Research Original Research| Volume 112, ISSUE 6, P816-823, June 2012

Mediterranean Diet and Cognitive Decline in Women with Cardiovascular Disease or Risk Factors



      Cardiovascular disease and vascular risk factors increase rates of cognitive impairment, but very little is known regarding prevention in this high-risk group. The heart-healthy Mediterranean-type dietary pattern may beneficially influence both vascular and cognitive outcomes.


      We examined the association between Mediterranean-style diet and cognitive decline in women with prevalent vascular disease or ≥3 coronary risk factors.


      Prospective cohort study among 2,504 women participants in the Women's Antioxidant Cardiovascular Study (WACS), a cohort of female health professionals. Adherence to a Mediterranean-style diet was determined at WACS baseline (1995-1996) using a 0- to 9-point scale with higher scores indicating higher adherence. In 1998-2000, participants aged ≥65 years underwent a telephone cognitive battery including five tests of global cognition, verbal memory, and category fluency. Tests were administered three additional times across 5.4 years.

      Statistical analyses performed

      We used multivariable-adjusted generalized linear models for repeated measures to compare the annual rates of cognitive score changes across tertiles of Mediterranean diet score, as assessed at WACS baseline.


      In both basic- and multivariable-adjusted models, consuming a Mediterranean-style diet was not related to cognitive decline. No effect modification was detected by age, education, depression, cardiovascular disease severity at WACS baseline, or level of cognition at initial assessment.


      In women at higher risk of cognitive decline due to vascular disease or risk factors, adherence to a Mediterranean-style diet was not associated with subsequent 5-year cognitive change.


