Hypertension: Panagiotakos DB

Kokkinos P, Panagiotakos DB, Polychronopoulos E. · Cardiology Division, Veterans Affairs Medical Center, Washington, DC, USA. · J Clin Hypertens (Greenwich). · Pubmed #15785158 No free full text.

Abstract: Hypertension has long been recognized as a major risk factor for several common cardiovascular diseases. The World Health Organization reports that the number of people with hypertension worldwide is estimated at 600 million, while 3 million will die annually as a result of hypertension. There is evidence to support that several factors related to lifestyle habits may influence blood pressure levels. Among these, the beneficial effect of diet on human health, as well as on the control of hypertension, has been underlined in several studies. Moreover, adherence to a Mediterranean diet has been associated with reduced all-cause mortality and, especially, coronary heart disease. The effect of this traditional diet on blood pressure levels has not been well understood and appreciated. This review summarizes the current understanding of the dietary influences on blood pressure control and the findings of observational and clinical studies that have evaluated the effect of the Mediterranean dietary pattern on the prevalence of chronic essential hypertension.

Panagiotakos DB, Pitsavos C, Chrysohoou C, Bratsas A, Toutouzas P, Stefanadis C. · Cardiology Department, School of Medicine, University of Athens, Greece. · Acta Cardiol. · Pubmed #15368799 No free full text.

Abstract: OBJECTIVE: In this work we assessed a risk score for developing a first event of acute coronary syndrome (ACS) based on the family history of the cardiovascular risk factors. METHODS AND RESULTS: The studied population consisted of 848 randomly selected middle-aged patients with first event of ACS and 1078 sex-age-region matched controls admitted to the same hospitals for minor operations and without any clinical suspicion of cardiovascular disease in their life. A Family History Score (FHS) was developed based on the presence of coronary heart disease, hypertension, hypercholesterolaemia and diabetes mellitus, among first-degree relatives of the participants after adjusting for the family size. The evaluation of FHS was based on conditional logistic regression analysis, after controlling for demographic variables as well as for the mutual confounding effects of other risk factors. Family history of CHD, hypercholesterolaemia and diabetes was highly associated with the development of the disease. The introduced FHS was also highly associated with the development of ACS among participants who had no family history of CHD (odds ratio = 10.9, p < 0.001), whereas it was not associated with the development of the disease among participants who had a family history of CHD (odds ratio = 1.41, p = 0.543). CONCLUSIONS: The suggested FHS could be a useful tool in the primary prevention of ACS, as well as in detecting and understanding associations between genetic vulnerability and cardiovascular risk factors.

Chrysohoou C, Pitsavos C, Panagiotakos DB, Skoumas J, Stefanadis C. · First Cardiology Clinic, School of Medicine, University of Athens, Athens, Greece. · Am J Hypertens. · Pubmed #15233975 No free full text.

Abstract: BACKGROUND: We sought to evaluate the association between prehypertension status and inflammatory markers (C-reactive protein, white blood cells, interleukin-6, tumor necrosis factor-alpha, amyloid-a, homocysteine, and fibrinogen), in a random sample of cardiovascular disease-free adults. METHODS: The ATTICA study is a cross-sectional population-based survey conducted in the Attica region during 2001 to 2002. Based on a multistage and stratified random sampling, 1514 men and 1528 women (18 to 89 years old) were enrolled. The survey included a detailed interview, blood samples collected after 12 h of fasting, and, among other clinical measurements, status of blood pressure levels. RESULTS: The prehypertensive population included 653 men (43%) and 535 women (35%). Compared to normotensives, prehypertensive men and women had 31% higher C-reactive protein (P <.01), 32% higher tumor necrosis factor-alpha (P <.05), 9% higher amyloid-a (P <.05), 6% higher homocysteine levels (P <.01), and a 10% higher white blood cell counts (P <.05), after correcting for multiple comparisons and adjusting for age, body mass index, blood lipids, glucose, food groups consumed, and other potential confounders. CONCLUSIONS: Studying a large sample of cardiovascular disease-free adults, we revealed an association between prehypertension and inflammatory markers linked to the atherosclerotic process, independently of other coexisting risk factors or unhealthy lifestyle behaviors. Our findings may be of clinical importance, as they suggest that prehypertension might be a pro-inflammatory condition.

Chrysohoou C, Panagiotakos DB, Pitsavos C, Kokkinos P, Marinakis N, Stefanadis C, Toutouzas PK. · Section of Preventive Cardiology, Cardiology Department, School of Medicine, University of Athens, Greece. · Prev Cardiol. · Pubmed #12732792 No free full text.

