Mediterranean diet better than low-fat plan for secondary CV prevention: CORDIOPREV
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A Mediterranean diet was superior to a low-fat diet in preventing major CV events in secondary prevention of CVD, according to findings from the CORDIOPREV study.
In a single-center analysis following more than 1,000 patients assigned to two high-intensity diet interventions for 7 years, researchers also found the intervention effectively changed the dietary habits for both the Mediterranean and the low-fat diet groups, resulting in significant dietary changes toward the assigned diet.
“Our study shows that the Mediterranean diet rich in virgin olive oil is better than the low-fat diet to reduce CV events in persons who already have a coronary disease,” José López Miranda, MD, full professor at the University of Cordoba, Spain, head of service of internal medicine at the Reina Sofia University Hospital, principal investigator at the IMIBIC institute and senior researcher at the CIBEROBN, told Healio. “Until now, dietary recommendations of the Mediterranean diet for preventing CVD relapses were not properly supported by clinical trials. After this study, the grade of evidence for recommending the Mediterranean diet will improve, helping to implement it worldwide.”
Outcomes by diet type
Lopez Miranda and colleagues analyzed data from 1,002 adults with established CHD (aged 20 to 75 years) randomly assigned to a Mediterranean diet or a low-fat diet intervention, with a follow-up of 7 years. The mean age was 60 years and 82.5% of participants were men.
Clinical investigators were masked to treatment assignment; participants were not. The primary outcome was a composite of major CV events, including MI, revascularization, ischemic stroke, peripheral artery disease and CV death.
The findings were published in The Lancet.
Researchers found participants in both groups adhered to the two diets; the Mediterranean and the low-fat diet groups also increased their fiber intake (mean, 2.3 g per 1,000 kcal vs. 3.2 g per 1,000 kcal) due to a higher intake of vegetables, fruits and legumes. Participants in both groups also decreased intake of red or processed meats, sweet or carbonated beverages and fat spreads.
The primary endpoint occurred in 87 participants in the Mediterranean diet group and in 111 in the low-fat group, for a crude rate of 28.1 per 1,000 person-years (95% CI, 27.9-28.3) in the Mediterranean diet vs. 37.7 per 1,000 person-years (95% CI, 37.5-37.9) in the low-fat group (P = .039).
In all models, researchers found the Mediterranean diet was superior to a low-fat diet.
Adjusted HRs for the primary endpoint ranged from 0.719 (95% CI, 0.541-0.957) to 0.753 (95% CI, 0.568-0.998) in favor of the Mediterranean diet vs. low-fat eating plan.
“When evaluating the different components of the composite primary outcome, we did not find any significant statistical difference between diets,” the researchers wrote.
When evaluating patient subgroups, the Mediterranean diet was superior to the low-fat diet in participants without a family history of CHD, in those without hypertension at baseline, in those younger than 70 years at study entry, and those with LDL lower than 100 mg/dL.
“The fact that primary endpoint rates were lower than expected might support the hypothesis that the two diets had high efficacy in preventing cardiovascular recurrences and support the previous results of studies with low-fat diet vs. control diets or with the Mediterranean diet in participants at high risk in primary prevention,” the researchers wrote.
Findings significant for men
The researchers also noted that the superiority of the Mediterranean diet was higher in men, suggesting there was not enough power in the female group or that sex is a factor in the dietary response. Primary endpoints occurred in 16.2% of men in the Mediterranean diet group vs. 22.8% of men in the low-fat diet group, for an adjusted HR of 0.669 (95% CI, 0.489-0.915; P = .013); however, there were no between-group differences for the women.
“Our study shows that it is possible to establish large-population dietary interventions, and that the results in terms of CV prevention are very important,” Lopez-Miranda told Healio. “This may allow the implementation of national or international initiatives for promoting dietary interventions with the Mediterranean diet in health care settings, public or private. Additionally, another possible line of future steps is repeating the study in other countries.”
For more information:
José López Miranda, MD, can be reached at md1lomij@uco.es; Twitter: @jlopezmir.
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