Mediterranean diet and primary prevention of CAD

The email/blog i sent out yesterday on the Mediterranean diet and diabetes prevention is a substudy of the larger PREDIMED study, and i forgot to mention that i had sent out another article on this study finding decreased development of cardiovascular disease with either of the Mediterranean diets (with extra--virgin olive oil or nuts) as compared to the low-fat diet.  this email/blog is as below.  geoff 
Nejm with article on mediterranean diet in primary prevention (see cad prevent mediterranean diet nejm 2013 in dropbox, or DOI: 10.1056/NEJMoa1200303), 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

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