Ikaria Study Research Articles

Abstract 188: Long-Term Coffee Consumption Is Associated with Improved Endothelial Function in Elderly Individuals: Ikaria Study

Background: Acute coffee consumption is associated with impaired endothelial function, though its long term impact on endothelial function is controversial. We evaluated the association between chronic coffee intake and endothelial function, in elderly residents of Ikaria Island, as the inhabitants of this island show increased longevity and low rates of cardiovascular mortality. Methods: The study was conducted on a subgroup population of IKARIA study consisted of 175 elderly subjects (aged 65-91 yrs), inhabitants of Ikaria Island. Endothelial function was evaluated by ultrasound measurement of flow-mediated-dilatation (FMD). Dietary habits (including coffee consumption in cups per week and in ml per week) were assessed through a food frequency questionnaire. Results: Among elderly subjects, 28% had diabetes mellitus, 29% had hypercholesterolemia, 37% had a BMI>30 kg/m2, and 72% were defined as hypertensives. Moreover, 97% of the study group consumed boiled, Greek type of coffee. There was no difference between hypertensives and normotensives concerning age (75±6 years vs. 73±5 years, p=NS), male sex (51% vs. 56%, p=NS) and coffee consumption [328(120-360) ml/day vs. 346(120-360) ml/day, p=NS]. Linear regression analysis after adjustment for confounders such as age, sex, the presence of cardiovascular disease, hypercholesterolemia, diabetes mellitus and hypertension revealed that elderly individuals who consume less that 7 cups of coffee per week had significant worse FMD compared to those consume 7 to 14 cups of coffee [B=1.37, 95%C.I.: (-0.005, 2.748), p=0.05]. Furthermore, linear regression analysis in hypertensive elderly individuals, after adjustment for the aforementioned confounders, revealed that coffee consumption in ml per week was associated with increased FMD, [B=0.003, 95%C.I.: (0.000, 0.005) p=0.039]. Conclusion: Long term consumption of boiled, Greek type of coffee, with its antioxidant properties, is associated with improved endothelial function in elderly individuals. The beneficial effects of coffee are consisted even in hypertensive individuals, illustrating another cardio-protective dietary pattern of elderly inhabitants in Ikaria Island.

Electrocardiographic diagnosis of left-ventricular hypertrophy

Electrocardiographic diagnosis of left-ventricular hypertrophy

Abstract 381: Favorable Effects of Habitual Physical Activity on Vascular Function: Ikaria Study

Background: Physical activity (PA) has substantial vascular and cardiac health benefits and can ameliorate cardiac risk. Measurement of endothelial function is well validated in large population studies as strong predictor of adverse cardiovascular outcomes. In the present study we evaluated the effect of habitual physical activity on vascular function in residents of Ikaria Island. The inhabitants of this island show increased longevity and high prevalence of healthy aging. Methods: The study was conducted on a subgroup population of IKARIA study consisted of 327 subjects (155 men) aged 40-91 years, permanent inhabitants of Ikaria Island. Endothelial function was evaluated by ultrasound measurement of flow-mediated-dilatation (FMD). We evaluated PA using the shortened version of the self-reported International Physical Activity Questionnaire (IPAQ). Overall the study sample was divided in three groups according to the categorical score achieved in IPAQ questionnaire: low PA (n=75), moderate PA (n=200) and vigorous PA (n=48). Subjects in the low PA group were recorded as physical inactive and the rest as physical active. Results: Mean FMD (5.79±3.19%) was inversely associated with age (r=-0.242, p<0.001). Inactive subjects had significantly lower FMD compared to active subjects (4.95±3.02% vs. 6.06±3.23%, p=0.008). Multiple linear regression analysis after adjustment for several known confounders (age, diabetes mellitus, hypertension, smoking, hypercholesterolemia, cardiovascular disease, body mass index) revealed significant differences in FMD values between moderate vs. low PA group [b=1.24, 95%CI: (0.28, 2.20), p=0.011] whereas a trend was evident between vigorous and low PA group [b=1.11, 95%CI: (-0.16, 2.38), p=0.089]. Moreover subjects walking for more than 10 minutes less than two times weakly had significantly lower FMD compared with subjects walking three to five days weakly or almost every day (5.13±2.82% vs. 6.95±3.84% vs. 6.00±3.23%, p=0.005). Conclusions: The present study revealed another cardioprotective mechanism of habitual PA through beneficial modification of endothelium function.

