Mediterranean bests low-fat diet in secondary cardiovascular disease prevention

In secondary prevention of major cardiovascular events, the Mediterranean diet offers superior cardioprotective effect compared with the low-fat diet, according to the CORDIOPREV study.

CORDIOPREV included 1,002 patients (mean age 59.5 years, 82.5 percent male) with established coronary heart disease. They were randomized to undergo either a Mediterranean diet or a low-fat diet intervention, with a follow-up of 7 years.

The primary efficacy outcome was a composite of major cardiovascular events, including myocardial infarction, revascularization, ischaemic stroke, peripheral artery disease, and cardiovascular death. This was evaluated by intention to treat.

During the follow-up, a total of 198 participants experienced major cardiovascular events. The incidence was markedly lower in the Mediterranean diet group than in the low-fat group (crude rate, 28.1 vs 37.7 per 1,000 person-years; p=0.039).

In multivariable Cox analysis, the risk of individual major cardiovascular events was much lower in the Mediterranean diet group, with hazard ratios (HRs) ranging between 0.719 (95 percent confidence interval [CI], 0.541–0.957) and 0.753 (95 percent CI, 0.568–0.998).

Of note, the cardiovascular benefits seen with the Mediterranean diet were more pronounced in men, with the primary endpoint occurring in 16.2 percent as opposed to 22.8 percent in the low-fat diet group (HR, 0.669, 95 percent CI, 0.489–0.915; p=0.013).

On the other hand, there was no difference in the incidence of major cardiovascular events between the two dietary interventions in women.