Abstract: Coronary heart disease (CHD) is more common in men than women. Gender differences in CHD risk may be explained by a different impact that coronary risk factors may have for men and women, in the development of CHD. Thus, the authors aimed to analyze the extent to which cardiovascular risk factors can explain the gender difference in CHD risk, at population level. During 2000-2001, 848 hospitalized patients with a first event of acute coronary syndrome and 1078 controls, paired by gender, age, and region with no evidence of overt CHD, were randomly selected from all Greek regions. Data revealed that women experiencing their first acute coronary syndrome were significantly older than men (65.3+/-8 vs. 59.7+/-10 years old; p<0.01), and that acute coronary syndrome occurred more frequently in men than women (frequency ratio 4:1, men:women). When adjusting for age, multivariate analysis revealed that both family history of premature CHD and hypercholesterolemia were associated with higher coronary risk in men than women (odds ratio [OR]=5.11 vs. 3.14; p<0.05 for family history and OR=3.77 vs. 2.19; p<0.05 for hypercholesterolemia). The presence of hypertension however, had a significantly greater effect in women than men (OR=4.86 vs. 1.66; p<0.01). Also, higher education level and the adoption of a Mediterranean diet had a more protective effect in women than men (OR=0.53 vs. 0.87; p<0.001; and OR=0.80 vs. 0.96; p<0.05, respectively). There was also evidence of a greater association between depression and higher coronary risk in women than men (OR=1.93 vs. 1.58; p<0.07). The impact of other factors (i.e., smoking, diabetes, body mass index, physical activity, alcohol consumption, and financial status), on the coronary risk difference between genders was similar for men and women. In conclusion, our findings suggest that the contribution of certain coronary risk factors to the risk for CHD is different for men and women.

Tyrovolas S, Zeimbekis A, Bountziouka V, Voutsa K, Pounis G, Papoutsou S, Metallinos G, Ladoukaki E, Polychronopoulos E, Lionis C, Panagiotakos DB. · Department of Nutrition and Dietetics, Harokopio University, Athens, Greece. · Rev Diabet Stud. · Pubmed #19557296 No free full text.

Abstract: BACKGROUND: The aim of the present work was to evaluate the relationships between socio-demographic, clinical, lifestyle and psychological characteristics and the presence of diabetes mellitus, among elderly individuals without known cardiovascular disease. METHODS: During 2005-2007, 1190 elderly (aged 65 to 100 years) men and women (from Cyprus, Mitilini, Samothraki, Cephalonia, Crete, Lemnos, Corfu and Zakynthos) were enrolled. Socio-demographic, clinical and lifestyle factors were assessed using standard procedures. Diabetes mellitus was defined as fasting blood glucose >125 mg/dl or use of special medication. RESULTS: 21% of males and 23% of females had diabetes. Only 70% of diabetic participants were on a special diet and 76% were receiving pharmaceutical treatment. Diabetic individuals had higher prevalence of hypertension (80% vs. 64%, p < 0.001) and hypercholesterolemia (63% vs. 51%, p < 0.001) and reported lower physical activity status (p < 0.001), compared with non-diabetic participants. After adjusting for various confounders, hypertension and hypercholesterolemia were associated with a 144% (95% CI, 1.37-4.35) and 83% (95% CI, 1.13-2.94) higher likelihood of having diabetes, while moderate and vigorous exercise correlated with a 82% (95% CI, 0.09-0.81) and 67% (95% CI, 0.11-0.97) lower likelihood of diabetes. CONCLUSIONS: A considerable proportion of our elderly sample had diabetes and other metabolic disorders, almost 25% of which were untreated. Promotion of physical activities, even in the elderly, may contribute to reducing their burden of diabetes and provide them with a better quality of living.

Lazarou C, Panagiotakos DB, Matalas AL. · Department of Nutrition-Dietetics, Harokopio University, Athens, Greece. · J Am Diet Assoc. · Pubmed #19465190 No free full text.

Abstract: Dietary modification is, in general, the preferred method when attempting reductions in blood pressure (BP) among adults. In children, however, few studies, have examined the relationship between dietary patterns and levels of BP, and the reported results are conflicting. The objective of this study was to investigate the association between levels of Foods E-KINDEX score and levels of BP in children. Measurements included BP, height, weight, and waist circumference. Diet quality was assessed by the Foods E-KINDEX diet score. The index includes 13 components that assess consumption frequency of 11 major food groups or foods, as well as two cooking techniques (fried and grilled foods). Its score ranges between 0 and 37. A subsample of 622 Cypriot children (mean age=11.7+/-0.83 years) from the CYKIDS national cross-sectional study was used. Logistic regression analysis was performed in order to examine the relationship of systolic BP, diastolic BP, and BP with diet quality (as assessed by the Foods E-KINDEX score). The median systolic BP and diastolic BP were 110 mm Hg (interquartile range [IQR]=100 to 120 mm Hg) and 68 mm Hg (IQR=60 to 70 mm Hg) for boys and 110 mm Hg (IQR=100 to 120 mm Hg) and 63 mm Hg (IQR=60 to 70 mm Hg) for girls, respectively. Mean Foods E-KINDEX score was 23.4+/-4.9 in boys and 24.3+/-4.8 in girls (P=0.487). Compared with children with a low diet score, those with at least an average Foods E-KINDEX score were 57% (odds ratio=0.43; 95% confidence interval: 0.19 to 0.98) less likely to have elevated systolic BP levels, regardless of various potential confounders. The Foods E-KINDEX score is independently associated with lower BP among healthy children. This finding might have implications in public health and should be further explored.

