute Coronary Syndrome score; range, 6-36) was developed and tested against in-hospital and 30-day outcome of the patients. Results: The Greek Acute Coronary Syndrome score showed strong discriminating ability for in-hospital mortality (area under the receiver operating characteristic curve, 0.812; 95% confidence interval, 0.750-0.874; P < .001) and 30-day death after hospitalization (area under the receiver operating characteristic curve, 0.720; 95% confidence interval, 0.724-0.837; P < .001). The optimal value of the score, which discriminates those who will die in-hospital from survivors, was 24, and that for those who will die within 30 days after discharge was 22. The score's classification ability was confirmed using 100 bootstrap samples and remained similar among several subgroups of patients (younger or older, men or women, type of ACS, and diabetes status). Conclusions: The suggested risk score using routinely collected clinical and biological data may be a useful tool in clinical practice for decision making regarding further management, not only during hospitalization but also in the postdischarge period. [ABSTRACT FROM AUTHOR]

This study aimed at evaluating the changes in platelet-activating factor (PAF) and its metabolic enzymes over a 6-week follow-up period in patients with newly diagnosed heart failure ([HF] n = 12) compared with age-, sex-, and BMI-matched apparently healthy volunteers (n = 10). The PAF, its key biosynthetic enzymes (lyso-PAF acetyltransferase [lyso-PAF-AT] and dithiothreitol [DTT]-insensitive CDP choline: 1-alkyl-2-acetyl-sn-glycerol cholinephosphotransferase [PAF-CPT]), and its catabolic isoenzymes (PAF-acetylhydrolase [PAF-AH] and lipoprotein-associated phospholipase A2 [Lp-PLA2]) were measured in serum and leukocytes of participants. At baseline, patients with HF had lower median activities of lyso-PAF-AT (P < .001) and PAF-CPT (P = .07) in parallel with PAF levels (P = .05) and higher activities of PAF-AH (P = .02) and Lp-PLA2 (P < .001) than controls. At follow-up, PAF-CPT and PAF levels marginally increased (P = .1), lyso-PAF-AT (P < .001) remained downregulated, while PAF-AH (P = .004) and Lp-PLA2 (P < .001) remained elevated compared with the controls. Newly diagnosed patients with HF under drug treatment have an affected profile of PAF biosynthetic enzymes and especially lyso-PAF-AT. [ABSTRACT FROM PUBLISHER]

Background Τhe influence of atrial septal occluders in left atrial ( LA) function after percutaneous closure of patent foramen ovale ( PFO) has not been thoroughly studied. Methods Twenty-five patients (mean age 40.7 ± 12 years) undergoing percutaneous PFO closure were enrolled in this study. Transthoracic echocardiogram ( TTE) was performed 3 and 6 months before the procedure. Volumetric indices (active emptying fraction: LA AEF, expansion index: LA EI, and passive emptying fraction: LA PEF), strain and strain rate ( SR), were calculated during the contractile, reservoir, and conduit LA phases for the lateral, anterior, and inferior LA walls with TTE. Results After 3 months, a decrease in the SR of the LA anterior wall was observed (from 2.12 ± 0.22 to 1.66 ± 0.26, P < 0.045), while the LA lateral wall strain was found to be increased (from 0.708 ± 0.15 to 0.783 ± 0.159, P < 0.001). Moreover, simultaneously LA AEF was greater compared with baseline (from 31.0 ± 1.6 to 34.0 ± 1.6, P < 0.004). However, all these alterations reversed at 6 months. Conclusions Segmental LA function is altered transiently after percutaneous PFO closure with a septal occlude. The LA anterior wall SR decreases, while the lateral wall strain increases. The impact of these alterations needs further clarification. [ABSTRACT FROM AUTHOR]

Objective. RA is associated with increased cardiovascular events, reportedly to equal diabetes mellitus (DM). The presence of myocardial ischaemia was assessed in asymptomatic high-risk RA patients and compared with patients with DM and a healthy control group.Methods. Eighteen consecutive non-diabetic RA patients without known cardiovascular disease who developed a new carotid atheromatic plaque during the last 3 years were matched 1:1 for traditional cardiovascular risk factors with asymptomatic type 2 DM patients and 1:2 with asymptomatic non-RA, non-DM control subjects. After dobutamine stress contrast echocardiography with wall-motion and perfusion evaluation, coronary angiography was performed in those with positive stress tests.Results. Ischaemia by echocardiography was found in 67% of RA patients; this was significantly higher than controls (31%, P = 0.019) but comparable to those with DM (78%, P = 0.71). Angiography performed in eight consenting RA patients was normal in four, revealed non-flow-limiting coronary atheromatic lesions in two and significant lesions in two patients. RA patients with ischaemia had CRP serum levels significantly higher by six-fold compared with those with normal stress echocardiography.Conclusion. Asymptomatic RA patients may display myocardial ischaemia at similar levels to DM patients but with low prevalence of obstructive coronary artery disease. Microvascular abnormalities associated with increased inflammatory response may account for these findings. Their exact nature and significance require further evaluation. [ABSTRACT FROM PUBLISHER]

Background: Elevated blood pressure (BP) during childhood and adolescence is not so rare and increases the risk of hypertension in adulthood. Physical activity (PA) is considered a key component for the prevention and treatment of hypertension in children and adolescents. Thus, the purpose of our study was to assess the level of PA in Greek adolescents and its relation to BP levels. Methods: The study included 496 students aged 12–17 years who were enrolled on a volunteer basis. All children were subjected to BP measurement on two different occasions during a routine school day. Demographic, socio-economic and lifestyle characteristics were assessed by means of a standard questionnaire. Information on the frequency and duration of PA and on the amount of time spent on sedentary activities was obtained by the short-form self-administered questionnaire International Physical Activity Questionnaire-IPAQ. Results: The study population was divided in three groups according to the score achieved in IPAQ questionnaire: low PA (n = 39), moderate PA (n = 230) and high PA (n = 231). Children with high PA compared to those with low PA exhibited higher systolic BP and pulse pressure levels, greater prevalence of prehypertension/hypertension status, while heart rate was significantly lower as the level of PA rose (P < 0.05 for all cases). Intense PA was positively correlated to systolic BP (r = 0.139, P = 0.003) and pulse pressure (r = 0.22, P = 0.0001). Conclusion: Intense PA is associated with higher systolic BP, pulse pressure levels and lower heart rate in healthy young adolescents. PA should be practiced at a moderate intensity level in everyday life. [ABSTRACT FROM AUTHOR]