Gender variation of exercise-induced anti-arrhythmic protection: the Ikaria Study

Regular physical activity (PA) has shown substantial cardiac benefits. We sought to investigate whether habitual PA is associated with changes of the electrical action potential duration, as it is represented by the QT duration on a rest ECG, in a population based sample of middle-aged and elderly individuals of Ikaria island. In a cross-sectional survey 1071 inhabitants of Ikaria Island (65 ± 13 years, 47% males) were enrolled. PA was estimated by means of IPAQ classifying the participants into low, moderate and vigorous group. QT duration was measured from a surface electrocardiogram; while using Bazett's formula the heart-rate-corrected QT (QTc) was calculated. Among participants, 85% reported at least moderate PA levels. Women in the 'vigorous' and 'moderate' PA level compared to those in the 'low' PA level had significantly shorter QTc (408 ± 2 ms vs. 411 ± 1 ms vs. 419 ± 2 ms, P = 0.001, respectively). In contrast, no significant difference in QTc according to PA levels was observed in men (P = 0.053). Linear regression analysis revealed that PA level was significantly associated with shorter QTc in women after adjustment for established confounders; while no such association was evident in men. Furthermore, compared to the 'low' PA group, women in the 'vigorous' PA group were 5.5-times less likely to have QTc interval above 450 ms (P = 0.031). Increased PA is associated with shorter QTc interval only in middle-aged and elderly women of Ikaria Island irrespectively of participant's habits or medical conditions, illustrating gender differences in the cardioprotective effect of habitual exercise.

Long-term adherence to the Mediterranean diet reduces the prevalence of hyperuricaemia in elderly individuals, without known cardiovascular disease: The Ikaria study

BackgroundThe purpose of this study was to evaluate the impact of adherence to Mediterranean diet on serum uric acid (UA) levels in elderly individuals, without known cardiovascular disease. MethodsDuring 2009, 281 females (75±6years old) and 257 males (75±7years old) permanent inhabitants of the island, were voluntarily enrolled. A diet score that assesses the inherent characteristics of the Mediterranean diet (MedDietScore, range 0–55) was applied. Serum levels of UA were determined using an enzymatic colorimetric test through the uricase-peroxidase method. Hyperuricaemia was defined as UA>7mg/dL in males and 6mg/dL in females. ResultsPrevalence of hyperuricaemia was 34% in males and 25% in females (p=0.02). Mean level of adherence to the Mediterranean diet was 35±2. Linear regression analysis revealed that MedDietScore was inversely associated with UA levels (b±SE: −1.48±0.17, p<0.001) in the overall sample, after controlling for hypertension, hypercholesterolemia, diabetes mellitus, creatinine clearance, physical activity, and coffee consumption. When the analysis was stratified by gender, MedDietScore was inversely associated with UA levels in males (b±SE: −1.10±0.42, p=0.009), but not in females (b±SE: 0.04±0.41, p=0.92). ConclusionAnother cardioprotective effect of Mediterranean diet was revealed, through the modification of UA levels in elderly individuals. The potential different effect size as regards the relationship between diet and UA levels between genders, deserves further investigation.

