Sense of coherence and carotid artery intima media thickness measurements presenting four case reports from the Spili cohort in rural Crete

Greece

D Anyfantakis EK Symvoulakis C LionisClinic of Social and Family Medicine University of Crete

Greece

ldquoThe Future of Primary Health Care in Europe IIIrdquo 30 - 31 August 2010 Pisa Italy

Summary of the presentation

bull Background

bull Methods

bull Results

bull Conclusions

THE SPILI PROJECT-PHASE I

Spili project the initial sample (1988)

bull 445 inhabitants aged 15-79

bull 343 examined for CV risk factors and morbidity (170 males ndash 173 females)

bull Participation rate 77

bull High smoking prevalence

bull High alcohol consumption

bull High cholesterol levels

bull High prevalence of diabetes and hypertension

Source Lindholm et al Eur Heart J 1992

THE SPILI PROJECT-PHASE II

Spili project phase II (2001)bull 48 subjects deceased (25

males ndash 23 females)bull 37 moved awaybull 248 currently living in the

rural area of Spilibull Re-examined 200 subjects

(91 males ndash 109 females)bull 2nd phase participation

8072bull

Source Karalis et al BMC Public Health 2007

THE SPILI PROJECT-PHASE III

Lionis C Anyfantakis D Symvoulakis EK et al accepted for publication on

BMC Research Notes

To report on four cases from the Spili cohort in rural Crete with the aim of raising a discussion on potential cardio-protective effects of socio-cultural factors such as sense of coherence religiosity and spirituality in conjunction with biological and preclinical markers of atherosclerosis

AIM

METHODS

Two males aged 71 and 85 year old and two females aged 77 and 85 year old were examinedMedical approach included Electrocardiogram (ECG)Carotid intima media thickness (CIMT) measurement on the Common Carotid Artery (CCA)Blood pressure assessmentLaboratory tests Body mass index evaluation Sense of coherence (29-item Antonovskyrsquos SOC questionnaire)

CASE REPORT 1

A 77-year old female with Positive history of hypertension (usual BP14070)Positive 7 year history of diabetes mellitusNo clinical evidence of CDPhysical examination normal Body Mass Index 305 kgm2

Laboratory Fasting plasma glucose 128 mgdl Total Cholesterol 247mgdlLDL 163 mgdl ECG normal IMT(R) 07 mm IMT(L) 06 mm (normal values04-1mm)

RESULTS

SOC score158

CASE REPORT 2

A 85-year old female with Positive history of hypertension (usual BP14080) No clinical evidence of CD Physical examination normalBMI 29 kgm2

Laboratory Fasting plasma glucose 103 mgdl Total Cholesterol 247 mgdl LDL 138 mgdl ECG normal IMT(R) 05 mm IMT(L) 06 mm (normal values04-1mm)

SOC score165

CASE REPORT 3

A 71-year old male withbull Positive history of hypertension (usual BP 14090)bull Positive 5 year history of diabetes mellitus bullNo clinical evidence of CDbullBMI 28 kgm2 bullLaboratorybullFasting plasma glucose 98mgdl bullTotal cholesterol 197 mgdlbullLDL 135 mgdlbull ECG normalbull IMT(R) 07mm IMT (L) 06 mm (normal values04-1mm)

SOC score169

CASE REPORT 4

bull A 85-year old male with

bull Positive history of hypertension (usual BP 13080)

bull Positive 8 year history of diabetes mellitus

bullNo clinical evidence of CD

bullBMI 265 Kgm2

Laboratory

bull Fasting plasma glucose 105 mgdl

bull Total Cholesterol 213 mgdl

bullLDL 151 mgdl

bull ECG normal

bullIMT(R) 06 mm IMT(L) 06 mm (normal values04-1mm)

SOC score161

Trials 2009 10119

Renaud S de Lorgeril M Wine alcohol platelets and the French paradox for coronary heart disease Lancet 1992 339(8808)1523-6

