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The purpose of this work was to evaluate the relation between serum glucose levels at hospital admission and left ventricular systolic function in nondiabetic patients with an acute coronary syndrome (ACS). Of the 1000 ACS patients who were consecutively enrolled during 2007-2008, 583 (63 ± 13 years, 20% females) nondiabetic patients were studied in this work. Of these, 254 presented left ventricular systolic dysfunction (ejection fraction 155 mg/dl) had lower left ventricular ejection fraction (40% vs 45%, P = 0.003), were older (66 ± 11 vs 61 ± 13, P = 0.004) and less physically active (49% vs 63%, P = 0.02), had higher troponin (14.7 ± 39.7 vs 5.6 ± 13.5, P = 0.03), higher brain natriuretic peptide (510.39 ± 932.33 vs 213.4 ± 301.14, P = 0.008), higher C-RP (42.26 ± 55.26 vs 26.46 ± 38.18, P = 0.04), lower creatinine clearance levels (68 ± 33 vs.81 ± 31, P = 0.009), higher white blood cell count (13 416 ± 16 420 vs 9310 ± 3020, P = 0.001), and lower body mass index (26.8 ± 4 vs 27.2 ± 4.4, P = 0.07), compared to those in the lowest tertile (

Background/objectives: To quantify the changes in 10-year cardiovascular disease (CVD) onset, recurrence, and mortality, in relation to transitioning from low to a higher level of adherence to the Mediterranean diet. Subjects/methods: An individual-level microsimulation was created based on ATTICA (2002–2012, n = 3042 subjects free-of-CVD) and GREECS (2004–2014, n = 2172 patients with acute coronary syndrome (ACS)) studies (in total n = 5214). Eight scenarios regarding the proportion of participants and the size of improvement of the level of adherence to the Mediterranean diet (corresponding to one to ten point increases in MedDietScore) were compared in terms of relative change in CVD incidence and mortality, as well as, the number of preventable CVD events and deaths. Results: Improving adherence to the Mediterranean diet in at least 10% of the population, a significant relative percentage reduction could be observed in 10-year CVD onset, recurrence, and mortality. At least 851 first CVD events, 374 recurrent CVD events, and 205 CVD deaths per 100,000 of the population could be averted or delayed. In addition, Mediterranean diet clustering revealed that scoring higher in fruits, vegetables, whole wheat products, and legumes was more important than achieving higher scores in low consumption of meat and full-fat dairy products against CVD (all HRs in the former cluster were lower than the latter, indicating a stronger protective effect). Conclusions: This microsimulation process confirms the added value of the Mediterranean diet in primary and secondary CVD prevention having great achievements even with modifications in a small part of the population (10%), while challenges the orientation of Mediterranean-diet interventions giving higher weights to plant-based part. © 2021, The Author(s), under exclusive licence to Springer Nature Limited.

Background/objectives: We evaluated the role of the presence of non-alcoholic fatty liver disease (NAFLD) at baseline in the transition from metabolically healthy to metabolically unhealthy obesity (MHO to MUO) ten years later. Methods: A prospective cohort study (ATTICA study, Greece) was performed between 2002 and 2012 studying a sample from the greater metropolitan Athens area. In total, 1514 (49·8%) men and 1528 (50.2%) women (aged >18 years old) free-of-CVD were included. Healthy metabolic status was defined as absence of all NCEP ATP III (2005) metabolic syndrome components. NAFLD was defined according to validated liver steatosis indices. Follow-up CVD assessment (2011–2012) was achieved in n = 2020 participants (n = 317 cases). Results: NAFLD prevalence among MHO participants ranged from 29% to 39% according to the specific NAFLD score used. MHO participants who developed metabolically unhealthy status had about two times higher odds to have NAFLD at baseline compared with their metabolically healthy normal weight counterparts whereas stable MHO was not associated significantly with NAFLD. Moreover, MHO status accompanied by NAFLD was associated with increased CVD risk (Hazard Ratio = 2.90 95% Confidence Interval (1.35, 5.40)) in comparison to their non-NAFLD MHO counterparts. Further analysis revealed that in the obese, NAFLD indices and not simply visceral adiposity increased significantly the ability of metabolic status (using standard definition) to predict long-term CVD incidence. Conclusions: Considering NAFLD, even when assessed using validated indices only, in the clinical assessment of apparently healthy obese individuals predicts who is to develop MUO and contributes independently and more accurately to defining future cardiometabolic risk. © 2021 Elsevier Inc.

