Adherence to the Mediterranean diet in patients with coronary artery disease referred to a cardiac rehabilitation program in a Mediterranean island (Mallorca)
Authors: Torres Marques J , Moranta Ribas ME , Melia Mesquida C , Alvarez Rubio J , Ruiz Pizarro V , Serra Creus J , Magnani Raganato S , Gamez Martinez JM , Cremer Luengos D , Ripoll Vera T , Ferrer Oliver JA , Trias Oliver C , Jardi Rodriguez AM , Gomez Monjo MJ , Pardo Martin L 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
A Mediterranean diet (MedDiet) is recommended in ESC guidelines to lower the risk of cardiovascular disease (CVD) and it’s part of the secondary prevention treatment in patients with coronary artery disease (CAD)

Purposes
To investigate the degree of adherence to the MedDiet in patients with CAD treated at a cardiac rehabilitation (CR) unit in Mallorca. To study wether the degree of adherence to the MedDiet correlates to any health-related characteristic of these patients.

Methods
Retrospective observational study. The degree of adherence to the MedDiet was measured using the 14-points MEDAS-14 questionnaire (validated in the PREDIMED study) administered by a trained nurse to patients with CAD referred to the CR program. A score of 0 to 8 points is considered low adherence, 9 or more is considered an acceptable adherence. We measured the relationship between the degree of adherence to the MedDiet and the presence cardiovascular risk factors, weight and body mass index (BMI), lipid and glycemic profile, and degrees of anxiety and depression measured by the hospital anxiety and depression scale (HADS).

Results
Since 2014, 485 patients with CAD have been treated in the CR program (83% of them after an acute coronary syndrome -ACS-).
Their mean age was 56 ± 9 years and 84% were men. Their average weight was 85 ± 15 kg. The mean BMI was 29.2 ± 4 (44% overweight, 39% obese).
The degree of adherence to MedDiet in these patients was low in 30% of patients and acceptable in 70%. The mean score obtained in the MEDAS-14 questionnaire was 9.3 ± 2,0 points.
There were no significant differences in the degree of adherence to the MedDiet between men or women. Nor were significante differences whether or not the patient was diabetic, overweight or obese.
Patients who had never smoked had greater adherence to the MedDiet (9.8±2 vs 9.1± 2, p: 0.02) and a higher percentage of them had an acceptable adherence compared to the smokers or former smokers (81 vs 67%, p: 0.01).
The youngest patients (below the mean age of the group) had a worse adherence to the MedDiet (8.9 ± 3 vs 9.6 ± 2, p: 0.007)
There were no significant differences in weight, BMI, LDL cholesterol, Triglycerides or HbA1c levels between patients with low and acceptable adherence to the MedDiet.
Patients with high levels of anxiety or depression measured in HADS obtained similar scores of adherence to MedDiet to people who had a better psicosocial profile.

Conclusions
Patients with CAD treated in a CR unit in Mallorca have acceptable levels of adherence to the Mediterranean diet, better than those seen in the general population or in other CAD patient samples previously published (1,2). The information received at hospital discharge after a recent ACS could have already caused changes in the eating pattern. Young patients and smokers or former smokers have lower adherence to the MedDiet.