Background. There are places around the world where people live longer and they are active past the age of 100 years, sharing common behavioral characteristics; these places (i.e., Sardinia in Italy, Okinawa in Japan, Loma Linda in California and Nicoya Peninsula in Costa Rica) have been named the "Blue Zones". Recently it was reported that people in Ikaria Island, Greece, have also one of the highest life expectancies in the world, and joined the "Blue Zones". The aim of this work work was to evaluate various demographic, lifestyle and psychological characteristics of very old (>80 years) people participated in Ikaria Study. Methods. During 2009, 1420 people (aged 30+) men and women from Ikaria Island, Greece, were voluntarily enrolled in the study. For this work, 89 males and 98 females over the age of 80 yrs were studied (13% of the sample). Socio-demographic, clinical, psychological and lifestyle characteristics were assessed using standard questionnaires and procedures. Results. A large proportion of the Ikaria Study's sample was over the age of 80; moreover, the percent of people over 90 were much higher than the European population average. The majority of the oldest old participants reported daily physical activities, healthy eating habits, avoidance of smoking, frequent socializing, mid-day naps and extremely low rates of depression. Conclusion. Modifiable risk factors, such as physical activity, diet, smoking cessation and mid-day naps, might depict the "secrets" of the long-livers; these findings suggest that the interaction of environmental, behavioral together with clinical characteristics may determine longevity. This concept must be further explored in order to understand how these factors relate and which are the most important in shaping prolonged life. [ABSTRACT FROM AUTHOR]

Background. The aim was to examine the association of depressive symptoms with fish eating habits, in elderly individuals. Methods. From June to October of 2009, we studied 330 men and 343 women, aged 65 to 100 years, permanent inhabitants of Ikaria Island. Among several characteristics, depression was assessed with the Geriatric Depression scale (GDS range 0-15), while dietary habits through a valid semiquantitative food frequency questionnaire. Results. Women had significantly higher values of the GDS compared to men (4.8 ± 3.5 versus 3.3 ± 3.1, P = .001). Participants in the upper tertile of depression scale ate less frequent fish and consumed higher quantities of alcohol, compared to those in the lowest tertile (all P < .05). Regarding fish consumption, 50% of the individuals reported consuming 1-2 times weekly, 32% 3 to 5 times weekly, 11% 2-3 times monthly, while the rest reported rare (4.5%) and everyday (1.2%) consumption. Logistic regression showed that increased fish consumption (>3 times/week versus never/rare) was inversely associated with the odds of having GDS greater the median value (i.e., 4) (odds ratio = 0.34, 95% CI: 0.19, 0.61), after controlling for several cofounders. Conclusion. Frequent fish consumption in elderly seems to moderate depression mood. [ABSTRACT FROM AUTHOR]

During 2000 to 2002, 700 men (59 ± 10 years) and 148 women (65 ± 9 years) patients with first event of an ACS were randomly selected from cardiology clinics of Greek regions. Afterwards, 1078 population-based, age-matched and sex-matched controls were randomly selected from the same hospitals. The frequency ratio between men and women in the case series of patients was about 4:1, in both south and north Greek areas. Hierarchical classification analysis showed that for north Greek areas family history of coronary heart disease, hypercholesterolemia, hypertension, diabetes (explained variability 35%), and less significantly, dietary habits, smoking, body mass index, and physical activity status (explained variability 4%) were associated with the development of ACS, whereas for south Greek areas hypercholesterolemia, family history of coronary heart disease, diabetes, smoking, hypertension, dietary habits, physical activity (explained variability 34%), and less significantly body mass index (explained variability <1%), were associated with the development of the disease. [ABSTRACT FROM AUTHOR]

Objective: In this work we evaluated the 5-year incidence of hypercholesterolemia, in a sample of cardiovascular disease free adult men and women from Greece. We also evaluated the association of several socio-demographic, dietary and lifestyle habits on the incidence of this disorder. Methods: 1514 men and 1528 women (>18 y) without any clinical evidence of cardiovascular disease, living in Attica area, Greece, were enrolled in the ATTICA study from May 2001 to December 2002. The sampling was random, multi-stage, and included information about various socio-demographic, lifestyle (diet, exercise, smoking etc), biological (lipids, and inflammatory markers), and clinical characteristics of the participants. In 2006, a group of experts performed the 5-year follow-up through telephone calls or personal visits (941 of the 3042 (31%) participants were lost to follow-up). Hypercholesterolemia, among people who had normal blood lipids at initial examination, was defined as fasting total cholesterol levels > 200 mg/dl or use of lipids lowering agents (NCEP ATPIII). Results: The 5-year incidence of hypercholesterolemia was 23.7% (n = 127) in men and 17.7% (n = 110) in women (p for gender differences < 0.001). Multi-adjusted logistic regression analysis which revealed that increased age (odds ratio = 1.05, p < 0.001), waist circumference (odds ratio = 1.02, p = 0.03), fasting blood glucose (odds ratio = 1.01, p = 0.08) and apolipoprotein B (odds ratio = 1.02, p = 0.001) levels, were the most significant baseline predictors of developing hypercholesterolemia within a 5-year period. Conclusion: Incidence of hypercholesterolemia was high in both genders, emphasizing the burden of this disorder at population level. Aging, increased waist circumference, fasting blood glucose and apolipoprotein B levels were the most significant baseline predictors of hypercholesterolemia. [ABSTRACT FROM AUTHOR]

Objective: Aim of the present study was to identify potential dietary, lifestyle, psychosocial and clinical correlates of underreporting in a population-based sample.Methods: Following a random multistage sampling, 1514 men (46+/-13 years old) and 1528 women (45+/-13 years old) from the Attica area, in Greece, participated in this study. All participants underwent a standard assessment procedure that included clinical, psychosocial and lifestyle parameters. Food consumption was assessed through a validated semi-quantitative food frequency questionnaire. The ratio of energy intake to estimated basal metabolic rate (EI/BMR) and the Goldberg cut-off points were used for the classification of subjects as low energy reporters (LERs) and non-LERs.Results: LERs represented 12.2% of the sample. This percentage was higher in obese subjects compared to overweight or normal weight (20.6 % vs. 9.9 % vs. 10.6 %, p = 0.05), as well as in women compared to men (14.6% vs. 9.9%, p<0.001). Data analysis was stratified by gender, since a significant interaction was observed between gender and LER group on several dietary parameters. Female LERs had higher Med Diet Score compared to non-LERs (30.6 +/- 8.2, 95%CI 30.2-31.04 vs. 26.9 +/- 6.3, 95%CI 26.05-27.7, p<0.001). Multiple regression analysis revealed that lower EI/BMR values were associated with younger age (p<0.001), higher BMI (p<0.001), presence of diabetes mellitus (p=0.012) and lower depression score (p=0.056) in women, whereas with younger age (p<0.001), higher BMI (p<0.001), higher education level (p=0.046) and higher anxiety score (p=0.08) in men.Conclusion: Several psychosocial and clinical characteristics operate in low energy reporting in both genders. Nutrition-related professionals should be aware of these gender-specific trends in dietary assessment procedures. [ABSTRACT FROM AUTHOR]

Objective: To investigate the association between chronic exposure to second hand smoke (SHS) and the short-term prognosis of patients hospitalised with acute coronary syndromes. Methods: Between 1 October 2003 and 30 September 2004, 2172 consecutive patients enrolled with acute coronary syndromes at the cardiology clinics or the emergency units of six major hospitals, in Greece were studied. Exposure to SHS was measured through a questionnaire administered during a specific interview, after the second day of hospitalisation. The main outcome of interest was the 30-day status of these patients (death, or rehospitalisation due to coronary heart disease). Results: 1003 (46%) of the patients were exposed to SHS. Patients reporting exposure to SHS had 61% (95% CI 14% to 118%) higher risk of having an event during the first 30 days after hospitalisation as compared with patients who were not exposed to SHS, after taking into account the effect of several potential confounders. A dose-response linear relationship was observed between the risk of having recurrent events and the years of exposure to SHS (p=0.17, p<0.001). Conclusions: Exposure to SHS increases considerably the risk of recurrent events in patients who had survived a cardiac event. [ABSTRACT FROM AUTHOR]

