title: Comparison of low-fat versus Mediterranean-style dietary intervention after first myocardial infarction (from The Heart Institute of Spokane Diet Intervention and Evaluation Trial).
abstract: Whether a Mediterranean-style diet reduces cardiovascular events and mortality more than a low-fat diet is uncertain. The objectives of this study were to actively compare low-fat and Mediterranean-style diets after first myocardial infarction (MI) in a randomized, controlled clinical trial and to compare dietary intervention per se with usual care in a case-control analysis. First MI survivors were randomized to a low-fat (n = 50) or Mediterranean-style (n = 51) diet. The 2 diets were low in saturated fat (< or =7% kcal) and cholesterol (< or =200 mg/day); the Mediterranean-style diet was distinguished by greater omega-3 fat intake (>0.75% kcal). Participants received individual dietary counseling sessions, 2 within the first month and again at 3, 6, 12, 18, and 24 months, along with 6 group sessions. Combined dietary intervention groups (cases, n = 101) were compared with a usual-care group (controls, n = 101) matched for age, gender, MI type and treatment, and status of diabetes mellitus and hypertension. Primary-outcome-free survival (a composite of all-cause and cardiac deaths, MI, hospital admissions for heart failure, unstable angina pectoris, or stroke) did not differ between low-fat (42 of 50) and Mediterranean-style (43 of 51) diet groups over a median follow-up period of 46 months (range 18 to 72; log-rank p = 0.81). Patients receiving dietary intervention had better primary-outcome-free survival (85 of 101) than usual-care controls (61 of 101) (log-rank p <0.001), with unadjusted and adjusted odds ratios of 0.33 (95% confidence interval 0.18 to 0.60, p <0.001) and 0.28 (95% confidence interval 0.13 to 0.63, p = 0.002), respectively. In conclusion, active intervention with either a low-fat or a Mediterranean-style diet similarly and significantly benefits overall and cardiovascular-event-free survival after MI.
authors.affiliation: The Heart Institute of Spokane, Sacred Heart Medical Center, Spokane, Washington, USA. ktuttle@shmc.org
authors.forename: Katherine R
authors.initials: KR
authors.lastname: Tuttle
authors.forename: Lynn A
authors.initials: LA
authors.lastname: Shuler
authors.forename: Diane P
authors.initials: DP
authors.lastname: Packard
authors.forename: Joan E
authors.initials: JE
authors.lastname: Milton
authors.forename: Kenn B
authors.initials: KB
authors.lastname: Daratha
authors.forename: Douglas M
authors.initials: DM
authors.lastname: Bibus
authors.forename: Robert A
authors.initials: RA
authors.lastname: Short
mesh_terms: D016001:Confidence Intervals; D018752:Diet, Fat-Restricted / Q000379:methods*; D038441:Diet, Mediterranean; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000178:diet therapy* / Q000453:epidemiology; D016017:Odds Ratio; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome; D014861:Washington / Q000453:epidemiology