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Primary Prevention of Cardiovascular Disease with a Mediterranean Diet

Background Observational cohort studies and a secondary prevention trial have shown an inverse association between adherence to the Mediterranean diet and cardiovascular risk. We conducted a randomized trial of this diet pattern for the primary prevention of cardiovascular events. Methods In a multi... Full description

Journal Title: The New England Journal of Medicine 2013, Vol.368(14), pp.1279-1290
Main Author: Estruch, Ramón
Other Authors: Ros, Emilio , Salas - Salvadó, Jordi , Covas, Maria - Isabel , Corella, Dolores , Arós, Fernando , Gómez - Gracia, Enrique , Ruiz - Gutiérrez, Valentina , Fiol, Miquel , Lapetra, José , Lamuela - Raventos, Rosa Maria , Serra - Majem, Lluís , Pintó, Xavier , Basora, Josep , Muñoz, Miguel Angel , Sorlí, José V , Martínez, José Alfredo , Martínez - González, Miguel Angel
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ID: ISSN: 0028-4793 ; E-ISSN: 1533-4406 ; DOI: 10.1056/NEJMoa1200303
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recordid: nejm10.1056/NEJMoa1200303
title: Primary Prevention of Cardiovascular Disease with a Mediterranean Diet
format: Article
creator:
  • Estruch, Ramón
  • Ros, Emilio
  • Salas - Salvadó, Jordi
  • Covas, Maria - Isabel
  • Corella, Dolores
  • Arós, Fernando
  • Gómez - Gracia, Enrique
  • Ruiz - Gutiérrez, Valentina
  • Fiol, Miquel
  • Lapetra, José
  • Lamuela - Raventos, Rosa Maria
  • Serra - Majem, Lluís
  • Pintó, Xavier
  • Basora, Josep
  • Muñoz, Miguel Angel
  • Sorlí, José V
  • Martínez, José Alfredo
  • Martínez - González, Miguel Angel
subjects:
  • Medicine
ispartof: The New England Journal of Medicine, 2013, Vol.368(14), pp.1279-1290
description: Background Observational cohort studies and a secondary prevention trial have shown an inverse association between adherence to the Mediterranean diet and cardiovascular risk. We conducted a randomized trial of this diet pattern for the primary prevention of cardiovascular events. Methods In a multicenter trial in Spain, we randomly assigned participants who were at high cardiovascular risk, but with no cardiovascular disease at enrollment, to one of three diets: a Mediterranean diet supplemented with extra-virgin olive oil, a Mediterranean diet supplemented with mixed nuts, or a control diet (advice to reduce dietary fat). Participants received quarterly individual and group educational sessions and, depending on group assignment, free provision of extra-virgin olive oil, mixed nuts, or small nonfood gifts. The primary end point was the rate of major cardiovascular events (myocardial infarction, stroke, or death from cardiovascular causes). On the basis of the results of an interim analysis, the trial was stopped after a median follow-up of 4.8 years. Results A total of 7447 persons were enrolled (age range, 55 to 80 years); 57% were women. The two Mediterranean-diet groups had good adherence to the intervention, according to self-reported intake and biomarker analyses. A primary end-point event occurred in 288 participants. The multivariable-adjusted hazard ratios were 0.70 (95% confidence interval [CI], 0.54 to 0.92) and 0.72 (95% CI, 0.54 to 0.96) for the group assigned to a Mediterranean diet with extra-virgin olive oil (96 events) and the group assigned to a Mediterranean diet with nuts (83 events), respectively, versus the control group (109 events). No diet-related adverse effects were reported. Conclusions Among persons at high cardiovascular risk, a Mediterranean diet supplemented with extra-virgin olive oil or nuts reduced the incidence of major cardiovascular events. (Funded by the Spanish government's Instituto de Salud Carlos III and others; Controlled-Trials.com number, ISRCTN35739639 .) In a randomized trial, participants assigned to a Mediterranean diet supplemented with either nuts or extra-virgin olive oil had a significantly lower rate of cardiovascular events at 4.8 years than participants assigned to a low-fat control diet. The traditional Mediterranean diet is characterized by a high intake of olive oil, fruit, nuts, vegetables, and cereals; a moderate intake of fish and poultry; a low intake of dairy products, red meat, processed me
