1. 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, Greece “The Future of Primary Health Care in Europe III” 30 - 31 August, 2010, Pisa, Italy

2. Summary of the presentation Background Methods Results Conclusions

3. 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

4. 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) 2 nd phase participation: 80.72% Source: Karalis et al, BMC Public Health 2007

5. THE SPILI PROJECT-PHASE III Lionis C, Anyfantakis D Symvoulakis EK et al., accepted for publication on BMC Research Notes

6. 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

7. 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 Antonovsky’s SOC questionnaire)

8. CASE REPORT 1 A 77-year old female with:  Positive history of hypertension (usual BP:140/70)  Positive 7 year history of diabetes mellitus  No clinical evidence of CD  Physical examination: normal  Body Mass Index: 30.5 kg/m 2 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 values:0.4-1mm) RESULTS SOC score:158

9. CASE REPORT 2 A 85-year old female with:  Positive history of hypertension (usual BP:140/80)  No clinical evidence of CD  Physical examination: normal  BMI: 29 kg/m 2 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 values:0.4-1mm) SOC score:165

10. 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/m 2 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 values:0.4-1mm) SOC score:169

11. 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/m 2 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 values:0.4-1mm) SOC score:161

12. Trials 2009, 10:119

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

16. 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

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