Mediterranean alpha-linolenic acid rich diet in secondary prevention of coronary heart disease.
Mediterranean alpha-linolenic acid rich diet in secondary prevention of coronary heart disease.
Year: 1994
Authors: M de Lorgeril, S Renaud, N Mamelle, P Salen, J L Martin, I Monjaud, J Guidollet, et al.
Publication Name: The Lancet.
Publication Details: Volume 343; Page 1454.
Abstract:
Controversy exists regarding the exact role of SFA and PUFA in the onset of CHD and eventual mortality. In a previous study by these investigators, a dietary ratio of PUFA:SFA of 1.0 in combination with low blood cholesterol levels was associated with enhanced platelet aggregation. The objective of the present research was to determine the effect of a Mediterranean style diet rich in fruits and vegetables in combination with ALA, on the prevention of secondary events in CHD. The investigation was based on the Lyon Diet Heart Study, a prospective, randomized single-blinded secondary prevention trial aimed a reducing the risk of cardiovascular deaths by diet modification and recurrent myocardial infarction in survivors of a first myocardial infarction. After a first myocardial infarction, patients were randomly assigned to the experimental (n=320) or control group (n=303). The experimental group was advised to adopt a Mediterranean style diet as described above. Butter and cream were replaced by olive and canola oil and by a canola oil based margarine. These products were supplied to the patients for the entire period. The oils provided higher levels of OA and ALA than consumed by the control group. The control group was provided with no dietary intervention. Patients were seen at 8 weeks after randomization, and each year for 5 years. Dietary evaluations were conducted at each visit. The results showed that throughout the study, the experimental group consumed significantly less total fat, SFA, cholesterol, and LA, and more OA and ALA as confirmed by measurements in plasma. Serum lipids, blood pressure, and body mass index remained similar in the 2 groups. After a mean follow up of 27 months, the experimental group experienced a reduced rate of cardiac recurrence, other cardiac events and overall mortality. There were 16 cardiac deaths in the control and 3 in the experimental group; 17 non-fatal myocardial infarction in the control and 5 in the experimental group. Overall mortality was 20 in the control and 8 in the experimental group. The authors speculated that a protective effect of the experimental diet on thrombogenesis may have occurred since the incidence of myocardial infarction was markedly reduced. A possible antiarrythmic effect of ALA was also proposed supported by the fact that there were no sudden deaths in the experimental group in comparison with 8 in the control group. The results of this study suggest that an ALA rich Mediterranean diet appears to be more effective than presently recommended diets in the secondary prevention of coronary events and death.
