Sotirios Tsalamandris , Evangelos Oikonomou , Tzortzina Vavuranaki , George Lazaros , Georgia Vogiatzi , Christos Chasikidis , Evangelia Christoforatou , George-Angelo Papamikroulis , Konstantinos Mourouzis , Vasiliki Mystakidou , Margienti Papakonstantinou , Panagiotis Theofilis , Savvas Mazaris , Nikolaos Galiatsatos and Dimitris Tousoulis First Cardiology Clinic , ‘Hippokration’ General Hospital , Athens, Greece National & Kapodistrian University of Athens , Athens, Greece

Background The dietary patterns, in cardiovascular diseases has been challenged and the role of breakfast as an element of balance energy intake has gained research interest. However, the effects of dietary patterns on vascular function is unknown. Therefore, we examined the association of breakfast consumption habits with arterial wall elastic properties and carotid atherosclerosis.

Methods In this cross-sectional study we enrolled 2043 inhabitants of the Corinthia region, Greece. Carotid femoral pulse wave velocity (PWV) was used to assess arterial stiffness. Carotid intima media thickness (IMT) was measured and the mean carotid IMT was calculated. According to food frequency questionnaires, breakfast contribution in total daily energy intake (>20%; 5-20% and <5%) was estimated and subjects were categorized as high-energy breakfast consumers (HeBC), low-energy breakfast consumers (LeBC) and those skipping breakfast (SBf) respectively.

Results From the study population 240 subjects were categorized as HeBC, 897 as LeBC, and 681 as SBf. The mean PWV was significant higher in subjects SBf compare to LeBC and HeBC (9.35±2.82m/sec vs. 9.09±2.77m/sec vs. 8.76±2.69m/sec, p=0.02). The mean IMT was significantly higher in subjects SBf compare to LeBC and HeBC (1.04±0.46mm vs. 0.99±0.43mm vs. 0.92±0.39mm, p=0.01). Regression analysis revealed that even after adjustment for potential confounders and cardiovascular risk factors subjects SBf has significantly increased mean IMT and PWV.

Conclusion Skipping breakfast has an adverse effect on arterial stiffness and carotid atheromatic burden. Interestingly, increased breakfast total energy intake may act protectively against atherosclerosis, a finding that emphasize the role of balanced energy consumption on the integrity and wellbeing of the cardiovascular system and worth of further pathophysiologic exploration with potential clinical implications.