Background and Objectives: Various bio-psychosocial mechanisms underlying the link between anxiety, depression and cardiovascular disease risk, remain unknown. We investigated the role of irrational beliefs in conjunction with anxiety and depression in the 10-year cardiovascular disease (CVD) incidence, and the effect of biochemical and socio-behavioral factors. Design: 853[453 men (45 ± 13 years) and 400 women (44 ± 18 years)] from the ATTICA study (2002–2012) and without evidence of CVD were assessed. Methods: The Irrational Beliefs Inventory (IBI), the Zung Self-Rating-Depression-Scale (ZDRS) and the State-Trait-Anxiety-Inventory (STAI) were used for the assessments. Incidence of CVD was defined according to the International Coding Diseases (ICD)−10 criteria. Results: Participants with high irrational beliefs and anxiety symptoms had a 138% greater risk of developing CVD during the 10-year follow-up (2.38; 95%CI 1.75, 3.23) as compared to those without anxiety. Among others, C-reactive protein, interleukin-6 and total antioxidant capacity were mediators in the tested association. Interaction of irrational beliefs and depression was not associated with the 10-year CVD in all models. Conclusions: Inflammation and oxidative stress, partially explained the associations between irrational beliefs and anxiety in predicting CVD risk. These findings advance psychological research in the area of primary prevention of mental health and cardiovascular diseases. © 2022 Informa UK Limited, trading as Taylor & Francis Group.

Objectives: To evaluate the association of meat consumption with prevalent depressive symptomatology and cardiovascular disease (CVD) incidence in apparently healthy individuals.Methods: ATTICA study was conducted during 2001-2012 including n = 1514 men and n = 1528 women (aged >18 years old) from the greater Athens area, Greece. At baseline, depressive symptomatology through Zung Self-Rating Depression Scale (range 20-80) and meat consumption (total meat, red, white and processed meat) through validated semi-quantitative food frequency questionnaire were assessed. Follow-up (2011-2012) was achieved in n = 2020 participants (n = 317 cases); n = 845 participants with complete psychological metrics were used for the primary analysis.Results: Ranking from 1st to 3rd total meat consumption (low to high) tertiles, participants assigned in 2nd tertile had the lowest depressive-symptomatology scoring (p

We explored the differences in dietary habits and dietary patterns between individuals characterized by irrational beliefs with no or low anxiety and depressive symptoms and individuals characterized by irrational beliefs with high anxiety and depressive symptomatology. Within the context of the ATTICA cohort study (2002–2012), 853 participants without evidence of cardiovascular disease (453 men (45 ± 13 years) and 400 women (44 ± 18 years)) underwent mental health assessment through the irrational beliefs inventory (IBI), the Zung self-rating depression scale (ZDRS) and the state–trait anxiety inventory (STAI). Demographic characteristics, a thorough medical history, dietary behaviour and other lifestyle behaviours were also evaluated and analysed using factor analysis. Five main factors related to dietary patterns were extracted for the high-IBI/low-STAI group of participants (explaining the 63% of the total variation in consumption), whereas four factors were extracted for the high-IBI/high-STAI participants, the high-IBI/low-ZDRS participants and the high-IBI/high-ZDRS participants, explaining 53%, 54% and 54% of the total variation, respectively. A Western-type dietary pattern was the most dominant factor for individuals reporting irrational beliefs and anxiety or depressive symptomatology. The high refined carbohydrates and fats dietary pattern was the most dominant factor for individuals with irrational beliefs but without psychopathology. Linear regression analysis showed that irrational beliefs, in combination with anxiety or depression, age, sex and BMI, were important predictors of adherence to the Mediterranean diet. Dietary habits interact with irrational beliefs and, in association with the consequent psychological disorders, are associated with overall diet, and presumably may affect the health status of individuals. © 2021 by the authors. Licensee MDPI, Basel, Switzerland.

