(Circulation. 1999;99:779-785.)
© 1999 American Heart Association, Inc.
Clinical Investigation and Reports |
Mediterranean Diet, Traditional Risk Factors, and the Rate of Cardiovascular Complications After Myocardial Infarction
Final Report of the Lyon Diet Heart Study
From Explorations Fonctionnelles Cardiorespiratoires et Métaboliques, CHU de Saint-Etienne (M.d.L., P.S., I.M.), Saint-Etienne; and INRETS Epidemiology Unit (J.L.M.), Hôpital Cardiovasculaire (J.D.) and INSERM Unit 265 (N.M.), Lyon, France.
Correspondence to Dr M. de Lorgeril, Explorations Fonctionnelles Cardiorespiratoires et Métaboliques, Niveau 6, CHU Nord, 42055 Saint-Etienne Cedex 2, France. E-mail lorgeril{at}univ-st-etienne.fr
Background—The Lyon Diet Heart Study is a randomized secondary prevention trial aimed at testing whether a Mediterranean-type diet may reduce the rate of recurrence after a first myocardial infarction. An intermediate analysis showed a striking protective effect after 27 months of follow-up. This report presents results of an extended follow-up (with a mean of 46 months per patient) and deals with the relationships of dietary patterns and traditional risk factors with recurrence.
Methods and Results—Three composite outcomes (COs) combining either cardiac death and nonfatal myocardial infarction (CO 1), or the preceding plus major secondary end points (unstable angina, stroke, heart failure, pulmonary or peripheral embolism) (CO 2), or the preceding plus minor events requiring hospital admission (CO 3) were studied. In the Mediterranean diet group, CO 1 was reduced (14 events versus 44 in the prudent Western-type diet group, P=0.0001), as were CO 2 (27 events versus 90, P=0.0001) and CO 3 (95 events versus 180, P=0.0002). Adjusted risk ratios ranged from 0.28 to 0.53. Among the traditional risk factors, total cholesterol (1 mmol/L being associated with an increased risk of 18% to 28%), systolic blood pressure (1 mm Hg being associated with an increased risk of 1% to 2%), leukocyte count (adjusted risk ratios ranging from 1.64 to 2.86 with count >9x109/L), female sex (adjusted risk ratios, 0.27 to 0.46), and aspirin use (adjusted risk ratios, 0.59 to 0.82) were each significantly and independently associated with recurrence.
Conclusions—The protective effect of the Mediterranean dietary pattern was maintained up to 4 years after the first infarction, confirming previous intermediate analyses. Major traditional risk factors, such as high blood cholesterol and blood pressure, were shown to be independent and joint predictors of recurrence, indicating that the Mediterranean dietary pattern did not alter, at least qualitatively, the usual relationships between major risk factors and recurrence. Thus, a comprehensive strategy to decrease cardiovascular morbidity and mortality should include primarily a cardioprotective diet. It should be associated with other (pharmacological?) means aimed at reducing modifiable risk factors. Further trials combining the 2 approaches are warranted.