Is there any paradox in these observations

We cannot exclude the plausibility of research hypotheses involving protective environmental interactions on the cardiovascular well being of certain population groups elsewhere in the world

B Simini Serge Renaud from French paradox to Cretan miracle Lancet 2000 355 (9197) 48

Summary of the presentation

bull Background

bull Methods

bull Results

bull Conclusions

THE SPILI PROJECT-PHASE I

Spili project the initial sample (1988)

bull 445 inhabitants aged 15-79

bull 343 examined for CV risk factors and morbidity (170 males ndash 173 females)

bull Participation rate 77

bull High smoking prevalence

bull High alcohol consumption

bull High cholesterol levels

bull High prevalence of diabetes and hypertension

Source Lindholm et al Eur Heart J 1992

THE SPILI PROJECT-PHASE II

Spili project phase II (2001)bull 48 subjects deceased (25

males ndash 23 females)bull 37 moved awaybull 248 currently living in the

rural area of Spilibull Re-examined 200 subjects

(91 males ndash 109 females)bull 2nd phase participation

8072bull

Source Karalis et al BMC Public Health 2007

THE SPILI PROJECT-PHASE III

Lionis C Anyfantakis D Symvoulakis EK et al accepted for publication on

BMC Research Notes

To report on four cases from the Spili cohort in rural Crete with the aim of raising a discussion on potential cardio-protective effects of socio-cultural factors such as sense of coherence religiosity and spirituality in conjunction with biological and preclinical markers of atherosclerosis

AIM

METHODS

Two males aged 71 and 85 year old and two females aged 77 and 85 year old were examinedMedical approach included Electrocardiogram (ECG)Carotid intima media thickness (CIMT) measurement on the Common Carotid Artery (CCA)Blood pressure assessmentLaboratory tests Body mass index evaluation Sense of coherence (29-item Antonovskyrsquos SOC questionnaire)

CASE REPORT 1

A 77-year old female with Positive history of hypertension (usual BP14070)Positive 7 year history of diabetes mellitusNo clinical evidence of CDPhysical examination normal Body Mass Index 305 kgm2

Laboratory Fasting plasma glucose 128 mgdl Total Cholesterol 247mgdlLDL 163 mgdl ECG normal IMT(R) 07 mm IMT(L) 06 mm (normal values04-1mm)

RESULTS

SOC score158

CASE REPORT 2

A 85-year old female with Positive history of hypertension (usual BP14080) No clinical evidence of CD Physical examination normalBMI 29 kgm2

Laboratory Fasting plasma glucose 103 mgdl Total Cholesterol 247 mgdl LDL 138 mgdl ECG normal IMT(R) 05 mm IMT(L) 06 mm (normal values04-1mm)

SOC score165

CASE REPORT 3

A 71-year old male withbull Positive history of hypertension (usual BP 14090)bull Positive 5 year history of diabetes mellitus bullNo clinical evidence of CDbullBMI 28 kgm2 bullLaboratorybullFasting plasma glucose 98mgdl bullTotal cholesterol 197 mgdlbullLDL 135 mgdlbull ECG normalbull IMT(R) 07mm IMT (L) 06 mm (normal values04-1mm)

SOC score169

CASE REPORT 4

bull A 85-year old male with

bull Positive history of hypertension (usual BP 13080)

bull Positive 8 year history of diabetes mellitus

bullNo clinical evidence of CD

bullBMI 265 Kgm2

Laboratory

bull Fasting plasma glucose 105 mgdl

bull Total Cholesterol 213 mgdl

bullLDL 151 mgdl

bull ECG normal

bullIMT(R) 06 mm IMT(L) 06 mm (normal values04-1mm)

SOC score161

Trials 2009 10119

Renaud S de Lorgeril M Wine alcohol platelets and the French paradox for coronary heart disease Lancet 1992 339(8808)1523-6

