Effect of the Mediterranean diet on heart failure biomarkers: a randomized sample from the PREDIMED trial

Eur J Heart Fail. 2014 May;16(5):543-50. doi: 10.1002/ejhf.61. Epub 2014 Feb 24.


Aims: Scarce data are available on the effect of the traditional Mediterranean diet (TMD) on heart failure biomarkers. We assessed the effect of TMD on biomarkers related to heart failure in a high cardiovascular disease risk population.

Methods and results: A total of 930 subjects at high cardiovascular risk (420 men and 510 women) were recruited in the framework of a multicentre, randomized, controlled, parallel-group clinical trial directed at testing the efficacy of the TMD on the primary prevention of cardiovascular disease (The PREDIMED Study). Participants were assigned to a low-fat diet (control, n = 310) or one of two TMDs [TMD + virgin olive oil (VOO) or TMD + nuts]. Depending on group assignment, participants received free provision of extra-virgin olive oil, mixed nuts, or small non-food gifts. After 1 year of intervention, both TMDs decreased plasma N-terminal pro-brain natriuretic peptide, with changes reaching significance vs. control group (P < 0.05). Oxidized low-density lipoprotein decreased in both TMD groups (P < 0.05), the decrease in TMD + VOO group reaching significance vs. changes in control group (P = 0.003). Changes in lipoprotein(a) after TMD + VOO were less than those in the control group (P = 0.046) in which an increase (P = 0.035) was observed. No changes were observed in urinary albumin or albumin/creatinine ratio.

Conclusions: Individuals at high risk of cardiovascular disease (CVD) who improved their diet toward a TMD pattern reduced their N-terminal pro-brain natriuretic peptide compared with those assigned to a low-fat diet. The same was found for in vivo oxidized low-density lipoprotein and lipoprotein(a) plasma concentrations after the TMD + VOO diet. From our results TMD could be a useful tool to mitigate against risk factors for heart failure. From our results TMD could modify markers of heart failure towards a more protective mode.

Keywords: Heart failure; N-terminal pro-brain natriuretic peptide; albumin/creatinine ratio; lipoprotein a; oxidized LDL; urinary albumin.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Albuminuria / metabolism
  • Biomarkers / blood
  • Diet, Fat-Restricted / methods
  • Diet, Mediterranean*
  • Female
  • Heart Failure* / diet therapy
  • Heart Failure* / metabolism
  • Heart Failure* / prevention & control
  • Humans
  • Lipoproteins, LDL / blood*
  • Male
  • Middle Aged
  • Natriuretic Peptide, Brain / blood*
  • Nuts
  • Olive Oil
  • Peptide Fragments / blood*
  • Plant Oils
  • Primary Prevention / methods
  • Spain
  • Treatment Outcome


  • Biomarkers
  • Lipoproteins, LDL
  • Olive Oil
  • Peptide Fragments
  • Plant Oils
  • oxidized low density lipoprotein
  • pro-brain natriuretic peptide (1-76)
  • Natriuretic Peptide, Brain