Mediterranean Diet, Traditional Risk Factors, and the Rate of Cardiovascular Complications After Myocardial Infarction Final Report of the Lyon Diet Heart Study
TLDR
The protective effect of the Mediterranean dietary pattern was maintained up to 4 years after the first infarction, confirming previous intermediate analyses and indicating that a comprehensive strategy to decrease cardiovascular morbidity and mortality should include primarily a cardioprotective diet.Abstract:
BACKGROUND--The Lyon Diet Heart Study is a randomized secondary prevention trial aimed at testing whether a Mediterranean-type diet may reduce the rate of recurrence after a first myocardial infarction. An intermediate analysis showed a striking protective effect after 27 months of follow-up. This report presents results of an extended follow-up (with a mean of 46 months per patient) and deals with the relationships of dietary patterns and traditional risk factors with recurrence. METHODS AND RESULTS--Three composite outcomes (COs) combining either cardiac death and nonfatal myocardial infarction (CO 1), or the preceding plus major secondary end points (unstable angina, stroke, heart failure, pulmonary or peripheral embolism) (CO 2), or the preceding plus minor events requiring hospital admission (CO 3) were studied. In the Mediterranean diet group, CO 1 was reduced (14 events versus 44 in the prudent Western-type diet group, P=0.0001), as were CO 2 (27 events versus 90, P=0.0001) and CO 3 (95 events versus 180, P=0. 0002). Adjusted risk ratios ranged from 0.28 to 0.53. Among the traditional risk factors, total cholesterol (1 mmol/L being associated with an increased risk of 18% to 28%), systolic blood pressure (1 mm Hg being associated with an increased risk of 1% to 2%), leukocyte count (adjusted risk ratios ranging from 1.64 to 2.86 with count >9x10(9)/L), female sex (adjusted risk ratios, 0.27 to 0. 46), and aspirin use (adjusted risk ratios, 0.59 to 0.82) were each significantly and independently associated with recurrence. CONCLUSIONS--The protective effect of the Mediterranean dietary pattern was maintained up to 4 years after the first infarction, confirming previous intermediate analyses. Major traditional risk factors, such as high blood cholesterol and blood pressure, were shown to be independent and joint predictors of recurrence, indicating that the Mediterranean dietary pattern did not alter, at least qualitatively, the usual relationships between major risk factors and recurrence. Thus, a comprehensive strategy to decrease cardiovascular morbidity and mortality should include primarily a cardioprotective diet. It should be associated with other (pharmacological?) means aimed at reducing modifiable risk factors. Further trials combining the 2 approaches are warranted.read more
Citations
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Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study
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Heart Disease and Stroke Statistics—2017 Update: A Report From the American Heart Association
Emelia J. Benjamin,Michael J. Blaha,Stephanie E. Chiuve,Mary Cushman,Sandeep R Das,Rajat Deo,Sarah D. de Ferranti,James S. Floyd,Myriam Fornage,Cathleen Gillespie,Carmen R. Isasi,Monik C. Jim'nez,Lori Chaffn Jordan,Suzanne E. Judd,Daniel T. Lackland,Judith H. Lichtman,Lynda D. Lisabeth,Simin Liu,Chris T. Longenecker,Rachel H. Mackey,Kunihiro Matsushita,Dariush Mozaffarian,Michael E. Mussolino,Khurram Nasir,Robert W. Neumar,Latha Palaniappan,Dilip K. Pandey,Ravi R. Thiagarajan,Mathew J. Reeves,Matthew D. Ritchey,Carlos J. Rodriguez,Gregory A. Roth,Wayne D. Rosamond,Comilla Sasson,Amytis Towfghi,Connie W. Tsao,Melanie B. Turner,Salim S. Virani,Jenifer H. Voeks,Joshua Z. Willey,John T. Wilkins,Jason H Y Wu,Heather M. Alger,Sally S. Wong,Paul Muntner +44 more
TL;DR: WRITING GROUP MEMBERS Emelia J. Benjamin, MD, SCM, FAHA Michael J. Reeves, PhD Matthew Ritchey, PT, DPT, OCS, MPH Carlos J. Jiménez, ScD, SM Lori Chaffin Jordan,MD, PhD Suzanne E. Judd, PhD
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Dariush Mozaffarian,Emelia J. Benjamin,Alan S. Go,Donna K. Arnett,Michael J. Blaha,Mary Cushman,Sandeep R Das,Sarah D. de Ferranti,Jean-Pierre Després,Heather J. Fullerton,Virginia J. Howard,Mark D. Huffman,Carmen R. Isasi,Monik C. Jiménez,Suzanne E. Judd,Brett M. Kissela,Judith H. Lichtman,Lynda D. Lisabeth,Simin Liu,Rachel H. Mackey,David J. Magid,Darren K. McGuire,Emile R. Mohler,Claudia S. Moy,Paul Muntner,Michael E. Mussolino,Khurram Nasir,Robert W. Neumar,Graham Nichol,Latha Palaniappan,Dilip K. Pandey,Mathew J. Reeves,Carlos J. Rodriguez,Wayne D. Rosamond,Paul D. Sorlie,Joel M. Stein,Amytis Towfighi,Tanya N. Turan,Salim S. Virani,Daniel Woo,Robert W. Yeh,Melanie B. Turner +41 more
TL;DR: Author(s): Writing Group Members; Mozaffarian, Dariush; Benjamin, Emelia J; Go, Alan S; Arnett, Donna K; Blaha, Michael J; Cushman, Mary; Das, Sandeep R; de Ferranti, Sarah; Despres, Jean-Pierre; Fullerton, Heather J; Howard, Virginia J; Huffman, Mark D; Isasi, Carmen R; Jimenez, Monik C; Judd, Suzanne
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TL;DR: The Statistical Update represents the most up-to-date statistics related to heart disease, stroke, and the cardiovascular risk factors listed in the AHA's My Life Check - Life’s Simple 7, which include core health behaviors and health factors that contribute to cardiovascular health.
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Heart Disease and Stroke Statistics—2020 Update: A Report From the American Heart Association
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TL;DR: This year's edition of the Statistical Update includes data on the monitoring and benefits of cardiovascular health in the population, metrics to assess and monitor healthy diets, an enhanced focus on social determinants of health, a focus on the global burden of cardiovascular disease, and further evidence-based approaches to changing behaviors, implementation strategies, and implications of the American Heart Association’s 2020 Impact Goals.
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