The CORA-Study: Nutrition and Lifestyle-related Risk Factors for Coronary Heart Disease in Women
Abstract
Background Atherosclerotic cardiovascular disease – particularly coronary heart disease – is a major health issue of women. Despite this fact most research comprises studies in men. The high morbidity and mortality of coronary artery disease especially in women calls for strong emphasis on primary prevention to influence major cardiovascular risk factors. Smoking, a sedentary lifestyle and particularly poor dietary habits are supposed to play a key role in the development of coronary heart disease. Aim of the Coronary Risk Factors for Atherosclerosis in Women (CORA)-Study was to investigate nutrition- and lifestyle-dependent risk factors predisposing women for coronary heart disease. Methods In a population-based case-control design 200 pre- and postmenopausal women with incident coronary heart disease and 255 age-matched controls from the same neighborhood were recruited. For assessment of dietary habits a self-administered well evaluated 146-item food frequency questionnaire was used. Further information on major risk factors, family history and the medication was obtained by a lifestyle questionnaire and a computer-assisted interview. Anthropometric parameters, blood pressure and various laboratory values from fasting blood samples were determined. Univariate and multivariate analyses were performed by standard methods. Results Cases reported a higher consumption of animal food groups such as meat and sausages. This is reflected by a higher intake of energy, animal fat, cholesterol and protein. In contrast the controls ate more vegetables and fruit. They also drank more alcohol, mostly due to a higher intake of red wine. Cases followed a more sedentary lifestyle, characterized by less regular physical activity. Compared to controls cases had a lower sociodemographic status and were more often homemakers. Smoking rates were high in the whole study population, particularly below the age of 60. Smoking cases showed poor nutrition habits and were more often affected by additional classical risk factors characterizing the metabolic Multivariate analysis showed that nutrition – particularly the intake of meat and sausage – is a risk factor for coronary heart disease in women independent of classical risk factors. Subgroup analyses demonstrated that this is even true for high risk groups: in addition to major cardiovascular risk factors such as dyslipidemia, hypertension, diabetes, smoking, sedentary lifestyle or central adiposity cases differed from controls with a comparable risk profile, by an unhealthy dietary pattern. Conclusions The findings of the CORA-Study indicates that a sedentary lifestyle and particularly poor nutrition characterizes women prone to coronary heart disease. A higher consumption of animal food groups, less fruit and vegetables and no regular physical activity is associated with a higher risk. The consecutively evolving metabolic syndrome appears to be the central problem. Primary prevention through a more healthy lifestyle and a prudent diet should provide major protection against the
