TABLE 3.
RRs (95% CIs) for mortality according to quintiles of the aMED among men and women with cardiovascular disease in the Health Professionals Follow-Up Study and the Nurses’ Health Study1
| Q1 | Q2 | Q3 | Q4 | Q5 | P-trend | RR (95% CI) for a 2-point increase in the aMED score | |
| Men | |||||||
| Death from all causes | |||||||
| Person-year | 10,389 | 9920 | 9430 | 9248 | 9873 | ||
| Deaths (n) | 460 | 437 | 367 | 380 | 338 | ||
| Age- and smoking-adjusted RR | 1.0 | 0.88 (0.77, 1.00) | 0.77 (0.67, 0.89) | 0.80 (0.70, 0.92) | 0.68 (0.59, 0.78) | <0.001 | 0.86 (0.82, 0.91) |
| Multivariable-adjusted RR | 1.0 | 0.94 (0.82, 1.07) | 0.85 (0.74, 0.98) | 0.86 (0.75, 0.99) | 0.79 (0.68, 0.91) | 0.003 | 0.92 (0.86, 0.97) |
| Death from cardiovascular disease | |||||||
| Deaths (n) | 268 | 240 | 213 | 235 | 186 | ||
| Age- and smoking-adjusted RR | 1.0 | 0.84 (0.71, 1.01) | 0.80 (0.66, 0.96) | 0.88 (0.73, 1.05) | 0.66 (0.54, 0.79) | <0.001 | 0.87 (0.81, 0.94) |
| Multivariable-adjusted RR | 1.0 | 0.89 (0.75, 1.07) | 0.88 (0.73, 1.05) | 0.95 (0.79, 1.14) | 0.77 (0.63, 0.93) | 0.05 | 0.93 (0.86, 1.00) |
| Death from cancer | |||||||
| Deaths (n) | 90 | 81 | 55 | 47 | 71 | ||
| Age- and smoking-adjusted RR | 1.0 | 0.85 (0.63, 1.16) | 0.61 (0.43, 0.86) | 0.54 (0.38, 0.77) | 0.78 (0.57, 1.07) | 0.03 | 0.86 (0.75, 0.98) |
| Multivariable-adjusted RR | 1.0 | 0.91 (0.67, 1.24) | 0.67 (0.47, 0.95) | 0.58 (0.40, 0.83) | 0.88 (0.63, 1.21) | 0.14 | 0.90 (0.79, 1.03) |
| Death from other causes | |||||||
| Deaths (n) | 102 | 5116 | 99 | 98 | 81 | ||
| Age- and smoking-adjusted RR | 1.0 | 1.03 (0.79, 1.35) | 0.90 (0.68, 1.20) | 0.90 (0.68, 1.19) | 0.72 (0.53, 0.97) | 0.02 | 0.87 (0.78, 0.98) |
| Multivariable-adjusted RR | 1.0 | 1.11 (0.85, 1.46) | 1.02 (0.77, 1.36) | 0.98 (0.74, 1.30) | 0.85 (0.63, 1.16) | 0.27 | 0.94 (0.83, 1.05) |
| Women | |||||||
| Death from all causes | |||||||
| Person-year | 15,494 | 16,160 | 16,055 | 15,769 | 16,279 | ||
| Deaths (n) | 346 | 345 | 288 | 287 | 202 | ||
| Age- and smoking-adjusted RR | 1.0 | 0.95 (0.82, 1.10) | 0.82 (0.70, 0.96) | 0.81 (0.69, 0.95) | 0.60 (0.50, 0.71) | <0.001 | 0.82 (0.76, 0.87) |
| Multivariable-adjusted RR | 1.0 | 1.03 (0.89, 1.20) | 0.95 (0.81, 1.11) | 1.01 (0.86, 1.19) | 0.85 (0.71, 1.02) | 0.11 | 0.95 (0.88, 1.01) |
| Death from cardiovascular disease | |||||||
| Deaths (n) | 141 | 158 | 141 | 131 | 95 | ||
