Dietary patterns and alcoholic beverage preference in relation to 10-year cardiovascular disease, hypertension, hypercholesterolemia and diabetes mellitus incidence in the ATTICA cohort study

Literature highlights the need for adjustment for diet quality when the effect of alcohol consumption on health is investigated. We sought to define—a-posterior—dietary patterns according to various drinking preferences as well as to evaluate their combined effect against 10-year cardio-metabolic incidence. During 2001–2002, 3042 CVD-free adults consented to participate in the ATTICA study; of them, 2583 completed the 10-year follow-up (85 % participation rate), but precise information about cardio-metabolic incidence was available in 2020 participants (overall retention rate 66 %). Intake per type of alcoholic beverage was assessed and “a posterior” dietary patterns were defined. Results showed that among participants not drinking alcoholic beverages, women adhering more to a healthier dietary pattern had 25 % lower CVD risk within the 10-year study follow-up, while men adhering more to an unhealthy dietary pattern had almost two times higher CVD risk (p-values < 0.05). Among beer drinkers, both men and women adhering more to a healthier dietary pattern were found to have at least 26 % lower risk of developing hypertension and at least 15 % lower risk of developing hypercholesterolemia, while men adhering more to a healthier dietary pattern were also found to have 29 % lower CVD risk (all p-values < 0.05). Similarly, among wine drinkers, women adhering more to a healthier dietary pattern were found to have a 16 % and 52 % lower risk of developing hypertension and diabetes mellitus, respectively, whereas men adhering more to a healthier dietary pattern had 22 % lower CVD risk (all p-values < 0.05). Finally, among spirit drinkers, higher adherence to an unhealthy dietary pattern in both genders had an aggravating effect on cardio-metabolic risk. It seems that the quality of dietary pattern stands out as a critical confounding factor in studies assessing the effect of alcohol consumption on cardio-metabolic risk. A Phytochemical-Rich Dietary Pattern is suggested, particularly among drinkers.