Ten-year (2002–2012) cardiovascular disease incidence and all-cause mortality, in urban Greek population: The ATTICA Study Demosthenes B. Panagiotakos a, ⁎, Ekavi N. Georgousopoulou a , Christos Pitsavos b , Christina Chrysohoou b , Vassiliki Metaxa b , Georgios A. Georgiopoulos b , Katerina Kalogeropoulou a , Dimitris Tousoulis b , Christodoulos Stefanadis b , ATTICA Study group a Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece b First Cardiology Clinic, School of Medicine, University of Athens, Greece abstract article info Article history: Received 17 October 2014 Received in revised form 24 November 2014 Accepted 25 November 2014 Available online 26 November 2014 Keywords: Cardiovascular disease Epidemiology Incidence Prevention Greece Aim: The 10-year incidence of cardiovascular disease (CVD) and all-cause mortality, as well as its determinants, in a sample of men and women from Greece, was evaluated. Methods: From May 2001 to December 2002, 1514 men and 1528 women (N 18 y) without any clinical evidence of CVD or any other chronic disease, at baseline, living in greater Athens area, in Greece, were enrolled. In 2011–12, the 10-year follow-up was performed in 2583 participants (15% of the participants were lost to follow-up). Incidence of fatal or non-fatal CVD (coronary heart disease, acute coronary syndromes, stroke, or other CVD) was defined according to World Health Organization (WHO)–International Coding Diseases (ICD)- 10 criteria. Results: The 10-year CVD incidence was 19.7% in men and 11.7% in women (p b 0.001). Multi-adjusted analysis revealed that the determinants of CVD events were increased age (Hazard ratio (HR) per year = 1.06, 95%Con- fidence Interval (CI): 1.04, 1.08), male sex (HR = 1.40, 95%CI: 0.90, 2.19), smoking (HR = 1.53, 95%CI: 1.03, 2.27), C-reactive protein levels (HR per 1 mg/L = 1.06, 95%CI: 1.02, 1.15), as well as adherence to Mediterranean diet (protective) (HR per 1/55 units = 0.98, 95%CI: 0.95, 1.01). Conclusion: The burden of CVD and its related risk factors is at emerging rates, in Greece, making the need for effective public health actions, more necessary than ever before. © 2014 Elsevier Ireland Ltd. All rights reserved. 1. Introduction Despite the steep decrease in cardiovascular disease (CVD) mortality reported in high-income countries [1], CVD still determines the health status of the vast majority of industrialized countries around the world [2], affecting even more younger men and women than previous years [3] and costing almost 150 million lost Disability Adjusted Life Years (DALY) in Europe, per year [4]. Prevalence of CVD varies from country to country, and culture to culture, as reported by several nation- al studies, due to various reasons [5–7]. Those factors, i.e., unhealthy di- etary habits, smoking and physical inactivity, according to the World Health Organization (WHO), constitute the major determinants for the development of CVD since they can be modified. In addition, un- healthy dietary factors are strongly associated with high blood pressure levels, glucose and lipids levels, together with low-grade inflammation process, which have been suggested to promote the development of the disease [8,9]. Diet exerts its influence in many CVD risk factors through a direct, or mediating or moderating effect. Moreover, in a recent review paper, the incorporation of the dietary assessment in the CVD risk estimation models reported an increased model perfor- mance, whereas the attributed to unhealthy diet population risk varied from 9 to 37% [10]. Greece in the past years had one of the lower-CVD risk rates among around the world [11], mainly due to the adoption of the aforemen- tioned lifestyle pattern that consisted of a healthy dietary model, and increased physical activity. However, current reports suggest that al- though there is a decline in CVD mortality, especially among urban cit- izens, there is an increase in non-fatal CVD incidence, in both genders, as well as in younger adults [12], mainly attributed to modifiable CVD risk factors that seem to explain the 71% of DALY and 80% of CVD events in the “modern” years [13–15]. Such alterations in CVD rates might have serious economical, political and social consequences, especially under the pressure of the current financial crisis that the country faces [13]. Current reports strongly suggest that Greece is not a low-CVD risk coun- try anymore; and this has been attributed to the serious lifestyle chang- es which occurred in the past decades, affecting most of all the urban population [14]. Taking into account the aforementioned considerations, the aim of the present work was to evaluate the 10-year incidence of CVD International Journal of Cardiology 180 (2015) 178–184 ⁎ Corresponding author at: 46 Paleon Polemiston St., Glyfada, Attica 166 74, Greece. E-mail address: d.b.panagiotakos@usa.net (D.B. Panagiotakos). http://dx.doi.org/10.1016/j.ijcard.2014.11.206 0167-5273/© 2014 Elsevier Ireland Ltd. All rights reserved. Contents lists available at ScienceDirect International Journal of Cardiology journal homepage: www.elsevier.com/locate/ijcard