title: Changes in ultrasound-assessed carotid intima-media thickness and plaque with a Mediterranean diet: a substudy of the PREDIMED trial.
abstract: OBJECTIVE
  The Prevención con Dieta Mediterránea (PREDIMED) trial showed that a Mediterranean diet (MedDiet) supplemented with either extra virgin olive oil or 30 g/d of mixed nuts reduced incident cardiovascular events compared with a control (low fat) diet. The mechanisms of cardiovascular protection afforded by MedDiets remain to be uncovered. We assessed the effect of both supplemented MedDiets on internal carotid intima-media thickness (ICA-IMT) and plaque height, the ultrasound features that best predict future cardiovascular events, in subjects at high cardiovascular risk.
  
  
  RESULTS
  In a PREDIMED subcohort (n=175), plaque height and carotid IMT of 3 prespecified segments (ICA, bifurcation, and common) were sonographically assessed at baseline and after intervention for a mean of 2.4 years. We evaluated 164 subjects with complete data. In a multivariate model, mean ICA-IMT progressed in the control diet group (mean [95% confidence interval], 0.052 mm [-0.014 to 0.118 mm]), whereas it regressed in the MedDiet+nuts group (-0.084 mm [-0.158 to -0.010 mm]; P=0.024 versus control). Similar results were observed for maximum ICA-IMT (control, 0.188 mm [0.077 to 0.299 mm]; MedDiet+nuts, -0.030 mm [-0.153 to 0.093 mm]; P=0.034) and maximum plaque height (control, 0.106 mm [0.001 to 0.210 mm]; MedDiet+nuts, -0.091 mm [-0.206 to 0.023 mm]; P=0.047). There were no changes in ICA-IMT or plaque after the MedDiet+extra virgin olive oil.
  
  
  CONCLUSIONS
  Compared with a control diet, consumption of a MedDiet supplemented with nuts is associated with delayed progression of ICA-IMT and plaque. The results contribute mechanistic evidence for the reduction of cardiovascular events observed in the PREDIMED trial.
  
  
  BACKGROUND
  http://www.controlled-trials.com. Unique identifier: ISRCTN35739639.
authors.affiliation: From the Lipid Clinic, Endocrinology and Nutrition Service, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, Barcelona, Spain (A.S.-V., E.R.); Ciber Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III (ISCIII), Madrid, Spain (A.S.-V., E.-S.R.-M., I.N., R.d.l.T., D.C., V.R.-G., M.-C.L.-S., X.P., J.R., M.-Á.M.-G., R.E., E.R.); Department of Internal Medicine, IDIBAPS, Hospital Clinic, Barcelona, Spain (E.-S.R.-M., R.E.); Diagnostic Imaging Centre, IDIBAPS, Hospital Clínic, Barcelona, Spain (R.G., I.N.); Human Pharmacology and Clinical Neurosciences Research Group, Institut de Investigacions Mèdiques Hospital del Mar, Barcelona, Spain (R.d.l.T.); Department of Preventive Medicine, University of Valencia, Valencia, Spain (D.C.); Instituto de la Grasa, Consejo Superior de Investigaciones Cientificas, Sevilla, Spain (V.R.-G.); Department of Nutrition and Food Science, School of Pharmacy, XaRTA, INSA, University of Barcelona, Barcelona, Spain (M.-C.L.-S.); Lipids and Vascular Risk Unit, Internal Medicine, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain (X.P.); Department of Cardiology, University Hospital of Alava, Vitoria, Spain (J.R.); and Department of Preventive Medicine and Public Health, School of Medicine, University of Navarra-Clínica Universidad de Navarra, Pamplona, Spain (M.-Á.M.-G.).
authors.forename: Aleix
authors.initials: A
authors.lastname: Sala-Vila
authors.forename: Edwin-Saúl
authors.initials: ES
authors.lastname: Romero-Mamani
authors.forename: Rosa
authors.initials: R
authors.lastname: Gilabert
authors.forename: Isabel
authors.initials: I
authors.lastname: Núñez
authors.forename: Rafael
authors.initials: R
authors.lastname: de la Torre
authors.forename: Dolores
authors.initials: D
authors.lastname: Corella
authors.forename: Valentina
authors.initials: V
authors.lastname: Ruiz-Gutiérrez
authors.forename: María-Carmen
authors.initials: MC
authors.lastname: López-Sabater
authors.forename: Xavier
authors.initials: X
authors.lastname: Pintó
authors.forename: Javier
authors.initials: J
authors.lastname: Rekondo
authors.forename: Miguel-Ángel
authors.initials: MÁ
authors.lastname: Martínez-González
authors.forename: Ramon
authors.initials: R
authors.lastname: Estruch
authors.forename: Emilio
authors.initials: E
authors.lastname: Ros
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002340:Carotid Artery Diseases / Q000150:complications / Q000000981:diagnostic imaging / Q000178:diet therapy*; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging*; D059168:Carotid Intima-Media Thickness; D016009:Chi-Square Distribution; D038441:Diet, Mediterranean; D018450:Disease Progression; D005260:Female; D006801:Humans; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009754:Nuts; D000069463:Olive Oil; D010938:Plant Oils; D058226:Plaque, Atherosclerotic; D011237:Predictive Value of Tests; D012307:Risk Factors; D013030:Spain; D013997:Time Factors; D016896:Treatment Outcome; D018615:Ultrasonography, Doppler, Color
chemical_list: D000069463:Olive Oil; D010938:Plant Oils
keywords: carotid intima-media thickness; carotid stenosis; diet, Mediterranean; nuts; olive oil