Atherosclerosis Volume 225, Issue 1, November 2012, Pages 187193

The mediating effect of the Mediterranean diet on the role of discretionary and hidden salt intake regarding non-fatal acute coronary syndrome or stroke events: A case/case-control study Christina-Maria Kastorinia, b, Haralampos J. Milionisa, Kallirroi Kalantzia, Eirini Trichiab, Vassilios Nikolaouc, Konstantinos N. Vemmosd, John A. Goudevenosa, Demosthenes B. Panagiotakosb, , a School of Medicine, University of Ioannina, Ioannina, Greece b Department of Nutrition and Dietetics, Harokopio University, Athens, Greece c Cardiology Clinic, Hellenic Red Cross Hospital, Athens, Greece d Acute Stroke Unit, Department of Clinical Therapeutics, Alexandra Hospital, Athens, Greece http://dx.doi.org/10.1016/j.atherosclerosis.2012.08.004, How to Cite or Link Using DOI Permissions & Reprints View full text Purchase $31.50 Abstract Objectives The aim of the present work was to evaluate the association between salt and salty food consumption on the development of an acute coronary syndrome (ACS) or ischemic stroke, under the context of adherence to the Mediterranean diet. Methods During 20092010, 1000 participants were enrolled; 250 were consecutive patients with a first ACS, 250 were consecutive patients with a first ischemic stroke and 500 population-based, control subjects, one-for-one matched to the patients by age and sex. Socio-demographic, clinical, psychological, dietary and other lifestyle characteristics were measured. Consumption of foods with high salt concentration was evaluated with a special score (range 0 10). Adherence to the Mediterranean diet was assessed by the validated MedDietScore (theoretical range: 055). Results After adjustment for potential confounding factors, use of salt added in table was associated with 81% higher likelihood of stroke (95% Confidence Interval: 1.03 3.20), whereas no association was observed regarding the development of ACS. Salt use during cooking was not associated with the development of ACS or stroke. Each unit increase of the score evaluating total salty food consumption was associated with 33% higher likelihood of stroke development (95% Confidence Interval: 1.081.64), but not with ACS. The effect of salt and salty food consumption regarding stroke presence was more evident for participants with lower adherence to the Mediterranean diet. Conclusion Simple dietary changes, with emphasis on reducing salt and salty food consumption, along with better adherence to the Mediterranean diet, should be incorporated in public health strategies for the primary prevention of stroke. Highlights For the stroke patients salt consumption was higher than for the controls. Salt and salty food

consumption were associated with higher likelihood of stroke. Salt intake was more detrimental for subjects away from the Mediterranean diet. Keywords Coronary heart disease; Stroke; Salt; Salty foods; Mediterranean diet Figures and tables from this article: Table 1. Socio-demographic, lifestyle and clinical characteristics of the study participants. Data are expressed as mean SD or frequencies (n, %).p-values derived from Student's t-test or the chi-square test.*p < 0.05, **p < 0.001 compared with the ACS or stroke control group, respectively. View Within Article Table 2. Frequency of consumption of salty foods of the study participants. Data are expressed as frequencies (n, %).p-values derived from the chi-square test.*p < 0.05, **p < 0.001 compared with the ACS or stroke control group, respectively. View Within Article Table 3. Results from the multiple logistic regression analysis that was developed to evaluate the likelihood of having an ACS (outcome) according to salt intake (main effect), among n = 250 ACS cases and n = 250 controls. Results are presented as OR (95%CI) obtained from multiple conditional (by age and sex) logistic regression. PA: physical activity, DM: diabetes mellitus, BMI: body mass index. View Within Article Table 4. Results from the multiple logistic regression analysis that was developed to evaluate the likelihood of having an ischemic stroke (outcome) according to salt intake (main effect), among n = 250 stroke cases and n = 250 controls. Results are presented as OR (95%CI) obtained from multiple conditional (by age and sex) logistic regression. PA: physical activity, DM: diabetes mellitus, BMI: body mass index. View Within Article Table 5. Results from the multiple logistic regression analysis that was developed to evaluate the likelihood of having an ACS or ischemic stroke (outcome) according to salt intake (main effect), among n = 250 ACS cases and n = 250 controls and n = 250 stroke cases and n = 250 controls, according to adherence to the Mediterranean dietary pattern. Results are presented as OR (95%CI) obtained from multiple conditional (by age and sex) logistic regression, adjusted for physical activity, smoking, BMI, family history of CVD, hypertension, hypercholesterolemia, diabetes mellitus Results regarding canned foods, fast-food and prepared sauces are not presented, due to insufficient number of subjects in each diet category. Mediterranean diet: participants with MedDietScore above the median. Unhealthy diet: participants with MedDietScore below the median. View Within Article Corresponding author. 46 Paleon Polemiston St., 166 74, Glyfada, Greece. Tel.: +30210 9603116;

fax: +30210 9600719. Copyright 2012 Elsevier Ireland Ltd. All rights reserved. About ScienceDirect About Elsevier Contact and support Information for advertisers Terms and conditions Privacy policy Copyright 2013 Elsevier B.V. All rights reserved. SciVerse is a registered trademark of Elsevier Properties S.A., used under license. ScienceDirect is a registered trademark of Elsevier B.V. Cookies are used by this site. To decline or learn more, visit our Cookies page Bibliographic information Citing and related articles Related articles Relation of Anemia at Discharge to Survival After Acute Coronary Syndromes 2005, The American Journal of Cardiology Show more information Symptoms of Men and Women Presenting With Acute Coronary Syndromes 2006, The American Journal of Cardiology Show more information The relationship between adherence to the Mediterranean diet and the severity and short-term prognosis of acute coronary syndromes (ACS): The Greek Study of ACS (The GREECS) 2006, Nutrition Show more information View more articles Cited by in Scopus (0) Related reference work articles No articles found.

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