Ikaria Island Research Articles

Mediterranean Diet And Longevity: An Example Of Nutraceuticals?

The Mediterranean diet (Mediet) is an eating pattern characterizing a lifestyle and culture that has been reported to contribute to better health and quality of life. The Mediet reflects food patterns typical of Mediterranean regions, where olive oil plays an essential role in the food pyramid. Olive oil is located in the middle and it is considered the principal source of dietary fat because of its high nutritional quality (particularly extra virgin olive oil). Several studies have shown the effect of the Mediet on healthy status by lowering the rates of coronary heart disease, certain cancers, and some other age-related chronic diseases. Although the scientific literature regarding diet and life span is complex and with different opinions, there are studies that demonstrate the beneficial effects of the Mediet on longevity. Therefore, the Mediet may be considered as including several nutraceuticals that favourably influence health. In the present review we discuss two Mediterranean populations from the island of Ikaria (Greece) and the Sicani Mounts (Sicily, Italy) whose longevity is attributed to a close adherence to the Mediet.

Low testosterone levels are associated with metabolic syndrome, in elderly men: the role of body weight, lipids, insulin resistance and inflammation; the Ikaria study

Objectives: Metabolic syndrome (MetS) shows increased prevalence in elderly population, and confers further to cardiovascular wear and total mortality. Recently, Ikaria island inhabitants, an isolated rural group with lifelong characteristics, have been recognized as having among the highest longevity rates universally with high percentage of healthy aging, despite the considerable prevalence of cardiovascular disease risk factors. Aim of this work was to evaluate the relationship between total serum testosterone levels with metabolic syndrome (MetS) and its components. Methods: The working sample consisted of in 467 elderly individuals (mean age 75±6 years old, n=220 men); MetS was defined according to NCEP ATPIII criteria. Results: MetS prevalence was 52% in men and 64% in women. In men, age-adjusted analysis showed that serum testosterone levels were inversely associated with the likelihood of having MetS; while, in women no such association was observed. Those with MetS had lower testosterone levels; i.e., 10 ng/dl increase of testosterone was associated with 3% lower odds of having MetS in men (95% CI: 0.95-0.99), but not in women, after various adjustments, including daily hours of sleep. Testosterone was inversely associated with abnormal waist circumference, hs-CRP, insulin, HDL-cholesterol levels, only in men. When categories of lipids, hs-CRP, BMI and insulin resistance levels were taken into account, testosterone lost its significance in predicting MetS (p>0.20), suggesting a mediating effect of these markers. Conclusion: Low serum testosterone was associated with MetS, in elderly men; while, lipids, BMI, inflammation and insulin resistance markers levels seems to explain this relationship, suggesting a potential mediating effect. This finding may support a research hypothesis relating serum testosterone with cardiovascular disease.

The influence of technical availability on the energy performance of wind farms: Overview of critical factors and development of a proxy prediction model

Nowadays wind energy comprises an established power generation solution that competes on equal terms with conventional thermal power generation technologies. On the other hand, the inherent characteristic of intermittent energy production, due to the stochastic nature of wind, still comprises the main drawback of wind power. In this regard, one of the most significant factors responsible for the reduction of the wind turbines' energy yield is the machines' technical unavailability. Realizing the important role of technical availability throughout the wind energy technology evolution, an overview of influencing factors and operational experience from wind farms around the globe are currently provided, while accordingly, a proxy prediction model is developed for the estimation of technical availability and the determination of its impact on the annual energy yield of a wind farm. Application results obtained for several case studies indicate the importance of the technical availability factor on the annual energy yield, while finally, the developed model is validated with the use of long-term real operation data from a wind farm installed on the island of Ikaria, Greece.

