Benefits of the Mediterranean Diet: Insights From the PREDIMED Study

• Published in: Progress in cardiovascular diseases Vol. 58; no. 1; pp. 50 - 60
• Main Authors: Martínez-González, Miguel A., Salas-Salvadó, Jordi, Estruch, Ramón, Corella, Dolores, Fitó, Montse, Ros, Emilio
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.07.2015
• Subjects: Atrial fibrillation; Cardiovascular; Cardiovascular Diseases - genetics; Cardiovascular Diseases - mortality; Cardiovascular Diseases - prevention & control; Diet, Mediterranean; Dietary intervention; Evidence-Based Medicine; Gene-Environment Interaction; Genetic Predisposition to Disease; Health Status; Humans; Mediterranean diet; Myocardial Infarction - mortality; Myocardial Infarction - prevention & control; Peripheral artery disease; Phenotype; Primary prevention; Primary Prevention - methods; Prognosis; Protective Factors; Randomized Controlled Trials as Topic; Randomized trials; Risk Assessment; Risk Factors; Risk Reduction Behavior; Stroke; Stroke - mortality; Stroke - prevention & control; Time Factors; Type-2 diabetes; T2DM; RCT; Dietary intervention; Stroke; HTN; AF; Mediterranean diet; Atrial fibrillation; Peripheral artery disease; DLP; CVD; FFQ; Type-2 diabetes; EVOO; PAD; CV; MetS; Primary prevention; Randomized trials; MeDiet; CHD; PREDIMED; PREvención con DIeta MEDiterránea; atrial fibrillation; type 2 diabetes mellitus; randomized control trial; peripheral artery disease; food frequency questionnaire; cardiovascular; extra-virgin olive oil; metabolic syndrome; CV disease; coronary heart disease; dyslipidemia; hypertension
• ISSN: 0033-0620; 1532-8643; 1873-1740
• DOI: 10.1016/j.pcad.2015.04.003

The PREDIMED (PREvención con DIeta MEDiterránea) multicenter, randomized, primary prevention trial assessed the long-term effects of the Mediterranean diet (MeDiet) on clinical events of cardiovascular disease (CVD). We randomized 7447 men and women at high CVD risk into three diets: MeDiet supplemented with extra-virgin olive oil (EVOO), MeDiet supplemented with nuts, and control diet (advice on a low-fat diet). No energy restriction and no special intervention on physical activity were applied. We observed 288 CVD events (a composite of myocardial infarction, stroke or CVD death) during a median time of 4.8years; hazard ratios were 0.70 (95% CI, 0.53–0.91) for the MeDiet+EVOO and 0.70 (CI, 0.53–0.94) for the MeDiet+nuts compared to the control group. Respective hazard ratios for incident diabetes (273 cases) among 3541 non-diabetic participants were 0.60 (0.43–0.85) and 0.82 (0.61–1.10) for MeDiet+EVOO and MeDiet+nuts, respectively versus control. Significant improvements in classical and emerging CVD risk factors also supported a favorable effect of both MeDiets on blood pressure, insulin sensitivity, lipid profiles, lipoprotein particles, inflammation, oxidative stress, and carotid atherosclerosis. In nutrigenomic studies beneficial effects of the intervention with MedDiets showed interactions with several genetic variants (TCF7L2, APOA2, MLXIPL, LPL, FTO, M4CR, COX-2, GCKR and SERPINE1) with respect to intermediate and final phenotypes. Thus, the PREDIMED trial provided strong evidence that a vegetable-based MeDiet rich in unsaturated fat and polyphenols can be a sustainable and ideal model for CVD prevention.