Mediterranean Diet and Physical Activity Decrease the Initiation of Cardiovascular Drug Use in High Cardiovascular Risk Individuals: A Cohort Study

Our aim was to assess whether long-term adherence to a Mediterranean diet (MedDiet)and leisure-time physical activity (LTPA) were associated with a lower initiation of cardiovasculardrug use. We studied the association between cumulative average of MedDiet adherence andLTPA and the risk of cardiovascular drug initiation in older adults at high cardiovascular risk(PREvención con DIeta MEDiterránea trial participants) non-medicated at baseline: glucose-loweringdrugs (n= 4437), antihypertensives (n= 2145), statins (n= 3977), fibrates (n= 6391), antiplatelets(n= 5760), vitamin K antagonists (n= 6877), antianginal drugs (n= 6837), and cardiac glycosides(n= 6954). One-point increases in MedDiet adherence were linearly associated with a decreasedinitiation of glucose-lowering (HR: 0.76 [0.71–0.80]), antihypertensive (HR: 0.79 [0.75–0.82]), statin (HR: 0.82 [0.78–0.85]), fibrate (HR: 0.78 [0.68–0.89]), antiplatelet (HR: 0.79 [0.75–0.83]), vitamin Kantagonist (HR: 0.83 [0.74; 0.93]), antianginal (HR: 0.84 [0.74–0.96]), and cardiac glycoside therapy(HR: 0.69 [0.56–0.84]). LTPA was non-linearly related to a delayed initiation of glucose-lowering,antihypertensive, statin, fibrate, antiplatelet, antianginal, and cardiac glycoside therapy (minimumrisk: 180–360 metabolic equivalents of task-min/day). Both combined were synergistically associatedwith a decreased onset of glucose-lowering drugs (p-interaction = 0.04), antihypertensive drugs (p-interaction < 0.001), vitamin K antagonists (p-interaction = 0.04), and cardiac glycosides (p-interaction= 0.01). Summarizing, sustained adherence to a MedDiet and LTPA were associated with lower riskof initiating cardiovascular-related medications