Low Total Testosterone Levels are Associated With the Metabolic Syndrome in Elderly Men: The Role of Body Weight, Lipids, Insulin Resistance, and Inflammation; The Ikaria Study

The prevalence of the metabolic syndrome (MetS) increases with age. Among other changes, testosterone levels decline with age. The relationship between testosterone levels and MetS components in older subjects has not been clearly defined until today. The aim of this work was to evaluate the relationship between total serum testosterone levels and MetS and its components. The working sample consisted of 467 elderly individuals (mean age 75 ± 6 years old, n = 220 men) from Ikaria Island, Greece. MetS was defined according to the NCEP ATPIII criteria. MetS prevalence was 52% in men and 64% in women. Those with MetS had lower testosterone levels; a 10 ng/dl increase in testosterone was associated with a 3% reduction in odds of having MetS in men (95% CI: 0.95-0.99), but not in women. This remained the result after various adjustments had been made, including daily hours of sleep. Testosterone was inversely associated with abnormal waist circumference, high-sensitivity C-reactive protein (hs-CRP), insulin, and HDL cholesterol levels in men only. When lipid categories, hs-CRP, BMI, and insulin resistance levels were taken into account, testosterone lost its significance in predicting MetS (p < 0.20), suggesting that these markers possess a mediating effect. In elderly men, low serum testosterone was associated with MetS. Lipids, BMI, inflammation, and insulin resistance levels seem to explain this relationship, suggesting a potential mediating effect. This finding may support a research hypothesis relating serum testosterone to cardiovascular disease, which requires further research.

Aortic elastic properties and cognitive function in elderly individuals: The Ikaria Study

BackgroundThe aim of this work was to evaluate the association between aortic elastic properties and cognitive function in elderly individuals, permanent inhabitants of Ikaria Island. MethodsIn 535 individuals (75±6 years, 53% males) aortic distensibility (AoD) was non-invasively calculated from the aortic diameters measured with echocardiography and brachial artery pressure using the formula by Stefanadis et al.; cognitive status was evaluated using the Mini Mental State Examination (MMSE). Results88% of the elders had normal values of MMSE score (i.e., ≥24). Elders who achieved MMSE score ≥24 had higher values of AoD (1.90±2.06 vs. 1.08±1.42, p<0.001), as well as were more physically active (85% vs. 69%, p=0.05), had higher educational status (8.5±2.8 years vs. 6±2 years, p=0.001), higher creatinine clearance levels (70±21 vs. 63±23, p=0.05) and lower pulse pressure (PP) values (63±16 vs. 68±18, p=0.06), as compared with those individuals with MMSE<24. Logistic regression analysis showed that for every unit increase in AoD there was a 25% higher likelihood of having MMSE≥24 (OR per 1000×mmHg−1=1.25, 95%CI 0.99–1.58), after adjustments for age, gender, current smoking, cardiovascular disease, creatinine clearance, hypertension, diabetes mellitus, obesity, physical activity status and education status. Furthermore having PP levels in the upper tertile (>70mmHg), increases by 55% the likelihood of having MMSE<24 (OR for above 70mmHg=0.45, 95%CI 0.22, 0.92), after the same adjustments were made. ConclusionArterial aging seems to affect cognitive function; a finding that states a novel research hypothesis about the pathophysiological mechanisms of mental functioning.

Long-Term Fish Intake Preserves Kidney Function in Elderly Individuals: The Ikaria Study

The aim of this work was to evaluate the correlation between the amount of weekly fish intake and kidney function as measured by creatinine clearance (CCr) rate among elderly inhabitants of Ikaria Island, a place that has been related to an increased rate of longevity. From June to October of 2009, 673 males and females, aged 65-100 years and long-term residents of Ikaria Island were enrolled. Of those, 328 (75±7 years) were males and 339 (75±6 years) were females. Nutritional habits, including fish intake, were evaluated using a validated, semi-frequent food questionnaire and the MedDietScore. Urea and creatinine were measured, and CCr rate was estimated by the Cockcroft-Gault formula. Eighty-four percent of participants reported fish consumption of more than 150 g/week; 35% had moderate to severe CCr (<60 mL). Crude analysis revealed that CCr rate was positively associated with fish intake (b ± SE per 100 g/day: 24±9, P = .007); multiple linear regression analysis confirmed the previous finding (b ± SE per 100 g/day: 11±2, P = .001) after adjusting for overall dietary habits through the MedDietScore and other potential confounders. Fish intake was positively associated with CCr. Furthermore, multi-adjusted logistic regression analysis showed that fish consumption of 100 g/day increased the likelihood by 121% of having a CCr greater than 60 mL (95% confidence interval 10%-343%). Long-term fish consumption was independently associated with improved kidney function among elderly individuals, a finding that extends the current knowledge regarding the benefits of fish intake on human health.

