3c25ca8de3178bb2e929815fbb93d137 308598.pdf 40e6dd267b1e64d853d73ae5da3d091b679e314d 308598.pdf 508e9ab7cab94cc7abdff6a04732aedc9298fc32b416a66e219f64a395aa3a2f 308598.pdf Title: Mediterranean Diet Is a Predictor of Progression of Subclinical Atherosclerosis in a Mediterranean Population: The ILERVAS Prospective Cohort Study Subject: Atherosclerotic cardiovascular disease remains a major health issue, often developing silently as subclinical atherosclerotic disease (SAD). The Mediterranean diet (MDiet) is known for its cardiovascular benefits, but the combined influence of both MDiet adherence and physical activity (PA) on SAD progression has not been previously documented. Objective: We aimed to investigate how adherence to a healthy lifestyle, defined as MDiet adherence and PA level, influences SAD progression in subjects from the ILERVAS cohort follow-up. Methods: A study on 3097 participants from the ILERVAS prospective cohort was conducted. MDiet adherence was assessed using the MEDAS score, and PA categories were established using the IPAQ, both categorized into low, moderate, and high levels. Two different lifestyle scores integrating the MDiet and PA categories were built. The presence of atherosclerotic plaques was assessed by carotid and femoral ultrasound examination. Demographic, clinical, and biochemical data were also obtained. Multivariable linear, logistic, and Poisson regression models adjusted for potential confounders were used to analyze the association between the lifestyle scores and SAD progression, as well as the MDiet and PA as separate variables and number of territories with plaque. Results: A healthier lifestyle score did not show an effect on SAD progression. However, a higher MEDAS score was associated with a 3% decrease in the number of territories with plaque (IRR 0.97, 95% CI 0.96–0.99, p < 0.001), suggesting a protective effect of the adherence to the MDiet. PA did not show a significant association (IRR 1.00, 95% CI 1.00–1.00, p = 0.269). Older age, hypertension, dyslipidemia, smoking, and lower eGFR were associated with SAD progression, while the female sex was protective (IRR 0.67, 95% CI 0.63–0.72, p < 0.001). Conclusions: The findings of this study show that higher adherence to the MDiet is associated with reduced incidence of SAD, indicating its potential role in cardiovascular prevention strategies. Although a higher lifestyle score or physical activity levels did not show any significant effect, promoting the MDiet, alongside managing traditional cardiovascular risk factors, could be an effective public health intervention to prevent atherosclerosis and reduce the burden of cardiovascular disease. Keywords: lifestyle score; Mediterranean diet; physical activity; atherosclerotic plaque; subclinical atherosclerosis Author: Marina Idalia Rojo-López, Marcelino Bermúdez-López, Eva Castro, Cristina Farràs, Gerard Torres, Reinald Pamplona, Albert Lecube, José Manuel Valdivieso, Elvira Fernández, Josep Julve, Esmeralda Castelblanco, Nuria Alonso, Maria Antentas, Maria Barranco-Altirriba, Alexandre Perera-Lluna, Josep Franch-Nadal, Minerva Granado-Casas, Didac Mauricio and on behalf of the ILERVAS project collaborators Creator: LaTeX with hyperref Producer: pdfTeX-1.40.25 CreationDate: Tue Oct 29 09:07:44 2024 CET ModDate: Tue Oct 29 09:09:53 2024 CET Custom Metadata: no Metadata Stream: no Tagged: no UserProperties: no Suspects: no Form: none JavaScript: no Pages: 15 Encrypted: no Page size: 595.276 x 841.89 pts (A4) Page rot: 0 File size: 485279 bytes Optimized: no PDF version: 1.7 name type encoding emb sub uni object ID ------------------------------------ ----------------- ---------------- --- --- --- --------- IUYWSY+VnURWPalladioL-Bold Type 1 Custom yes yes yes 10 0 UFDJFY+URWPalladioL-Bold Type 1 Custom yes yes yes 16 0 XEPYRT+URWPalladioL-Roma Type 1 Custom yes yes yes 22 0 OLLZGD+URWPalladioL-Ital Type 1 Custom yes yes yes 27 0 MYIFST+VnURWPalladioL Type 1 Custom yes yes yes 32 0 HGMNRX+TimesNewRomanPS-BoldItalicMT Type 1C WinAnsi yes yes no 48 0 PDTLUH+CMSY10 Type 1 Builtin yes yes yes 71 0 WBVKDJ+URWPalladioL-BoldItal Type 1 Custom yes yes yes 82 0 PIKGBD+PalatinoLinotype,Bold TrueType WinAnsi yes yes no 101 0 PIKGBE+PalatinoLinotype CID TrueType Identity-H yes yes yes 104 0 PIKGBF+PalatinoLinotype TrueType