Mediterranean diet, traditional risk factors, and the rate of cardiovascular complications after myocardial infarction - Final report of the Lyon Diet Heart Study

Background-The Lyon Diet Heart Study is a randomized secondary prevention t rial aimed at testing whether a Mediterranean-type diet may reduce the rate of recurrence after a first myocardial infarction. An intermediate analysi s showed a striking protective effect after 27 months of follow-up. This re port presents results of an extended follow-up (with a mean of 46 months pe r patient) and deals with the relationships of dietary patterns and traditi onal risk factors with recurrence. Methods and Results-Three composite outcomes (COs) combining either cardiac death and nonfatal myocardial infarction (CO 1), or the preceding plus maj or secondary end points (unstable angina, stroke, heart failure, pulmonary or peripheral embolism) (CO 2), or the preceding plus minor events requirin g hospital admission (CO 3) were studied. In the Mediterranean diet group, CO 1 was reduced (14 events versus 44 in the prudent Western-type diet grou p, P=0.0001), as were CO 2 (27 events versus 90, P=0.0001) and CO 3 (95 eve nts versus 180, P=0.0002). Adjusted risk ratios ranged from 0.28 to 0.53, A mong the traditional risk factors, total cholesterol (1 mmol/L being associ ated with an increased risk of 18% to 28%), systolic blood pressure (1 mm H g being associated with an increased risk of 1% to 2%), leukocyte count (ad justed risk ratios ranging from 1.64 to 2.86 with count >9x10(9)/L), female sex (adjusted risk ratios, 0.27 to 0.46), and aspirin use (adjusted risk r atios, 0.59 to 0.82) were each significantly and independently associated w ith recurrence. Conclusions-The protective effect of the Mediterranean dietary pattern was maintained up to 4 years after the first infarction, confirming previous in termediate analyses. Major traditional risk factors, such as high blood cho lesterol and blood pressure, were shown to be independent and joint predict ors of recurrence, indicating that the Mediterranean dietary pattern did no t alter, at least qualitatively, the usual relationships between major risk factors and recurrence. Thus, a comprehensive strategy to decrease cardiov ascular morbidity and mortality should include primarily a cardioprotective diet. It should be associated with other (pharmacological?) means aimed at reducing modifiable risk factors. Further trials combining the 2 approache s are warranted.