Mediterranean diet is superior to low-fat diet for secondary cardiovascular prevention

In a 7-year randomised trial, men (but not women) had fewer adverse CV events with a Mediterranean diet, but it relied on an intensive, long-term dietary intervention that would be difficult to reproduce in most care settings.

The Mediterranean diet (which emphasises fruits, vegetables, legumes, cereals, white meat, fish, and olive oil) lowers the risk for first adverse cardiovascular (CV) events in high-risk people, but evidence of its long-term effectiveness for secondary prevention is sparse.

Researchers randomised 1,000 coronary artery disease patients (83% men; average age, 60) to the Mediterranean or low-fat diet in Spain. All patients saw a nutritionist at least 12 times a year and received diet-friendly food. Both groups' dietary intake changed significantly.

During a median of 7 years, the primary outcome — a composite of myocardial infarction, revascularisation, ischemic stroke, peripheral artery disease, and CV-related death — occurred significantly less frequently in the Mediterranean group than in the low-fat group (17% vs 22%). The effect was confined to men; no difference was detected among women (perhaps owing to their smaller numbers in the cohort).