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Open Access Hypothesis

Bio-psychosocial determinants of cardiovascular disease in a rural population on Crete, Greece: formulating a hypothesis and designing the SPILI-III study

Christos Lionis1*, Dimitrios Anyfantakis1, Emmanouil K Symvoulakis1, Sue Shea12, Demosthenes Panagiotakos3 and Elias Castanas4

Author Affiliations

1 Clinic of Social and Family Medicine, Faculty of Medicine, University of Crete, Greece

2 School of Health and Social Care, University of Greenwich, UK

3 Department of Nutrition-Dietetics, Harokopio University, Athens, Greece

4 Laboratory of Experimental Endocrinology, School of Medicine, University of Crete, Heraklion, Greece

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BMC Research Notes 2010, 3:258  doi:10.1186/1756-0500-3-258

Published: 11 October 2010

Abstract

Background

In 1988, the SPILI project was established in order to evaluate the cardiovascular disease (CVD) risk profile of the inhabitants of Spili, in rural Crete, Greece. The first reports from this project revealed that against the unfavourable risk factors' profile observed, only a few men with a previous myocardial infarction were encountered. A follow-up study (SPILI II) was performed twelve years after the initial examination, and the unfavourable cardiovascular risk profile was re-confirmed.

Presentation of the Hypothesis

This paper presents a hypothesis formulated on the basis of previous research to investigate if dynamic psycho-social determinants, including social coherence of the local community, religiosity and spirituality, are protective against the development of coronary heart disease in a well-defined population.

Testing the Hypothesis

A follow-up examination of this Cretan cohort is currently being performed to assess the link between psychosocial factors and CVD. Psychosocial factors including sense of control, religiosity and spirituality are assessed in together with conventional CVD risk factors. Smoking and alcohol consumption, as well as dietary habits and activity levels are recorded. Oxidative stress and inflammatory markers, as well as ultrasound measurement of carotid intima media thickness, a preclinical marker of atherosclerosis, will also be measured.

Implications of the hypothesis tested

The issue of the cardio-protective effect of psycho-social factors would be revisited based on the results of this Cretan cohort; nevertheless, further research is needed across different sub-populations in order to establish a definite relationship. A comprehensive approach based on the aspects of bio-social life may result in more accurate CVD risk management.