Mediterranean diet superior to Low-Fat diet for Long-Term Secondary Prevention of Cardiovascular disease
The Lancet:
The traditional Mediterranean diet consisted of a high proportion of fruits, vegetables, nuts, legumes, and cereals, a moderate intake of fish and poultry as the main protein source and olive oil as the main fat source. A low intake of dairy products, red meat, processed meats, and sweets.
Current recommendation for patients with adverse cardiovascular (CV) events is to limit fat intake.
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The authors of this study conducted a single-center, randomised clinical trial to compare the effect of a Mediterranean versus low-fat diet for secondary prevention in patients with established coronary heart disease. This study conducted in Spain evaluated 1002 patients aged between 20 and 75 years with established coronary heart disease and randomly assigned them to either a Mediterranean diet or a low-fat diet. The follow-up period was 7 years.
The Mediterranean diet was modelled prescribing 35% of the calories as fat (22% monounsaturated fatty acids) and a maximum of 50% carbohydrates, while the low-fat diet comprised less than 30% of total fat (12–14% monounsaturated fatty acids), and a minimum of 55% carbohydrates.
The primary outcome was a composite of major CV events, myocardial infarction, revascularization, ischemic stroke, peripheral artery disease, and CV death. There were 111 events in the low-fat group and 87 events in the Mediterranean group, representing a 25% reduction in events in favor of the Mediterranean diet.Â
For men, the reduction was 33%. For women, there was no difference between the groups. However, there were only 175 women in the trial, so the lack of effect may be just due to the small number. Beneficial effects appeared to be restricted to men versus women, in whom there was no difference between diet groups.
The lipid profile and glucose levels of the participants did not change significantly during the study.
Dietary reduction remains a critical element of primary and secondary prevention of atherosclerotic cardiovascular disease, and these data highlight the effectiveness of the Mediterranean diet in risk reduction for patients with established coronary disease.
These findings suggest that the Mediterranean diet may be more effective in preventing secondary cardiovascular events in patients with established coronary disease compared with low-fat diets.
The Mediterranean diet is the only nutritional approach that, in a randomized clinical trial, was demonstrated to be beneficial in the primary prevention of CVD. This clinical trial showing that the Mediterranean diet is also effective in secondary prevention, with an additive effect on top of optimal pharmacological treatment of established CVD.Doctors Liked to Read More
Background: Mediterranean and low-fat diets are effective in the primary prevention of cardiovascular disease. We did a long-term randomised trial to compare the effects of these two diets in secondary prevention of cardiovascular disease.
Methods: The CORDIOPREV study was a single-centre, randomised clinical trial done at the Reina Sofia University Hospital in Córdoba, Spain. Patients with established coronary heart disease (aged 20-75 years) were randomly assigned in a 1:1 ratio by the Andalusian School of Public Health to receive a Mediterranean diet or a low-fat diet intervention, with a follow-up of 7 years. Clinical investigators (physicians, investigators, and clinical endpoint committee members) were masked to treatment assignment; participants were not. A team of dietitians did the dietary interventions. The primary outcome (assessed by intention to treat) was a composite of major cardiovascular events, including myocardial infarction, revascularisation, ischaemic stroke, peripheral artery disease, and cardiovascular death.
Findings: From Oct 1, 2009, to Feb 28, 2012, a total of 1002 patients were enrolled, 500 (49·9%) in the low-fat diet group and 502 (50·1%) in the Mediterranean diet group. The mean age was 59·5 years (SD 8·7) and 827 (82·5%) of 1002 patients were men. The primary endpoint occurred in 198 participants: 87 in the Mediterranean diet group and 111 in the low-fat group. These effects were more evident in men, with primary endpoints occurring in 67 (16·2%) of 414 men in the Mediterranean diet group versus 94 (22·8%) of 413 men in the low-fat diet group, than in 175 women for whom no difference was found between groups.
Interpretation: In secondary prevention, the Mediterranean diet was superior to the low-fat diet in preventing major cardiovascular events. Our results are relevant to clinical practice, supporting the use of the Mediterranean diet in secondary prevention.
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