Objective: We investigated the association between adherence to Mediterranean diet and fasting indices of glucose homoeostasis, in a Greek adult population.Methods: During 2001-2002 we randomly enrolled 1514 men and 1528 women (18-89 years old) without history of CVD, from the Attica area. Diabetes mellitus (type 2) and impaired fasting glucose (IFG) were defined according to the established ADA criteria. Insulin resistance was evaluated by HOMA-IR. Dietary habits were assessed through a validated food frequency questionnaire and a diet score (range 0-55) was developed (higher values means greater adherence to the Mediterranean diet).Results: The overall prevalence of diabetes type 2 was 7.9% in men and 6.0% in women (P = 0.05). Mean diet score was 26.3 +/- 6.8 in normoglycemic, 25.7 +/- 6.4 in IFG and 22.2 +/- 5.8 in diabetic subjects (p < 0.001). In normoglycemic subjects who were in the upper tertile of the diet score we observed 7% lower glucose (p < 0.05), 5% lower insulin (p < 0.05) and 15% lower HOMA-IR (p < 0.01) levels compared to subjects in the lower tertile of the diet score. Additionally, in diabetic/IFG participants who where in the upper tertile of the diet score we observed 15% lower glucose (p < 0.05), 15% lower insulin (p < 0.05) and 27% lower HOMA-IR (p < 0.01) levels compared to those in the lower tertile. However, multiple regression analysis, adjusted for age, sex, BMI, waist-to-hip ratio, physical activity, smoking status, and presence of hypertension and hypercholesterolemia, confirmed the previous associations in normoglycemic, but not in diabetic/IFG people.Conclusion: An inverse association was observed between adherence to Mediterranean diet and indices of glucose homeostasis, only in normoglycemic people. [ABSTRACT FROM AUTHOR]

Background: Although General Practice (GP) was recognized as a medical specialty in Greece in 1986, the number of GPs is insufficient to cover needs and only few medical graduates choose GP as a career option. In the present study we investigated the profile of medical students in terms of their decisions regarding specialization and the possible association of career choices different from GP with the status of undergraduate training regarding GP. Methods: The sample consisted of final year students in the Medical School of the University of Athens, Greece. Students filled in a self-reported questionnaire focusing on medical specialization, and GP in particular. Results: Response rate was 82.5% with 1021 questionnaires collected, out of 1237 eligible medical students. Only 44 out of the 1021 (4.3%) respondents stated that GP is -or could be- among their choices for specialty. The most popular medical specialty was General Surgery (10.9%), followed by Cardiology (9.6%), Endocrinology (8.7%) and Obstetrics-Gynaecology (8.3%). The most common criterion for choosing GP was the guaranteed employment on completion of the residency (54.6%) while a 56.6% of total respondents were positive to the introduction of GP/FM as a curriculum course during University studies. Conclusion: Despite the great needs, GP specialty is currently not a career option among undergraduate students of the greater Medical University in Greece and is still held in low esteem. A university department responsible for undergraduate teaching, promotion and research in GP (where not available) is essential; the status of undergraduate training in general practice/family medicine seems to be one of the most important factors that influence physician career choices regarding primary care specialties. [ABSTRACT FROM AUTHOR]

Background: We aimed to evaluate the prevalence, frequency and type of leisure-time physical activity (LTPA) among adults in Greece, as well as its relationship with socio-demographic, lifestyle and clinical characteristics of these people. Methods: From May 2001 to December 2002 we randomly enrolled 1514 men and 1528 women, without any evidence of cardiovascular or any other chronic disease. The sampling was stratified by the age - gender distribution of (census 2001) of the greater area of Athens. Weekly energy expenditure assessed by considering frequency, duration (in minutes) and intensity of sports related physical activity during a usual week. Results: 53% of men and 48% of women were classified as physically active. Men were more likely to be active as compared to women (p < 0.05), while the lowest activity rates were observed in 40 to 49 years old participants (p < 0.01). Physically active people had higher occupation skills, were more likely to live in rural areas, to be unmarried, non smokers and they were devoted to a healthier dietary pattern, as compared to sedentary, irrespective of age and sex (all p < 0.05). In addition, the cumulative risk factors score of obesity, hypertension, hypercholesterolemia and diabetes, was inversely associated with activity status (p < 0.001). Finally, physically active men and women were less likely to report depressive symptoms (p < 0.01), after various adjustments were made. Conclusion: Half of the studied population reported physically inactive, indicating that sedentary lifestyle becomes a serious epidemic in Greece. High occupation skills, non-smoking, devotion to a healthier dietary pattern and a better cardiovascular risk factors profile were some of the determinants of physically active people. [ABSTRACT FROM AUTHOR]

The effect of coffee consumption on cardiovascular disease has been debated for many years. In this work, we evaluated the association between coffee consumption and the risk of developing acute coronary syndromes, based on a random sample of 848 patients with their first coronary heart disease event and 1078 frequency-matched controls with no cardiovascular disease in their medical history, from the entire country. The multivariate analysis raises a J-shaped association between the risk of developing acute coronary syndromes and the quantity of coffee consumed per day. In particular, the odds ratios for moderate (<300 mL/d), heavy (300-600 mL/d), and very heavy (>600 mL/d), consumption, relative to no consumption, were 0.69 (95% CI, 0.50-0.86), 1.56 (95% CI, 1.10-2.34) and 3.10 (95% CI, 1.82-5.26), respectively, after controlling for the presence of hypertension, hypercholesterolemia, diabetes mellitus, family history of premature coronary heart disease, physical activity status, smoking habits, BMI, alcohol consumption, triglycerides, consumption of several food items, depression scale score and education status. The suggested J-shaped association between coffee consumption and the risk of developing acute coronary syndromes may partially explain the conflicting results from other studies in the past. [ABSTRACT FROM AUTHOR]

Background: Visceral adiposity index (VAI) is a novel marker of visceral adipose tissue accumulation and dysfunction. The study aim was to explore the association of VAI with the 10-year type 2 diabetes mellitus (T2DM) incidence in apparently healthy individuals and compare its T2DM predictive ability against common anthropometric indices.Methods: In 2001 to 2002, the ATTICA study (Greece) recruited a random sample of 1514 and 1528 CVD-free men (18-87 years old) and women (18-89 years old), respectively. Sociodemographic, lifestyle, clinical, and biochemical characteristics of participants were measured at baseline, and the 10-year follow-up was performed during 2011 to 2012. After excluding participants with diabetes at baseline and participants without complete follow-up information regarding diabetes status and/or baseline VAI values, the working sample consisted of 1049 participants. In this sample, the predictive value of baseline VAI value was studied in relation to 10-year diabetes incidence.Results: One hundred thirty-three incident cases of diabetes were documented (10-year incidence: 12.7%). In the fully adjusted model, VAI significantly increased diabetes risk by 22% (OR per 1-unit increase =1.22; 95%CI, 1.09-1.37). Markers of oxidative stress and inflammation were found to, at least partly, mediate this relationship. Also, a moderating effect of menstruation status was revealed among women. VAI showed the highest predictive ability and contributed the most, along with waist-to-height ratio, to the correct classification of participants who developed diabetes.Conclusions: The present findings suggest that VAI may be a useful index for predicting long-term diabetes development and may exhibit better predictive ability to commonly used anthropometric indices. [ABSTRACT FROM AUTHOR]

