HOW COULD CHANGES IN DIET EXPLAIN CHANGES IN CORONARY HEART-DISEASE MORTALITY IN SPAIN - THE SPANISH PARADOX

We review and compare trends in coronary heart disease (CHD) and strok e mortality in Spain from 1966 to 1990 and changes in food consumption at national and regional levels. Since 1976, a decrease in cardiovasc ular disease (CVD) mortality in males and females has been observed, a nd standardized CHD mortality rates have fallen. Stroke mortality decr eased during the same period. Trends in food consumption show increase s in intakes of meat, dairy products, fish, and fruit, but decreases i n consumption of olive oil, sugar, and all foods rich in carbohydrates . Although fat and saturated fat intakes increased, these changes were not accompanied by an increase in CHD mortality rates. This paradoxic al situation can be explained by expanded access to clinical care, inc reased consumption of fruit and fish, improved control of hypertension , and a reduction in cigarette smoking. Diet appears to have an import ant role in this paradox, but it may not be as critical as other facto rs. Nevertheless, we suggest dietary guidelines for prevention of CHD in Spain.