Kourlaba G, Polychronopoulos E, Zampelas A, Lionis C, Panagiotakos DB. · Department of Nutrition Science-Dietetics, Harokopio University, Kallithea, Athens, Greece. · J Am Diet Assoc. · Pubmed #19465184 No free full text.

Abstract: OBJECTIVE: To develop an index that assesses the degree of adherence to nutritional recommendations for older adults (Elderly Dietary Index [EDI]) and investigate its association with risk factors related to cardiovascular disease (CVD). METHODS: The EDI was constructed using 10 components (ie, questions about the consumption frequency of meat, fish, fruits, vegetables, grains, legumes, olive oil, and alcohol as well as the type of bread and dairy products) according to the Modified MyPyramid for Older Adults and select features of the traditional Mediterranean diet. Scores from 1 to 4 were assigned to all components of the index. The EDI total score had a range between 10 and 40. As a validation procedure, a sample of 668 elderly individuals without known CVD (the MEDIS Study) was used to evaluate the associations between the proposed index and various health outcomes. RESULTS: The overall mean EDI score was 29.2+/-3.5. This score implies that study participants were 73% (ie, 29.2/40) adherent to the nutritional recommendations that the EDI evaluates. Regarding the conventional CVD risk factors, it was found that a 1 unit increase in the EDI score is associated with almost 10% lower odds of being obese or hypertensive or having at least one of the investigated CVD risk factors (P<0.001) after controlling for potential confounders. CONCLUSIONS: The suggested EDI may be a useful tool for public health policymakers and other health care professionals to assess diet quality and health status (especially concerning the risk for developing CVD) in older adults.

Tyrovolas S, Lionis C, Zeimbekis A, Bountziouka V, Micheli M, Katsarou A, Papairakleous N, Metallinos G, Makri K, Polychronopoulos E, Panagiotakos DB. · Department of Nutrition Science - Dietetics, Harokopio University, Athens, Greece. · Lipids Health Dis. · Pubmed #19331683 links to  free full text

Abstract: BACKGROUND: Hypercholesterolemia is one of the most important factors causing cardiovascular disease (CVD). The aim of the present work was to evaluate the relationships between socio-demographic, clinical, lifestyle and depression status and the presence of hypercholesterolemia, among elderly individuals without known CVD. METHODS: During 2005-2007, 1190 elderly (aged 65 to 100 years) men and women (from Cyprus, Mitilini, Samothraki, Cephalonia, Crete, Lemnos, Corfu and Zakynthos) were enrolled. Socio-demographic, clinical and lifestyle factors were assessed through standard procedures. Symptoms of depression were evaluated using the short-form of the Geriatric Depression Scale (GDS, range 0-15). Dietary habits were assessed through a semi-quantitative food frequency questionnaire. Hypercholesterolemia was defined as total serum cholesterol > 200 mg/dL or use of lipids lowering medication. RESULTS: 44.6% of males and 61.9% of females had hypercholesterolemia (p < 0.001). Only, 63% of hypercholesterolemic participants were under special diet or pharmaceutical treatment. Hypercholisterolemic individuals had higher prevalence of obesity (43% vs. 25%), hypertension (76% vs. 57%) and diabetes (25% vs. 17%) compared with normal participants (p < 0.001). Furthermore, hypercholisterolemic participants showed higher depression levels (p = 0.002). After adjusting for various confounders, GDS score and BMI correlated with 13% (95%CI 0.98-1.30) and 14% (95%CI 0.99-1.31) higher likelihood of having hypercholesterolemia. CONCLUSION: A considerable proportion of our elderly sample had hypercholesterolemia, while 1/3 of them were untreated. Furthermore, presence of hypercholesterolemia was correlated with depressive symptomatology and increased BMI.

Kokkinos P, Manolis A, Pittaras A, Doumas M, Giannelou A, Panagiotakos DB, Faselis C, Narayan P, Singh S, Myers J. · Veterans Affairs Medical Center/Cardiology Division, 50 Irving St, NW, Washington, DC 20422, USA. · Hypertension. · Pubmed #19171789 No free full text.

Abstract: We assessed the association between exercise capacity and mortality in hypertensive men with and without additional cardiovascular risk factors. A cohort of 4631 hypertensive veterans, who successfully completed a graded exercise test at the Veterans Affairs Medical Center in Washington, DC, and Palo Alto, California, was followed for 7.7+/-5.4 years (35,629 person-years) for all-cause mortality. Fitness categories were established based on peak metabolic equivalent (MET) levels achieved. In each fitness category, we defined individuals with and without additional cardiovascular risk factors. Exercise capacity was the strongest predictor of all-cause mortality. The adjusted mortality risk was 13% lower for every 1-MET increase in exercise capacity. Compared with the very low fit (< or =5.0 MET), the adjusted risk was 34% lower for those achieving 5.1 to 7.0 MET (low fit; hazard ratio: 0.66; CI: 0.58 to 0.76; P<0.001), 59% lower for the moderate fit (7.1 to 10.0 MET; hazard ratio: 0.41; CI: 0.35 to 0.50; P<0.001), and 71% lower for the high-fit category (>10.0 MET; hazard ratio: 0.29; CI: 0.21 to 0.40; P<0.001). Within the very-low-fit category, mortality risk was 47% higher for those with additional risk factors compared with individuals with no risk factors. This risk was eliminated for those in the next fitness category (5.1 to 7.0 MET) and was progressively reduced for the moderate and high-fit categories regardless of the presence or absence of additional risk factors. In conclusion, exercise capacity was the strongest predictor of all-cause mortality in hypertensive men. The increased risk imposed by low fitness and additional cardiovascular risk factors was eliminated by relatively small increases in exercise capacity and declined progressively with higher exercise capacity.

