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Background: The Food Compass Score (FCS) is a novel nutrient profiling system, which evaluates food and diet quality. The present study aimed to prospectively assess the relationship of FCS with short‐term (10 years) and long‐term (20 years) cardiovascular disease (CVD) incidence and to explore whether this relationship is modified by long‐term adherence to a Mediterranean type diet (MTD). Methods: Volunteers of the ATTICA cohort study, with complete data for the calculation of FCS and incident CVD were included (n = 759). Development of CVD was determined at 10 and 20 years after baseline. Dietary intake was assessed through a validated food frequency questionnaire. The FCS was calculated for each participant based on the published algorithm. Long‐term adherence to a MTD was evaluated through MedDietScore. Results: FCS was inversely associated with CVD incidence (hazard ratio [HR] for 20‐year follow‐up = 0.97, 95% confidence interval [CI] = 0.95–0.99; HR for 10‐year follow‐up = 0.98, 95% CI = 0.96–1.01) in the total sample, as well as in those with a high baseline adherence to a MTD (HR for 20‐year follow‐up = 0.96, 95% CI = 0.93–0.99; HR for 10‐year follow‐up = 0.98, 95% CI = 0.95–1.02). FCS was also inversely associated with CVD risk in those who went away from the MTD (HR = 0.97, 95% CI = 0.96–0.99). Conclusions: FCS, a novel tool for assessing overall diet quality, was also found to be useful in identifying potential CVD candidates in a long‐term period, even in populations with good background dietary habits, such as those following a MTD. Key points: Food Compass Score (FCS) was inversely related to incident cardiovascular disease.FCS was shown to be a useful tool for assessing overall diet quality.FCS could be used to identify potential cardiovascular disease candidates. [ABSTRACT FROM AUTHOR]

The study aimed to assess the trajectories of lifestyle characteristics and their association with 20-year cardiovascular disease (CVD) incidence. In 2002, 3042 Greek adults (aged: 45 (12) years) free of CVD were enrolled. In 2022, the 20-year follow-up was performed on 2169 participants; of those, 1988 had complete data for CVD. The 20-year CVD incidence was 3600 cases/10,000 individuals; the man-to-woman ratio was 1.25, with the peak difference in the 35–45 age group (i.e., 2.1); however, a reversal of the trend was observed in the age-groups 55–65 and 65–75, with a resumption of an almost equal incidence in those >75 years. In multi-adjusted analysis, age, sex, abnormal waist circumference, hypercholesterolemia, hypertension, and diabetes were positively associated with 20-year CVD risk, explaining 56% of the excess CVD risk, whereas an additional 30% was attributed to lifestyle trajectories; being physically active throughout life-course and being close to the Mediterranean diet were protective, while continuous smoking was detrimental against CVD risk. Mediterranean diet adherence protected against CVD development even if not sustained, while quitting smoking or engaging in physical activities during the 20-year observation did not offer any significant protection. A life-course personalized approach that is cost-effective and long-term sustained is needed to prevent CVD burden. [ABSTRACT FROM AUTHOR]

Familial hypercholesterolemia (FH) is the most frequent genetic disorder resulting in increased low-density lipoprotein cholesterol (LDL-C) levels from childhood, leading to premature atherosclerotic cardiovascular disease (ASCVD) if left untreated. FH diagnosis is based on clinical criteria and/or genetic testing and its prevalence is estimated as being up to 1:300,000–400,000 for the homozygous and ~1:200–300 for the heterozygous form. Apart from its late diagnosis, FH is also undertreated, despite the available lipid-lowering therapies. In addition, elevated lipoprotein(a) (Lp(a)) (>50 mg/dL; 120 nmol/L), mostly genetically determined, has been identified as an important cardiovascular risk factor with prevalence rate of ~20% in the general population. Novel Lp(a)-lowering therapies have been recently developed and their cardiovascular efficacy is currently investigated. Although a considerable proportion of FH patients is also diagnosed with high Lp(a) levels, there is a debate whether these two entities are associated. Nevertheless, Lp(a), particularly among patients with FH, has been established as a significant cardiovascular risk factor. In this narrative review, we present up-to-date evidence on the pathophysiology, diagnosis, and treatment of both FH and elevated Lp(a) with a special focus on their association and joint effect on ASCVD risk. [ABSTRACT FROM AUTHOR]

The recently launched Food Compass Score (FCS) is a novel nutrient profiling system (NPS), which evaluates food and diet quality to assist in food choices and policy design. The Food compass score (FCS) is a holistic food score assessing 54 parameters. The aim of this study was, firstly, to evaluate the relation of FCS with inflammatory markers and secondly, to prospectively assess the relationship of FCS with the 20-year incidence of cardiovascular disease (CVD). Adults free-of-CVD from the ATTICA cohort study, with complete data for the calculation of FCS and incident CVD were included (n=759). C-reactive protein and amyloid A were determined by immunonephelometry, fibrinogen by nephelometry, homocysteine by fluorometry, while tumor necrosis factor-a (TNF-a), interleukin-6 (IL-6), adiponectin and leptin were determined by ELISA in fasting blood samples. Development of CVD was determined at 20 years after baseline (in 2022). Dietary intake was evaluated through a validated food frequency questionnaire. FCS was calculated for each participant based on the published values. Mean FCS was 56 (Standard deviation: 5.7). In multiple linear regression models, after adjusting for confounders, FCS was inversely associated with CRP (-0.03, 0.01), TNF-a (-0.04, 0.01), amyloid A (-0.10, 0.04) and homocysteine (-0.09, 0.04) (b coefficients, standard errors, all p-values<0.05). FCS was not associated with IL-6, fibrinogen, adiponectin, leptin nor lipids (total cholesterol, high density lipoprotein, low density lipoprotein, triacyclglycerols) in multivariate models (all p-values>0.05). Moreover, FCS was inversely associated with the 20-year CVD incidence [Hazard Ratio-HR for 20-year follow-up: 0.97] in multi-adjusted models. A diet containing higher quality foods, as evaluated by FCS, was associated with lower levels of inflammatory indices, as well as CVD risk in a cohort of apparently healthy adults prospectively studied for 20-years. Thus, FCS was proved to be a useful tool not only to evaluate dietary habits, but also inflammation and CVD risk. [ABSTRACT FROM AUTHOR]

