title: Effect of an Indo-Mediterranean diet on progression of coronary artery disease in high risk patients (Indo-Mediterranean Diet Heart Study): a randomised single-blind trial.
abstract: The rapid emergence of coronary artery disease (CAD) in south Asian people is not explained by conventional risk factors. In view of cardioprotective effects of a Mediterranean style diet rich in alpha-linolenic acid, we assessed the benefits of this diet for patients at high risk of CAD.
  
  
  
  We did a randomised, single-blind trial in 1000 patients with angina pectoris, myocardial infarction, or surrogate risk factors for CAD. 499 patients were allocated to a diet rich in whole grains, fruits, vegetables, walnuts, and almonds. 501 controls consumed a local diet similar to the step I National Cholesterol Education Program (NCEP) prudent diet.
  
  
  
  The intervention group consumed more fruits, vegetables, legumes, walnuts, and almonds than did controls (573 g [SD 127] vs 231 g [19] per day p<0.001). The intervention group had an increased intake of whole grains and mustard or soy bean oil. The mean intake of alpha-linolenic acid was two-fold greater in the intervention group (1.8 g [SD 0.4] vs 0.8 g [0.2] per day, p<0.001). Total cardiac end points were significantly fewer in the intervention group than the controls (39 vs 76 events, p<0.001). Sudden cardiac deaths were also reduced (6 vs 16, p=0.015), as were non-fatal myocardial infarctions (21 vs 43, p<0.001). We noted a significant reduction in serum cholesterol concentration and other risk factors in both groups, but especially in the intervention diet group. In the treatment group, patients with pre-existing CAD had significantly greater benefits compared with such patients in the control group.
  
  
  
  An Indo-Mediterranean diet that is rich in alpha-linolenic acid might be more effective in primary and secondary prevention of CAD than the conventional step I NCEP prudent diet.
authors.affiliation: Centre of Nutrition and Heart, Medical Hospital and Research Centre, Moradabad, India.
authors.forename: Ram B
authors.initials: RB
authors.lastname: Singh
authors.forename: Gal
authors.initials: G
authors.lastname: Dubnov
authors.forename: Mohammad A
authors.initials: MA
authors.lastname: Niaz
authors.forename: Saraswati
authors.initials: S
authors.lastname: Ghosh
authors.forename: Reema
authors.initials: R
authors.lastname: Singh
authors.forename: Shanti S
authors.initials: SS
authors.lastname: Rastogi
authors.forename: Orly
authors.initials: O
authors.lastname: Manor
authors.forename: Daniel
authors.initials: D
authors.lastname: Pella
authors.forename: Elliot M
authors.initials: EM
authors.lastname: Berry
mesh_terms: D000787:Angina Pectoris / Q000178:diet therapy / Q000453:epidemiology / Q000517:prevention & control; D003324:Coronary Artery Disease / Q000178:diet therapy* / Q000453:epidemiology / Q000517:prevention & control; D038441:Diet, Mediterranean; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000178:diet therapy / Q000453:epidemiology / Q000517:prevention & control; D016016:Proportional Hazards Models; D012307:Risk Factors; D016037:Single-Blind Method; D016019:Survival Analysis