Objectives: The aim of the study was to understand determinants of ageing in relation to future cardiovascular disease (CVD) events at population level, and to explore determinants of healthy ageing and its relation to 10-year CVD incidence among apparently healthy individuals.Methods: In the context of the ATTICA study 453 apparently healthy men (45±13 years) and 400 women (44±18 years) with complete psychological evaluation were studied and followed during 2002-2012. Healthy Ageing Index (HAI) (range 0-7) was calculated based on socio-economical, bio-clinical, psychological, and lifestyle characteristics (i.e. dietary habits and physical activity) of the participants during the baseline examination. CVD incidence during the follow-up period was defined according to ICD-10 criteria.Results: Healthy Ageing Index was inversely associated with higher 10-year CVD risk (OR per 1/7 (95% CI): 0.47 (0.28, 0.80). Age and sex-adjusted determinants of healthy ageing were abnormal waist to hip ratio (p<0.001), increased coffee consumption (p=0.04), reduced basic metabolic rhythm (p<0.001), increased triglycerides (p=0.003), and C-reactive protein levels (p=0.02), as aggravating factors, while moderate alcohol consumption (p=0.002) was identified as a positive influential parameter.Conclusions: Understanding healthy ageing, as a dominant factor of CVD development, provides a new direction for better prevention efforts focused on healthy ageing at both population and individual level. [ABSTRACT FROM AUTHOR]

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 18-89years). 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. [ABSTRACT FROM AUTHOR]

Aim The 10-year incidence of cardiovascular disease (CVD) and all-cause mortality, as well as its determinants, in a sample of men and women from Greece, was evaluated. Methods From May 2001 to December 2002, 1514 men and 1528 women (> 18 y) without any clinical evidence of CVD or any other chronic disease, at baseline, living in greater Athens area, in Greece, were enrolled. In 2011-12, the 10-year follow-up was performed in 2583 participants (15% of the participants were lost to follow-up). Incidence of fatal or non-fatal CVD (coronary heart disease, acute coronary syndromes, stroke, or other CVD) was defined according to World Health Organization (WHO)-International Coding Diseases (ICD)-10 criteria. Results The 10-year CVD incidence was 19.7% in men and 11.7% in women (p < 0.001). Multi-adjusted analysis revealed that the determinants of CVD events were increased age (Hazard ratio (HR) per year = 1.06, 95%Confidence Interval (CI): 1.04, 1.08), male sex (HR = 1.40, 95%CI: 0.90, 2.19), smoking (HR = 1.53, 95%CI: 1.03, 2.27), C-reactive protein levels (HR per 1 mg/L = 1.06, 95%CI: 1.02, 1.15), as well as adherence to Mediterranean diet (protective) (HR per 1/55 units = 0.98, 95%CI: 0.95, 1.01). Conclusion The burden of CVD and its related risk factors is at emerging rates, in Greece, making the need for effective public health actions, more necessary than ever before. [ABSTRACT FROM AUTHOR]

Objectives To evaluate the potential differences in risk factors’ profile for in-hospital mortality and up to 1-year prognosis, between younger and older patients with first acute coronary syndromes (ACS). Methods From October 2003 to September 2004, 1323 patients with first ACS event from 6 urban and rural Greek hospitals were enrolled into the study, classified as those <65 years and ≥65 years old. Multiple logistic regression analysis was used to evaluate the association between socio-demographic, lifestyle, clinical characteristics and the disease prognosis for one year after discharge. Results The men-to-women ratio was 8.5-to-1.5 for those <65 years, whereas, it was 6.6-to-3.4 for those above 65 years ( p < 0.001). In-hospital deaths and recurrent event within 30-days was higher among older patients ( p < 0.001). After the period of 6-months, the event-rate was higher among the younger patients ( p < 0.001). Current smoking was associated with increased risk of 1-month recurrent events, in patients <65 years ( p < 0.05). Myocardial infarction and history of diabetes were associated with increased risk in older patients ( p < 0.1). Conclusion Age-specific identification of the risk factors for recurrent events may have important clinical and public health implications and lead to the development of more effective risk reduction strategies. [ABSTRACT FROM AUTHOR]

To investigate the association of dietary habits with cognitive function among elders (>65 years). Complete sociodemographic, dietary information, serum measurements, and Mini-Mental State Examination (MMSE) assessments were available for 237 elderly men and 320 women residing in Velestino, Greece (a rural Greek town). All models were adjusted for age, education, social activity, smoking, depression symptomatology (using the Geriatric Depression Scale), MedDietScore (range 0-55), and metabolic syndrome. About 49.8% men and 66.6% women had MMSE scores <24, with a mean MMSE score of 22.7±4.43 and 21.1±4.73, respectively. Adherence to the Mediterranean diet was moderate (mean MedDietScore of 34.1±3.25 in men and 35.1±2.48 in women). Indicative cognitive impairment (MMSE score <24) was positively associated with age and low education in women and with depressive symptoms, low education status, and low social activity in men. Adherence to the Mediterranean diet was positively associated with MMSE score in men ( P=.02), but inversely associated in women ( P=.04). Concerning the food groups studied, intake of pulses, nuts, and seeds was associated with lower likelihood of having MMSE score<24 in men ( P=.04). Only the Mediterranean dietary pattern showed a significant association with MMSE score positive for cognitive impairment ( i.e., protective in men, but not in women), while individual food groups or nutrients did not achieve significance. The latter findings support the role of whole diet in the prevention of mental disorders, and state a research hypothesis for a sex-diet interaction on cognitive function among elders. [ABSTRACT FROM AUTHOR]

Abstract: Background: The purpose of this study was to evaluate the impact of adherence to Mediterranean diet on serum uric acid (UA) levels in elderly individuals, without known cardiovascular disease. Methods: During 2009, 281 females (75±6years old) and 257 males (75±7years old) permanent inhabitants of the island, were voluntarily enrolled. A diet score that assesses the inherent characteristics of the Mediterranean diet (MedDietScore, range 0–55) was applied. Serum levels of UA were determined using an enzymatic colorimetric test through the uricase-peroxidase method. Hyperuricaemia was defined as UA>7mg/dL in males and 6mg/dL in females. Results: Prevalence of hyperuricaemia was 34% in males and 25% in females (p =0.02). Mean level of adherence to the Mediterranean diet was 35±2. Linear regression analysis revealed that MedDietScore was inversely associated with UA levels (b ±SE: −1.48±0.17, p <0.001) in the overall sample, after controlling for hypertension, hypercholesterolemia, diabetes mellitus, creatinine clearance, physical activity, and coffee consumption. When the analysis was stratified by gender, MedDietScore was inversely associated with UA levels in males (b ±SE: −1.10±0.42, p =0.009), but not in females (b ±SE: 0.04±0.41, p =0.92). Conclusion: Another cardioprotective effect of Mediterranean diet was revealed, through the modification of UA levels in elderly individuals. The potential different effect size as regards the relationship between diet and UA levels between genders, deserves further investigation. [Copyright &y& Elsevier]