Tektonidou MG, Laskari K, Panagiotakos DB, Moutsopoulos HM. · National University of Athens, Athens, Greece. · Arthritis Rheum. · Pubmed #19116963 No free full text.

Abstract: OBJECTIVE: Antiphospholipid antibodies (aPL), namely anticardiolipin antibodies (aCL) and lupus anticoagulant (LAC), have been associated with an increased risk of thrombosis in systemic lupus erythematosus (SLE). We examined additional thrombosis risk factors (aPL profile, SLE-related, and traditional risk factors) and the primary thrombosis prevention in SLE patients with and without aPL. METHODS: All SLE patients with positive aPL but without previous thrombotic manifestations who were regularly followed up at our department (n = 144) and 144 age- and sex-matched SLE patients with negative aPL were included in this study. The median followup times were 104 and 112 months, respectively. The demographic, clinical, laboratory, and treatment characteristics and the traditional thrombosis risk factors were recorded. RESULTS: The thrombosis rate was 29 per 144 aPL-positive patients (20.1%) and 11 per 144 aPL-negative patients (7.6%; P = 0.003). In multiadjusted analysis, significant predictors of thrombosis were male sex (hazard ratio [HR] 6.25, P < 0.01), LAC (HR 3.48, P = 0.04), and constantly positive aCL (HR 5.87, P = 0.01) for aPL-positive patients, while male sex (HR 7.14, P = 0.03) and hypertension were predictors for aPL-negative patients (HR 6.49, P = 0.03). Additionally, the duration of low-dose aspirin treatment played a protective role against thrombosis in aPL-positive patients (HR per month 0.98, P = 0.05), as did the duration of hydroxychloroquine in both aPL-positive (HR per month 0.99, P = 0.05) and aPL-negative patients (HR per month 0.98, P = 0.04). CONCLUSION: Independent predictors of thrombosis for aPL-positive patients were male sex, LAC, and constantly positive aCL, and for aPL-negative patients were male sex and hypertension. The duration of low-dose aspirin use played a protective role against thrombosis in aPL-positive patients as did the duration of hydroxychloroquine in both groups.

Evangelopoulos AA, Vallianou NG, Panagiotakos DB, Georgiou A, Zacharias GA, Alevra AN, Zalokosta GJ, Vogiatzakis ED, Avgerinos PC. · Department of Microbiology, Polykliniki General Hospital, 10552 Athens, Greece. · Nutr Res. · Pubmed #19083473 No free full text.

Abstract: Metabolic syndrome has been defined as the presence of abdominal obesity combined with 2 of the following factors: hypertension, dyslipidemia, and impaired glucose tolerance, or diabetes mellitus. Magnesium is an essential cofactor for more than 300 enzymes involved in carbohydrate and lipid metabolism. In this study, we enrolled 117 consecutive overweight and obese patients and we measured serum magnesium levels together with fasting serum glucose, high-density lipoprotein cholesterol, and triacylglycerols. A strong inverse relationship between magnesium levels in serum and the presence of metabolic syndrome was noticed. Moreover, magnesium levels decreased as the number of components of metabolic syndrome increased. Also, there is an inverse relationship between serum magnesium levels and high-sensitivity C-reactive protein. We concluded that decreased levels of serum magnesium are associated with increased risk for metabolic syndrome, perhaps by a low-grade inflammation process.

Panagiotakos DB, Pitsavos C, Chrysohoou C, Vlismas K, Skoumas Y, Palliou K, Stefanadis C. · Department of Nutrition Science - Dietetics, Harokopio University, Athens, Greece. · Public Health Nutr. · Pubmed #18616850 No free full text.

Abstract: BACKGROUND: The aims of the present work were to investigate whether dietary habits are associated with socio-economic status (SES), and if they modify the relationship between SES and CVD risk factors, in a sample of men and women free from known CVD. METHODS: This population-based study was carried out in the province of Attica, where Athens is a major metropolis. During 2001-2002, information from 1,528 men (18-87 years old) and 1,514 women (18-89 years old) was collected (75 % participation rate). Among several sociodemographic, clinical and biological factors, adherence to the Mediterranean diet was assessed by a special diet score (Mediterranean Diet Score, MDS) that incorporated the inherent characteristics of this traditional diet. CVD risk factors were examined across the participants' educational level and annual income that defined their SES. RESULTS: Low SES groups exhibited higher prevalence of CVD risk factors, such as obesity, hypertension, diabetes mellitus and hypercholesterolaemia (all P < 0.001). Low SES groups also showed less adherence to the Mediterranean diet than high SES groups (MDS: 23.6 (sd 8.1) v. 25.6 (sd 5.6), P < 0.001). Higher SES index was associated with lower likelihood of having hypercholesterolaemia (OR = 0.91; 95 % CI 0.83, 1.00) and diabetes (OR = 0.83; 95 % CI 0.72, 0.95), after adjusting for various potential confounders. However, the previously mentioned inverse relationship observed between SES and prevalence of CVD risk factors was mainly explained by the dietary habits of the participants. CONCLUSIONS: Low SES groups showed less adherence to the Mediterranean diet compared with high SES groups. This finding may, in part, explain the higher CVD risk factors profile observed among low SES participants.

