The effect of menopause on the associations between dietary intake and the 20-year incidence of cardiovascular disease in women: the ATTICA cohort study (2002−2022)

Objectives

The purpose of this study was to elucidate associations between incident cardiovascular disease and dietary risk factors in women classified by their menopausal status.

Study design

The ATTICA Study is a prospective cohort study initiated in 2001–2002 with a representative sample of 3042 adults (mean age 45 years) from the Attica region (Greece); follow-up examinations were performed after 5, 10, and 20 years Of the participants, 1528 (50.2 %) were women, of whom 65 % had not experienced menopause (35 % were in postmenopause at baseline). The sample for the present analysis comprised the 1001 women who had undergone cardiovascular assessment at the 20-year follow-up. Dietary habits were assessed through a validated food frequency questionnaire; the MedDietScore (range 0–55) evaluated adherence to the Mediterranean dietary pattern.

Main outcome measures

Cumulative fatal and non-fatal incidence of cardiovascular disease.

Results

Compared with women before menopause, postmenopausal women had an unfavorable risk profile for cardiovascular disease -including dietary habits- at baseline examination, which was not fully explained by age. At the 20-year follow-up, postmenopausal women exhibited a higher cumulative incidence of cardiovascular disease (post-menopause: 813/1000; before-menopause: 71/1000; p-value = 0.011); age-adjusted analysis revealed that postmenopausal women had a 4.38 times (95 % CI 2.08, 9.21) higher risk of cardiovascular disease, compared with their counterparts. Higher MedDietScore was associated with a significant reduction in the 20-year risk of cardiovascular disease, with more prominent associations observed among postmenopausal women.

Conclusion

These findings highlight the urgent need for targeted public health initiatives to encourage preventive dietary strategies in women from an early age.