Following a Mediterranean-style diet was better than following a low-fat diet for preventing a major cardiovascular event in people with established heart disease, according to a new study published in the journal The Lancet.
People with diabetes are at greater risk for cardiovascular disease, including major cardiovascular events like a heart attack or stroke. Especially for people with established cardiovascular risk factors — including elevated blood glucose levels, as well as high blood pressure and high blood lipid (cholesterol and triglyceride) levels — a major goal of health care is to prevent a major cardiovascular event, which can lead to significant loss of quality of life, disability, or death. While there is no way to completely eliminate your risk for a heart attack or stroke, there are a number of strategies that have been shown to help — including avoiding body weight swings, getting vaccinated against COVID-19, taking blood-pressure-lowering drugs, and undergoing bariatric surgery if appropriate.
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For the latest study, researchers looked at the long-term risk for major cardiovascular events in people with established coronary artery disease (CAD) who followed either a Mediterranean-style or a low-fat diet. A total of 1,002 participants recruited at a single university hospital in Córdoba, Spain, were randomly assigned to each diet group — with 500 following a low-fat diet and 502 following a Mediterranean diet. Participants ranged in age from 20 to 75, with an average age of 59.5, and 82.5% of participants were men. The main endpoint the researchers were interested in was whether participants experienced any of the following outcomes: heart attack, stroke, peripheral artery disease (PAD), revascularization surgery (a procedure to restore blood flow to blocked blood vessels), or death from cardiovascular disease.
Lower risk of cardiovascular events linked to Mediterranean diet
During a follow-up period lasting seven years, a total of 198 participants experienced at least one of the outcomes included as part of the main endpoint. This endpoint occurred in 87 participants in the Mediterranean diet group, and in 111 participants in the low-fat diet group. When the researchers broke these numbers down based on how much time passed before the endpoint, they found that the risk for members of the Mediterranean diet group was 28.1 per 1,000 person-years, compared with 37.7 per 1,000 person-years in the low-fat diet group. After adjusting for a number of factors known to affect participants’ cardiovascular risk, this translated to at least a 25% lower risk for the main endpoint in the Mediterranean diet group.
The researchers also found that the presumed benefits of following a Mediterranean diet were even greater specifically in men. In men alone, 67 out of 414 participants experienced the main endpoint in the Mediterranean diet group, compared with 94 out of 413 participants in the low-fat diet group. After adjusting for cardiovascular risk factors, this translated to a 33% lower risk for the main endpoint. In fact, the lower risk in men completely accounted for the overall lower risk seen in the study — there was no difference in the main endpoint for women in each diet group, as highlighted in an article on the study at Healio.
The researchers noted that aside from the specific finding of this study, the results show that it is possible to effectively compare dietary interventions on a large scale, over several years, in people with an elevated risk for major cardiovascular events. Further studies, they pointed out, could examine the effects of these dietary interventions in different populations — including in countries where a Mediterranean-style diet may be less a part of the local culture, and more difficult to follow.
In a previously published study involving the same group of participants, those who followed a Mediterranean-style diet experienced a smaller decline in kidney function if they had type 2 diabetes. Among participants without diabetes, there was no difference in the rate of kidney function decline between the two diet groups.
Want to learn more about the Mediterranean diet? Read “Five Reasons to Try the Mediterranean Diet” and “Eating Patterns and Type 1 Diabetes: Mediterranean Diet,” then try five of our favorite diabetes-friendly Mediterranean recipes.
