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. Lionis. Clinic of Social and Family Medicine, University of Crete,

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Sense of coherence and carotid artery intima
media thickness measurements presenting four
case reports from the Spili cohort in rural
Crete, GreeceD. Anyfantakis, EK Symvoulakis, C.
Lionis.Clinic of Social and Family Medicine,
University of Crete, GreeceThe Future of
Primary Health Care in Europe III 30 - 31
August, 2010, Pisa, Italy
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Summary of the presentation

• Background
• Methods
• Results
• Conclusions

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THE SPILI PROJECT-PHASE I

• Spili project, the initial sample (1988)
• 445 inhabitants aged 15-79
• 343 examined for CV risk factors and morbidity
  (170 males 173 females)
• Participation rate 77
• High smoking prevalence
• High alcohol consumption
• High cholesterol levels
• High prevalence of diabetes and hypertension

Source Lindholm, et al, Eur Heart J, 1992
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THE SPILI PROJECT-PHASE II

• Spili project, phase II (2001)
• 48 subjects deceased (25 males 23 females)
• 37 moved away
• 248 currently living in the rural area of Spili
• Re-examined 200 subjects (91 males 109
  females)
• 2nd phase participation 80.72

Source Karalis et al, BMC Public Health 2007
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THE SPILI PROJECT-PHASE III
Lionis C, Anyfantakis D Symvoulakis EK et al.,
accepted for publication on BMC Research Notes
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AIM

• 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.

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METHODS

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

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RESULTS
CASE REPORT 1

• A 77-year old female with
• Positive history of hypertension (usual
  BP140/70)
• Positive 7 year history of diabetes mellitus
• No clinical evidence of CD
• Physical examination normal
• Body Mass Index 30.5 kg/m2
• Laboratory
• Fasting plasma glucose 128 mg/dl
• Total Cholesterol 247mg/dl
• LDL 163 mg/dl
• ECG normal
• IMT(R) 0.7 mm IMT(L) 0.6 mm (normal
  values0.4-1mm)

SOC score158
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CASE REPORT 2

• A 85-year old female with
• Positive history of hypertension (usual
  BP140/80)
• No clinical evidence of CD
• Physical examination normal
• BMI 29 kg/m2
• Laboratory
• Fasting plasma glucose 103 mg/dl
• Total Cholesterol 247 mg/dl
• LDL 138 mg/dl
• ECG normal
• IMT(R) 0.5 mm IMT(L) 0.6 mm (normal
  values0.4-1mm)

SOC score165
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CASE REPORT 3

• A 71-year old male with
• Positive history of hypertension (usual BP
  140/90)
• Positive 5 year history of diabetes mellitus
• No clinical evidence of CD
• BMI 28 kg/m2
• Laboratory
• Fasting plasma glucose 98mg/dl
• Total cholesterol 197 mg/dl
• LDL 135 mg/dl
• ECG normal
• IMT(R) 0.7mm, IMT (L) 0.6 mm (normal
  values0.4-1mm)

SOC score169
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CASE REPORT 4

• A 85-year old male with
• Positive history of hypertension (usual BP
  130/80)
• Positive 8 year history of diabetes mellitus
• No clinical evidence of CD
• BMI 26.5 Kg/m2
• Laboratory
• Fasting plasma glucose 105 mg/dl
• Total Cholesterol 213 mg/dl
• LDL 151 mg/dl
• ECG normal
• IMT(R) 0.6 mm, IMT(L) 0.6 mm (normal
  values0.4-1mm)

SOC score161
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Trials 2009, 10119
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Is there any paradox in these observations?

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

B. Simini. "Serge Renaud from French paradox to
Cretan miracle". Lancet. 2000 355 (9197) 48.
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
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What is the reason for this paradox?

• Psycho-socio-cultural determinants
• Psychological factors
• Social coherence of the local community
• Socio-economic status
• Family and social support
• Religiosity and spirituality
• Mediterranean diet
• Genetics

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What is the reason for this paradox?
Alan Rozanski and Laura Kubsansky. Psychosomatic
Medicine 2005