Primary Prevention of Cardiovascular Disease with a Mediterranean Diet Supplemented with Extra-Virgin Olive Oil or Nuts

Martínez‐González, Miguel Ángel; Ros, Emilio; Estruch, Ramón

doi:10.1056/nejmoa1800389

Cited by 2,446 publications

(1,857 citation statements)

References 31 publications

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“…While small phase II clinical trials, such as DASH-Sodium,40 have achieved these targets in the short term, they required complete control of dietary intake, which is impractical in free living populations. In contrast, the PREDIMED study,43 which promoted increased intake of potassium containing foods (fruit, vegetables, nuts) with greater adherence to the Mediterranean diet, without focusing on low sodium intake, reported a statistically significant reduction in cardiovascular disease and mortality, and adherence to a Mediterranean diet has an inconsistent correlation with sodium intake 4445. In addition, a recent analysis of the NHANES study reported that sodium intake >2.3 g/day was associated with better diet quality, compared with diets of less than 2.3 g/day, meaning that improving dietary quality is likely to be easier to achieve within a moderate sodium intake range 46.…”

Section: Discussionmentioning

confidence: 94%

Joint association of urinary sodium and potassium excretion with cardiovascular events and mortality: prospective cohort study

O’Donnell

Mente

Rangarajan

et al. 2019

BMJ

108

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ObjectiveTo evaluate the joint association of sodium and potassium urinary excretion (as surrogate measures of intake) with cardiovascular events and mortality, in the context of current World Health Organization recommendations for daily intake (<2.0 g sodium, >3.5 g potassium) in adults.DesignInternational prospective cohort study.Setting18 high, middle, and low income countries, sampled from urban and rural communities.Participants103 570 people who provided morning fasting urine samples.Main outcome measuresAssociation of estimated 24 hour urinary sodium and potassium excretion (surrogates for intake) with all cause mortality and major cardiovascular events, using multivariable Cox regression. A six category variable for joint sodium and potassium was generated: sodium excretion (low (<3 g/day), moderate (3-5 g/day), and high (>5 g/day) sodium intakes) by potassium excretion (greater/equal or less than median 2.1 g/day).ResultsMean estimated sodium and potassium urinary excretion were 4.93 g/day and 2.12 g/day, respectively. After a median follow-up of 8.2 years, 7884 (6.1%) participants had died or experienced a major cardiovascular event. Increasing urinary sodium excretion was positively associated with increasing potassium excretion (unadjusted r=0.34), and only 0.002% had a concomitant urinary excretion of <2.0 g/day of sodium and >3.5 g/day of potassium. A J-shaped association was observed of sodium excretion and inverse association of potassium excretion with death and cardiovascular events. For joint sodium and potassium excretion categories, the lowest risk of death and cardiovascular events occurred in the group with moderate sodium excretion (3-5 g/day) and higher potassium excretion (21.9% of cohort). Compared with this reference group, the combinations of low potassium with low sodium excretion (hazard ratio 1.23, 1.11 to 1.37; 7.4% of cohort) and low potassium with high sodium excretion (1.21, 1.11 to 1.32; 13.8% of cohort) were associated with the highest risk, followed by low sodium excretion (1.19, 1.02 to 1.38; 3.3% of cohort) and high sodium excretion (1.10, 1.02 to 1.18; 29.6% of cohort) among those with potassium excretion greater than the median. Higher potassium excretion attenuated the increased cardiovascular risk associated with high sodium excretion (P for interaction=0.007).ConclusionsThese findings suggest that the simultaneous target of low sodium intake (<2 g/day) with high potassium intake (>3.5 g/day) is extremely uncommon. Combined moderate sodium intake (3-5 g/day) with high potassium intake is associated with the lowest risk of mortality and cardiovascular events.