Is there any paradox in these observations

We cannot exclude the plausibility of research hypotheses involving protective environmental interactions on the cardiovascular well being of certain population groups elsewhere in the world

B Simini Serge Renaud from French paradox to Cretan miracle Lancet 2000 355 (9197) 48

THE SPILI PROJECT-PHASE I

Spili project the initial sample (1988)

bull 445 inhabitants aged 15-79

bull 343 examined for CV risk factors and morbidity (170 males ndash 173 females)

bull Participation rate 77

bull High smoking prevalence

bull High alcohol consumption

bull High cholesterol levels

bull High prevalence of diabetes and hypertension

Source Lindholm et al Eur Heart J 1992

THE SPILI PROJECT-PHASE II

Spili project phase II (2001)bull 48 subjects deceased (25

males ndash 23 females)bull 37 moved awaybull 248 currently living in the

rural area of Spilibull Re-examined 200 subjects

(91 males ndash 109 females)bull 2nd phase participation

8072bull

Source Karalis et al BMC Public Health 2007

THE SPILI PROJECT-PHASE III

Lionis C Anyfantakis D Symvoulakis EK et al accepted for publication on

BMC Research Notes

To report on four cases from the Spili cohort in rural Crete with the aim of raising a discussion on potential cardio-protective effects of socio-cultural factors such as sense of coherence religiosity and spirituality in conjunction with biological and preclinical markers of atherosclerosis

AIM

METHODS

Two males aged 71 and 85 year old and two females aged 77 and 85 year old were examinedMedical approach included Electrocardiogram (ECG)Carotid intima media thickness (CIMT) measurement on the Common Carotid Artery (CCA)Blood pressure assessmentLaboratory tests Body mass index evaluation Sense of coherence (29-item Antonovskyrsquos SOC questionnaire)

CASE REPORT 1

A 77-year old female with Positive history of hypertension (usual BP14070)Positive 7 year history of diabetes mellitusNo clinical evidence of CDPhysical examination normal Body Mass Index 305 kgm2

Laboratory Fasting plasma glucose 128 mgdl Total Cholesterol 247mgdlLDL 163 mgdl ECG normal IMT(R) 07 mm IMT(L) 06 mm (normal values04-1mm)

RESULTS

SOC score158

CASE REPORT 2

A 85-year old female with Positive history of hypertension (usual BP14080) No clinical evidence of CD Physical examination normalBMI 29 kgm2

Laboratory Fasting plasma glucose 103 mgdl Total Cholesterol 247 mgdl LDL 138 mgdl ECG normal IMT(R) 05 mm IMT(L) 06 mm (normal values04-1mm)

SOC score165

CASE REPORT 3

A 71-year old male withbull Positive history of hypertension (usual BP 14090)bull Positive 5 year history of diabetes mellitus bullNo clinical evidence of CDbullBMI 28 kgm2 bullLaboratorybullFasting plasma glucose 98mgdl bullTotal cholesterol 197 mgdlbullLDL 135 mgdlbull ECG normalbull IMT(R) 07mm IMT (L) 06 mm (normal values04-1mm)

SOC score169

CASE REPORT 4

bull A 85-year old male with

bull Positive history of hypertension (usual BP 13080)

bull Positive 8 year history of diabetes mellitus

bullNo clinical evidence of CD

bullBMI 265 Kgm2

Laboratory

bull Fasting plasma glucose 105 mgdl

bull Total Cholesterol 213 mgdl

bullLDL 151 mgdl

bull ECG normal

bullIMT(R) 06 mm IMT(L) 06 mm (normal values04-1mm)

SOC score161

Trials 2009 10119

Renaud S de Lorgeril M Wine alcohol platelets and the French paradox for coronary heart disease Lancet 1992 339(8808)1523-6

Is there any paradox in these observations

We cannot exclude the plausibility of research hypotheses involving protective environmental interactions on the cardiovascular well being of certain population groups elsewhere in the world