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        • Battistin L.
        • Cagnin A.
        Vascular cognitive disorder.
        Neurochem Res. 2010; 35: 1933-1938
        • Reitz C.
        • Tang M.-X.
        • Schupf N.
        • Manly J.J.
        • Mayeux R.
        • Luchsinger J.A.
        A summary risk score for the prediction of Alzheimer Disease in elderly persons.
        Arch Neurol. 2010; 67: 835-841
        • Lloyd-Jones D.
        • Adams R.
        • Carnethon M.
        • et al.
        Heart disease and stroke statistics—2009 update: A report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee.
        Circulation. 2009; 119: e21-e181
        • Hill A.M.
        • Fleming J.A.
        • Kris-Etherton P.M.
        The role of diet and nutritional supplements in preventing and treating cardiovascular disease.
        Curr Opin Cardiol. 2009; 24: 433-441
        • Sesso H.D.
        • Buring J.E.
        • Christen W.G.
        • et al.
        Vitamins E and C in the prevention of cardiovascular disease in men: The Physicians' Health Study II randomized controlled trial.
        JAMA. 2008; 300: 2123-2133
        • Kromhout D.
        • Giltay E.J.
        • Geleijnse J.M.
        n-3 fatty acids and cardiovascular events after myocardial infarction.
        N Engl J Med. 2010; 363: 2015-2026
        • Galan P.
        • Kesse-Guyot E.
        • Czernichow S.
        • Briancon S.
        • Blacher J.
        • Hercberg S.
        Effects of B vitamins and omega 3 fatty acids on cardiovascular diseases: A randomised placebo controlled trial.
        BMJ. 2010; 341: c6273
        • Eussen S.J.
        • de Groot L.C.
        • Joosten L.W.
        • et al.
        Effect of oral vitamin B-12 with or without folic acid on cognitive function in older people with mild vitamin B-12 deficiency: A randomized, placebo-controlled trial.
        Am J Clin Nutr. 2006; 84: 361-370
        • Kang J.H.
        • Cook N.
        • Manson J.
        • Buring J.E.
        • Grodstein F.
        A randomized trial of vitamin E supplementation and cognitive function in women.
        Arch Intern Med. 2006; 166: 2462-2468
        • Aisen P.S.
        • Schneider L.S.
        • Sano M.
        • et al.
        High-dose B vitamin supplementation and cognitive decline in Alzheimer Disease.
        JAMA. 2008; 300: 1774-1783
        • de Lorgeril M.
        • Salen P.
        • Martin J.-L.
        • Monjaud I.
        • Delaye J.
        • Mamelle N.
        mediterranean diet, traditional risk factors, and the rate of cardiovascular complications after myocardial infarction: Final Report of the Lyon Diet Heart Study.
        Circulation. 1999; 99: 779-785
        • Estruch R.
        • Martinez-Gonzalez M.A.
        • Corella D.
        • et al.
        Effects of a Mediterranean-style diet on cardiovascular risk factors: A randomized trial.
        Ann Intern Med. 2006; 145: 1-11
        • Nunez-Cordoba J.M.
        • Valencia-Serrano F.
        • Toledo E.
        • Alonso A.
        • Martinez-Gonzalez M.A.
        The Mediterranean diet and incidence of hypertension: the Seguimiento Universidad de Navarra (SUN) Study.
        Am J Epidemiol. 2009; 169: 339-346
        • Fung T.T.S.
        • Rexrode K.M.M.D.
        • Mantzoros C.S.M.D.
        • Manson J.E.M.D.D.
        • Willett W.C.M.D.D.
        • Hu F.B.M.D.P.
        Mediterranean diet and incidence of and mortality from coronary heart disease and stroke in women.
        Circulation. 2009; 119: 1093-1100
        • Chrysohoou C.
        • Panagiotakos D.B.
        • Aggelopoulos P.
        • et al.
        The Mediterranean diet contributes to the preservation of left ventricular systolic function and to the long-term favorable prognosis of patients who have had an acute coronary event.
        Am J Clin Nutr. 2010; 92: 47-54
        • Sofi F.
        • Abbate R.
        • Gensini G.F.
        • Casini A.
        Accruing evidence on benefits of adherence to the Mediterranean diet on health: An updated systematic review and meta-analysis.
        Am J Clin Nutr. 2010; 92: 1189-1196
        • Scarmeas N.
        • Stern Y.
        • Tang M.X.
        • Mayeux R.
        • Luchsinger J.A.
        Mediterranean diet and risk for Alzheimer's disease.
        Ann Neurol. 2006; 59: 912-921
        • Feart C.
        • Samieri C.
        • Rondeau V.
        • et al.
        Adherence to a Mediterranean Diet, Cognitive Decline, and Risk of Dementia.
        JAMA. 2009; 302: 638-648
        • Tangney C.C.
        • Kwasny M.J.
        • Li H.
        • Wilson R.S.
        • Evans D.A.
        • Morris M.C.
        Adherence to a Mediterranean-type dietary pattern and cognitive decline in a community population.
        Am J Clin Nutr. 2011; 93: 601-607
        • Cook N.R.
        • Albert C.M.
        • Gaziano J.M.
        • et al.
        A randomized factorial trial of vitamins C and E and beta carotene in the secondary prevention of cardiovascular events in women: Results from the Women's Antioxidant Cardiovascular Study.
        Arch Intern Med. 2007; 167: 1610-1618
        • Albert C.M.
        • Cook N.R.
        • Gaziano J.M.
        • et al.
        Effect of folic acid and B vitamins on risk of cardiovascular events and total mortality among women at high risk for cardiovascular disease: A randomized trial.