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identifier: ISSN: 0028-4793 ; E-ISSN: 1533-4406 ; DOI: 10.1056/NEJMoa1200303
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  • 0028-4793
  • 00284793
  • 1533-4406
  • 15334406
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titlePrimary Prevention of Cardiovascular Disease with a Mediterranean Diet
creatorEstruch, Ramón ; Ros, Emilio ; Salas - Salvadó, Jordi ; Covas, Maria - Isabel ; Corella, Dolores ; Arós, Fernando ; Gómez - Gracia, Enrique ; Ruiz - Gutiérrez, Valentina ; Fiol, Miquel ; Lapetra, José ; Lamuela - Raventos, Rosa Maria ; Serra - Majem, Lluís ; Pintó, Xavier ; Basora, Josep ; Muñoz, Miguel Angel ; Sorlí, José V ; Martínez, José Alfredo ; Martínez - González, Miguel Angel
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descriptionBackground Observational cohort studies and a secondary prevention trial have shown an inverse association between adherence to the Mediterranean diet and cardiovascular risk. We conducted a randomized trial of this diet pattern for the primary prevention of cardiovascular events. Methods In a multicenter trial in Spain, we randomly assigned participants who were at high cardiovascular risk, but with no cardiovascular disease at enrollment, to one of three diets: a Mediterranean diet supplemented with extra-virgin olive oil, a Mediterranean diet supplemented with mixed nuts, or a control diet (advice to reduce dietary fat). Participants received quarterly individual and group educational sessions and, depending on group assignment, free provision of extra-virgin olive oil, mixed nuts, or small nonfood gifts. The primary end point was the rate of major cardiovascular events (myocardial infarction, stroke, or death from cardiovascular causes). On the basis of the results of an interim analysis, the trial was stopped after a median follow-up of 4.8 years. Results A total of 7447 persons were enrolled (age range, 55 to 80 years); 57% were women. The two Mediterranean-diet groups had good adherence to the intervention, according to self-reported intake and biomarker analyses. A primary end-point event occurred in 288 participants. The multivariable-adjusted hazard ratios were 0.70 (95% confidence interval [CI], 0.54 to 0.92) and 0.72 (95% CI, 0.54 to 0.96) for the group assigned to a Mediterranean diet with extra-virgin olive oil (96 events) and the group assigned to a Mediterranean diet with nuts (83 events), respectively, versus the control group (109 events). No diet-related adverse effects were reported. Conclusions Among persons at high cardiovascular risk, a Mediterranean diet supplemented with extra-virgin olive oil or nuts reduced the incidence of major cardiovascular events. (Funded by the Spanish government's Instituto de Salud Carlos III and others; Controlled-Trials.com number, ISRCTN35739639 .) In a randomized trial, participants assigned to a Mediterranean diet supplemented with either nuts or extra-virgin olive oil had a significantly lower rate of cardiovascular events at 4.8 years than participants assigned to a low-fat control diet. The traditional Mediterranean diet is characterized by a high intake of olive oil, fruit, nuts, vegetables, and cereals; a moderate intake of fish and poultry; a low intake of dairy products, red meat, processed meats, and sweets; and wine in moderation, consumed with meals.1 In observational cohort studies2,3 and a secondary prevention trial (the Lyon Diet Heart Study),4 increasing adherence to the Mediterranean diet has been consistently beneficial with respect to cardiovascular risk.2–4 A systematic review ranked the Mediterranean diet as the most likely dietary model to provide protection against coronary heart disease.5 Small clinical trials have uncovered . . .