This document presents the consensus recommendations of the Hellenic Stroke Organization and the Hellenic Atherosclerosis Society for lipid modification in patients with ischemic stroke or transient ischemic attack. This clinical guide summarizes the current literature on lipid management and can be of assistance to the physicians treating stroke patients in clinical practice. © 2020 World Stroke Organization.

Background and aims: We assessed the association of Mediterranean diet with NAFLD and their interaction in predicting ten-year diabetes onset and first fatal/non-fatal cardiovascular disease (CVD) incidence. Methods: The ATTICA prospective observational study in Athens, Greece included 1,514 men and 1,528 women (>18 years old) free-of-CVD at baseline. Liver steatosis and fibrosis indices were calculated. Mediterranean diet adherence was assessed through MedDietScore. At the ten-year follow-up visit, CVD evaluation was performed in an a priori specified subgroup of n = 2,020 participants and diabetes onset in n = 1,485 free-of-diabetes participants. Results: MedDietScore was inversely associated with steatosis and fibrosis; e.g. in the case of the TyG index the Odds Ratio (OR) of the 3rd vs. 1st MedDietScore tertile was = 0·53, [95% Confidence Interval (95% CI) (0·29, 0·95)] and the associations persisted in multi-adjusted models. NAFLD predicted incident diabetes prospectively over a ten year period [HR = 1·87, 95% CI (0·75, 4·61)] and the association remained significant only in subjects with low MedDietScore (below median) whereas diabetes onset among subjects with higher MedDietScore was not influenced by NAFLD. Similarly, NAFLD predicted CVD [Hazard Ratio (HR) = 3·01, 95%CI(2·28, 3·95)]; the effect remained significant only in subjects with MedDietScore below median [HR = 1·38, 95% CI (1·00, 1·93)] whereas it was essentially null [HR = 1·00,95% CI (0·38, 2·63)] among subjects with higher score. Mediation analysis revealed that adiponectin and adiponectin-to-leptin ratio were the strongest mediators. Conclusions: We report an inverse association between Mediterranean diet and NAFLD. Mediterranean diet protected against diabetes and CVD prospectively among subjects with NAFLD. © 2020 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism

Purpose: To investigate the combined role of irrational beliefs, anxiety and depression in the 10-year incidence of type 2 diabetes, and the underlying effect of biochemical, and socio-behavioural factors. Methods: Within the context of the ATTICA cohort study (2002–2012), 853 participants without evidence of CVD [453 men (45 ± 13 years) and 400 women (44 ± 18 years)] underwent psychological evaluation through the Irrational Beliefs Inventory (IBI) (range 0–88), the Zung Self-Rating-Depression-Scale (ZDRS) and the State-Trait-Anxiety-Inventory (STAI). Diagnosis of diabetes at follow-up examination was based on the criteria of the American Diabetes Association (ADA). Results: Mean IBI score was 53 ± 10 in men and 51 ± 11 in women (p = 0.68). Participants with high irrational beliefs who also had anxiety symptoms had a 93% excess risk of developing diabetes during the 10-year follow-up (Hazard Ratio 1.93; 95%CI 1.34, 2.78) as compared to those without anxiety. Moreover, diabetes risk was 73% higher among individuals with high levels of irrational beliefs and depression as compared to those where depression was absent (1.73; 1.21, 2.46). Lower education status, family history of diabetes, hypercholesterolemia, high BMI, as well as tumor necrosis factor and total antioxidant capacity were revealed as mediating risk factors related to the tested associations. Conclusion: Irrational beliefs among apparently healthy adults trigger depression and anxiety symptomatology, and through the increased inflammation and oxidative stress profile, were associated with increased diabetes risk. This observation moves psychological research a step forward in supporting and guiding primary prevention of mental health and metabolic conditions. © 2021, Springer Nature Switzerland AG.