B Simini Serge Renaud from French paradox to Cretan miracle Lancet 2000 355 (9197) 48

THE SPILI PROJECT-PHASE II

Spili project phase II (2001)bull 48 subjects deceased (25

males ndash 23 females)bull 37 moved awaybull 248 currently living in the

rural area of Spilibull Re-examined 200 subjects

(91 males ndash 109 females)bull 2nd phase participation

8072bull

Source Karalis et al BMC Public Health 2007

THE SPILI PROJECT-PHASE III

Lionis C Anyfantakis D Symvoulakis EK et al accepted for publication on

BMC Research Notes

To report on four cases from the Spili cohort in rural Crete with the aim of raising a discussion on potential cardio-protective effects of socio-cultural factors such as sense of coherence religiosity and spirituality in conjunction with biological and preclinical markers of atherosclerosis

AIM

METHODS

Two males aged 71 and 85 year old and two females aged 77 and 85 year old were examinedMedical approach included Electrocardiogram (ECG)Carotid intima media thickness (CIMT) measurement on the Common Carotid Artery (CCA)Blood pressure assessmentLaboratory tests Body mass index evaluation Sense of coherence (29-item Antonovskyrsquos SOC questionnaire)

CASE REPORT 1

A 77-year old female with Positive history of hypertension (usual BP14070)Positive 7 year history of diabetes mellitusNo clinical evidence of CDPhysical examination normal Body Mass Index 305 kgm2

Laboratory Fasting plasma glucose 128 mgdl Total Cholesterol 247mgdlLDL 163 mgdl ECG normal IMT(R) 07 mm IMT(L) 06 mm (normal values04-1mm)

RESULTS

SOC score158

CASE REPORT 2

A 85-year old female with Positive history of hypertension (usual BP14080) No clinical evidence of CD Physical examination normalBMI 29 kgm2

Laboratory Fasting plasma glucose 103 mgdl Total Cholesterol 247 mgdl LDL 138 mgdl ECG normal IMT(R) 05 mm IMT(L) 06 mm (normal values04-1mm)

SOC score165

CASE REPORT 3

A 71-year old male withbull Positive history of hypertension (usual BP 14090)bull Positive 5 year history of diabetes mellitus bullNo clinical evidence of CDbullBMI 28 kgm2 bullLaboratorybullFasting plasma glucose 98mgdl bullTotal cholesterol 197 mgdlbullLDL 135 mgdlbull ECG normalbull IMT(R) 07mm IMT (L) 06 mm (normal values04-1mm)

SOC score169

CASE REPORT 4

bull A 85-year old male with

bull Positive history of hypertension (usual BP 13080)

bull Positive 8 year history of diabetes mellitus

bullNo clinical evidence of CD

bullBMI 265 Kgm2

Laboratory

bull Fasting plasma glucose 105 mgdl

bull Total Cholesterol 213 mgdl

bullLDL 151 mgdl

bull ECG normal

bullIMT(R) 06 mm IMT(L) 06 mm (normal values04-1mm)

SOC score161

Trials 2009 10119

Renaud S de Lorgeril M Wine alcohol platelets and the French paradox for coronary heart disease Lancet 1992 339(8808)1523-6

Is there any paradox in these observations

We cannot exclude the plausibility of research hypotheses involving protective environmental interactions on the cardiovascular well being of certain population groups elsewhere in the world

B Simini Serge Renaud from French paradox to Cretan miracle Lancet 2000 355 (9197) 48

THE SPILI PROJECT-PHASE III

Lionis C Anyfantakis D Symvoulakis EK et al accepted for publication on

BMC Research Notes

To report on four cases from the Spili cohort in rural Crete with the aim of raising a discussion on potential cardio-protective effects of socio-cultural factors such as sense of coherence religiosity and spirituality in conjunction with biological and preclinical markers of atherosclerosis

