The Mediterranean diet, which typically prioritizes eating fruits and vegetables while limiting fatty foods and animal products, is more effective than a standard low-fat diet when it comes to the secondary prevention of cardiovascular disease (CVD), according to new findings published in The Lancet.[1]
“Besides drugs and invasive interventional measures, lifestyle is a clear determinant of both incidence and recurrence of cardiovascular events,” wrote first author Javier Delgado-Lista, MD, of Hospital Universitario Reina Sofia in Spain, and colleagues. “Among its components, diet is the most studied and supported factor. The composition of the optimal diet for cardiovascular prevention has been evolving over the past decades.”
Delgado-Lista et al. noted that low-fat diets and the Mediterranean diet have both received attention in recent years for their ability to potentially prevent CVD. To compare the two diets with one another, the group tracked data from 1,002 patients for a median follow-up period of seven years. Patients were enrolled from October 2009 to February 2012. While 502 patients followed a Mediterranean diet, the remaining 500 patients followed a standard low-fat diet. The mean patient age was just shy of 60 years old, and 82.5% of patients were men.
The study’s Mediterranean diet recommendations stated that a minimum of 35% of the patient’s calories should be fat, 15% should be proteins and a maximum of 50% should be carbohydrates. The study’s low-fat diet recommendations stated that less than 30% should be total fat, 15% should be protein and a minimum of 55% should be carbohydrates. For both diets, cholesterol was limited to 300 mg or less per day. No rules related to exercise or physical activity were included in the instructions shared with patients.
The authors had face-to-face visits with patients every six months and held group sessions every three months. Telephone calls also occurred every two months, all to ensure patients and dieticians maintained communication over the course of the analysis.
Overall, major cardiovascular events — which included myocardial infarctions, revascularization, ischemic stroke, peripheral artery disease and cardiovascular mortality — were seen in 19.7% of patients; 56% of those patients were following a low-fat diet and 44% were following a Mediterranean diet. This difference was primarily seen in male patients, with researchers detecting no significant difference in the risk of major cardiovascular events among women.
Also, 17.2% of patients following a low-fat diet and 9.2% of patients following the Mediterranean diet abandoned the intervention before the study was complete. Most of these patients still gave the authors permission to examine their data, but 2.8% of low-fat diet patients and 1.2% of Mediterranean diet patients would not give permission.
“In secondary prevention, the Mediterranean diet was superior to the low-fat diet in preventing major cardiovascular events,” the authors wrote. “Our results are relevant to clinical practice, supporting the use of the Mediterranean diet in secondary prevention.”
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Michael has more than 16 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.