Mediterranean diet and primary prevention of CAD

Nejm with article on mediterranean diet in primary prevention (see cad prevent mediterranean diet nejm 2013 in dropbox), as follows:
 
--7500 spanish patients aged 55-80, 57% women, with high cardiovascular risk (type 2 dm, or at least 3 risk factors of smoking, htn, inc LDL, low HDL, overwt/obese, or fam hx premature cad) but no evident cardiac disease. Other baseline characteristics: 40% on statins, 20% on antiplatelet rx, 50% on ACE-i. pts assessed for primary outcome of major cardiovasc event rate (MI, stroke, of death from cardiovasc causes). put on one of 3 diets:
        -mediterranean with extra olive oil (given 1 qt of extra-virgin olive oil/week)
        -mediterranean with extra mixed nuts (given 30 g mixed nuts/day)       
        -control diet (advise to reduce dietary fat).
--study stopped early, after 4.8 yrs, with (compared to control diet):
        -30% decrease in primary outcome in those on medit diet and olive oil
        -28% decrease in primary outcome in those on medit diet and mixed nuts
        -these translate to absolute risk reduction of 3 major cardiovasc events per 1000 person-yrs
 
These studies fit in with others i've sent out, which show that mediterranean diet decreases metabolic syndrome, has anti-inflammatory effects, improves endothelial function.
 
And, as with the few other dietary intervention studies in high risk pts (eg Lyon diet), the magnitude of the effect (30% reduction) is of the same order of magnitude as putting patients on statins.  Reinforces the importance of diet/exercise in preventing disease as a very powerful tool

Comments

Post a Comment

if you would like to receive the near-daily emails regularly, please email me at gmodest@uphams.org

Popular posts from this blog

cystatin c: better predictor of bad outcomes than creatinine

  another article found significant discordance between creatinine and cystatin C in assessing renal function,  finding that the latter correlated most strongly with both renal and non-renal adverse clinical outcomes (see   ckd cystatin c better than creat AJKD2023  in  dropbox or doi: 10.1053/ j.ajkd.2023.04.002)   Details: -- 158,601 adults who were in the Stockholm Creatinine Measurements (SCREAM) project and had testing of creatinine and cystatin C on the same day during a healthcare encounter, from 2010-2018     -- >400,000 outpatient tests were done for both creatinine and cystatin C levels -- mean age 62, 48% female -- mean eGFR by creatinine (   eGFR cr ) 80; mean eGFR by cystatin C ( eGFR cys  ) 73 -- mean stage of renal insufficiency: 39%  eGFR cr   90+; 38%  eGFR cr  60-89; 12%  eGFR cr  45-59; 7.1%  eGFR cr  30-44; 3.2%  eGFR cr  15-29, 0.7%  eGFR cr ...
Read more

diabetes DPP-4 inhibitors and the risk of heart failure

the FDA just came out with a safety alert about 2 DPP-4 inhibitors and the increased risk of heart failure (released 04/05/2016)(see  http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm494252.htm?source=govdelivery&utm_medium=email&utm_source=govdelivery ​ ). details: --saxagliptin and alogliptin were singled out because of 2 clinical trials in diabetic patients with heart disease. in each trial more patients taking these meds were hospitalized for heart failure vs those on placebo     --in the saxagliptin trial: 3.5% were hospitalized for heart failure (vs 2.8% on placebo). risk factors included prior heart failure or kidney disease     --in the alogliptin trial: 3.9% were hospitalized for heart failure (vs 3.3% on placebo) --recommendation by the FDA:     -- we should consider stopping these drugs if the patient develops heart failure ...
Read more

UPDATE: ASCVD risk factor critique

I decided to do an extensive update of my prior ASCVD (atherosclerotic cardiovascular disease) risk analysis and critique of risk calculators, with much more information about the “non-traditional” risk factors. I felt that there should be more data/clarification, since I think we are really undertreating/not preventing the most common cause of death by relying on the current ASCVD risk calculators   -- Cardiovascular risk models:      -- many of us rely on the various cardiovascular risk models to determine the appropriate approach to patients, and these are often integrated into the electronic medical records      -- these risk models have several very important limitations:          -- they are typically based on community data, eg from the Framingham study etc. But, in clinical practice, we are dealing with the individual and not the community:          ...
Read more