AIM

METHODS

Two males aged 71 and 85 year old and two females aged 77 and 85 year old were examinedMedical approach included Electrocardiogram (ECG)Carotid intima media thickness (CIMT) measurement on the Common Carotid Artery (CCA)Blood pressure assessmentLaboratory tests Body mass index evaluation Sense of coherence (29-item Antonovskyrsquos SOC questionnaire)

CASE REPORT 1

A 77-year old female with Positive history of hypertension (usual BP14070)Positive 7 year history of diabetes mellitusNo clinical evidence of CDPhysical examination normal Body Mass Index 305 kgm2

Laboratory Fasting plasma glucose 128 mgdl Total Cholesterol 247mgdlLDL 163 mgdl ECG normal IMT(R) 07 mm IMT(L) 06 mm (normal values04-1mm)

RESULTS

SOC score158

CASE REPORT 2

A 85-year old female with Positive history of hypertension (usual BP14080) No clinical evidence of CD Physical examination normalBMI 29 kgm2

Laboratory Fasting plasma glucose 103 mgdl Total Cholesterol 247 mgdl LDL 138 mgdl ECG normal IMT(R) 05 mm IMT(L) 06 mm (normal values04-1mm)

SOC score165

CASE REPORT 3

A 71-year old male withbull Positive history of hypertension (usual BP 14090)bull Positive 5 year history of diabetes mellitus bullNo clinical evidence of CDbullBMI 28 kgm2 bullLaboratorybullFasting plasma glucose 98mgdl bullTotal cholesterol 197 mgdlbullLDL 135 mgdlbull ECG normalbull IMT(R) 07mm IMT (L) 06 mm (normal values04-1mm)

SOC score169

CASE REPORT 4

bull A 85-year old male with

bull Positive history of hypertension (usual BP 13080)

bull Positive 8 year history of diabetes mellitus

bullNo clinical evidence of CD

bullBMI 265 Kgm2

Laboratory

bull Fasting plasma glucose 105 mgdl

bull Total Cholesterol 213 mgdl

bullLDL 151 mgdl

bull ECG normal

bullIMT(R) 06 mm IMT(L) 06 mm (normal values04-1mm)

SOC score161

Trials 2009 10119

Renaud S de Lorgeril M Wine alcohol platelets and the French paradox for coronary heart disease Lancet 1992 339(8808)1523-6

Is there any paradox in these observations

We cannot exclude the plausibility of research hypotheses involving protective environmental interactions on the cardiovascular well being of certain population groups elsewhere in the world

B Simini Serge Renaud from French paradox to Cretan miracle Lancet 2000 355 (9197) 48

To report on four cases from the Spili cohort in rural Crete with the aim of raising a discussion on potential cardio-protective effects of socio-cultural factors such as sense of coherence religiosity and spirituality in conjunction with biological and preclinical markers of atherosclerosis

AIM

METHODS

Two males aged 71 and 85 year old and two females aged 77 and 85 year old were examinedMedical approach included Electrocardiogram (ECG)Carotid intima media thickness (CIMT) measurement on the Common Carotid Artery (CCA)Blood pressure assessmentLaboratory tests Body mass index evaluation Sense of coherence (29-item Antonovskyrsquos SOC questionnaire)

CASE REPORT 1

A 77-year old female with Positive history of hypertension (usual BP14070)Positive 7 year history of diabetes mellitusNo clinical evidence of CDPhysical examination normal Body Mass Index 305 kgm2

Laboratory Fasting plasma glucose 128 mgdl Total Cholesterol 247mgdlLDL 163 mgdl ECG normal IMT(R) 07 mm IMT(L) 06 mm (normal values04-1mm)

RESULTS

SOC score158

CASE REPORT 2

A 85-year old female with Positive history of hypertension (usual BP14080) No clinical evidence of CD Physical examination normalBMI 29 kgm2

Laboratory Fasting plasma glucose 103 mgdl Total Cholesterol 247 mgdl LDL 138 mgdl ECG normal IMT(R) 05 mm IMT(L) 06 mm (normal values04-1mm)

