Primary Prevention of Cardiovascular Disease with a Mediterranean Diet

Estruch, Ramón; Ros, Emilio; Salas‐Salvadó, Jordi; Covas, Marı́a-Isabel; Corella, Dolores; Arós, Fernando; Gómez‐Gracia, Enrique; Ruı́z-Gutı́errez, Valentina; Fiol, Miquel; Lapetra, José; Lamuela‐Raventós, Rosa M.; Serra-Majem, Lluís; Pintó, Xavier; Basora, Josep; Muñoz, Miguel Ángel; Sorlí, José V.; Martínéz, J. Alfredo; González, Carlos A.

doi:10.1056/nejmoa1200303

Cited by 3,814 publications

(2,954 citation statements)

References 39 publications

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“…The MedDiet (MedDiet/EVOO plus MedDiet/nuts versus low‐fat diet; DietGroup variable) had a protective effect (HR 0.72, 95% CI 0.54–0.97; P =0.0329) on CVD events, as reported previously for the whole PREDIMED cohort 19. The benefits of the MedDiet were similar across all estimated risk strata, for both MACE and expanded MACE, and before and after taking into account additional risk factors not included in the F‐R strategy ( P >0.4 for DietGroup×REGICOR group interaction for all comparisons) (Figure 3).…”

Section: Resultssupporting

confidence: 80%

Prediction of Cardiovascular Disease by the Framingham‐REGICOR Equation in the High‐Risk PREDIMED Cohort: Impact of the Mediterranean Diet Across Different Risk Strata

Amor

Serra‐Mir

Martínez‐González

et al. 2017

JAHA

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BackgroundThe usefulness of cardiovascular disease (CVD) predictive equations in different populations is debatable. We assessed the efficacy of the Framingham‐REGICOR scale, validated for the Spanish population, to identify future CVD in participants, who were predefined as being at high‐risk in the PREvención con DIeta MEDiterránea (PREDIMED) study—a nutrition‐intervention primary prevention trial—and the impact of adherence to the Mediterranean diet on CVD across risk categories.Methods and ResultsIn a post hoc analysis, we assessed the CVD predictive value of baseline estimated risk in 5966 PREDIMED participants (aged 55–74 years, 57% women; 48% with type 2 diabetes mellitus). Major CVD events, the primary PREDIMED end point, were an aggregate of myocardial infarction, stroke, and cardiovascular death. Multivariate‐adjusted Cox regression was used to calculate hazard ratios for major CVD events and effect modification from the Mediterranean diet intervention across risk strata (low, moderate, high, very high). The Framingham‐REGICOR classification of PREDIMED participants was 25.1% low risk, 44.5% moderate risk, and 30.4% high or very high risk. During 6‐year follow‐up, 188 major CVD events occurred. Hazard ratios for major CVD events increased in parallel with estimated risk (2.68, 4.24, and 6.60 for moderate, high, and very high risk), particularly in men (7.60, 13.16, and 15.85, respectively, versus 2.16, 2.28, and 3.51, respectively, in women). Yet among those with low or moderate risk, 32.2% and 74.3% of major CVD events occurred in men and women, respectively. Mediterranean diet adherence was associated with CVD risk reduction regardless of risk strata (P>0.4 for interaction).ConclusionsIncident CVD increased in parallel with estimated risk in the PREDIMED cohort, but most events occurred in non–high‐risk categories, particularly in women. Until predictive tools are improved, promotion of the Mediterranean diet might be useful to reduce CVD independent of baseline risk.Clinical Trial Registration URL: http://www.Controlled-trials.com. Unique identifier: ISRCTN35739639.

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Section: Resultssupporting

confidence: 80%

Prediction of Cardiovascular Disease by the Framingham‐REGICOR Equation in the High‐Risk PREDIMED Cohort: Impact of the Mediterranean Diet Across Different Risk Strata

Amor

Serra‐Mir

Martínez‐González

et al. 2017

JAHA

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“…Taken together, these finding supports the emerging understanding that lipid functionality rather than absolute cholesterol mass maybe a better indicator of atherosclerosis risk 10. In those in whom potentially lowered levels of HDL‐C is a concern, other foods that fit with a vegetarian diet such as nuts and olive oil,11 may be included to raise HDL‐C and reduce CVD risk as demonstrated by the PREDIMED trial 12…”