Key Words: diet • trials • coronary disease • myocardial infarction
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A. Csiszar, K. Smith, N. Labinskyy, Z. Orosz, A. Rivera, and Z. Ungvari Resveratrol attenuates TNF-{alpha}-induced activation of coronary arterial endothelial cells: role of NF-{kappa}B inhibition. Am J Physiol Heart Circ Physiol, October 1, 2006; 291(4): H1694 - H1699. [Abstract] [Full Text] [PDF]
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 Developed in Collaboration With the European Heart, D. P. Zipes, A. J. Camm, M. Borggrefe, A. E. Buxton, B. Chaitman, M. Fromer, G. Gregoratos, G. Klein, A. J. Moss, et al. ACC/AHA/ESC 2006 Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: A Report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death) J. Am. Coll. Cardiol., September 5, 2006; 48(5): e247 - e346. [Full Text] [PDF]
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N. O'Kennedy, L. Crosbie, M. van Lieshout, J. I Broom, D. J Webb, and A. K Duttaroy Effects of antiplatelet components of tomato extract on platelet function in vitro and ex vivo: a time-course cannulation study in healthy humans. Am. J. Clinical Nutrition, September 1, 2006; 84(3): 570 - 579. [Abstract] [Full Text] [PDF]
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 R. C. Oh, S. A. A. Beresford, and W. E. Lafferty The Fish in Secondary Prevention of Heart Disease (FISH) Survey--Primary Care Physicians and {omega}3 Fatty Acid Prescribing Behaviors J Am Board Fam Med, September 1, 2006; 19(5): 459 - 467. [Abstract] [Full Text] [PDF]
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 Writing Committee Members, D. P. Zipes, A. J. Camm, M. Borggrefe, A. E. Buxton, B. Chaitman, M. Fromer, G. Gregoratos, G. Klein, A. J. Moss, et al. ACC/AHA/ESC 2006 guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: A report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death) Developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society Europace, September 1, 2006; 8(9): 746 - 837. [Full Text] [PDF]
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 M. Fisher, K. Lees, and J. D. Spence Nutrition and Stroke Prevention Stroke, September 1, 2006; 37(9): 2430 - 2435. [Abstract] [Full Text] [PDF]
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I. G.E. Zarraga and E. R. Schwarz Impact of Dietary Patterns and Interventions on Cardiovascular Health Circulation, August 29, 2006; 114(9): 961 - 973. [Full Text] [PDF]
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D. Giugliano, A. Ceriello, and K. Esposito The Effects of Diet on Inflammation: Emphasis on the Metabolic Syndrome J. Am. Coll. Cardiol., August 15, 2006; 48(4): 677 - 685. [Abstract] [Full Text] [PDF]
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S. Lee, K. M. Gura, S. Kim, D. A. Arsenault, B. R. Bistrian, and M. Puder Current Clinical Applications of {Omega}-6 and {Omega}-3 Fatty Acids Nutr Clin Pract, August 1, 2006; 21(4): 323 - 341. [Abstract] [Full Text] [PDF]
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K. Erdmann, N. Grosser, K. Schipporeit, and H. Schroder The ACE Inhibitory Dipeptide Met-Tyr Diminishes Free Radical Formation in Human Endothelial Cells via Induction of Heme Oxygenase-1 and Ferritin J. Nutr., August 1, 2006; 136(8): 2148 - 2152. [Abstract] [Full Text] [PDF]
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 M. A. Mittleman A 39-year-old woman with hypercholesterolemia. JAMA, July 19, 2006; 296(3): 319 - 326. [Abstract] [Full Text] [PDF]
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S. E. Chiuve, M. L. McCullough, F. M. Sacks, and E. B. Rimm Healthy Lifestyle Factors in the Primary Prevention of Coronary Heart Disease Among Men: Benefits Among Users and Nonusers of Lipid-Lowering and Antihypertensive Medications Circulation, July 11, 2006; 114(2): 160 - 167. [Abstract] [Full Text] [PDF]
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C. Wang, W. S Harris, M. Chung, A. H Lichtenstein, E. M Balk, B. Kupelnick, H. S Jordan, and J. Lau n-3 Fatty acids from fish or fish-oil supplements, but not {alpha}-linolenic acid, benefit cardiovascular disease outcomes in primary- and secondary-prevention studies: a systematic review Am. J. Clinical Nutrition, July 1, 2006; 84(1): 5 - 17. [Abstract] [Full Text] [PDF]
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 M. Pignone Low-Total-Fat Diet Did Not Reduce the Risk of Cardiovascular Events Clin. Diabetes, July 1, 2006; 24(3): 143 - 144. [Full Text] [PDF]
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K. Dalziel, L. Segal, and M. de Lorgeril A Mediterranean Diet Is Cost-Effective in Patients with Previous Myocardial Infarction J. Nutr., July 1, 2006; 136(7): 1879 - 1885. [Abstract] [Full Text] [PDF]
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D. Giugliano and K. Esposito Statins, diet, and low cholesterol. JAMA, June 7, 2006; 295(21): 2479 - 2479. [Full Text] [PDF]
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