Assessment of Risk Factors and Biomarkers Associated With Risk of Cardiovascular Disease Among Women Consuming a Mediterranean Diet
Assessment of Risk Factors and Biomarkers Associated With Risk of Cardiovascular Disease Among Women Consuming a Mediterranean Diet
复制标题
DOI：
10.1001/jamanetworkopen.2018.5708
复制
发表时间：
2018-12-01
影响因子：
13.8
通讯作者：
Mora, Samia
中科院分区：
文献类型：
--
作者：
Ahmad, Shafqat;Moorthy, M. Vinayaga;Mora, Samia
较高的地中海饮食（MED）摄入量与较低的心血管疾病（CVD）风险相关，但关于人类群体中这种反向疾病关联的潜在分子机制的数据有限。目的：更好地描述传统因素和新型因素对美国人群中心血管疾病相关风险降低的相对贡献。设计、环境和参与者采用前瞻性队列设计，对25994名最初健康的美国女性进行基线MED摄入量评估，这些女性在女性健康研究中随访了12年。评估了一组40种生物标志物的潜在介导作用，包括脂质、脂蛋白、载脂蛋白、炎症、葡萄糖代谢和胰岛素抵抗、支链氨基酸、小分子代谢物和临床因素。基线研究资料和样本收集于1993年4月30日至1996年1月24日。分析时间为2017年8月1日至2018年10月30日。摄入MED是衡量是否坚持地中海饮食模式的9类指标。根据受试者对medd的依从性，将其分为3个级别。主要结局和措施：通过医疗记录确认的心血管疾病事件和由调解员解释的心血管疾病风险降低的比例。结果在25994名女性（平均[SD]年龄54.7[7.1]岁）中，低、中、高MED摄入量的女性分别占研究人群的39.0%、36.2%和24.8%，分别经历了428例（4.2%）、356例（3.8%）和246例（3.8%）心血管事件。与低MED摄入量的参照组相比，中高组CVD风险降低，hr分别为0.77 （95% CI, 0.67-0.90）和0.72 (95% CI, 0.61-0.86)（趋势P < 0.001）。摄入MED降低心血管疾病风险的最大媒介是炎症生物标志物（占MED-CVD关联的29.2%），葡萄糖代谢和胰岛素抵抗（27.9%）和体重指数（27.3%），其次是血压（26.6%），传统脂质（26.0%），高密度脂蛋白（24.0%）或极低密度脂蛋白（20.8%），低密度脂蛋白（13.0%），支链氨基酸（13.6%），低密度脂蛋白（13.0%），低密度脂蛋白（13.0%），低密度脂蛋白（13.0%），低密度脂蛋白（13.0%），低密度脂蛋白（13.0%），低密度脂蛋白（13.6%），低密度脂蛋白（13.0%），低密度脂蛋白（13.6%）和低密度脂蛋白（13.6%）。载脂蛋白（6.5%）或其他小分子代谢物（5.8%）。结论和相关性在这项研究中，较高的MED摄入量与大约四分之一的CVD事件相对风险降低相关，这可以部分解释为已知的危险因素，包括传统的和新的。
IMPORTANCE Higher Mediterranean diet (MED) intake has been associated with lower risk of cardiovascular disease (CVD), but limited data are available about the underlying molecular mechanisms of this inverse disease association in human populations.OBJECTIVE To better characterize the relative contribution of traditional and novel factors to the MED-related risk reduction in CVD events in a US population.DESIGN, SETTING, AND PARTICIPANTS Using a prospective cohort design, baseline MED intake was assessed in 25 994 initially healthy US women in theWomen's Health Study who were followed up to 12 years. Potential mediating effects of a panel of 40 biomarkers were evaluated, including lipids, lipoproteins, apolipoproteins, inflammation, glucose metabolism and insulin resistance, branched-chain amino acids, small-molecule metabolites, and clinical factors. Baseline study information and samples were collected between April 30, 1993, and January 24, 1996. Analyses were conducted between August 1, 2017, and October 30, 2018.EXPOSURES Intake of MED is a 9-category measure of adherence to a Mediterranean dietary pattern. Participants were categorized into 3 levels based on their adherence to the MED.MAIN OUTCOMES AND MEASURES Incident CVD confirmed through medical records and the proportion of CVD risk reduction explained by mediators.RESULTS Among 25 994women (mean [SD] age, 54.7 [7.1] years), those with low, middle, and upper MED intakes composed 39.0%, 36.2%, and 24.8% of the study population and experienced 428 (4.2%), 356 (3.8%), and 246 (3.8%) incident CVD events, respectively. Compared with the reference group who had low MED intake, CVD risk reductions were observed for the middle and upper groups, with respective HRs of 0.77 (95% CI, 0.67-0.90) and 0.72 (95% CI, 0.61-0.86) (P for trend < .001). The largest mediators of the CVD risk reduction of MED intake were biomarkers of inflammation (accounting for 29.2% of the MED-CVD association), glucose metabolism and insulin resistance (27.9%), and body mass index (27.3%), followed by blood pressure (26.6%), traditional lipids (26.0%), high-density lipoprotein measures (24.0%) or very low-density lipoprotein measures (20.8%), with lesser contributions from low-density lipoproteins (13.0%), branched-chain amino acids (13.6%), apolipoproteins (6.5%), or other small-molecule metabolites (5.8%).CONCLUSIONS AND RELEVANCE In this study, higher MED intake was associated with approximately one-fourth relative risk reduction in CVD events, which could be explained in part by known risk factors, both traditional and novel.