Prevention It has been speculated that consumption of olive oil reduces the incidence of coronary heart disease, based on the observation that countries where the Mediterranean diet is consumed, chiefly Greece, Italy and Spain, have a lower incidence of coronary heart disease.
In 1999, the Lyon Diet Heart Study was published and is widely claimed to be a landmark study investigating whether a Mediterranean type diet could reduce the rate of myocardial infarction (de Lorgeril et al 1999). It was a randomised secondary prevention trial that used a Mediterranean-type diet (with butter and cream replaced by a margarine based on rapeseed/canola oil and rich in alpha-linolenic acid). At a mean follow-up of 27 months, there was a 73% decrease in combined end-points of cardiac death and non-fatal myocardial infarction, with a 70% decrease in cardiac death in the group eating the Mediterranean-style diet. Benefits were maintained for nearly 4 years after follow-up, which translates to 12 lives saved per 300 people in 27 months. Interestingly, these impressive results were obtained without lowering blood pressure, LDL-cholesterol and triglycerides, or raising HDL-cholesterol.
Several years later, data from the CARDI02000 multicentre study was used to investigate the association between acute coronary syndromes (ACS) and a
Mediterranean-style diet. Once again it was shown that the Mediterranean diet reduced the risk of developing ACS regardless of the presence of other risk factors such as hyperlipidaemia, type 2 diabetes or a sedentary lifestyle (Panagiotakos et al 2002). In this instance, primary prevention benefits were observed.
Positive results were also seen with the Indo-Mediterranean diet, which has increased intakes of whole grains, walnuts and almonds, fruit and vegetables (Singh et al 2002). The randomised trial involving 1000 patients with angina pectoris, myocardial infarction or other risk factors for coronary artery disease compared the Indo-Mediterranean diet to the Step I National Cholesterol Education Program diet and found total cardiac end-points were significantly fewer with the Indo-Mediterranean diet, as were sudden cardiac deaths and non-fatal myocardial infarctions.
Overall, these results suggest the Mediterranean diet has both primary and secondary prevention effects.
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