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16Martínez, José Alfredo
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titlePrimary Prevention of Cardiovascular Disease with a Mediterranean Diet
descriptionBackground Observational cohort studies and a secondary prevention trial have shown an inverse association between adherence to the Mediterranean diet and cardiovascular risk. We conducted a randomized trial of this diet pattern for the primary prevention of cardiovascular events. Methods In a multicenter trial in Spain, we randomly assigned participants who were at high cardiovascular risk, but with no cardiovascular disease at enrollment, to one of three diets: a Mediterranean diet supplemented with extra-virgin olive oil, a Mediterranean diet supplemented with mixed nuts, or a control diet (advice to reduce dietary fat). Participants received quarterly individual and group educational sessions and, depending on group assignment, free provision of extra-virgin olive oil, mixed nuts, or small nonfood gifts. The primary end point was the rate of major cardiovascular events (myocardial infarction, stroke, or death from cardiovascular causes). On the basis of the results of an interim analysis, the trial was stopped after a median follow-up of 4.8 years. Results A total of 7447 persons were enrolled (age range, 55 to 80 years); 57% were women. The two Mediterranean-diet groups had good adherence to the intervention, according to self-reported intake and biomarker analyses. A primary end-point event occurred in 288 participants. The multivariable-adjusted hazard ratios were 0.70 (95% confidence interval [CI], 0.54 to 0.92) and 0.72 (95% CI, 0.54 to 0.96) for the group assigned to a Mediterranean diet with extra-virgin olive oil (96 events) and the group assigned to a Mediterranean diet with nuts (83 events), respectively, versus the control group (109 events). No diet-related adverse effects were reported. Conclusions Among persons at high cardiovascular risk, a Mediterranean diet supplemented with extra-virgin olive oil or nuts reduced the incidence of major cardiovascular events. (Funded by the Spanish government's Instituto de Salud Carlos III and others; Controlled-Trials.com number, ISRCTN35739639 .) In a randomized trial, participants assigned to a Mediterranean diet supplemented with either nuts or extra-virgin olive oil had a significantly lower rate of cardiovascular events at 4.8 years than participants assigned to a low-fat control diet. The traditional Mediterranean diet is characterized by a high intake of olive oil, fruit, nuts, vegetables, and cereals; a moderate intake of fish and poultry; a low intake of dairy products, red meat, processed meats, and sweets; and wine in moderation, consumed with meals.1 In observational cohort studies2,3 and a secondary prevention trial (the Lyon Diet Heart Study),4 increasing adherence to the Mediterranean diet has been consistently beneficial with respect to cardiovascular risk.2–4 A systematic review ranked the Mediterranean diet as the most likely dietary model to provide protection against coronary heart disease.5 Small clinical trials have uncovered . . .
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abstractBackground Observational cohort studies and a secondary prevention trial have shown an inverse association between adherence to the Mediterranean diet and cardiovascular risk. We conducted a randomized trial of this diet pattern for the primary prevention of cardiovascular events. Methods In a multicenter trial in Spain, we randomly assigned participants who were at high cardiovascular risk, but with no cardiovascular disease at enrollment, to one of three diets: a Mediterranean diet supplemented with extra-virgin olive oil, a Mediterranean diet supplemented with mixed nuts, or a control diet (advice to reduce dietary fat). Participants received quarterly individual and group educational sessions and, depending on group assignment, free provision of extra-virgin olive oil, mixed nuts, or small nonfood gifts. The primary end point was the rate of major cardiovascular events (myocardial infarction, stroke, or death from cardiovascular causes). On the basis of the results of an interim analysis, the trial was stopped after a median follow-up of 4.8 years. Results A total of 7447 persons were enrolled (age range, 55 to 80 years); 57% were women. The two Mediterranean-diet groups had good adherence to the intervention, according to self-reported intake and biomarker analyses. A primary end-point event occurred in 288 participants. The multivariable-adjusted hazard ratios were 0.70 (95% confidence interval [CI], 0.54 to 0.92) and 0.72 (95% CI, 0.54 to 0.96) for the group assigned to a Mediterranean diet with extra-virgin olive oil (96 events) and the group assigned to a Mediterranean diet with nuts (83 events), respectively, versus the control group (109 events). No diet-related adverse effects were reported. Conclusions Among persons at high cardiovascular risk, a Mediterranean diet supplemented with extra-virgin olive oil or nuts reduced the incidence of major cardiovascular events. (Funded by the Spanish government's Instituto de Salud Carlos III and others; Controlled-Trials.com number, ISRCTN35739639 .) In a randomized trial, participants assigned to a Mediterranean diet supplemented with either nuts or extra-virgin olive oil had a significantly lower rate of cardiovascular events at 4.8 years than participants assigned to a low-fat control diet. The traditional Mediterranean diet is characterized by a high intake of olive oil, fruit, nuts, vegetables, and cereals; a moderate intake of fish and poultry; a low intake of dairy products, red meat, processed meats, and sweets; and wine in moderation, consumed with meals.1 In observational cohort studies2,3 and a secondary prevention trial (the Lyon Diet Heart Study),4 increasing adherence to the Mediterranean diet has been consistently beneficial with respect to cardiovascular risk.2–4 A systematic review ranked the Mediterranean diet as the most likely dietary model to provide protection against coronary heart disease.5 Small clinical trials have uncovered . . .
pubMassachusetts Medical Society
doi10.1056/NEJMoa1200303
pages1279-1290
date2013-04-04