Cardiovascular Disease-Related Lifestyle Factors and Longevity

Cardiovascular disease is one of the leading causes of death in the developed world. Understanding trends in cardiovascular disease prevalence and identifying factors associated with its development are important, since they provide information to define the burden and the mechanisms of the disease, which is the first step before population-based interventions. This special issue is devoted to highlight lifestyle factors and behaviors associated with the development of cardiovascular disease. According to the World Health Organization, sedentary lifestyle, smoking habits, and unhealthy dietary habits, are the most important factors associated with the development of cardiac diseases; and the main reason for classifying these factors as the most significant is because they can be prevented. In their paper, G. S. Metsios et al. presented current scientific evidence about the role of passive smoking in the development of cardiovascular disease in children. The authors identified a total of 42 articles (i.e., 30 reviews and 12 observational), and they revealed that passive smoking may be implicated in deteriorating cardiovascular status in children in terms of unfavorable high-density lipoprotein levels and deteriorated vascular function. In another article based on a middle-aged population of the Ikaria island in Greece, C. Chrysohoou et al. reported that short-term depressive symptoms are related to a worse 30-day prognosis of ACS patients; however, this relationship was mediated by Mediterranean diet adherence. It is well known that depression is an independent risk factor for cardiac diseases. Due to a significant increase of the incidence of depression during the past decades, there has been a growing interest regarding the mechanisms underlying its pathogenesis, including the parameter of nutrition. Y. Ma et al. reported that chronic depression is associated with inflammatory response in women, but not in men. Previous studies have also observed the positive relationship between depression and inflammation. It seems that Mediterranean diet, due to its antioxidant role, may mediate the adverse effect of depression on cardiac system; the majority of studies suggest the beneficial effects of omega-3 PUFAs, a main constituent of Mediterranean diet, in the treatment of clinical depression, with eicosapentaenoic acid (EPA) being more effective than docosahexaenoic (DHA). Another lifestyle factor that has received much attention concerning the prevention of cardiovascular diseases is physical activity status. In the paper by S. A. Kavouras et al., from the ATTICA study, the investigators revealed another mechanism about the protective role of physical activity in atherosclerosis, the improvement in total antioxidant capacity of the study's participants. Moreover, under the context of the IKARIA study, the authors observed that frequent fish intake (i.e., >3 times per week) seems to moderate depressive mood. In addition to the latter, Tyrovolas et al. reported that nutrition services provided in Greek islands played a significant role in modifying dietary habits of older adults. M. M. Pryde and W. B. Kannel resumed that dietary modifications about polyunsaturated fat intake, processed meat consumption, fish choices and preparation, trans fatty acids, low carbohydrate diets, egg consumption, coffee, added sugar, soft drink beverages, glycemic load, chocolate, orange juice, nut consumption, vitamin D supplements, food portion size, and alcohol drinking may preserve cardiovascular health and longevity. In this special issue, the role of lifestyle, mainly represented by diet, smoking, and physical activity, has been extensively studied in relation to cardiovascular disease development. The scientific evidence strongly supports the protective role of healthy diet, abstinence of smoking, and engagement in physical activities for the prevention of cardiovascular disease. Public health policy makers should target on these lifestyle behaviors which seemingly can cost-effectively reduce the burden of the disease at population level. Christina Chrysohoou Christodoulos Stefanadis Christos Pitsavos Demosthenes Panagiotakos Undurti N. Das Dario Giugliano

Sociodemographic and Lifestyle Statistics of Oldest Old People (&gt;80 Years) Living in Ikaria Island: The Ikaria Study

Background. There are places around the world where people live longer and they are active past the age of 100 years, sharing common behavioral characteristics; these places (i.e., Sardinia in Italy, Okinawa in Japan, Loma Linda in California and Nicoya Peninsula in Costa Rica) have been named the “Blue Zones”. Recently it was reported that people in Ikaria Island, Greece, have also one of the highest life expectancies in the world, and joined the “Blue Zones”. The aim of this work work was to evaluate various demographic, lifestyle and psychological characteristics of very old (>80 years) people participated in Ikaria Study. Methods. During 2009, 1420 people (aged 30+) men and women from Ikaria Island, Greece, were voluntarily enrolled in the study. For this work, 89 males and 98 females over the age of 80 yrs were studied (13% of the sample). Socio-demographic, clinical, psychological and lifestyle characteristics were assessed using standard questionnaires and procedures. Results. A large proportion of the Ikaria Study's sample was over the age of 80; moreover, the percent of people over 90 were much higher than the European population average. The majority of the oldest old participants reported daily physical activities, healthy eating habits, avoidance of smoking, frequent socializing, mid-day naps and extremely low rates of depression. Conclusion. Modifiable risk factors, such as physical activity, diet, smoking cessation and mid-day naps, might depict the “secrets” of the long-livers; these findings suggest that the interaction of environmental, behavioral together with clinical characteristics may determine longevity. This concept must be further explored in order to understand how these factors relate and which are the most important in shaping prolonged life.

Fish Consumption Moderates Depressive Symptomatology in Elderly Men and Women from the IKARIA Study

Background. The aim was to examine the association of depressive symptoms with fish eating habits, in elderly individuals. Methods. From June to October of 2009, we studied 330 men and 343 women, aged 65 to 100 years, permanent inhabitants of Ikaria Island. Among several characteristics, depression was assessed with the Geriatric Depression scale (GDS range 0–15), while dietary habits through a valid semiquantitative food frequency questionnaire. Results. Women had significantly higher values of the GDS compared to men (4.8 ± 3.5 versus 3.3 ± 3.1, P = .001). Participants in the upper tertile of depression scale ate less frequent fish and consumed higher quantities of alcohol, compared to those in the lowest tertile (all P < .05). Regarding fish consumption, 50% of the individuals reported consuming 1-2 times weekly, 32% 3 to 5 times weekly, 11% 2-3 times monthly, while the rest reported rare (4.5%) and everyday (1.2%) consumption. Logistic regression showed that increased fish consumption (>3 times/week versus never/rare) was inversely associated with the odds of having GDS greater the median value (i.e., 4) (odds ratio = 0.34, 95% CI: 0.19, 0.61), after controlling for several cofounders. Conclusion. Frequent fish consumption in elderly seems to moderate depression mood.