Monthly Archives: September 2017

Med’Diet V Statins

“Recently, researchers in Lyon, France, prospectively studied the effects of the Cretan Mediterranean diet on a group of 605 postmyocardial infarction patients (9). Patients were randomized either to the Cretan diet or to a “prudent” diet similar in composition to the American Heart Association Step 1 diet (control group). All other aspects of the patients’ health care were identical. An astonishing 70% reduction in the incidence of subsequent death and nonfatal myocardial infarction was reported in patients on the Mediterranean diet after a mean follow-up of 27 months, a ratio that was maintained through a final 48-month mean follow-up (10). Even more remarkable is that this mortality benefit occurred despite no difference between the study and the control populations in follow-up LDL and HDL cholesterol levels and only a very modest 6% drop in total cholesterol levels in both groups from 250 mg/dL to 237 mg/dL. The magnitude of benefit reported with the diet alone should be contrasted with that achievable by other routine secondary prevention therapies, including statin drugs (35% event reduction) (11), beta-blockers (15% reduction), and angiotensin-converting enzyme inhibitors (20% reduction) (12).”

Pescitarians are the longest living amongst dietary categories. The success of the Med’ diet may have something to do with fish.

“Two large prospective studies have reviewed the benefit of fish oil. The Diet and Reinfarction Trial (DART) randomized 2033 men to either a low-fat diet, a high-fiber diet, or a 200- to 400-g per week fish diet (30). There was a remarkable 29% reduction in all-cause mortality at 2 years in the fish diet group vs the other 2 groups. An even larger 62% reduction in ischemic heart disease death was noted in those patients who chose to take fish oil tablets (900 mg omega-3 per day) rather than eat fish. Fish oil has antithrombotic, antiarrhythmic, and anti-inflammatory properties in addition to lipid-lowering effects, which probably account for these results. This may help explain the beneficial results found in the a-linolenic acid–rich Mediterranean diet, as alinolenic acid is converted to DHA and EPA in the body. DART, however, had a number of confounding factors in its intricate multifactorial design, and the results are tantalizing but not convincing.

The larger GISSI Prevention Study randomized 11,324 Italians with recent myocardial infarctions to 850 mg of omega-3 fatty acids per day, 300 mg of vitamin E per day, neither, or both (31). In the fish oil group there was a statistically significant 20% reduction in total mortality at 3.5 years and a more striking 45% reduction in sudden death, reinforcing a possible antiarrhythmic property of omega-3 fatty acids. Although this study was not designed to investigate this hypothesis, a large majority of the study subjects appeared to be eating components of a Mediterranean diet at baseline, and the extra fish oil produced additive benefits.”