Abstract: Brugada syndrome (BrS) is an inherited cardiac arrhythmia that may lead to sudden death in patients with structurally normal heart. Mutations in the alpha subunit of the cardiac sodium channel SCN5A gene are found in approximately 20% of cases. We clinically evaluated and genetically screened 7 patients that fully satisfied the clinical diagnostic criteria for the syndrome and 8 patients with a partial clinical diagnosis, for mutations in the SCN5A gene in order to explore the genetic status of BrS patients from Greece for whom there are no published data available. Genetic testing was positive in 3 out of the 7 patients with a definite diagnosis. The probands carried 1 nonsense (p.Trp301X) and 2 missense (p.Ala1949Pro and p.Arg808Cys) mutations. All 3 mutations were novel. Furthermore, genetic testing was negative in all 8 clinically suspected cases. Additionally, 10 single nucleotide polymorphisms (SNPs) were detected, 2 of which are novel. We report on the genetic status of BrS patients of Greek origin amongst whom novel SCN5A mutations were a frequent underlying cause of the syndrome. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To evaluate the effect of anthropometric indices in the 5-year incidence of hypertension, in a sample of cardiovascular disease-free adults. Methods: 1514 men and 1528 women (>18 years) without any clinical evidence of cardiovascular disease, living in Attica area, Greece, were enrolled in the ATTICA study from May 2001 to December 2002. In 2006, the 5-year follow-up was performed. Hypertension was defined as systolic/diastolic blood pressure measurements >140/90mmHg or use of antihypertensive treatment. Weight, height, waist and hip circumferences, as well as body mass index (BMI) and waist-to-height and waist-to-hip ratios were tested in relation to the development of hypertension. Results: During 2001–2006, 86 men and 102 women were diagnosed as having hypertension. Thus, annual incidence rate is 2.86 per 100 men and 2.68 per 100 women. From the anthropometric indices, waist, and hip circumferences, BMI, weight and waist-to-height ratio were associated with the development of hypertension. Particularly, for every 1cm difference in baseline measurements of waist a 2% higher risk of hypertension was observed; while abnormal waist at baseline examination was associated with 1.92-times (95% CI, 1.35–2.77) higher risk of hypertension, in both genders. Moreover, presence of obesity at baseline examination was associated with a 2.4-fold (95% CI, 1.62–3.79) of the risk of hypertension. All the aforementioned relationships were independent from age, sex, and various other confounders, while the model that contained waist had the best diagnostic ability, followed by BMI, hip circumference and weight. Conclusions: Among various anthropometric measurements that showed a significant association with hypertension incidence, waist circumference was the best predictor. The latter finding may lead to new pathophysiological mechanisms for the development of hypertension. [Copyright &y& Elsevier]

Abstract: The effect of anxiety on dietary intake of humans has been investigated through a number of laboratory, clinical and cross-sectional studies; no prior study, however, has examined potential associations between anxiety and overall dietary patterns. Aim of the present work was to describe dietary patterns in relation to anxiety trait in a nationally representative sample of Greek adults from the ATTICA Study. A sample of 453 men and 400 women were randomly selected from various areas of Attica region, Greece. Anxiety levels were assessed through Spielberger State-Trait Anxiety Inventory. Dietary habits, socio-demographic and lifestyle characteristics were recorded for all participants. Principal component analysis was used for the extraction of dietary patterns. More anxious, compared to less anxious, men and women exhibited different dietary patterns. In particular, the “light” dietary patterns that were emerged in the less anxious men and women did not appear as distinct patterns among men and women in the upper anxiety tertile. In women, a “Western-type” diet explained two times greater variance of food intake of those in the upper-anxiety tertile, compared to their counterparts in the low tertile. A vegetarian pattern was found only among the less anxious women, who also exhibited the lowest consumption of red meat and sweets. Regression analysis supported and further elucidated previous results: after adjusting for potential confounders, sweets intake, as well as meat and products intake, were positively associated with anxiety score in females; in males a negative association was found with legumes/cereals intake. From a public health point of view, given the increased prevalence of anxiety and other mental disorders, these findings should be taken into account when designing and evaluating interventions for the general population. [Copyright &y& Elsevier]

Abstract: Objective: In this work we assessed the relationship between HDL-cholesterol levels and various inflammation markers status in a sample of cardiovascular disease free adult men and women from Greece. Methods: The ATTICA study is a population-based cohort that has randomly enrolled 1128 men and 1154 women (aged >18 years old), stratified by age–gender, from the greater area of Athens, during 2001–2002. Adherence to Mediterranean diet was assessed through a diet-score that was based on a validated food-frequency questionnaire. In this study we assessed the relationship between HDL-cholesterol levels and inflammation markers (high sensitivity C-reactive protein, interleukin-6, homocysteine and amyloid-a), after taking into account the effect of several confounders. Results: 46% of men and 40% of women had total serum cholesterol levels >200 mg/dl, while 21% of men and 7% of women had HDL-cholesterol levels <35 mg/dl. The mean value for HDL-cholesterol was 53±14 mg/dl in females and 44±14 mg/dl in males. HDL-cholesterol levels were inversely correlated to the hs-CRP levels (b =−0.028, P =0.001) and homocysteine levels (b =−0.039, P =0.036), after adjustment for sex, age, body mass index, physical activity status, smoking, total cholesterol levels, lipid lower agents, ethanol intake and diabetes mellitus; while no statistical significance was found between HDL-cholesterol levels and interleukin-6 and serum amyloid-a. Conclusions: In this work we evaluated the inverse relationship between HDL-cholesterol levels and inflammatory markers in a sample adult cardiovascular disease free population. This study among others illustrates the anti-inflammatory emerging role of HDL-cholesterol in reducing cardiovascular risk. [Copyright &y& Elsevier]

Objective: Although there are several dietary guidelines accepted at the international and national level, there are indications that dietary habits in Greece have been changing, moving away from the traditional Mediterranean diet pattern. The aim of this work was to evaluate the dietary habits of a randomly selected sample from the general adult population, in Greece.Subjects: The "ATTICA" study is a prospective health and nutrition survey. For the purpose of this study, 3,042 adults, from whom 1514 were men (48%) and 1,528 were women (52%), were selected from the greater Athens area during 2001 and 2002. The assessment of the dietary habits was carried out using a validated food frequency questionnaire.Results: Dietary intakes of red meat and sweets were higher (p<0.005), and dietary intakes of fish, poultry, dairy products, vegetables, and cereals were lower (p<0.05) than the ones recommended by the Hellenic Ministry of Health.Conclusion: The results from the present study indicate a change in the dietary habits towards an unhealthier type of diet. [ABSTRACT FROM AUTHOR]