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confidence: 64%

“…In a systematic review and meta‐analysis of prospective cohorts, vegetarian compared with non‐vegetarian diets reduced ischemic heart disease risk by ∼30% (risk ratio [RR]= 0.71 [95% CI: 0.56, 0.87]),14 a risk reduction that is similar to what was reported in PREDIMED trial where modified‐Mediterranean diets was compared to a low‐fat diet with a 5‐year follow‐up duration 12. Furthermore, improvement of the risk factors of cardiovascular disease have been reported.…”

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confidence: 64%

“Fleshing Out” the Benefits of Adopting a Vegetarian Diet

Souza

2015

JAHA

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“…To test this hypothesis, we longitudinally investigated the association of baseline dietary ALA intake with all‐cause and cardiovascular mortality in a cohort of older persons at high cardiovascular risk enrolled into the PREvención con DIeta MEDiterránea (PREDIMED) study, a randomized nutrition intervention trial for the primary prevention of CVD conducted in Spain 10. In addition, we examined the effects on mortality of exposure to LCn‐3PUFA.…”

Section: Introductionmentioning

confidence: 99%

Dietary α‐Linolenic Acid, Marine ω‐3 Fatty Acids, and Mortality in a Population With High Fish Consumption: Findings From the PREvención con DIeta MEDiterránea (PREDIMED) Study

Sala‐Vila¹,

Guasch‐Ferré²,

Hu³

et al. 2016

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BackgroundEpidemiological evidence suggests a cardioprotective role of α‐linolenic acid (ALA), a plant‐derived ω‐3 fatty acid. It is unclear whether ALA is beneficial in a background of high marine ω‐3 fatty acids (long‐chain n‐3 polyunsaturated fatty acids) intake. In persons at high cardiovascular risk from Spain, a country in which fish consumption is customarily high, we investigated whether meeting the International Society for the Study of Fatty Acids and Lipids recommendation for dietary ALA (0.7% of total energy) at baseline was related to all‐cause and cardiovascular disease mortality. We also examined the effect of meeting the society's recommendation for long‐chain n‐3 polyunsaturated fatty acids (≥500 mg/day).Methods and ResultsWe longitudinally evaluated 7202 participants in the PREvención con DIeta MEDiterránea (PREDIMED) trial. Multivariable‐adjusted Cox regression models were fitted to estimate hazard ratios. ALA intake correlated to walnut consumption (r=0.94). During a 5.9‐y follow‐up, 431 deaths occurred (104 cardiovascular disease, 55 coronary heart disease, 32 sudden cardiac death, 25 stroke). The hazard ratios for meeting ALA recommendation (n=1615, 22.4%) were 0.72 (95% CI 0.56–0.92) for all‐cause mortality and 0.95 (95% CI 0.58–1.57) for fatal cardiovascular disease. The hazard ratios for meeting the recommendation for long‐chain n‐3 polyunsaturated fatty acids (n=5452, 75.7%) were 0.84 (95% CI 0.67–1.05) for all‐cause mortality, 0.61 (95% CI 0.39–0.96) for fatal cardiovascular disease, 0.54 (95% CI 0.29–0.99) for fatal coronary heart disease, and 0.49 (95% CI 0.22–1.01) for sudden cardiac death. The highest reduction in all‐cause mortality occurred in participants meeting both recommendations (hazard ratio 0.63 [95% CI 0.45–0.87]).ConclusionsIn participants without prior cardiovascular disease and high fish consumption, dietary ALA, supplied mainly by walnuts and olive oil, relates inversely to all‐cause mortality, whereas protection from cardiac mortality is limited to fish‐derived long‐chain n‐3 polyunsaturated fatty acids.Clinical Trial Registration URL: http://www.Controlled-trials.com/. Unique identifier: ISRCTN35739639.

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Primary Prevention of Cardiovascular Disease with a Mediterranean Diet

Cited by 3,814 publications

References 39 publications

Prediction of Cardiovascular Disease by the Framingham‐REGICOR Equation in the High‐Risk PREDIMED Cohort: Impact of the Mediterranean Diet Across Different Risk Strata

Prediction of Cardiovascular Disease by the Framingham‐REGICOR Equation in the High‐Risk PREDIMED Cohort: Impact of the Mediterranean Diet Across Different Risk Strata

“Fleshing Out” the Benefits of Adopting a Vegetarian Diet

Dietary α‐Linolenic Acid, Marine ω‐3 Fatty Acids, and Mortality in a Population With High Fish Consumption: Findings From the PREvención con DIeta MEDiterránea (PREDIMED) Study

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