Abstract
BackgroundIn 1988, the SPILI project was established in order to evaluate the cardiovascular disease (CVD) risk profile of the inhabitants of Spili, in rural Crete, Greece. The first reports from this project revealed that against the unfavourable risk factors' profile observed, only a few men with a previous myocardial infarction were encountered. A follow-up study (SPILI II) was performed twelve years after the initial examination, and the unfavourable cardiovascular risk profile was re-confirmed.Presentation of the HypothesisThis paper presents a hypothesis formulated on the basis of previous research to investigate if dynamic psycho-social determinants, including social coherence of the local community, religiosity and spirituality, are protective against the development of coronary heart disease in a well-defined population.Testing the HypothesisA follow-up examination of this Cretan cohort is currently being performed to assess the link between psychosocial factors and CVD. Psychosocial factors including sense of control, religiosity and spirituality are assessed in together with conventional CVD risk factors. Smoking and alcohol consumption, as well as dietary habits and activity levels are recorded. Oxidative stress and inflammatory markers, as well as ultrasound measurement of carotid intima media thickness, a preclinical marker of atherosclerosis, will also be measured.Implications of the hypothesis testedThe issue of the cardio-protective effect of psycho-social factors would be revisited based on the results of this Cretan cohort; nevertheless, further research is needed across different sub-populations in order to establish a definite relationship. A comprehensive approach based on the aspects of bio-social life may result in more accurate CVD risk management.
Highlights
In 1988, the SPILI project was established in order to evaluate the cardiovascular disease (CVD) risk profile of the inhabitants of Spili, in rural Crete, Greece
Testing the Hypothesis: A follow-up examination of this Cretan cohort is currently being performed to assess the link between psychosocial factors and CVD
Evidence suggests that low socio-economic status, social isolation, lack of social support, familial and occupational stress, negative emotions including depression and hostility, may aggravate the prognosis and clinical course in patients with coronary heart disease (CHD) [4]
Summary
Cardiovascular disease (CVD) represents the leading cause of mortality in both the industrialised and developing world [1]. Testing the hypothesis In order to confirm or refute the “Cretan hypothesis” outlined above, we will conduct a cohort study (SPILI III), which will evaluate the effect of cultural, religious and related psychosocial characteristics (shared within this rural population of Crete), with the relationship between traditional risk factors and CVD (Figure 1). Implications of the hypothesis The current proposed study aims to explore the extent to which Cretan individuals with greater sense of coherence and high religiosity and spirituality levels, are less likely to be affected by chronic inflammation and atherosclerosis related burden and abnormal levels of the relative bio-markers examined. Future interventions and health promotion programmes which take into consideration classical cardiovascular morbidity determinants (e.g. smoking, hyperlipidaemia and hypertension) and adverse psycho-social risk factors may influence our understanding of CVD features in relation to its presentation and natural history. We anticipate that certain patterns will be identified which could have both immediate applicability for current clinical and public health concerns, and which may generate a new round of research questions with regard to the significance of the community for the health and well-being of the individual
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