Abstract: Objective: We evaluated the interaction between adherence to the Mediterranean diet and region of Greece on the likelihood of having acute coronary syndromes (ACS). Methods: During 2000–2001, a random sample of 848 patients (61±10 years) with their first coronary heart disease event, and 1078 frequency matched (by age–sex) controls with no cardiovascular disease in their medical history, from all the country, entered into the study. Among several factors, adherence to the Mediterranean diet was assessed by a diet-score that incorporated the inherent characteristics of this diet. Results: The multi-adjusted analysis showed that a 10-unit increase in the diet score was associated with a 27% (95% CI 0.66 to 0.89) decrease of the odds of having ACS. Moreover, a highly significant interaction was observed between region and diet score (p<0.001). The odds ratios varied from roughly 0.5 in Southern to 1.2 or more in Northern Greek regions (p for heterogeneity<0.05). Differences in food patterns consumed did not explain the previous findings. In addition, when we stratified our analysis by rural and urban areas we found significant differences in the estimated odds ratios (p for interaction between diet score and area=0.01), since a 10-unit increase in the diet score was associated with 22% (95% CI 0.63 to 0.96) lower odds n urban areas and 31% (95% CI 0.48 to 0.98) lower odds in rural areas. Conclusion: Our findings underline the significance of the Mediterranean diet on the primary prevention of ACS. Moreover, we revealed a geographical variation in the importance of this dietary pattern on coronary risk, independent from the composition of food patterns followed and the prevalence of the common cardiovascular risk factors. [Copyright &y& Elsevier]

: PurposeWe sought to investigate the effect of secondhand smoke exposure on inflammatory markers related to cardiovascular disease.: MethodsDuring 2001 to 2002, we randomly selected a stratified (age-sex) sample of adults without clinical evidence of cardiovascular disease. Exposure to secondhand smoke (>30 minutes per day and ≥1 day per week) was recorded. Multivariate regression analysis was used to evaluate the effects of exposure to secondhand smoke on levels of C-reactive protein, fibrinogen, homocysteine, and oxidized low-density lipoprotein (LDL) cholesterol, and on white blood cell count.: ResultsOne hundred and thirty-seven (38%) of the 357 men who had never smoked and 211 (33%) of the 638 never-smoking women reported current exposure to secondhand smoke. Compared with those who were not exposed to secondhand smoke, those exposed more than 3 days per week had higher white blood cell counts (by 600 cells per μL; P = 0.02), as well as higher levels of C-reactive protein (by 0.08 mg/dL; P = 0.03), homocysteine (by 0.4 μmol/L; P = 0.002), fibrinogen (by 5.2 mg/dL; P = 0.4), and oxidized LDL cholesterol (by 3.3 mg/dL; P = 0.03), after adjusting for several potential confounders.: ConclusionOur findings suggest another pathophysiological mechanism by which exposure to secondhand smoke is associated with the development of atherosclerosis. [Copyright &y& Elsevier]

Background. In past years several risk factors have been associated with the incidence of coronary heart disease. The aim of this study was to investigate the associations between the risk of developing acute coronary syndromes and several risk factors in Greece.Methods. During 2000–2002, 700 male (59 ± 10 years old) and 148 female (65 ± 9 years old) patients with the first event of an acute coronary syndrome were randomly selected from cardiological clinics of all Greek regions. Afterward, 1,078 population-based controls were randomly selected from the same hospitals and matched to the patients by sex and age. Detailed information regarding their medical and psychosocial status and various lifestyle habits related to coronary risk was recorded.Results. The frequency ratio between males and females in the case series of patients was 4:1. The statistical analysis showed that smoking (odds ratio = 1.61, P < 0.001), hypertension (odds ratio = 1.99, P < 0.001), hypercholesterolemia (odds ratio = 3.53, P < 0.001), diabetes mellitus (odds ratio = 2.44, P < 0.01), family history of CHD (odds ratio = 3.19, P < 0.001), exposure to passive cigarette smoking (odds ratio = 1.54, P < 0.01), and depressive episodes (odds ratio = 1.35, P < 0.01) were associated with an increased coronary risk, while physical activity (odds ratio = 0.81, P = 0.01), adoption of Mediterranean diet (odds ratio = 0.80, P < 0.05), and high education (odds ratio = 0.81, P < 0.001) were associated with a significant reduction of the coronary risk. Also, a J-shape association was found between alcohol intake and coronary risk.Conclusion. Several emerging lifestyle risk factors (education, depression, diet, passive smoking), in addition to the conventional ones, may contribute to the risk of coronary events in this population. [Copyright &y& Elsevier]

Objective As a measure of socioeconomic status, low educational level is positively associated with the risk of developing adverse health events. The aim of this study was to investigate the relationship between the level of education and the risk of developing non-fatal acute coronary syndromes. Methods During 2000 and 2001, 1619 randomly selected subjects from several regions of Greece were entered into a case-control study. Of these, 750 were patients with their first acute coronary heart syndrome event, and 869 were hospitalized controls with no cardiovascular disease in their medical history. Trends in cardiovascular risk factors were then examined across patient and control educational level by years of schooling. Findings In both patients and controls, education status was related to economic and occupation status, smoking habits, physical inactivity, alcohol consumption and non-compliance to treatment. After adjusting for these and other conventional risk factors, as well as for the effects of age and sex, we found that coronary risk increases by 82% (odds ratio (OR) = 1.82, P<0.05) for individuals with a lower level of education, and by 65% (OR = 1.65, P<0.05) for individuals with an average education, compared to those with an academic education. Conclusions Although the least-educated subjects adopted a more adverse lifestyle than the more-educated subjects, the inverse association between education and coronary risk was independent from such factors. The inverse association may be due to psychosocial differences, and prospective cohort studies are needed to confirm or refute these results. [ABSTRACT FROM AUTHOR]

The sex-specific effect of skeletal muscle mass (SMM) index (SMI) on 4-year first fatal/non-fatal cardiovascular disease (CVD) event in free-of-disease individuals was examined. In 2009, n = 1411 inhabitants (mean age = 64(12)) from Ikaria were selected. Follow-up was performed in 2013. SMI was created to reflect SMM through appendicular skeletal muscle mass (indirectly calculated through formulas) divided by body mass index (BMI). Fifteen and six tenths percent of participants exhibited CVD (19.8% in men/12% in women, p = 0.002). Significant U-shape trends were observed in participants >65 years old and women irrespective to age confirmed through multi-adjusted Cox regression analysis; in age >65 years, Hazard Ratio (HR) (2nd vs. 1st SMI tertile) = 0.80, 95% Confidence Interval (95%CI) (0.45, 0.96) and in women HR (2nd vs. 1st SMI tertile) = 0.71, 95% CI (0.33, 0.95), while, as for the 3rd SMI tertile, no significant trends were observed. Mediation analysis revealed that mediators of the aforementioned associations in men were the arterial distensibility and total testosterone, while, in women, inflammation, insulin resistance, and arterial distensibility. High SMM accompanied by obesity may not guarantee lower CVD risk. Specific cardiometabolic factors seem to explain this need for balance between lean and fat mass., Competing Interests: The authors declare no conflict of interest.