WinAnsi yes yes no 110 0 PIKGCH+PalatinoLinotype,Italic TrueType WinAnsi yes yes no 113 0 PIKHHA+PalatinoLinotype TrueType MacRoman yes yes no 116 0 Jhove (Rel. 1.28.0, 2023-05-18) Date: 2025-03-04 02:44:16 CET RepresentationInformation: 308598.pdf ReportingModule: PDF-hul, Rel. 1.12.4 (2023-03-16) LastModified: 2025-03-03 13:42:55 CET Size: 485279 Format: PDF Version: 1.7 Status: Well-Formed and valid SignatureMatches: PDF-hul MIMEtype: application/pdf PDFMetadata: Objects: 347 FreeObjects: 1 IncrementalUpdates: 0 DocumentCatalog: PageLayout: SinglePage PageMode: UseNone Outlines: Item: Title: Introduction Destination: section.1 Item: Title: Materials and Methods Destination: section.2 Children: Item: Title: Study Design Destination: subsection.2.1 Item: Title: Assessment of the Mediterranean Diet Adherence Destination: subsection.2.2 Item: Title: Physical Activity Destination: subsection.2.3 Item: Title: Clinical Variables Destination: subsection.2.4 Item: Title: Subclinical Atherosclerotic Disease Destination: subsection.2.5 Item: Title: Lifestyle Score Destination: subsection.2.6 Item: Title: Statistical Analysis Destination: subsection.2.7 Item: Title: Results Destination: section.3 Item: Title: Discussion Destination: section.4 Item: Title: Conclusions Destination: section.5 Item: Title: References Destination: appendix.A. Info: Title: Mediterranean Diet Is a Predictor of Progression of Subclinical Atherosclerosis in a Mediterranean Population: The ILERVAS Prospective Cohort Study Author: Marina Idalia Rojo-López, Marcelino Bermúdez-López, Eva Castro, Cristina Farràs, Gerard Torres, Reinald Pamplona, Albert Lecube, José Manuel Valdivieso, Elvira Fernández, Josep Julve, Esmeralda Castelblanco, Nuria Alonso, Maria Antentas, Maria Barranco-Altirriba, Alexandre Perera-Lluna, Josep Franch-Nadal, Minerva Granado-Casas, Didac Mauricio and on behalf of the ILERVAS project collaborators Subject: Atherosclerotic cardiovascular disease remains a major health issue, often developing silently as subclinical atherosclerotic disease (SAD). The Mediterranean diet (MDiet) is known for its cardiovascular benefits, but the combined influence of both MDiet adherence and physical activity (PA) on SAD progression has not been previously documented. Objective: We aimed to investigate how adherence to a healthy lifestyle, defined as MDiet adherence and PA level, influences SAD progression in subjects from the ILERVAS cohort follow-up. Methods: A study on 3097 participants from the ILERVAS prospective cohort was conducted. MDiet adherence was assessed using the MEDAS score, and PA categories were established using the IPAQ, both categorized into low, moderate, and high levels. Two different lifestyle scores integrating the MDiet and PA categories were built. The presence of atherosclerotic plaques was assessed by carotid and femoral ultrasound examination. Demographic, clinical, and biochemical data were also obtained. Multivariable linear, logistic, and Poisson regression models adjusted for potential confounders were used to analyze the association between the lifestyle scores and SAD progression, as well as the MDiet and PA as separate variables and number of territories with plaque. Results: A healthier lifestyle score did not show an effect on SAD progression. However, a higher MEDAS score was associated with a 3% decrease in the number of territories with plaque (IRR 0.97, 95% CI 0.96 0.99, p < 0.001), suggesting a protective effect of the adherence to the MDiet. PA did not show a significant association (IRR 1.00, 95% CI 1.00 1.00, p = 0.269). Older age, hypertension, dyslipidemia, smoking, and lower eGFR were associated with SAD progression, while the female sex was protective (IRR 0.67, 95% CI 0.63 0.72, p < 0.001). Conclusions: The findings of this study show that higher adherence to the MDiet is associated with reduced incidence of SAD, indicating its potential role in cardiovascular prevention strategies. Although a higher lifestyle score or physical activity levels did not show any significant effect, promoting the MDiet, alongside managing traditional cardiovascular risk factors, could be an effective public health intervention to prevent atherosclerosis and reduce the burden of cardiovascular disease. 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