Mediterranean Diet Lowers Rates of Adverse Cardiovascular Events

Mediterranean Diet Lowers Rates of Adverse Cardiovascular Events

In a primary prevention trial, this diet modestly outperformed a low-fat diet.

The so-called Mediterranean diet is thought, mostly on the basis of observational studies, to confer cardiovascular benefit. Now, Spanish researchers have put this diet to the ultimate test — a large, randomized, primary-prevention trial.
About 7500 people (age range, 55–80) without known cardiovascular disease but with either diabetes or 3 nondiabetes cardiac risk factors were randomized to one of three diets:

• Mediterranean diet supplemented with extra-virgin olive oil (at least 4 tablespoons daily)
• Mediterranean diet supplemented with a daily 30-g serving of walnuts, almonds, and hazelnuts
• Low-fat control diet

During average follow-up of 5 years, the primary composite outcome (myocardial infarction, stroke, or cardiovascular-related death) occurred significantly less often in the two Mediterranean-diet groups than in the control group (8 per 1000 person-years in each Mediterranean group vs. 11 per 1000 person-years in the control group). Among the three components of the primary endpoint, only stroke was significantly lower in the intervention groups. The two Mediterranean diets did not lower all-cause mortality significantly.
Comment: In this primary-prevention trial, two Mediterranean diets were associated with lower rates of cardiovascular events — about three fewer events per 1000 person-years — compared with a standard low-fat diet. Although some of the publicity surrounding this trial emphasized the merits of supplemental extra-virgin olive oil and nuts, we should note that the underlying diets differed: For example, wine with meals and legumes were recommended in the Mediterranean diets, whereas low-fat dairy products, bread, pasta, and potatoes were recommended in the control diet.
— Allan S. Brett, MD
Published in Journal Watch General Medicine March 12, 2013

Citation(s):

Estruch R et al. Primary prevention of cardiovascular disease with a Mediterranean diet. N Engl J Med 2013 Feb 25; [e-pub ahead of print]. (http://dx.doi.org/10.1056/NEJMoa1200303)