Importance: Severe acute respiratory syndrome coronavirus 2 infection has evolved into a global pandemic. Low-dose colchicine combines anti-inflammatory action with a favorable safety profile., Objective: To evaluate the effect of treatment with colchicine on cardiac and inflammatory biomarkers and clinical outcomes in patients hospitalized with coronavirus disease 2019 (COVID-19)., Design, Setting, and Participants: In this prospective, open-label, randomized clinical trial (the Greek Study in the Effects of Colchicine in COVID-19 Complications Prevention), 105 patients hospitalized with COVID-19 were randomized in a 1:1 allocation from April 3 to April 27, 2020, to either standard medical treatment or colchicine with standard medical treatment. The study took place in 16 tertiary hospitals in Greece., Intervention: Colchicine administration (1.5-mg loading dose followed by 0.5 mg after 60 min and maintenance doses of 0.5 mg twice daily) with standard medical treatment for as long as 3 weeks., Main Outcomes and Measures: Primary end points were (1) maximum high-sensitivity cardiac troponin level; (2) time for C-reactive protein to reach more than 3 times the upper reference limit; and (3) time to deterioration by 2 points on a 7-grade clinical status scale, ranging from able to resume normal activities to death. Secondary end points were (1) the percentage of participants requiring mechanical ventilation, (2) all-cause mortality, and (3) number, type, severity, and seriousness of adverse events. The primary efficacy analysis was performed on an intention-to-treat basis., Results: A total of 105 patients were evaluated (61 [58.1%] men; median [interquartile range] age, 64 [54-76] years) with 50 (47.6%) randomized to the control group and 55 (52.4%) to the colchicine group. Median (interquartile range) peak high-sensitivity cardiac troponin values were 0.0112 (0.0043-0.0093) ng/mL in the control group and 0.008 (0.004-0.0135) ng/mL in the colchicine group (P = .34). Median (interquartile range) maximum C-reactive protein levels were 4.5 (1.4-8.9) mg/dL vs 3.1 (0.8-9.8) mg/dL (P = .73), respectively. The clinical primary end point rate was 14.0% in the control group (7 of 50 patients) and 1.8% in the colchicine group (1 of 55 patients) (odds ratio, 0.11; 95% CI, 0.01-0.96; P = .02). Mean (SD) event-free survival time was 18.6 (0.83) days the in the control group vs 20.7 (0.31) in the colchicine group (log rank P = .03). Adverse events were similar in the 2 groups, except for diarrhea, which was more frequent with colchicine group than the control group (25 patients [45.5%] vs 9 patients [18.0%]; P = .003)., Conclusions and Relevance: In this randomized clinical trial, participants who received colchicine had statistically significantly improved time to clinical deterioration. There were no significant differences in high-sensitivity cardiac troponin or C-reactive protein levels. These findings should be interpreted with caution., Trial Registration: ClinicalTrials.gov Identifier: NCT04326790.

The clinical significance of pleural effusions (PLEs) in the setting of acute pericarditis remains poorly investigated. We sought to identify predictive factors for PLEs and their association with the short- and long-term prognosis of patients with acute pericarditis. We enrolled 177 patients hospitalized with a first episode of acute pericarditis. In all cases an extensive clinical, biochemical, and diagnostic work-up to detect PLEs and establish etiological diagnosis was performed. All patients included were prospectively followed for a maximum of 18 months (median 12, range 1-18) and complications were recorded. PLEs were detected in n = 94 cases (53.1% of the cohort; bilateral 53.2%, left-sided 28.7%, right-sided 18.1%) and were strongly associated with c-reactive protein (CRP) levels at admission (rho = 0.328, p < 0.001). In multivariate logistic regression, independent predictors for PLEs were female gender (OR = 2.46, 95% CI 1.03-5.83), age (per 1-year increment OR = 1.030, 95% CI 1.005-1.056), CRP levels (per 1 mg/L increment OR = 1.012, 95% CI 1.006-1.019) and size of pericardial effusion (per 1 cm increment, OR = 1.899, 95% CI 1.228-2.935). Bilateral PLEs were associated with increased risk for in-hospital cardiac tamponade (OR = 7.52, 95% CI 2.16-26.21). There was no association of PLEs with new onset atrial fibrillation or pericarditis recurrence during long-term follow-up (χ 2  = 0.003, p = 0.958). We conclude that PLEs are common in patients hospitalized with a first episode of acute pericarditis. They are related to the intensity of inflammatory reaction, and they should not be considered necessarily as a marker of secondary etiology. Bilateral PLEs are associated with increased risk of in-hospital cardiac tamponade, but do not affect the long-term risk of pericarditis recurrence.

Aim: To identify dietary patterns among apparently healthy individuals and to determine their long-term effect on diabetes incidence., Methods: During 2001-2002, a random sample of 3,042 men and women (18-89 years old), living in greater Athens, was randomly selected to participate in the study. During 2011-2012, the 10-year follow-up was performed in 2,583 participants (15% drop-out rate). After excluding participants with diabetes at baseline and those for whom no information on diabetes status was available at follow-up, the working sample consisted of 1,485 participants. Dietary habits were assessed by means of a validated semi-quantitative, food frequency questionnaire. Factor analysis was performed to extract dietary patterns from 18 food groups., Results: Diabetes diagnosis at follow-up was made in 191 participants, yielding an incidence rate of 12.9%. Six factors (i.e. dietary patterns) were identified that explained 54% of the variation in consumption. After adjusting for major confounders, and stratification by age-group, logistic regression revealed that the most healthful pattern consisted of the consumption of fruits, vegetables, legumes, bread, rusk, and pasta which reduced the 10-year diabetes risk by 40%, among participants aged 45-55 years. The association reached marginal statistical significance (95% CI: 0.34, 1.07), while no significant association was observed for the other age-groups. When the analysis was additionally adjusted for carbohydrate percentage, statistical significance was lost completely, suggesting a possibly mediating effect of this macronutrient., Conclusions: The results confirm the potentially protective effect of a plant-based dietary pattern in the primary prevention of diabetes, in particular among middle-aged people. Carbohydrate content may be a specific factor in this relationship; other micronutrients found in plant-based food groups may also play a role.

Background: In past years the prediction of cardiovascular disease (CVD) risk has received special attention; however, the presented risk models have so far not been very successful or appreciated., Design: The aim of the present work was to examine whether the inclusion of a diet quality evaluation in a CVD risk prediction model is associated with the accuracy of estimating future events., Methods: The working sample consisted of the 2009 ATTICA study participants (aged 18-89 years). The HellenicSCORE (a calibration of the European Society of Cardiology SCORE, based on age, gender, smoking habits, systolic blood pressure and total cholesterol) was calculated as a proxy of heart disease risk, while assessment of diet quality was based on the MedDietScore, which evaluates adherence to a Mediterranean diet. Fatal or non-fatal incidence of CVD (i.e., development of acute coronary syndromes, stroke or other CVD according to WHO-ICD-10 criteria) was calculated using the 10-year follow-up (2002-2012) data of the ATTICA study participants., Results: The MedDietScore and the HellenicSCORE were significant predictors of CVD events (p < 0.05). The estimating bias (i.e., misclassification rate of cases) of the model that included only the HellenicSCORE was significantly reduced by the inclusion of MedDietScore in the risk model (Harrell's C = 0.027, p = 0.012), improving the classification ability of the risk model by 56%., Conclusion: The inclusion of dietary evaluation increased the accuracy of HellenicSCORE risk estimation and, thus, its incorporation into CVD risk prediction scores might help clinicians and public health professionals to better allocate future CVD candidates., (© The European Society of Cardiology 2014.)