Panagiotakos DB, Pitsavos C, Chrysohoou C, Vlismas K, Skoumas Y, Palliou K, Stefanadis C. · Dept of Nutrition Science-Dietetics, Harokopio University, Athens, Greece. · Eur J Nutr. · Pubmed #18604622 No free full text.

Abstract: OBJECTIVE: The aim of this work was to investigate whether clinical characteristics and dietary habits influence the association between education status and 5-year incidence of cardiovascular disease (CVD). METHODS: From 2001 to 2002, 1,514 men and 1,528 women (>18 year) without known CVD were enrolled. In 2006, the 5-year follow-up was performed (31% participants were lost to follow-up). Development of fatal or non-fatal CVD (coronary heart disease, acute coronary syndromes, stroke, or other CVD) was defined according to WHO-ICD-10 criteria. Education status was measured in years of school, while baseline dietary habits were assessed through a semi-quantitative food-frequency questionnaire (EPIC-Greek). The Mediterranean-Diet-Score was applied to assess overall adherence to this pattern using scores of 11 food-variables and alcohol, according to the principles of the Mediterranean-diet. RESULTS: The 5-year incidence of CVD was 108 (11.0%) cases in men and 62 (6.1%) cases in women (P < 0.001); 32 (1.6%) of these events were fatal (21 in men). People in the low education group had significantly higher prevalence of hypertension, diabetes, and dyslipidemias, were more likely to be sedentary and smokers, compared to high group. Moreover, compared to high, people in low education group had less healthy dietary habits, as assessed using the diet score (P < 0.001). Multi-adjusted analysis revealed that low education was positively associated with 5-year incidence of CVD, after adjusting for age and sex (HR = 1.64; 95%CI 1.05-2.55); however this association lost its significance when clinical characteristics and dietary habits were taken into account (HR = 1.31; 95%CI 0.63-2.74). CONCLUSIONS: Low education seems to increase CVD risk, an observation that was partially explained by baseline clinical characteristics and unhealthy dietary choices of people belonging into this group.

Panagiotakos DB, Pitsavos C, Chrysohoou C, Skoumas I, Stefanadis C, Anonymous00379. · Department of Dietetics-Nutrition, Harokopio University, Athens, Greece. · Vasc Med. · Pubmed #18593800 No free full text.

Abstract: The 5-year incidence of cardiovascular disease (CVD) and its determinants, in a sample of men and women from Greece, was evaluated. From May 2001 to December 2002, 1514 men and 1528 women (>18 years old) without any clinical evidence of CVD, living in the Attica area, Greece, were enrolled in the ATTICA study. In 2006, a group of experts performed the 5-year follow-up (941 of the 3042 (31%) participants were lost to follow-up). Development of CVD (coronary heart disease, acute coronary syndromes, stroke, or other CVD) during the follow-up period was defined according to WHO-ICD-10 criteria. The 5-year incidence of CVD was 11.0% in men and 6.1% in women (p<0.001); the case fatality rate was 1.6%. Multi-adjusted logistic regression analysis revealed that increased age (odds ratio per year=1.09, p=0.04), waist-to-hip ratio (odds ratio=5.07, p=0.02), hypertension (odds ratio=4.53, p=0.001), diabetes (odds ratio=4.53, p=0.001) and C-reactive protein levels (odds ratio per 1 mg/dl=1.31, p=0.02) were the most significant baseline bio-clinical predictors of CVD. Furthermore, an increased education level and greater adherence to the Mediterranean diet (among 35-65-year-old individuals) were associated with a lower CVD incidence (odds ratio per 3 years of school difference=0.83, p<0.001 and odds ratio per 1/55 units in diet score=0.94, p<0.001), irrespective of various potential confounders. In conclusion, aging, central fat, hypertension and diabetes, inflammation process, low social status and abstinence from a Mediterranean diet seem to predict CVD events within a 5-year period.

Pitsavos C, Chrysohoou C, Panagiotakos DB, Lentzas Y, Stefanadis C. · First Cardiology Clinic, School of Medicine, University of Athens, Athens, Greece. · Heart Vessels. · Pubmed #18389333 No free full text.