        JAMA. 2008; 299: 2027-2036
        • Kang J.H.
        • Cook N.
        • Manson J.
        • Buring J.E.
        • Albert C.M.
        • Grodstein F.
        A trial of B vitamins and cognitive function among women at high risk of cardiovascular disease.
        Am J Clin Nutr. 2008; 88: 1602-1610
        • Kang J.H.
        • Cook N.R.
        • Manson J.E.
        • Buring J.E.
        • Albert C.M.
        • Grodstein F.
        Vitamin E, vitamin C, beta carotene, and cognitive function among women with or at risk of cardiovascular disease: The Women's Antioxidant and Cardiovascular Study.
        Circulation. 2009; 119: 2772-2780
        • Brandt J.
        • Folstein M.F.
        Telephone Interview for Cognitive Status: Professional Manual.
        Psychological Assessment Resources, Inc, Lutz, FL2003
        • Scherr P.A.
        • Albert M.S.
        • Funkenstein H.H.
        • et al.
        Correlates of cognitive function in an elderly community population.
        Am J Epidemiol. 1988; 128: 1084-1101
        • Morris J.C.
        • Heyman A.
        • Mohs R.C.
        • et al.
        The Consortium to Establish a Registry for Alzheimer's Disease (CERAD).
        Neurology. 1989; 39: 1159-1165
        • Small B.J.
        • Fratiglioni L.
        • Viitanen M.
        • Winblad B.
        • Backman L.
        The course of cognitive impairment in preclinical Alzheimer disease: Three- and 6-year follow-up of a population-based sample.
        Arch Neurol. 2000; 57: 839-844
        • Vercambre M.N.
        • Grodstein F.
        • Manson J.E.
        • Stampfer M.J.
        • Kang J.H.
        Physical activity and cognition in women with vascular conditions.
        Arch Intern Med. 2010; 171: 1244-1250
        • Willett W.C.
        • Sampson L.
        • Stampfer M.J.
        • et al.
        Reproducibility and validity of a semiquantitative food frequency questionnaire.
        Am J Epidemiol. 1985; 122: 51-65
        • Trichopoulou A.
        • Kouris-Blazos A.
        • Wahlqvist M.L.
        • et al.
        Diet and overall survival in elderly people.
        BMJ. 1995; 311: 1457-1460
        • Trichopoulou A.
        • Costacou T.
        • Bamia C.
        • Trichopoulos D.
        Adherence to a Mediterranean diet and survival in a Greek population.
        N Engl J Med. 2003; 348: 2599-2608
        • Trichopoulou A.
        • Orfanos P.
        • Norat T.
        • et al.
        Modified Mediterranean diet and survival: EPIC-elderly prospective cohort study.
        BMJ. 2005; 330: 991
        • Willett W.C.
        • Stampfer M.J.
        Total energy intake: Implications for epidemiologic analyses.
        Am J Epidemiol. 1986; 124: 17-27
        • Panagiotakos D.B.
        • Pitsavos C.
        • Arvaniti F.
        • Stefanadis C.
        Adherence to the Mediterranean food pattern predicts the prevalence of hypertension, hypercholesterolemia, diabetes and obesity, among healthy adults; the accuracy of the MedDietScore.
        Prev Med. 2007; 44: 335-340
        • Scarmeas N.
        • Stern Y.
        • Mayeux R.
        • Manly J.J.
        • Schupf N.
        • Luchsinger J.A.
        Mediterranean diet and mild cognitive impairment.
        Arch Neurol. 2009; 66: 216-225
        • Scarmeas N.
        • Stern Y.
        • Mayeux R.
        • Luchsinger J.A.
        Mediterranean diet, Alzheimer disease, and vascular mediation.
        Arch Neurol. 2006; 63: 1709-1717
        • Kang J.H.
        • Ascherio A.
        • Grodstein F.
        Fruit and vegetable consumption and cognitive decline in aging women.
        Ann Neurol. 2005; 57: 713-720
        • Devore E.E.
        • Stampfer M.J.
        • Breteler M.M.
        • et al.
        Dietary fat intake and cognitive decline in women with type 2 diabetes.
        Diabetes Care. 2009; 32: 635-640
        • Erkkila A.T.
        • Sarkkinen E.S.
        • Koukkunen H.
        • et al.
        Concordance of diet with the recommended cholesterol lowering diet in patients with coronary heart disease.
        Eur J Clin Nutr. 1998; 52: 279-285
        • Ma Y.
        • Li W.
        • Olendzki B.C.
        • et al.
        Dietary quality 1 year after diagnosis of coronary heart disease.
        J Am Diet Assoc. 2008; 108: 240-246
        • Vercambre M.N.
        • Grodstein F.
        • Kang J.H.
        Dietary fat intake in relation to cognitive change in high-risk women with cardiovascular disease or vascular factors.
        Eur J Clin Nutr. 2010; 64: 1134-1140


      M.-N. Vercambre is a research scientist, Foundation for Public Health, Mutuelle Generale de l'Education Nationale (MGEN), Paris, France.


      F. Grodstein is an associate professor of Medicine, Channing Laboratory, Department of Medicine, Brigham and Women's Hospital/Harvard Medical School, Boston, MA, and associate professor, Department of Epidemiology, Harvard School of Public Health, Boston, MA.


      C. Berr is research director, INSERM U 1061, University Montpellier I, Montpellier, France.


      J. H. Kang is an assistant professor of Medicine, Channing Laboratory, Department of Medicine, Brigham and Women's Hospital/Harvard Medical School, Boston, MA.