Background: The traditional view on the relationship between lipid biomarkers and CVD risk has changed during the last decade. However, it is not clear whether novel lipid biomarkers are able to confer a better predictability of CVD risk, compared to traditional ones.Under this perspective, the aim of the present work was to evaluate the predictive ability of blood lipids' profile on all cause mortality as well as 10-year incidence of CVD, in a sample of apparently healthy adults of the ATTICA epidemiological study., Methods: From May 2001 to December 2002, 1514 men and 1528 women (>18 y) without any clinical evidence of any other chronic disease, at baseline, were enrolled. In 2011-12, the 10-year follow-up was performed in 2583 participants (85 % follow-up participation rate). Incidence of fatal or non-fatal CVD was defined according to WHO-ICD-10 criteria. Baseline serum blood lipids' profile (Total-C, HDL-, non HDL-, LDL-cholesterol, triglycerides (TG), apolipoprotein (Apo)A1 and B, and lipoprotein-(a) levels were also measured., Results: The 10-year all-cause mortality rate was 5.7 % for men and 2.0 % for women (p = 0.55). The, 10-year CVD incidence was 19.7 % in men and 11.7 % in women (p < 0.001). Multi-adjusted analysis revealed that TC, non-HDL-C, TG and TG/HDL-C ratio, were independent predictors of all cause mortality (RR per 1 mg/dL or unit (95 % CI): 1.006 (1.000-1.013), 1.006 (1.000-1.013), 1.002 (1.000-1.004), 1.038 (1.001-1.077), respectively). Moreover, TC, HDL-, LDL-, non-HDL-cholesterol, TG, apoA1, TC/HDL-C and TG/HDL-C were independently associated with CVD risk. Among all lipid indices the ratio of apoB/apoA1 demonstrated the best correct reclassification ability, followed by non-HDL-C and TC/HDL-C ratio (continuous Net Reclassification Index 26.1 and 21.2 %, respectively)., Conclusion: Elevated levels of lipid biomarkers are independently associated with all-cause mortality, as well as CVD risk. The ratio of apoB/apoA1, followed by non-HDL-C, demonstrated the best correct classification ability of the developed CVD risk models.

Introduction: There is increasing interest in indexes that estimate the individual risk of developing a cardiovascular disease (CVD) event; the European Society of Cardiology (ESC), in the latest guidelines (2012) for CVD prevention, acknowledged the importance of risk evaluation through risk scores, i.e. the ESC SCORE (Systematic COronary Risk Estimation). However, there has been much discussion about the reliability of such CVD risk scores among different populations. The ESC SCORE is a CVD risk-specific tool for Europe, based on datasets from 12 European countries (Greece did not participate). In the mid-2000s the HellenicSCORE, a calibration of the ESC SCORE based on national mortality data and prevalence regarding risk factors as reported by the ATTICA study, was proposed for the Greek population and became a part of daily clinical practice. This validation of the HellenicSCORE was performed using the 10-year follow-up examination of the ATTICA study participants., Methods: Of the 3042 participants of the ATTICA study (enrolment 2001-2002), 2583 were contacted in the 10-year follow-up (2011-2012). The HellenicSCORE as calculated using participants' baseline characteristics was tested against the 10-year CVD event rates., Results: The 10-year fatal or non-fatal CVD incidence rate was 15.7% (19.7% in men and 11.7% in women). The HellenicSCORE correctly predicted 95.6% of fatal CVD cases and 93.2% of the fatal and non-fatal CVD cases. No interactions with sex, age group or comorbidities were observed., Conclusion: The HellenicSCORE is a valid tool for CVD risk estimation in Greek subjects. The present work suggests a calibration methodology that could be used by other nations for CVD risk estimation.

Background: Financial status has been considered as an important health determinant and associated with compliance to healthier lifestyle habits, medical treatment and increased prevalence of mental disorders. The aim of this work was to evaluate the association between financial status, patient adherence to medication, 10-year allcause mortality and risk for Acute Coronary Syndrome (ACS), in a Greek sample of cardiac patients., Methods: From October 2003-September 2004 a sample of 2,172 consecutive ACS patients from 6 hospitals was enrolled. In 2013-14, the 10-year follow-up was performed in 1,918 participants. Adherence to medical treatment was recorded through self-reports and financial status was classified as low (<9,000€), moderate (9-18,000€), good (19-48,000€) and very good (>48,000€)., Results: The "low"-to-"very" good financial status 10-year all-cause mortality rate was 1.7:1 (p<0.001). Unadjusted analysis revealed no association between financial status and ACS incidence (p=0.22); however, multi-adjusted analysis, after taking into account various clinical and lifestyle factors, revealed that "good/very good" financial status was associated with 23% (95%CI 2%, 40%, p=0.04) lower 10-year risk of ACS as compared with "low/moderate"; a finding that became insignificant when adherence to medication was taken into account., Conclusions: Low financial status seems to play a critical role in the long-term ACS prognosis. Health policies, to tackle non-compliance to medication, are needed to minimize the disease burden in clinical and community settings.

Background and Aims: The protective role of Mediterranean diet on cardiovascular disease (CVD) risk has been extensively discussed in the literature, but its incremental effect over the use of CVD risk reducing agents (such as hypolipidemic treatment) has rarely been evaluated., Methods: The ATTICA study was carried out in the Athens area during 2001-2002 and included 3042 participants free of CVD at baseline (49.8% men, aged 18-89 years). Adherence to Mediterranean diet was assessed using the MedDietScore (range 0-55) and statin use was recorded for all subjects. During 2011-2012, 2583 out of the 3042 baseline participants attended the 10-year follow-up of the ATTICA study (15% lost-to-follow-up) and CVD development was recorded., Results: Adherence to Mediterranean diet (highest tertile) decreased CVD risk by 29.3% (Hazard Ratio (HR): 0.707, 95% Confidence Intervals (CI): 0.537-0.831) as compared with the lowest tertile, independently of statin use. Patients with hyperlipidemia on a statin that adopted unhealthy dietary habits (lowest tertile) had 75% increased CVD risk than normolipidemic subjects with healthy dietary habits (HR=1.75, 95%CI: 1.33-2.29). The addition of Mediterranean diet tertiles in the multivariable model reclassified 46.7% of the participants to CVD risk categories., Conclusion: Adherence to Mediterranean diet confers a considerable reduction in CVD risk, independently of gender, age, family history of CVD, diabetes mellitus, smoking status, hypertension and physical activity status. Therefore, CVD prevention strategies should involve the implementation of a Mediterranean diet in both the general population and patients on a statin.