SOC score165

CASE REPORT 3

A 71-year old male withbull Positive history of hypertension (usual BP 14090)bull Positive 5 year history of diabetes mellitus bullNo clinical evidence of CDbullBMI 28 kgm2 bullLaboratorybullFasting plasma glucose 98mgdl bullTotal cholesterol 197 mgdlbullLDL 135 mgdlbull ECG normalbull IMT(R) 07mm IMT (L) 06 mm (normal values04-1mm)

SOC score169

CASE REPORT 4

bull A 85-year old male with

bull Positive history of hypertension (usual BP 13080)

bull Positive 8 year history of diabetes mellitus

bullNo clinical evidence of CD

bullBMI 265 Kgm2

Laboratory

bull Fasting plasma glucose 105 mgdl

bull Total Cholesterol 213 mgdl

bullLDL 151 mgdl

bull ECG normal

bullIMT(R) 06 mm IMT(L) 06 mm (normal values04-1mm)

SOC score161

Trials 2009 10119

Renaud S de Lorgeril M Wine alcohol platelets and the French paradox for coronary heart disease Lancet 1992 339(8808)1523-6

Is there any paradox in these observations

We cannot exclude the plausibility of research hypotheses involving protective environmental interactions on the cardiovascular well being of certain population groups elsewhere in the world

B Simini Serge Renaud from French paradox to Cretan miracle Lancet 2000 355 (9197) 48

METHODS

Two males aged 71 and 85 year old and two females aged 77 and 85 year old were examinedMedical approach included Electrocardiogram (ECG)Carotid intima media thickness (CIMT) measurement on the Common Carotid Artery (CCA)Blood pressure assessmentLaboratory tests Body mass index evaluation Sense of coherence (29-item Antonovskyrsquos SOC questionnaire)

CASE REPORT 1

A 77-year old female with Positive history of hypertension (usual BP14070)Positive 7 year history of diabetes mellitusNo clinical evidence of CDPhysical examination normal Body Mass Index 305 kgm2

Laboratory Fasting plasma glucose 128 mgdl Total Cholesterol 247mgdlLDL 163 mgdl ECG normal IMT(R) 07 mm IMT(L) 06 mm (normal values04-1mm)

RESULTS

SOC score158

CASE REPORT 2

A 85-year old female with Positive history of hypertension (usual BP14080) No clinical evidence of CD Physical examination normalBMI 29 kgm2

Laboratory Fasting plasma glucose 103 mgdl Total Cholesterol 247 mgdl LDL 138 mgdl ECG normal IMT(R) 05 mm IMT(L) 06 mm (normal values04-1mm)

SOC score165

CASE REPORT 3

A 71-year old male withbull Positive history of hypertension (usual BP 14090)bull Positive 5 year history of diabetes mellitus bullNo clinical evidence of CDbullBMI 28 kgm2 bullLaboratorybullFasting plasma glucose 98mgdl bullTotal cholesterol 197 mgdlbullLDL 135 mgdlbull ECG normalbull IMT(R) 07mm IMT (L) 06 mm (normal values04-1mm)

SOC score169

CASE REPORT 4

bull A 85-year old male with

bull Positive history of hypertension (usual BP 13080)

bull Positive 8 year history of diabetes mellitus

bullNo clinical evidence of CD

bullBMI 265 Kgm2

Laboratory

bull Fasting plasma glucose 105 mgdl

bull Total Cholesterol 213 mgdl

bullLDL 151 mgdl

bull ECG normal

bullIMT(R) 06 mm IMT(L) 06 mm (normal values04-1mm)

SOC score161

Trials 2009 10119

Renaud S de Lorgeril M Wine alcohol platelets and the French paradox for coronary heart disease Lancet 1992 339(8808)1523-6