Aortic artery distensibility shows inverse correlation with heart rate variability in elderly non-hypertensive, cardiovascular disease-free individuals: the Ikaria Study

The aim of this study was to evaluate the relation between aortic artery distensibility, expressed by pulse pressure (PP) and autonomic nervous system function expressed by heart rate variability (HRV), among elders. During 2009, 469 individuals (50 % males, mean age 75 ± 6 years old), permanent inhabitants of Ikaria Island, were enrolled. Among several sociodemographic, bioclinical, lifestyle, and dietary characteristics, and biochemical parameters related to cardiovascular risk, a digital, standard, 12-lead electrocardiogram (ECG) and 5-min ECG monitoring were recorded. Smart ECG measurement and interpretation programs were used for the automated measurement and interpretation of ECG intervals. Autonomic nervous system tone was estimated with the HRV-standard deviation of normal to normal intervals (SDNN)-in surface ECG. Pulse pressure was calculated as the difference between systolic and diastolic blood pressures. Pulse pressure showed a positive association with age, systolic blood pressure levels, and presence of diabetes mellitus (all P < 0.001) and an inverse correlation with logSDNN. Multiadjusted logistic regression analysis revealed that 10-unit increase in SDNN values decreases by 26 % the likelihood of having PP above 70 mmHg; when the analysis was stratified according to hypertension status, the relationship remained significant only among non-hypertensive individuals. These data support the hypothesis that cardiac sympathovagal disturbance correlates with impaired elasticity properties of aorta, indicating parallel impairment in cardiac autonomic modulation and mechanical vessel wall properties in elderly non-hypertensive individuals.

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&gt;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.

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&lt;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.

FAVORABLE EFFECTS OF HABITUAL PHYSICAL ACTIVITY ON VASCULAR FUNCTION: IKARIA STUDY

Background: Physical activity (PA) has substantial vascular and cardiac health beneits 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.

Quaternary and Holocene coastal uplift in Ikaria Island, Aegean Sea

Geomorphological, biological and AMS radiocarbon dating provide evidence of an about lm high elevated palaeo-shoreline at the NE coast of Ikaria Island,Aegean Sea, and to a seismic uplift which occurred after AD950-1150 and was probably responsible for damage in an ancient tower. These data are important for several reasons. They provide evidence for a strong earthquake in an island usually assumed aseismic, coastal uplifts and coastal fauna are scarce in this region, while the Late Holocene uplift correlates with a flight of marine terraces of probably Quaternary age, at least up to 40m high. Long-term uplift is not observed at the footwall of a fault bounding a major graben north of Ikaria, it represents a structural puzzle and it may help to shed some light to the evolution of various extensional terranes.

Distinct role of electrocardiographic criteria in echocardiographic diagnosis of left ventricular hypertrophy according to age, in the general population

The age-dependent performance of electrocardiographic (ECG) criteria was examined for left ventricular hypertrophy (LVH) prediction. During 2009, 570 middle-aged (54 ± 7 years, 45% men) and 507 elderly (75 ± 6 years, 45% men) inhabitants of the Ikaria Island were studied. Seven ECG criteria were calculated (Sokolow-Lyon voltage and product, sex-specific Cornell voltage and product, Gubner-Ungerleider voltage, Lewis voltage and Framingham), whereas LVH was defined as left ventricular mass indexed for body surface area (BSA) at least 125 g/m in men and at least 110 g/m in women or left ventricular mass indexed for height 49 g/m or more in men and 45 g/m or more in women. The Framingham criteria had in hierarchical order the highest, although insignificant, sensitivity among the elderly individuals, either when LVH was indexed for BSA or for height (18.4 and 16.7%, respectively). Cornell voltage and product criteria had hierarchically the highest sensitivity among middle-aged participants, either when LVH was indexed for BSA (19.0 and 23.8%, respectively) or for height (17.2 and 20.3%, respectively). In the multiadjusted analysis applied in elderly participants, Cornell voltage, its product and Framingham criteria were associated with echocardiographic detection of LVH (indexed for BSA); however, when LVH was indexed for height, the Sokolow-Lyon and Framingham criteria were associated with LVH detection. In contrast, among middle-aged individuals, the Cornell product was the only ECG criterion that was associated with LVH detection (irrespective of indexation). Age should be taken into consideration in selection of appropriate ECG criteria for LVH detection. Indexation of left ventricular mass differentiates the diagnostic ability of ECG criteria, especially in older patients.