Abstract: The aim of this work was to assess the 5-year incidence of hypertension and its predictors among prehypertensive adults. Under the context of the ATTICA Study, data from 1188 individuals, free of cardiovascular disease, but with defined high blood pressure levels (prehypertension) at baseline examination (during 2001-2002) were retrieved. In 2006, the 5-year follow-up of the study was performed, and 798 of the prehypertensive participants were allocated. In this work, incidence and determinants of developing hypertension were evaluated. The 5-year ageadjusted incidence of hypertension was 18.7% in men and 24.6% in women (P = 0.05); while almost one half of prehypertensive individuals at the age of 55-65 years developed hypertension, and approximately 6 out of 10 people over 65 years of age developed the disease. Multiple logistic regression analysis revealed that increased age (odds ratio [OR] per 1 year = 1.09, 95% confidence interval [CI] 1.07-1.12), male sex (OR = 0.40, 95% CI 0.21-0.68), high education status (OR per 1 year of school = 0.94, 95% CI 0.88-0.98), waist circumference (OR per 1 cm = 1.04, 95% CI 1.02-1.06) and C-reactive protein (OR per 1 mg/l = 1.12, 95% CI 1.05-1.20), were positively associated with the development of hypertension. Moreover, greater adherence to Mediterranean diet seems to protect only prehypertensive, with abdominal obesity patients prone to develop hypertension (OR = 0.94, 95% CI 0.90-0.98). Annual incidence of hypertension was roughly 4% in men and women. Older people, with low education, abdominal obesity, lower adherence to the Mediterranean diet, and increased inflammation, constitute a model of prehypertensive individuals that are prone to develop hypertension.

Panagiotakos DB, Pitsavos C, Chrysohoou C, Stefanadis C. · Department of Dietetics-Nutrition, Harokopio University, Greece. · Angiology. · Pubmed #18388034 No free full text.

Abstract: 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.

Panagiotakos DB, Kinlaw M, Papaerakleous N, Papoutsou S, Toutouzas P, Polychronopoulos E. · Department of Nutrition Science and Dietetics, Harokopio University, Athens, Greece. · J Clin Nurs. · Pubmed #18279301 No free full text.

Abstract: AIMS: The purpose of this paper is to explore the link between symptoms of depression and the prevalence of cardiovascular risk factors in older adults. METHODS: During 2005, 136 older men and 164 women from various parts of Cyprus agreed to participate in the study. The sampling was random and multistage (according to age-sex distribution of the referent population). All participants were living in the community and not in institutions. Among several socio-demographic, bioclinical, lifestyle and dietary characteristics, depressive symptoms were assessed using the short version of the Geriatric Depression Scale (GDS). RESULTS: Participants without signs of depression, typically, have fewer cardiovascular risk factors (i.e. hypertension, hypercholesterolemia, diabetes and obesity) than those with moderate or severe symptoms. Even when behavioural variables (e.g. diet, smoking, exercise) are statistically controlled, participants that are higher than others on depression are more likely to have hypertension and/or hypercholesterolemia than those with lower scores. Every one-unit increase in GDS score (range 0-15) is associated with a 12% higher likelihood of having an additional cardiovascular disease risk factor. CONCLUSIONS: Symptoms of depression are positively associated with the number of cardiovascular risk factors in 'healthy' older adults, irrespective of lifestyle behaviours (e.g. smoking, dietary intake and physical activity). RELEVANCE TO CLINICAL PRACTICE: Healthcare providers should consider the implications of both the presence and nature of this relationship in their continuing care of older adults.

Panagiotakos DB, Lionis C, Zeimbekis A, Makri K, Bountziouka V, Economou M, Vlachou I, Micheli M, Tsakountakis N, Metallinos G, Polychronopoulos E. · Department of Nutrition and Dietetics, Harokopio University, Athens, Greece. · Rev Diabet Stud. · Pubmed #17823695 links to  free full text

Abstract: BACKGROUND: We evaluated the association between coffee drinking and the prevalence of type 2 diabetes mellitus in elderly people from the Mediterranean islands. METHODS: During 2005-2007, 500 men and 437 women (aged 65 to 100 years) from the islands of Cyprus (n = 300), Mitilini (n = 142), Samothraki (n = 100), Cephalonia (n = 104), Corfu (n = 160) and Crete (n = 131) participated in the survey. Cardiovascular disease (CVD) risk factors (i.e. hypertension, diabetes, hypercholesterolemia and obesity), as well as behavioral, lifestyle and dietary characteristics were assessed using face-to-face interviews and standard procedures. Among various factors, fasting blood glucose was measured and prevalence of type 2 diabetes mellitus was estimated, according to the established American Diabetes Association (ADA) criteria, while all participants were asked about the frequency of any type of coffee consumption over the last year. RESULTS: Coffee drinking was reported by 84% of the participants, the majority of whom drank boiled coffee. The participants reported that they had consumed coffee for at least 30 years of their life. Data analysis adjusted for various potential confounders, revealed that, compared to non-consumption, the multi-adjusted odds ratio for having diabetes was 0.47 (95%, CI 0.32 to 0.69) for 1-2 cups/day, while it was 1.05 (95%, CI 0.70 to 1.55) for >3 cups/day, after adjusting for various potential confounders. The association of coffee drinking with diabetes was significant only among non-tea drinkers. Increased coffee intake was not associated with diabetes prevalence. CONCLUSION: The data presented suggest that moderate coffee drinking is associated with a lower likelihood of having diabetes, after adjusting for various potential confounders.