Is there any paradox in these observations

We cannot exclude the plausibility of research hypotheses involving protective environmental interactions on the cardiovascular well being of certain population groups elsewhere in the world

B Simini Serge Renaud from French paradox to Cretan miracle Lancet 2000 355 (9197) 48

CASE REPORT 1

A 77-year old female with Positive history of hypertension (usual BP14070)Positive 7 year history of diabetes mellitusNo clinical evidence of CDPhysical examination normal Body Mass Index 305 kgm2

Laboratory Fasting plasma glucose 128 mgdl Total Cholesterol 247mgdlLDL 163 mgdl ECG normal IMT(R) 07 mm IMT(L) 06 mm (normal values04-1mm)

RESULTS

SOC score158

CASE REPORT 2

A 85-year old female with Positive history of hypertension (usual BP14080) No clinical evidence of CD Physical examination normalBMI 29 kgm2

Laboratory Fasting plasma glucose 103 mgdl Total Cholesterol 247 mgdl LDL 138 mgdl ECG normal IMT(R) 05 mm IMT(L) 06 mm (normal values04-1mm)

SOC score165

CASE REPORT 3

A 71-year old male withbull Positive history of hypertension (usual BP 14090)bull Positive 5 year history of diabetes mellitus bullNo clinical evidence of CDbullBMI 28 kgm2 bullLaboratorybullFasting plasma glucose 98mgdl bullTotal cholesterol 197 mgdlbullLDL 135 mgdlbull ECG normalbull IMT(R) 07mm IMT (L) 06 mm (normal values04-1mm)

SOC score169

CASE REPORT 4

bull A 85-year old male with

bull Positive history of hypertension (usual BP 13080)

bull Positive 8 year history of diabetes mellitus

bullNo clinical evidence of CD

bullBMI 265 Kgm2

Laboratory

bull Fasting plasma glucose 105 mgdl

bull Total Cholesterol 213 mgdl

bullLDL 151 mgdl

bull ECG normal

bullIMT(R) 06 mm IMT(L) 06 mm (normal values04-1mm)

SOC score161

Trials 2009 10119

Renaud S de Lorgeril M Wine alcohol platelets and the French paradox for coronary heart disease Lancet 1992 339(8808)1523-6

Is there any paradox in these observations

We cannot exclude the plausibility of research hypotheses involving protective environmental interactions on the cardiovascular well being of certain population groups elsewhere in the world

B Simini Serge Renaud from French paradox to Cretan miracle Lancet 2000 355 (9197) 48

CASE REPORT 2

A 85-year old female with Positive history of hypertension (usual BP14080) No clinical evidence of CD Physical examination normalBMI 29 kgm2

Laboratory Fasting plasma glucose 103 mgdl Total Cholesterol 247 mgdl LDL 138 mgdl ECG normal IMT(R) 05 mm IMT(L) 06 mm (normal values04-1mm)

SOC score165

CASE REPORT 3

A 71-year old male withbull Positive history of hypertension (usual BP 14090)bull Positive 5 year history of diabetes mellitus bullNo clinical evidence of CDbullBMI 28 kgm2 bullLaboratorybullFasting plasma glucose 98mgdl bullTotal cholesterol 197 mgdlbullLDL 135 mgdlbull ECG normalbull IMT(R) 07mm IMT (L) 06 mm (normal values04-1mm)

SOC score169

CASE REPORT 4

bull A 85-year old male with

bull Positive history of hypertension (usual BP 13080)

bull Positive 8 year history of diabetes mellitus

bullNo clinical evidence of CD

bullBMI 265 Kgm2

Laboratory

bull Fasting plasma glucose 105 mgdl

bull Total Cholesterol 213 mgdl

bullLDL 151 mgdl

bull ECG normal

bullIMT(R) 06 mm IMT(L) 06 mm (normal values04-1mm)

SOC score161

Trials 2009 10119

Renaud S de Lorgeril M Wine alcohol platelets and the French paradox for coronary heart disease Lancet 1992 339(8808)1523-6