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.

Major-element and Li, Be compositional evolution of tourmaline in an S-type granite-pegmatite system and its country rocks: an example from Ikaria, Aegean Sea, Greece

The chemical evolution of tourmaline in a granite – pegmatite – hydrothermal system and its metamorphic country-rock on the island of Ikaria, in Greece, has been investigated to elucidate the range of compositions generated from a single intrusive system, and the relation between genetic types of tourmaline and their chemical composition. On Ikaria, an S-type granite intruded metapelites, and several aplitic and pegmatitic dykes originating from the granite cross-cut the granite as well as the country rock. Quartz–tourmaline rocks occur in both the S-type granite and in the metapelite. Tourmaline in rocks genetically related to the granite have Li concentrations between 9.3 and 473 μg/g and Be concentrations between 1.5 and 41.8 μg/g. Tourmaline in rocks genetically related to the metapelite have more than an order of magnitude lower concentrations (Li: 2.0–5.8 μg/g, Be: 0.3–0.9 μg/g). Tourmaline in these rocks is typically zoned, with abrupt changes in composition between core and rim. Generally, the cores have a high Al and low minor-element concentrations. Oscillatory-zoned tourmaline rims formed by diffusion-limited growth. Dykes in which the magma travelled far through the metapelitic country-rocks are more differentiated than others, and contain tourmaline with very low Mg/Fe in the core. The dykes interacted with the surrounding rocks in places, leading to Mg enrichment in the dykes. This interaction also introduced Mn into the dykes; spessartine-rich garnet formed with Li concentrations as high as 166 μg/g. Boron-rich fluids segregating from the metapelite during an amphibolite-facies metamorphic event produced quartz–tourmaline rocks in the metapelite, which are probably unrelated to the S-type granite. The metamorphic fluids in the metapelites interacted with marble units where they were in close vicinity, leading to the formation of Ca-rich tourmaline in those quartz–tourmaline rocks. Concentrations of Li, Be and B in associated minerals decrease as follows: Li: St > Bt > Ms > Grt > Tur, Kfs > Pl; Be: St > Pl > Ms > Tur > Bt > Kfs > Grt; B: Tur >> Ms > Bt > Pl > Grt > Kfs, St.

Hazardous medical waste generation in Greece: case studies from medical facilities in Attica and from a small insular hospital

The accurate calculation of the unit generation rates and composition of medical waste generated from medical facilities is necessary in order to design medical waste treatment systems. In this work, the unit medical waste generation rates of 95 public and private medical facilities in the Attica region were calculated based on daily weight records from a central medical waste incineration facility. The calculated medical waste generation rates (in kg bed(-1) day( -1)) varied widely with average values at 0.27 ± 113% and 0.24 ± 121%, for public and private medical facilities, respectively. The hazardous medical waste generation was measured, at the source, in the 40 bed hospital of the island of Ikaria for a period of 42 days during a 6 month period. The average hazardous medical waste generation rate was 1.204 kg occupied bed(-1) day(-1) or 0.33 kg (official) bed( -1) day(-1). From the above amounts, 54% resulted from the patients' room (solid and liquid wastes combined), 24% from the emergency department (solid waste), 17% from the clinical pathology lab and 6% from the X-ray lab. In average, 17% of the total hazardous medical waste was solely infectious. Conclusively, no correlation among the number of beds and the unit medical waste generation rate could be established. Each hospital should be studied separately, since medical waste generation and composition depends on the number and type of departments/laboratories at each hospital, number of external patients and number of occupied beds.