OBJECTIVE: The aim of this study was to evaluate the dietary habits and irrational beliefs of apparently healthy individuals in relation to their 10-year diabetes incidence. METHODS: The ATTICA study (2002-2012) is a prospective population-based cohort study, in which 853 participants (453 men (aged 45 ± 13 years) and 400 women (aged 44 ± 18 years)) without a history of cardiovascular disease (CVD) underwent psychological evaluations. Among other things, participants completed the Irrational Beliefs Inventory (IBI, range 0-88), a brief, self-reported measure consistent with the Ellis model of psychological disturbance. Demographic characteristics, detailed medical history, and dietary and other lifestyle habits were evaluated as well. Diagnosis of diabetes at follow-up examination was based on the criteria of the American Diabetes Association. RESULTS: Mean IBI score was 53 ± 10 in men and 51 ± 11 in women (p = 0.68). IBI was positively associated with the 10-year type 2 diabetes incidence (hazard ratio: 1.14; 95% CI: 1.04-1.25) in both men and women, and even more distinctly associated with participants with the following characteristics: lower education status, married, overweight, smokers, anxiety and depressive symptomatology, and unhealthy dietary habits. Especially, participants with increased irrational beliefs and low adherence to the Mediterranean diet were 37% more likely to develop type 2 diabetes than those with the reverse status (hazard ratio: 3.70; 95% CI: 2.32-5.88). CONCLUSIONS: These data support the need for lifestyle changes towards healthier nutrition which can be achieved by educating people so that they are equipped to recognize false and unhelpful thoughts and thus to prevent negative psychological and clinical outcomes such as mental health disorders and type 2 diabetes. © 2021, Society for Biomedical Diabetes Research. All rights reserved.

Background: The role of adipose tissue (AT) in arterial inflammation in familial dyslipidaemias is poorly studied. We investigated the relationship between AT and arterial inflammation in patients with heterozygous familial hypercholesterolemia (heFH) and familial combined hyperlipidemia (FCH). Methods and Results: A total of 40 patients (20 heFH/20 FCH) and a subgroup of 20 of non-heFH/FCH patients were enrolled. Participants underwent blood sampling for serum adipokine measurements and Fluorine-18 fluorodeoxyglucose (18F-FDG) PET/CT imaging. Abdominal visceral (VAT) and subcutaneous (SAT) AT volumes and AT and abdominal aorta 18F-FDG uptake were quantified. FCH patients had increased VAT (pANOVA = 0.004) and SAT volumes (pANOVA = 0.003), lower VAT metabolic activity (pANOVA = 0.0047), and lower adiponectin levels (pANOVA = 0.007) compared to heFH or the control group. Log(Serum adiponectin) levels were correlated with aortic TBR (b = − 0.118, P = 0.038). In mediation analysis, VAT volume was the major determinant of circulating adiponectin, an effect partly mediated via VAT TBR. Clustering of the population of heFH/FCH by VAT volume/TBR and serum adiponectin identified two distinct patient clusters with significant differences in aortic TBR levels (2.11 ± 0.06 vs 1.89 ± 0.05, P= 0.012). Conclusions: VAT phenotype (increased VAT volume and/or high VAT TBR) and hypoadiponectinemia may account for the observed differences in arterial inflammation levels between heFH and FCH patients. © 2021, American Society of Nuclear Cardiology.