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Section: Discussionmentioning

confidence: 94%

Joint association of urinary sodium and potassium excretion with cardiovascular events and mortality: prospective cohort study

O’Donnell

Mente

Rangarajan

et al. 2019

BMJ

108

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“…Feeding mice with a high‐fibre diet increased the abundance of acetate‐producing gut bacteria, which significantly decreased myocardial hypertrophy and fibrosis (Marques, et al , ). Furthermore, a Mediterranean diet resulted in low TMAO levels, which can consequently prevent cardiovascular consequences and HF (Papadaki, et al , ; Estruch, et al , ). One study specifically demonstrated that ginger supplementation modulated the gut microbiota community, inducing a significant increase in fatty acid metabolism (Wang, et al , ).…”

Section: Gut Microbiota Interventions For Cvdmentioning

confidence: 99%

The gut microbiota and its interactions with cardiovascular disease

Wang

Feng

et al. 2020

Microbial Biotechnology

128

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Summary The intestine is colonized by a considerable community of microorganisms that cohabits within the host and plays a critical role in maintaining host homeostasis. Recently, accumulating evidence has revealed that the gut microbial ecology plays a pivotal role in the occurrence and development of cardiovascular disease (CVD). Moreover, the effects of imbalances in microbe–host interactions on homeostasis can lead to the progression of CVD. Alterations in the composition of gut flora and disruptions in gut microbial metabolism are implicated in the pathogenesis of CVD. Furthermore, the gut microbiota functions like an endocrine organ that produces bioactive metabolites, including trimethylamine/trimethylamine N‐oxide, short‐chain fatty acids and bile acids, which are also involved in host health and disease via numerous pathways. Thus, the gut microbiota and its metabolic pathways have attracted growing attention as a therapeutic target for CVD treatment. The fundamental purpose of this review was to summarize recent studies that have illustrated the complex interactions between the gut microbiota, their metabolites and the development of common CVD, as well as the effects of gut dysbiosis on CVD risk factors. Moreover, we systematically discuss the normal physiology of gut microbiota and potential therapeutic strategies targeting gut microbiota to prevent and treat CVD.

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“…41 Finally, study participants were mainly white men, limiting generalizability. The study duration might have been too short for postulated effects on endothelial function and graft fibrosis to translate into improved renal function.…”

mentioning

confidence: 99%

Effects of marine n-3 fatty acid supplementation in renal transplantation: A randomized controlled trial

Eide

Reinholt

Jenssen

et al. 2019

American Journal of Transplantation

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Marine n-3 fatty acids (FAs) may exert beneficial effects on inflammation, fibrosis, and endothelial function, which could preserve renal graft function. In this randomized controlled trial, 132 Norwegian renal transplant recipients received either 2.6 g of marine n-3 FAs or olive oil (control) daily for 44 weeks, in addition to standard care. Thirty patients did not complete the trial. The primary endpoint was change (Δ) in measured glomerular filtration rate (mGFR) during follow-up. We found no significant difference in Δ mGFR between the marine n-3 FA group and controls (6.7 vs 3.8 mL/min per 1.73 m , P = .15). Significant beneficial effects from marine n-3 FA supplementation were, however, seen in secondary endpoints plasma triglycerides, plasma high-sensitivity C-reactive protein, and brachial artery flow-mediated dilation. In the per-protocol population, the renal graft indices percent interstitial fibrosis and Chronic Allograft Damage Index also were significantly lower in the marine n-3 FA group. The cumulative incidence of adverse events did not differ between the marine n-3 FA group (n = 218) and controls (n = 240). In conclusion, marine FA supplementation did not improve renal function compared with controls, but was safe, lowered plasma triglyceride and high-sensitivity C-reactive protein levels, and improved endothelial function (Clinical.Trials.gov identifier NCT01744067).

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Primary Prevention of Cardiovascular Disease with a Mediterranean Diet Supplemented with Extra-Virgin Olive Oil or Nuts

Cited by 2,446 publications

References 31 publications

Joint association of urinary sodium and potassium excretion with cardiovascular events and mortality: prospective cohort study

Joint association of urinary sodium and potassium excretion with cardiovascular events and mortality: prospective cohort study

The gut microbiota and its interactions with cardiovascular disease

Effects of marine n-3 fatty acid supplementation in renal transplantation: A randomized controlled trial

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