1. Fewer composite cardiovascular events were seen in patients on a Mediterranean diet compared to low-fat diet during the 7-year period.
2. A greater benefit favouring the Mediterranean diet was seen for male participants.
Evidence Rating Level: 1 (Excellent)
Study Rundown: Cardiovascular disease is the leading cause of death globally. Lifestyle modifications are often the first steps in managing heart disease. However, there remains many questions around the optimal diet for secondary prevention of cardiovascular diseases. This study compared the Mediterranean diet compared to the low-fat diet in secondary prevention of cardiovascular events over a seven-year follow-up period. Participants were enrolled if they had known coronary artery disease and were randomly assigned to either diet. The primary outcome was a composite of major cardiovascular events, including myocardial infarction and cardiovascular death. After the follow-up period, it was found that the Mediterranean diet was superior to the low-fat diet at preventing cardiovascular events. Limitations of this study include the study location, Spain, where a Mediterranean diet may be easier to transition to and more culturally accepted. Nonetheless, this study provided comprehensive and standardized care over a long follow-up period for a complex intervention.
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In-Depth [randomized controlled trial]: The CORDIOPREV study enrolled 1002 men (82.5%) and women aged 20-75 years (average 59.5 years) who had a diagnosis of coronary heart disease. The participants were randomized 1:1 to low-fat diet or Mediterranean diet. Olive oil was provided for free for participants in the Mediterranean diet group. Physicians (cardiologists, internists) were masked to the diet of patients. The primary outcome for the study was a composite of major cardiovascular events for 7 years which includes myocardial infarction, revascularization, ischemic stroke, peripheral artery disease and cardiovascular death. The Mediterranean diet was found to be superior to the low-fat diet at preventing cardiovascular events (Hazard ratio 0.745, 95% CI 0.563-0.986; p=0.04). The absolute number of events was 87 in the Mediterranean group and 111 in the low-fat group. There was no significant difference between the primary outcome and when looking at the different components of the composite. The benefit was seen across multiple variables but the greatest effect was in male sex.
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