Mediterranean diet slows atherosclerosis progression: Time to shift?

Many diets, whether it be low fat or low carbs, perform about equally miserably in the long term, but this one sounds different. Compared with a low-fat diet, the Mediterranean diet appeared more effective at reducing atherosclerosis progression in patients with coronary heart disease for up to 7 years, suggests an analysis of the CORDIOPREV* study.

“This is the first study to establish an effective dietary strategy for secondary cardiovascular prevention, reinforcing the Mediterranean diet – one that is rich in extra virgin olive oil – in the prevention of atherosclerosis progression,” said study author Dr Jose Jimenez-Torres from the Reina Sofia University Hospital in Córdoba, Spain, and his colleagues. “Patients with a higher atherosclerotic burden appeared to benefit the most.”

“The role of the Mediterranean diet in reducing cardiovascular risk is not a novel concept in primary prevention. But there isn’t any consensus about a recommended dietary model for the secondary prevention of cardiovascular disease (CVD),” added co-author Dr Elena M. Yubero-Serrano from the same institution.

The winner of 2 diets

The experts compared the effects of the low-fat vs Mediterranean diet in 1,002 patients for the secondary prevention of CVD, a key secondary endpoint of the CORDIOPREV study. [Stroke 2021;doi:10.1161/STROKEAHA.120.033214]

Half of the patients follow a Mediterranean diet rich in extra virgin olive oil, fruits and vegetables, whole grains, fish, and nuts whereas the other half follow a diet low in fat, but rich in complex carbohydrates.

There were 459 participants in the low-fat diet group and 480 in the Mediterranean diet group. Both groups completed the intima-media thickness evaluation of both common carotid arteries (IMT-CC) – a valid predictor of CVD risk – at baseline.  At least 809 (377 and 432, respectively) completed the IMT-CC evaluation at 5 years and 731 (335 and 396, respectively) at 7 years.

IMT-CC decreased at 5 and 7 years

After 5 years, the Mediterranean diet significantly decreased the IMT-CC (-0.027; p< 0.001) compared to baseline. The same was true after 7 years (-0.031 mm; p<0.001). By contrast, the low-fat diet did not exert any change on IMT-CC either at 5 or 7 years.

The higher the IMT-CC at baseline, the greater the reduction in IMT-CC.

There were also greater reductions in the IMT-CC and carotid plaque maximum height with the Mediterranean diet than the low-fat diet throughout follow-up. No between-group differences in carotid plaque numbers were observed.

“Other than reinforcing the clinical benefits of the Mediterranean diet, our data provide a beneficial dietary strategy as a clinical and therapeutic tool that could reduce the high CVD recurrence in the context of secondary prevention,” said Yubero-Serrano.