Panagiotakos DB, Zeimbekis A, Boutziouka V, Economou M, Kourlaba G, Toutouzas P, Polychronopoulos E. · Department of Nutrition-Dietetics, Harokopio University, Athens, Greece. · Med Sci Monit. · Pubmed #17599024 links to  free full text

Abstract: BACKGROUND: A study to evaluate the link between long-term fish intake and health status in a sample of elderly adults was undertaken. MATERIAL/METHODS: Three hundred men and women from Cyprus, 142 from Mitilini, and 100 from Samothraki islands (aged 65 to 100 years) were enrolled in this study during 2005-2006. Dietary habits (including fish consumption) were assessed through a food frequency questionnaire. Among various factors, fasting blood glucose, arterial blood pressures, and blood lipids were measured. RESULTS: Sixty-one percent of the participants reported that they had consumed fish approximately once a week (mean intake: 1.9+/-1.2 servings/week) for a mean period of 30 years. After adjusting for various confounders, fish intake was inversely associated with systolic blood pressure (p=0.026), fasting glucose (p<0.001), total serum cholesterol (p=0.012), and triglyceride levels (p=0.024). Multinomial logistic regression revealed that a decrease of 100 g per week in fish intake was associated with a 19% (95%CI: 1-41) higher likelihood of having one additional cardiovascular risk factor (i.e. hypertension, hypercholesterolemia, diabetes, obesity). CONCLUSIONS: The results indicate that long-term fish intake is associated with reduced levels of the most common cardiovascular disease risk markers in a cohort of elderly people.

Stergiou GS, Yiannes NG, Rarra VC, Panagiotakos DB. · Hypertension Center, Third University Department of Medicine, Sotiria Hospital, Athens, Greece. · J Hypertens. · Pubmed #17563558 No free full text.

Abstract: OBJECTIVE: There is evidence that home blood pressure (BP) is being used in clinical practice for the assessment of out-of-office blood pressure in children. However, there is no information on the normal range of home BP in this population. This prospective school-based study was designed to investigate the normal range of home BP in children and adolescents. SUBJECTS AND METHODS: A total of 778 healthy subjects (358 boys) with mean age 12.3 +/- 3.3 (SD) years (range 6-18 years), height 157 +/- 18 cm (113-198 cm) and weight 50 +/- 18 kg (16-135 kg) were included. Home BP was monitored for 3 days using validated electronic devices (Omron 705IT). RESULTS: Reliable home BP readings provided by 767 subjects (98%) were analysed. Strong correlations were found between systolic home BP and body height (r = 0.49) and age (r = 0.41), whereas for diastolic BP these correlations were poor (r = 0.11 and 0.08, respectively). The 50th (midpoint of distribution) and the 95th percentile (suggested upper normal limit) for systolic and diastolic home BP in children are provided by body height. There was a marked increase in the estimated 95th percentile for systolic home BP with increasing height in boys (from 119 to 134 mmHg) and less so in girls (from 119 to 128 cm). Regarding diastolic home BP, there was little change with increasing height (from 75 to 80 cm) and no difference between boys and girls. CONCLUSIONS: These data suggest that home BP monitoring in children and adolescents is feasible. Reference values for home BP in the paediatric population are provided.

Pitsavos C, Panagiotakos DB, Tzima N, Lentzas Y, Chrysohoou C, Das UN, Stefanadis C. · Unit of Preventive Cardiology-Epidemiology, First Cardiology Clinic, School of Medicine, University of Athens, Greece. · Angiology. · Pubmed #17495273 No free full text.

Abstract: We evaluated the association of physical activity and diet with C-reactive protein (CRP) levels among subjects with abdominal obesity. During 2001-2002, we enrolled 625 men (18 to 87 years old) and 712 women (18 to 89 years old) with abdominal obesity (waist-to-hip ratio > or =0.95 in men and > or =0.8 in women) from the Attica area, Greece. The sampling was stratified by the age-gender distribution of the region (census 2001). Among several variables, we also measured plasma high-sensitivity CRP, physical activity status, dietary habits, blood lipids, and blood pressure levels. Adherence to the Mediterranean diet was evaluated through a diet score (0 to 55) that assessed the inherent characteristics of the diet. Compared with those with low CRP levels, subjects with high CRP levels (ie, >3.0 mg/L) were physically inactive (P = .01), were less likely to adopt the Mediterranean diet (P = .008), had higher glucose levels, had a higher prevalence of hypertension, had a lower high-density lipoprotein cholesterol, and had increased smoking habits and higher anthropometric indices (all P < .05). Moreover, adoption of the Mediterranean diet in combination with medium physical activity seems to reduce the likelihood of having high CRP levels by 72% (P = .018), irrespective of smoking and various clinical and biological characteristics. Among subjects with abdominal obesity, low-grade systemic inflammation appears to be associated with the adoption of an unfavorable lifestyle, including physical inactivity and unhealthy dietary habits, as well as increased blood pressure levels and low high-density lipoprotein cholesterol.

