Incidence of major adverse cardiovascular events decreases with greater adherence to both Mediterranean and low-fat dietary patterns in secondary prevention patients: a randomized controlled trial

Abstract

Background: Recent guidelines emphasize a healthy diet as a key element in secondary cardiovascular prevention.

Methods: This study included 1002 patients with cardiovascular disease from the CORDIOPREV Study (NCT00924937). Participants were randomized to follow a Mediterranean or low-fat diet for 7 years. We assessed whether the degree of dietary adherence, measured by the 14-point Mediterranean Diet Adherence Screener (MEDAS) and a 9-point low-fat diet adherence questionnaire, influenced the incidence of major cardiovascular events (MACE) in each diet and whether any diet proved superior when excluding the least adherent patients.

Findings: MACE incidence significantly decreased with higher adherence in both diet groups (log-rank p < 10⁻⁶). Indeed, in the Mediterranean Diet group (n = 502), MACE rates were 44.44 %, 25.49 %, 20 %, 14.77 %, 11.59 % and 10.81 % in patients achieving a MEDAS score of <9, 9, 10, 11, 12 and >12, respectively. Similarly, in the low-fat diet group (n = 500), MACE rates were 37 %, 35.4 %, 32.2 %, 18.5 %, 17.4 % and 9.1 % in patients achieving an adherence score of <4, 4, 5, 6, 7 and >7, respectively. The multivariate-adjusted hazard ratios (HR) for the highest versus lowest adherence categories ranged from 0.142 to 0.148 for the Mediterranean Diet and 0.127 to 0.142 for the low-fat diet.

Interpretation: Adherence to both dietary patterns was inversely associated with MACE recurrence over 7 years, with reductions of up to 30-35 %. High adherence to either the Mediterranean or the low-fat diet was associated with significant reductions in cardiovascular risk compared to the lowest adherence categories within each group.

Funding: Fundacion Patrimonio Comunal Olivarero; Fundacion Centro para la Excelencia en Investigacion sobre Aceite de Oliva y Salud; local, regional, and national Spanish Governments; European Union.

Cordioprev trial registration number: ClinicalTrials.gov, NCT00924937.

Keywords: Dietary intervention; Long-term secondary prevention; Low-fat Diet; Major adverse cardiovascular events; Mediterranean diet.