Stroke is associated with a heavy burden of mortality and disability, underscoring the importance of effective primary and secondary prevention measures. Dyslipidemia as a risk factor for ischemic stroke has long been disputed. Nevertheless, accumulating epidemiological evidence supports a role of lipid abnormalities in increasing ischemic stroke risk and representing a potential target for therapeutic interventions. 3-hydroxy-3-methyl-glutaryl-(HMG-) CoA reductase inhibitors (i.e., statins) are currently the mainstay of therapy for the management of hypercholesterolemia in patients with cardiovascular disease and stroke. Although their beneficial effects on stroke risk have been attributed chiefly to their lipid-lowering capacity, they also have pleiotropic effects. Other lipid lowering modalities have been shown to reduce the risk of ischemic stroke in individuals at high cardiovascular risk, but data regarding their use in secondary stroke prevention are lacking. [ABSTRACT FROM AUTHOR]

This was a retrospective study that assessed achievement of lipid-lowering treatment targets in the setting of a University Hospital Lipid Clinic. Low-density lipoprotein cholesterol (LDL-C) goal attainment according to National Cholesterol Education Program-Adult Treatment Panel III (NCEP ATP III) and European Society of Cardiology/European Atherosclerosis Society (ESC/EAS) guidelines was recorded in 1000 consecutive adult patients followed for ≥3 years (mean 8 years). The LDL-C targets according to the NCEP ATP III were attained by 66% and 86% of patients with “very high” (n = 477) and “high” (n = 408) cardiovascular risk, respectively. Fewer patients were within LDL-C goals according to the ESC/EAS guidelines: 25% and 42%. Overall, 92% of the patients were on statins: 67% were on statin monotherapy, while 33% were on combinations with ezetimibe (25%), ω-3 fatty acids (5%), fibrates (4%), or colesevelam (2%). Even in a specialist lipid clinic, a large proportion of patients are not at goal according to the recent ESC/EAS guidelines. [ABSTRACT FROM PUBLISHER]

Increased adiposity predisposes to cardiovascular disease (CVD). We hypothesized that the presence of obesity would be positively associated with CVD risk, and that the co-presence of central obesity would modify/enhance this association. This was a prospective study (2002–2022) among 1845 Greek adults (mean age, 44.8 ± 13.5 years; men, 49.8%). At baseline, the presence of overweight/obesity was assessed via body mass index (BMI), whereas central obesity was defined as waist circumference ≥102/88 cm, waist-to-hip-ratio ≥0.95/0.80, or waist-to-height-ratio ≥0.50 in men/women. BMI was reevaluated at 10 years and longitudinal BMI trajectories (2002–2012) were identified. CVD incidence was recorded at 20 years (ratio of new cases to the number of participants assessed). Compared with participants with normal weight at baseline, those with obesity exhibited a 27% higher 20-year CVD risk after adjustment for age, sex, lifestyle habits, and medical status (hazard ratio, 1.271; 95% confidence interval, 1.012–1.597). In similar multiadjusted models, compared with participants who were always non-overweight/obese, those who were always overweight/obese exhibited a 40% higher 20-year CVD risk (hazard ratio, 1.403; 95% confidence interval, 1.018–1.936). Additional control for high-sensitivity C-reactive protein attenuated the associations. In the combined baseline body weight classification analysis, CVD incidence was the lowest in participants with normal weight without central obesity, moderate in those with overweight/obesity without central obesity, and highest in those with normal weight and central obesity and overweight/obesity and central obesity (P <.001). Obesity leads to increased CVD risk, partly mediated by inflammation. The combination of BMI with simple measures of abdominal adiposity is superior for CVD risk screening. In a sample of 1845 healthy Greek adults, compared with subjects with normal weight at baseline, those with obesity exhibited a ∼2 times higher 20-year CVD risk, partly mediated by inflammation. When baseline general and central adiposity measures were combined, CVD risk was significantly higher for subjects with central obesity, even those in the normal range of BMI, indicating the superiority of their combination for CVD risk screening. Abbreviations: BMI, body mass index; CVD, cardiovascular disease; WC, waist circumference; WHR, waist-to-hip ratio; WHtR, waist-to-height ratio. [Display omitted] [ABSTRACT FROM AUTHOR]

We aimed to predict lifetime risk for cardiovascular disease (CVD). The sample consisted of 1988 participants with complete CVD data during the 20-year follow-up (50% men, 45 ± 14 years) of the ATTICA study. Lifetime risk for CVD was predicted at specific index ages (40, 50, and 60 years), based on the life-table method, with death free-of-CVD treated as a competing event. 718 participants experienced a fatal or nonfatal CVD event, corresponding to a crude CVD incidence of 36.1% (men: 40.2%, women: 32.1%, P -value <.001). Overall, women and men had similar lifetime CVD risk (P -value =.245); at index age of 40, the lifetime risk for CVD was 68% for men and 63% for women, with a progressive decline to 56% and 50% at the index age of 50, and to 55% for both men and women, at the index age of 60 years, respectively. These results on lifetime risk for CVD can guide the allocation of resources to improve public health and preventive services, especially in ages below 50 years, in both men and women. [Display omitted] [ABSTRACT FROM AUTHOR]