Pitsavos C, Kourlaba G, Panagiotakos DB, Stefanadis C. · First Cardiology Clinic, School of Medicine, University of Athens, Greece. · Clin Cardiol. · Pubmed #17492678 No free full text.

Abstract: OBJECTIVES: In this work, we sought to describe the baseline characteristics and the management of patients with and without diabetes hospitalized with acute coronary syndromes (ACS), as well as to assess the prognostic value of diabetes status to the severity of ACS and in-hospital mortality. METHODS: A sample of six hospitals located in Greek urban and rural regions was selected and we recorded almost all admissions due to ACS, from October 2003 to September 2004. 2,172 patients were included in the study. Socio-demographic, clinical, dietary and other lifestyle characteristics was recorded. RESULTS: Approximately 1 in 3 patients admitted at the hospital with ACS had history of diabetes. Diabetes mellitus was associated with old age, female gender and more prevalent history of coronary heart disease, hypertension and renal failure. Diabetics sought medical care later and they were less likely to receive fibrinolytic therapy. No statistically significant difference was observed on severity of ACS between diabetics and nondiabetics. The in-hospital mortality was higher in diabetics compared to nondiabetics. In a multivariate analysis only insulin-treated diabetics had an increased mortality rate compared to nondiabetics. CONCLUSIONS: The use of more effective medications and interventions must be used in diabetics who develop ACS, as well as educational efforts should be directed to those patients for reducing the pre-hospital delay.

Panagiotakos DB, Polystipioti A, Papairakleous N, Polychronopoulos E. · Department of Nutrition Science-Dietetics, Harokopio University, Athens, Greece. · Asia Pac J Clin Nutr. · Pubmed #17468091 No free full text.

Abstract: BACKGROUND: There is increasing evidence that there are protective health effects from diets which are high in fruits, vegetables, legumes, and whole grains, and which include fish, nuts, and low-fat dairy products. We sought to investigate the association of Mediterranean diet on clinical status of 150 elderly men and women. METHODS: During 2004 - 2005, we studied 53 men and 97 women, aged 65 to 100 years, from various areas of Cyprus. A diet score that assesses the inherent characteristics of the Mediterranean diet was developed for each individual (range 0-55). Adoption of the Mediterranean diet was evaluated against the presence of cardiovascular risk factors like hypertension, diabetes, hypercholesterolemia and obesity. RESULTS: 26% of men and 18% of women had diabetes, 60% of men and 58% of women had hypertension, 60% of men and 68% of women had hypercholesterolemia, and 34% of men and 52% of women were obese. More than 90% of the participants reported consistency in their dietary habits for at least the past 3-4 decades. A significant inverse correlation was observed between diet score and the number of the investigated risk factors (rho= -0.26, p< 0.001). When we took into account age, sex, smoking habits, and physical activity status, we observed that a 10-unit increase in the diet score was associated with 21% lower odds of having one additional risk factor in women (p< 0.001) and with 14% lower odds in men (p = 0.05). CONCLUSION: Adherence to a Mediterranean diet is associated with reduced odds of having hypercholesterolemia, hypertension, diabetes and obesity among elderly people.

Kontogianni MD, Panagiotakos DB, Chrysohoou C, Pitsavos C, Zampelas A, Stefanadis C. · Department of Nutrition & Dietetics, Harokopio University of Athens, Athens, Greece. · Clin Cardiol. · Pubmed #17385704 No free full text.

Abstract: BACKGROUND: According to epidemiological and metabolic studies monounsaturated fatty acids (MUFAs) seem to exert a protection against coronary heart disease (CHD) risk. The aim of the present study was to evaluate the association between the pattern of edible oils and fats consumption and the prevalence of a first, nonfatal event of an acute coronary syndrome (ACS) in a Greek sample. METHODS: Seven hundred males and 148 females patients with first event of an ACS and 1078 population-based controls, age and sex matched, were randomly selected. Detailed information regarding their medical records, alcohol intake, physical activity and smoking habits was recorded. Nutritional habits were evaluated with a semi-quantitative food-frequency questionnaire and use of oils in daily cooking or preparation of food was also recorded. Multiple logistic regression analysis estimated the odds ratio (OR) of having ACS by types of oil used, after taking into account the effect of several confounders. RESULTS: Exclusive use of olive oil was associated with 47% (95% confidence interval (CI) 0.4-0.71) lower likelihood of having ACS, compared to nonuse, after adjusting for BMI, smoking, physical activity level, educational status, the presence of family history of CHD, as well as hypertension, hypercholesterolemia and diabetes. Consumption of olive oil in combination with other oils or fats was not significantly associated with lower odds of ACS compared to no olive oil consumption (p=0.14). CONCLUSIONS: Exclusive use of olive oil during food preparation seems to offer significant protection against CHD, irrespective of various clinical, lifestyle and other characteristics of the participants.

Panagiotakos DB, Tzima N, Pitsavos C, Chrysohoou C, Zampelas A, Toussoulis D, Stefanadis C. · Department of Nutrition and Dietetics, Harokopio University, Athens, Greece. · J Am Coll Nutr. · Pubmed #17353581 links to  free full text

Abstract: 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.