Lifestyle, Mediterranean diet and survival in European post-myocardial infarction patients

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Abstract
Background The extent and benefits of adherence to lifestyle and dietary recommendations in secondary prevention are largely unknown. Design We examined the frequency of healthy dietary and lifestyle behaviours and their impact on survival in post-myocardial infarction (MI) patients in a prospective cohort study of elderly Europeans. Methods Adherence to a Mediterranean-type diet was measured with a modified Mediterranean Diet Score (MDS) on an eight-point scale. Results Participants were 426 men and women, aged 70 years or more, from 10 European countries, with a history of MI. During 10 years of follow-up mortality was 53%. Frequency of non-smoking behaviour (85%), moderate to vigorous physical activity (54%), moderate alcohol consumption (45%) and a Mediterranean-type diet (63%) in patients differed only marginally as compared with ‘healthy’ elderly. The median MDS in patients from northern Europe was two points lower than in southern Europe. Non-smoking [hazards ratio (HR) 0.62; 95% confidence interval (95% CI) 0.44–0.88], physical activity (HR 0.69; 95% CI 0.53–0.90), moderate alcohol consumption (HR 0.77; 95% CI 0.58–1.02) and a Mediterranean-type diet (HR 0.75; 95% CI 0.57–0.97) were associated with lower all-causes mortality. Presence of at least three healthy behaviours was associated with 40% lower mortality. Conclusion There is a strong relationship between lifestyle and dietary habits and mortality in post-MI patients. The findings implicate that substantial health gain can be obtained by better adherence to dietary and lifestyle recommendations.