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Mediterranean and low-fat diets minimally decrease mortality in patients at high risk of cardiovascular disease
Clinical Question
In patients at high risk of cardiovascular disease, what is the effect of specific diets on mortality and cardiovascular events?
Bottom line
This meta-analysis, which did not include low-carbohydrate/high-fat diets or intermittent fasting (for lack of research), found the Mediterranean diet (increased fish, fruit, and vegetable intake and A LOT of olive oil) and low-fat dieting to be associated with a small benefit on reducing mortality and cardiovascular disease in patients with at least 2 risk factors. The small net benefit makes me wonder whether we should devote so much time to asking about and trying to affect diet, even in patients at high risk of adverse cardiovascular outcomes. 1a-
Reference
Study design: Meta-analysis (randomized controlled trials)
Funding: Self-funded or unfunded
Setting: Various (meta-analysis)
Synopsis
These investigators searched 6 databases, including Cochrane CENTRAL and a clinical trials database, and identified 40 English-language randomized studies that enrolled more than 35,000 participants across 7 dietary programs: low fat, 18 studies; Mediterranean, 12; very low fat, 6; modified fat, 4; combined low fat and low sodium, 3; Ornish, 3; and Pritikin, 1. All participants had at least 2 risk factors for cardiovascular disease. There were no studies of low-carbohydrate/high-fat diets or intermittent fasting included in this analysis since these have not been directly studied for their effects on cardiovascular disease and overall mortality. Two investigators independently selected studies for inclusion and extracted the data. The Mediterranean diet was associated with a small decrease in overall mortality (1.7%), as was a low-fat diet (0.9%). These diets were the most studied approaches in this analysis. The Mediterranean Diet also decreased, slightly, the risk of cardiovascular mortality (1.3%), stroke (0.7%), and nonfatal myocardial infarction (1.7%). The investigators rated the certainty of evidence as moderate for these approaches.
Reviewer
Allen F. Shaughnessy, PharmD, MMedEd
Professor of Family Medicine
Tufts University
Boston, MA
Comments
Diet and CV Risk
The American College of Lifestyle Medicine has good evidence on how lifestyle, including diet, can reduce CV risk
Impact assessment
Excellent
Diet and CV disease
The best diet is the one that keeps one's weight in the normal BMI range.
Seriously?
To see the reviewer say “The small net benefit makes me wonder whether we should devote so much time to asking about and trying to affect diet” really sums up how ignorant we still are in medicine today. When it comes to health and diet it’s sad to see this attitude permeating our CPD
MEDITERIEN AND LOW FAT DIET
GOOD TO KNOW
diète méditerranéenne
le problème avec ce genre d'étude, c'est comment il font pour mesurer la réelle adhérence des patients à la diète en question
dietary interventions
May enhance medications on health