Lower consumption of wine and fish as a possible explanation for higher ischaemic heart disease mortality in Spain's Mediterranean region.

Abstract

There is an apparent paradox in the geographical distribution of ischaemic heart disease (IHD) mortality in Spain. The Mediterranean regions, those with the lowest consumption of total and saturated fats, register the highest mortality due to IHD. This paper seeks to explain this paradox by examining the provincial distribution of IHD mortality in Spain and their known risk factors, dietetic and non-dietetic. The study was based on data aggregated by province. Mortality data were taken from official vital statistics, while data on diet and other lifestyle habits were obtained from representative, large-scale, sample-based population surveys. Correlation and multiple regression analyses were run on standardized IHD mortality ratios for the period 1983-1987 and potential dietetic and non-dietetic determinants in 1989-1981. Intake of total lipids, saturated and polyunsaturated fatty acids, fish and wine were lower in Spain's southern and eastern provinces. Consumption of wine, fish, chicken, dairy products, vegetables and blond cigarettes, as well as unemployment, explained 53% of the variation in IHD mortality. Consumption of fish and wine alone exhibited a statistically significant relationship (P < 0.05) with IHD mortality. Moderate consumption of wine was negatively associated with IHD mortality, whereas heavy consumption patterns revealed a positive association. Based on correlation analyses of ecological data, lower consumption of wine and fish may explain the apparent paradox of higher IHD mortality in the presence of a lower intake of saturated fats in Spain's Mediterranean regions.