Is there any paradox in these observations

We cannot exclude the plausibility of research hypotheses involving protective environmental interactions on the cardiovascular well being of certain population groups elsewhere in the world

B Simini Serge Renaud from French paradox to Cretan miracle Lancet 2000 355 (9197) 48

CASE REPORT 3

A 71-year old male withbull Positive history of hypertension (usual BP 14090)bull Positive 5 year history of diabetes mellitus bullNo clinical evidence of CDbullBMI 28 kgm2 bullLaboratorybullFasting plasma glucose 98mgdl bullTotal cholesterol 197 mgdlbullLDL 135 mgdlbull ECG normalbull IMT(R) 07mm IMT (L) 06 mm (normal values04-1mm)

SOC score169

CASE REPORT 4

bull A 85-year old male with

bull Positive history of hypertension (usual BP 13080)

bull Positive 8 year history of diabetes mellitus

bullNo clinical evidence of CD

bullBMI 265 Kgm2

Laboratory

bull Fasting plasma glucose 105 mgdl

bull Total Cholesterol 213 mgdl

bullLDL 151 mgdl

bull ECG normal

bullIMT(R) 06 mm IMT(L) 06 mm (normal values04-1mm)

SOC score161

Trials 2009 10119

Renaud S de Lorgeril M Wine alcohol platelets and the French paradox for coronary heart disease Lancet 1992 339(8808)1523-6

Is there any paradox in these observations

We cannot exclude the plausibility of research hypotheses involving protective environmental interactions on the cardiovascular well being of certain population groups elsewhere in the world

B Simini Serge Renaud from French paradox to Cretan miracle Lancet 2000 355 (9197) 48

CASE REPORT 4

bull A 85-year old male with

bull Positive history of hypertension (usual BP 13080)

bull Positive 8 year history of diabetes mellitus

bullNo clinical evidence of CD

bullBMI 265 Kgm2

Laboratory

bull Fasting plasma glucose 105 mgdl

bull Total Cholesterol 213 mgdl

bullLDL 151 mgdl

bull ECG normal

bullIMT(R) 06 mm IMT(L) 06 mm (normal values04-1mm)

SOC score161

Trials 2009 10119

Renaud S de Lorgeril M Wine alcohol platelets and the French paradox for coronary heart disease Lancet 1992 339(8808)1523-6

Is there any paradox in these observations

We cannot exclude the plausibility of research hypotheses involving protective environmental interactions on the cardiovascular well being of certain population groups elsewhere in the world

B Simini Serge Renaud from French paradox to Cretan miracle Lancet 2000 355 (9197) 48

Trials 2009 10119

Renaud S de Lorgeril M Wine alcohol platelets and the French paradox for coronary heart disease Lancet 1992 339(8808)1523-6

Is there any paradox in these observations

We cannot exclude the plausibility of research hypotheses involving protective environmental interactions on the cardiovascular well being of certain population groups elsewhere in the world

B Simini Serge Renaud from French paradox to Cretan miracle Lancet 2000 355 (9197) 48

Renaud S de Lorgeril M Wine alcohol platelets and the French paradox for coronary heart disease Lancet 1992 339(8808)1523-6

Is there any paradox in these observations

We cannot exclude the plausibility of research hypotheses involving protective environmental interactions on the cardiovascular well being of certain population groups elsewhere in the world

B Simini Serge Renaud from French paradox to Cretan miracle Lancet 2000 355 (9197) 48

What is the reason for this paradox

bull Psycho-socio-cultural determinantsPsychological factorsSocial coherence of the local communitySocio-economic statusFamily and social supportReligiosity and spiritualitybull Mediterranean dietbull Genetics

What is the reason for this paradox

Alan Rozanski and Laura Kubsansky Psychosomatic Medicine 2005

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What is the reason for this paradox

Alan Rozanski and Laura Kubsansky Psychosomatic Medicine 2005

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