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Mediterranean Diet Reduces Atherosclerosis Progression
Quick Takes
- A Mediterranean dietary pattern appears beneficial in the secondary prevention of coronary heart disease (CHD).
- Reductions in intima-media thickness (IMT) measures after adopting a Mediterranean diet were observed in adults with established CHD. In contrast, a low-fat diet did not result in changes in IMT.
- Changes in carotid IMT were observed over a long-term follow-up (i.e., up to 7 years).
Study Questions:
Does a Mediterranean dietary pattern reduce atherosclerosis among patients with established coronary heart disease (CHD)?
Methods:
The CORDIOPREV study (Coronary Diet Intervention With Olive Oil and Cardiovascular Prevention) is an ongoing prospective, randomized, single-blind, controlled trial in 1,002 CHD patients recruited between November 2009 and February 2012 from one European country (Spain). The study compared two healthy dietary patterns (low-fat rich in complex carbohydrates vs. a Mediterranean diet rich in extra virgin olive oil) on the incidence of cardiovascular events. The Mediterranean diet was defined as 35% fat, 22% monounsaturated fatty acids (MUFAs), and <50% carbohydrates. The low-fat diet included 28% fat, 12% MUFAs, and >55% carbohydrates. This study presents outcomes including common carotid artery intima-media thickness (IMT-CC) assessment with ultrasound at baseline, 5 years, and 7 years. An additional outcome included carotid plaque number and height.
Results:
A total of 939 participants who completed baseline and follow-up ultrasounds were included in the present analysis. During follow-up, both dietary intervention groups reduced total energy intake. The Mediterranean diet group increased fiber and total fat intake (i.e., increased MUFAs and polyunsaturated fatty acids [PUFAs]) but reduced consumption of saturated fatty acids, total carbohydrates, and cholesterol. The low-fat diet group increased total carbohydrates and fiber intake while decreasing cholesterol and total fat (i.e., increased PUFAs with reductions in MUFAs and saturated fatty acids). The Mediterranean diet group had reduced IMT at 5 years (-0.27 ± 0.008 mm, p < 0.001), compared to baseline, which was maintained at 7 years (-0.31 ± 0.008 mm, p < 0.001). No change in IMT after 5 or 7 years was observed for the low-fat diet group. Baseline IMT had the strongest association with the changes in IMT. From baseline, reductions in carotid plaque height were observed in the Mediterranean diet group, while the low-fat group demonstrated no such change. No change in carotid plaque number was observed for either group.
Conclusions:
The investigators concluded that long-term consumption of a Mediterranean diet rich in extra virgin olive oil was associated with decreased atherosclerosis progression, as shown by reduced IMT-CC and carotid plaque height, compared to a low-fat diet.
Perspective:
These data support the current recommendation for a Mediterranean diet for secondary prevention of CHD. This dietary pattern is high in fruits and vegetables, legumes, and whole grains. In addition, participants in the current study also consumed higher amounts of oily fish, nuts, and extra virgin olive oil, while lowering the intake of red meats and processed foods compared to the typical western diet.
Clinical Topics: Diabetes and Cardiometabolic Disease, Dyslipidemia, Noninvasive Imaging, Prevention, Lipid Metabolism, Nonstatins, Statins, Echocardiography/Ultrasound, Diet
Keywords: Atherosclerosis, Carotid Artery, Common, Carotid Intima-Media Thickness, Cholesterol, Coronary Disease, Diet, Diet, Fat-Restricted, Diet, Mediterranean, Energy Intake, Fatty Acids, Fatty Acids, Monounsaturated, Fatty Acids, Unsaturated, Fruit, Nuts, Primary Prevention, Secondary Prevention, Stroke, Vegetables
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