Function of Agricultural Terraces in Mediterranean Conditions - Selected Examples From the Island of Ikaria (The Southern Sporades, Greece)

Function of Agricultural Terraces in Mediterranean Conditions - Selected Examples From the Island of Ikaria (The Southern Sporades, Greece) The aim of the research was to define the influence of agricultural terraces on slope erosion. There have been selected three plots located on the Greek island Ikaria. On the plots detailed geomorphological mapping was done, spatial relief models were created based on the measurements taken using GPS RTK, georadar profiles were made using RAMAC/GPR and the extent of destruction of terrace resistance walls was evaluated. In comparison with similar forms on other Aegean islands, Ikarian terraces are narrow and high. Their stability depends on: lihtology, slope gradient, height and spatial arrangement of particular terrace steps and the current way of their usage. It was acknowledged that the most stable are the forms created on crystalline schists and gneisses, whereas the slopes, which erode the easiest, are the terraced ones consisting of carbonate rocks. The obtained results indicate that on Ikaria similarly to numerous other regions the most significant factor facilitating erosion on the terraced slopes is the cessation of their agricultural usage.

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.

Coffee Tied to Measures of Elders' Health

Bruce Jancin is with the Denver bureau of Elsevier Global Medical News. STOCKHOLM — The fountain of youth just might be a basin filled with rich, strong coffee, a study of one of the world's longest-lived people indicates. “Our results suggest that drinking coffee in moderation should be encouraged even in elderly hypertensive subjects, as it seems it may improve arterial aging. Maybe regular coffee consumption is one of the key elements of the longevity we have noticed in the Ikaria Islanders, Christina Chrysohoou, MD, PhD, mused at the annual congress of the European Society of Cardiology. The Aegean Sea island of Ikaria has one of the world's highest proportions of individuals who survive into their 90s and 100s. Seeking an explanation last year Dr. Chrysohoou led a 5-month University of Athens–sponsored in-depth study of 343 male and 330 female long-time residents aged 65-100 years. As a cardiologist, Dr. Chrysohoou said, one of the factors she was particularly eager to examine was coffee consumption, since it is a deeply embedded part of the Ikarian way of life, and also because coffee – especially Greek-style coffee – is a rich source of antioxidants and anti-inflammatory compounds, Among the 465 study participants being treated for hypertension, those who were moderate coffee drinkers – averaging 1-2 of the traditional small 50-mL cups daily – had a significantly lower prevalence of diabetes, dyslipidemia, and cardiovascular disease as well as a lower mean body mass index and higher creatinine clearance than did hypertensive non–coffee drinkers. Of particular interest was the finding that hypertensive moderate coffee drinkers had significantly greater aortic distensibility as measured echocardiographically than did hypertensive subjects who consumed coffee rarely or never. Traditional Greek coffee is very strong and dark. It is made by boiling the beans for 2-3 minutes. The resultant beverage contains up to 50 times greater concentrations of cafestol, kahweol, and other diterpenes than those of filtered coffee. Greek coffee also is rich in flavonoids, niacin, magnesium, potassium, and vitamin E, Dr. Chrysohoousheplained. One caveat regarding the study findings is that coffee drinking on Ikaria is very much a social experience. The elderly study participants generally take their coffee while socializing in the morning or early afternoon with long-time friends orwfamily aCoffee consumption on the island is a relaxing, unhurried experience enjoyed while discussing daily events. “The psychological and social circumstances play an important role,” she observed. “I'm a clinical cardiologist, and most clinicians forbid coffee for their hypertensive patients,” noted Dr. Xavier Bosch of the University of Barcelona, who added he will reconsider his stance as a result of the Greek study. The other key factor Dr. Chrysohoou and her coworkers identified as likely to contribute to the extended life expectancy of Ikaria Islanders is that these oldest residents are of a generation that tends to adhere most strictly to the traditional Mediterranean diet as popularized by the late University of Minnesota cardiovascular epidemiologist Ancel Keys, PhD, also known for formulating K-rations in World War II. Dr. Chrysohoou declared having no financial conflicts.

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

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.