Mediterranean Diet, Traditional Risk Factors, and the Rate of Cardiovascular Complications After Myocardial Infarction – Final Report of the Lyon Diet Heart Study.
Mediterranean Diet, Traditional Risk Factors, and the Rate of Cardiovascular Complications After Myocardial Infarction – Final Report of the Lyon Diet Heart Study.
Year: 1999
Authors: M de Lorgeril, P Salen, J L Martin, I Monjaud, J Delaye, N Mamelle.
Publication Name: Circulation.
Publication Details: Volume 99; Page 779.
Abstract:
The “Mediterranean diet” has been touted as the ideal diet to help prevent heart disease. A number of foods characteristic of the diet including red wine, olive oil and a high intake of fruits and vegetables have been proposed to be responsible for the heart healthy effects. However, in this study, ALA from canola oil margarines is included as a possible mediator in reducing the risk of coronary heart disease. In this paper, the authors present the findings of the Lyon Diet Heart Study, a randomized secondary prevention trial aimed at testing whether a Mediterranean-type diet may reduce the rate of recurrence after a first myocardial infarction (heart attack). This report presents the results of an extended follow-up (with a mean of 46 months per patient) of patients who had survived a first myocardial infarction between 1998 and 1992. Following their first heart attack, the 600 patients of average age 53 were divided into two groups. The control group continued to eat a “Western-style” diet containing 33% of daily energy from fat and 12% from SFA. The experimental group ate a diet closer to the Mediterranean diet. It was characterized by more fruit, vegetables, bread, chicken, and fish, less cheese, meat, ham and sausage. Approximately 30% of daily energy came from fat and 8% from SFA. The most important difference between the groups was that the Mediterranean diet group was instructed to consume whenever possible, margarine made from canola oil instead of butter and cream. Both groups consumed similar amounts of wine. Over the course of close to four years, the Mediterranean diet reduced the risk of a second heart attack and the overall death rate by as much as 70%. Among dietary constituents, only ALA was significantly correlated with a reduction in myocardial infarction. The researchers attributed this significant observation to the change in fats in the diet, largely the increase consumption of canola-oil margarines. Three composite outcomes (COs) combining either cardiac death and nonfatal myocardial infarction (CO 1), or CO 1 plus major secondary end points (unstable angina, stroke, heart failure, pulmonary or peripheral embolism – CO 2), or CO 2 plus minor events requiring hospital admission (CO 3) were studied. Compared to the group consuming the Western style diet, CO 1, CO2 and CO 3, were significantly reduced in the Mediterranean diet group. Results showed for the Mediterranean versus the Western diet, CO 1, 14 events versus 44, CO 2, 27 events versus 90 and CO 3, 95 events versus 180. Increases of 1 mmol/L in total blood cholesterol and 1 mm Hg increase in were significantly associated with an increased risk of infarction of18% to 28% and 1% to 2%, respectively. Lower leukocyte counts, female sex and aspirin use were each significantly and negatively associated with the rate of recurrence after a first myocardial infarction. The protective effect of the Mediterranean diet was maintained up to 4 years after the first heart attack. Major traditional risk factors, such as high blood cholesterol and blood pressure, were shown to be independent and joint predictors of recurrence, indicating that the Mediterranean dietary pattern did not alter, at least qualitatively, the traditional relationships between major risk factors and recurrence. The reduction of risk of a second heart attack and the overall death rate were attributed to the change dietary fats, largely due to the canola oil margarine. A cardioprotective effect was observed after about two months. The authors indicate that a comprehensive public education strategy to decrease cardiovascular mortality should focus primarily on the consumption of a cardioprotective diet. The results of this long term and well-designed study indicate that relatively simple dietary changes such a reduction in total intake of SFAs and an increase in intake of ALA through the consumption of canola oil can led to significant reductions in coronary heart disease mortality.