| Age- and smoking-adjusted RR | 1.0 | 1.05 (0.83, 1.32) | 0.97 (0.77, 1.23) | 0.90 (0.71, 1.14) | 0.68 (0.52, 0.88) | 0.002 | 0.86 (0.78, 0.94) |
| Multivariable-adjusted RR | 1.0 | 1.15 (0.91, 1.45) | 1.13 (0.89, 1.44) | 1.15 (0.90, 1.46) | 0.99 (0.75, 1.29) | 0.87 | 1.01 (0.91, 1.11) |
| Death from cancer | |||||||
| Deaths (n) | 43 | 39 | 47 | 42 | 26 | ||
| Age- and smoking-adjusted RR | 1.0 | 0.85 (0.55, 1.31) | 1.12 (0.74, 1.70) | 1.00 (0.65, 1.54) | 0.67 (0.41, 1.10) | 0.14 | 0.87 (0.73, 1.04) |
| Multivariable-adjusted RR | 1.0 | 0.87 (0.56, 1.36) | 1.20 (0.79, 1.84) | 1.12 (0.72, 1.74) | 0.80 (0.48, 1.33) | 0.48 | 0.94 (0.78, 1.13) |
| Death from other causes | |||||||
| Deaths (n) | 16 | 148 | 100 | 114 | 81 | ||
| Age- and smoking-adjusted RR | 1.0 | 0.89 (0.71, 1.12) | 0.61 (0.48, 0.79) | 0.69 (0.54, 0.88) | 0.52 (0.39, 0.68) | <0.001 | 0.76 (0.68, 0.84) |
| Multivariable-adjusted RR | 1.0 | 0.97 (0.77, 1.22) | 0.70 (0.54, 0.91) | 0.85 (0.67, 1.09) | 0.75 (0.56, 0.98) | 0.02 | 0.88 (0.79, 0.97) |
| Pooled results2 | |||||||
| Death from all causes | 1 | 0.98 (0.89, 1.08) | 0.90 (0.81, 1.00) | 0.94 (0.81, 1.08) | 0.81 (0.72, 0.91) | <0.001 | 0.93 (0.89, 0.97) |
| Death from cardiovascular disease | 1 | 1.00 (0.79, 1.27) | 0.99 (0.78, 1.25) | 1.02 (0.87, 1.21) | 0.85 (0.67, 1.09) | 0.30 | 0.96 (0.89, 1.04) |
| Death from cancer | 1 | 0.89 (0.69, 1.15) | 0.88 (0.50, 1.55) | 0.80 (0.42, 1.54) | 0.85 (0.65, 1.11) | 0.10 | 0.91 (0.82, 1.02) |
| Death from other causes | 1 | 1.03 (0.86, 1.22) | 0.84 (0.59, 1.22) | 0.91 (0.75, 1.09) | 0.79 (0.65, 0.97) | 0.01 | 0.91 (0.84, 0.98) |
Adjusted for age (1-y increment), smoking status (never, past, or current 1–14, 15–24, or ≥25 cigarettes/d), BMI (in kg/m2; <23.0, 23.0–24.9, 25.0–27.9, 28.0–29.9, or ≥30.0), leisure-time physical activity (<1.5, 1.5–5.9, 6.0–11.9, 12.0–20.9, or ≥21.0 MET-h/wk), parental history of myocardial infarction before age 65 y, menopausal status and use of HT in women (premenopausal women, postmenopausal without HT, postmenopausal with past HT, or postmenopausal with current HT), multivitamin use, and medication use (aspirin, diuretics, β-blockers, calcium channel blockers, other blood pressure medication, or statins and other cholesterol-lowering drugs). aMED, Alternate Mediterranean Diet; HT, hormone therapy; MET, metabolic equivalent task; Q, quintile.
Results from the multivariable-adjusted models were combined by using a random-effects model.