Background: As we move towards a post-pandemic society, a question arises: How will the way we live look different in the wake of the COVID-19 pandemic? Aim: The aim of this survey was to evaluate changes in eating habits and other lifestyle behaviours (i.e., exercise and smoking) of people of almost all ages, who live in Greece, during the COVID-19 pandemic. Methods: A web-based survey using conventional sampling was conducted from during December 2020, in Greece. A total of 2258 individuals, aged 17 years and older voluntarily participated (912 (40%) men). Results: 89 (3.94%) of the participants reported that they had, or currently have been diagnosed with COVID-19. Moreover, 36.4% of the participants reported that they have changed their dietary habits during the pandemic towards a healthier diet – those participants had median age of 35 years, were of both sexes, 17% had co-morbidities and 69% with higher education level; moreover, 19% of those participants have started or increased the frequency of receiving dietary supplements that enhance the immune system, 34% of the participants reported that they gained weight during the pandemic period, whereas 19.8% reported that they have lost weight, and 37% of the participants reported that they have started or increased, as compared to the pre-pandemic time, their frequency of physical activities. Conclusions: The COVID-19_pandemic seems to have forced people to discover again habits and traditions towards a more natural and healthier way of living. Long-term consequences and the evolution of these lifestyle changes after the COVID-19 pandemic have to be evaluated relevant to their implications in public health. © The Author(s) 2021.

Objective: To compare the Mediterranean and Dietary Approaches to Stop Hypertension (DASH) diets in deterring 10-year CVD. Design: Prospective cohort (n 2020) with a 10-year follow-up period for the occurrence of combined (fatal or non-fatal) CVD incidence (International Classification of Diseases (ICD)-10). Baseline adherence to the Mediterranean and DASH diets was assessed via a semi-quantitative FFQ according to the MedDietScore and DASH scores, respectively. Setting: Attica, Greece. Participants: Two thousand twenty individuals (mean age at baseline 45·2 (sd 14·0) years). Results: One-third of individuals in the lowest quartile of Mediterranean diet consumption, as compared with 3·1 % of those in the highest quartile, developed 10-year CVD (P < 0·0001). In contrast, individuals in the lowest and highest DASH diet quartiles exhibited similar 10-year CVD rates (n (%) of 10-year CVD in DASH diet quartiles 1 v. 4: 79 (14·7 %) v. 75 (15·3 %); P = 0·842). Following adjustment for demographic, lifestyle and clinical confounding factors, those in the highest Mediterranean diet quartile had a 4-fold reduced 10-year CVD risk (adjusted hazard ratio (HR) 4·52, 95 % CI 1·76, 11·63). However, individuals with highest DASH diet quartile scores did not differ from their lowest quartile counterparts in developing such events (adjusted HR 1·05, 95 % CI 0·69, 1·60). Conclusions High adherence to the Mediterranean diet, and not to the DASH diet, was associated with a lower risk of 10-year fatal and non-fatal CVD. Therefore, public health interventions aimed at enhancing adherence to the Mediterranean diet, rather than the DASH diet, may most effectively deter long-term CVD outcomes particularly in Mediterranean populations. ©

Purpose: The built and food environments are widely acknowledged to play an important role in defining human health by influencing, among others, behaviors such as nutrition habits and physical activities. The aim of this study was to identify the spatial variability of the sex-specific prevalence of the metabolic syndrome (MetS) and its environmental determinants in the Athens metropolitan area. Methods: Data on the prevalence of the MetS were provided by the ATTICA epidemiological study for 2749 participants, with complete data for geographical identification (1375 women [44 years old {SD = 14 years}] and 1374 men [45 years old {SD = 13 years}]), while socioeconomic, demographic, and environmental characteristics were provided by official national and international databases. Results: Approximately 20% of the people residing in the study area were diagnosed with MetS, with its prevalence being almost two times higher in men compared to women. Areas more extensively covered by green urban spaces and sports facilities were shown to have a lower prevalence of MetS, while greater density and availability of supermarkets and street markets were inversely related to MetS prevalence in both sexes. In addition, the present analysis revealed that the beneficial role of the built environment’s characteristics on MetS prevalence was significantly stronger in the male population, while the preventive effect of the food environment’s characteristics was almost 1.5 times stronger in the female population Conclusion: Although individualized prevention and treatment approaches are necessary to decrease the burden of MetS, environmental modifications that promote healthy behaviors represent an essential health approach. © 2021, Hellenic Endocrine Society.