Abstract
Smoking is a strong risk factor for the development of abdominal aortic aneurysm (AAA). It was hypothesised that a Mediterranean diet via its anti-oxidative properties would decrease the risk of AAA, particularly among smokers. The study population included the Cohort of Swedish Men (45 072 men) and the Swedish Mammography Cohort (36 632 women), aged 45 - 83 years at baseline. A modified Mediterranean Diet (mMED) score, including eight food groups, was calculated based on a food frequency questionnaire. Cox proportional hazard models were used to estimate hazard ratios (HRs) with 95% confidence intervals (CIs). During 17.5 years of follow up (1 427 841 person-years), 1 781 AAA cases (1 496 in men, 285 in women; 1497 non-ruptured, 284 ruptured) were ascertained via Swedish registers. The mMED score was inversely associated with AAA incidence in men (per each one point increment in mMED score HR 0.96, 95% CI 0.93 - 1.00) and in women (HR 0.83, 95% CI 0.77 - 0.90), for non-ruptured (HR 0.95, 95% CI 0.92 - 0.99; in men with infrarenal aortic diameter ≥ 30 mm HR 0.90, 95% CI 0.81 - 1.00) and for ruptured AAA (HR 0.81, 95% CI 0.70 - 0.93). In current and ex-smokers with low (< 20) and moderate (20 - 39.9) pack-years of smoking, a statistically significant inverse association was observed. HRs for each one point increment in the mMED score in current smokers were 0.83 (95% CI 0.75 - 0.91) and 0.90 (95% CI 0.84 - 0.97), respectively; in ex-smokers 0.89 (95% CI 0.81 - 0.97) and 0.93 (95% CI 0.85 - 1.01), respectively. No association was observed among current or ex-smokers with ≥ 40 pack-years; HRs 1.02 (95% CI 0.91 - 1.13) and 0.95 (95% CI 0.83 - 1.10), respectively. Adherence to the Mediterranean diet was associated with a reduced AAA risk in current and ex-smokers with low pack-years of smoking.
Highlights
A dominant role in the aetiology of abdominal aortic aneurysm (AAA) is attributed to oxidative stress and inflammation,[1] and cigarette smoking is a major risk factor.[2,3] Among smokers who quit, the risk of developing AAA becomes similar to that among never smokers 25 years after smoking cessation.[4]
Large population based prospective cohorts of men and women, adherence to a Mediterranean style diet was inversely associated with AAA incidence
To the best of the present authors’ knowledge, this is the first study to examine the association between Mediterranean diet and AAA incidence
Summary
A dominant role in the aetiology of abdominal aortic aneurysm (AAA) is attributed to oxidative stress and inflammation,[1] and cigarette smoking is a major risk factor.[2,3] Among smokers who quit, the risk of developing AAA becomes similar to that among never smokers 25 years after smoking cessation.[4] Current smoking has been observed to be associated with a larger relative risk of AAA among women, while smoking cessation halved the excess risk twice as quickly among women than men (after 11 years in women and 23 years in men).[5]. In the recently published European Society for Vascular Surgery 2019 Clinical Practice Guidelines on the Management of Abdominal Aorto-iliac Artery Aneurysms, dietary factors are not addressed among risk factors for disease development.[3] When the optimal management of patients with small AAAs is discussed in those Guidelines, dietary interventions are not mentioned, and no data to suggest that diet may inhibit growth are presented.[3]
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