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BACKGROUND: Lifestyle remains a huge driving force of Cardiovascular Diseases (CVD) onset/ progression. Lifestyle-patterns are highly dependent on gender-related attitudes. OBJECTIVE: To evaluate the gender-specific association of lifestyle-related factors (adherence to Mediterranean diet (MedDiet), Physical Activity (PA), smoking) with 10-year first and recurrent CVD events. METHODS: Two prospective studies, the ATTICA (2002-2012, n=3,042 subjects free-of-CVD) and GREECS (2004-2014, n=2,172 subjects with Acute Coronary Syndrome (ACS)) were undertaken. Baseline adherence to MedDiet (MedDietScore <27/≥27, range 0-55), PA (sedentary/physically active) and smoking (current/never) was tested against 10-year first (ATTICA) and recurrent (GREECS) CVD events, in men and women. RESULTS: The "superiority" of men over women regarding overall CVD events was revealed in both first (ATTICA, 19.7% men vs. 11.7% women, p<0.001) and recurrent CVD events, but less significantly (GREECS, 38.8% men vs. 32.9% women, p=0.016). Gender-stratified analysis revealed that: lower adherence to MedDiet in women (Odds Ratio (OR)=1.22, 95% Confidence Interval (95%CI) 1.03, 1.51) and PA (OR=1.35, 95%CI 1.01, 1.85) and smoking (OR=1.28, 95%CI 1.04, 1.82) in men, were independent predictors of 10-year first CVD event; whereas, adherence to MedDiet (OR=1.28, 95%CI 1.01, 1.59), PA (OR=1.25, 95%CI 1.01, 2.50) and smoking (OR=1.15, 95%CI 1.01, 1.30) in women, yet only adherence to MedDiet (OR=1.27, 95%CI 1.01, 1.35) and PA (OR=1.27, 95%CI 1.02, 1.59) in men, were independent predictors of 10-year CVD recurrent events. CONCLUSION: Differences between men and women, in the effect-size measures of lifestyle-related factors, underline different paths for men and women, probably contributing to better designing strategies for primary and secondary CVD prevention.

Original publication




Journal article


Curr Vasc Pharmacol

Publication Date





401 - 410


Cardiovascular diseases, gender, lifestyle, primary prevention, secondary prevention, sex., Adult, Aged, Aged, 80 and over, Cardiovascular Diseases, Diet, Mediterranean, Exercise, Female, Greece, Health Status Disparities, Healthy Lifestyle, Humans, Male, Middle Aged, Non-Smokers, Primary Prevention, Prognosis, Risk Assessment, Risk Factors, Risk Reduction Behavior, Secondary Prevention, Sex Factors, Smoking, Smoking Cessation, Time Factors