Long-term secondary prevention of cardiovascular disease with a Mediterranean diet and a low-fat diet (CORDIOPREV) a randomised controlled trial
Por:
Delgado-Lista J., Alcala-Diaz J.F., Torres-Peña J.D., Quintana-Navarro G.M., Fuentes F., Garcia-Rios A., Ortiz-Morales A.M., Perez-Caballero A.I., Yubero-Serrano E.M., Rangel-Zuñiga O.A., Camargo A., Rodriguez-Cantalejo F., Lopez-Segura F., Badimon L., Ordovas J.M., Perez-Jimenez F., Perez-Martinez P., Lopez-Miranda J., Almaden Peña Y., Aranda E., Arenas de Larriva A.P., Badimon J.J., Blanco-Molina A., Blanco-Rojo R., Bolivar-Muñoz J., Caballero-Villarraso J., Chica J., Corina A., Criado-Garcia J., Cruz-Teno C., Daponte-Codina A., de Teresa Galvan E., Delgado-Casado N., Estruch R., Fernandez J.M., Fernandez-Gandara C., Fuentes-Jimenez F., Garcia-Carpintero Fernandez-Pacheco S., Gomez-Delgado F., Gomez-Garduño A., Gomez-Luna P., Gomez-Luna M.J., Gonzalez-Guardia L., Gonzalez-Requero A.I., Gutierrez-Mariscal F.M., Haro-Mariscal C.M., Jimenez-Lucena R., Jimenez-Morales A.I., Leon-Acuña A., Marin-Hinojosa C., Meneses Alvarez M.E., Mesa-Luna D., Moya-Garrido M.N., Muñoz-Carvajal I., Navarro-Martos V., Ochoa J.J., Ortiz-Minuesa J.A., Pan M., Peña-Orihuela P., Perez-Corral I., Pi-Sunyer F.X., Ramirez-Lara I., Rodriguez-Artalejo F., Romero M.A., Roncero-Ramos I., Ruano-Ruiz J.A., Ruiz de Castroviejo J., Sanchez-Villegas P., Suarez de Lezo J., Vals-Delgado C., Valverde R., Visioli F.
Publicada:
14 may 2022
Ahead of Print:
1 may 2022
Resumen:
Background Mediterranean and low-fat diets are effective in the primary prevention of cardiovascular disease. We did a long-term randomised trial to compare the effects of these two diets in secondary prevention of cardiovascular disease.
Methods The CORDIOPREV study was a single-centre, randomised clinical trial done at the Reina Sofia University Hospital in Cordoba, Spain. Patients with established coronary heart disease (aged 20-75 years) were randomly assigned in a 1:1 ratio by the Andalusian School of Public Health to receive a Mediterranean diet or a low-fat diet intervention, with a follow-up of 7 years. Clinical investigators (physicians, investigators, and clinical endpoint committee members) were masked to treatment assignment; participants were not. A team of dietitians did the dietary interventions. The primary outcome (assessed by intention to treat) was a composite of major cardiovascular events, including myocardial infarction, revascularisation, ischaemic stroke, peripheral artery disease, and cardiovascular death. This study is registered with ClinicalTrials.gov, NCT00924937.
Findings From Oct 1, 2009, to Feb 28, 2012, a total of 1002 patients were enrolled, 500 (49.9%) in the low-fat diet group and 502 (50.1%) in the Mediterranean diet group. The mean age was 59.5 years (SD 8.7) and 827 (82.5%) of 1002 patients were men. The primary endpoint occurred in 198 participants: 87 in the Mediterranean diet group and 111 in the low-fat group (crude rate per 1000 person-years: 28.1 [95% CI 27.9-28.3] in the Mediterranean diet group vs 37.7 [37.5-37.9] in the low-fat group, log-rank p=0.039). Multivariable-adjusted hazard ratios (HRs) of the different models ranged from 0.719 (95% CI 0.541-0.957) to 0.753 (0.568-0.998) in favour of the Mediterranean diet. These effects were more evident in men, with primary endpoints occurring in 67 (16.2%) of 414 men in the Mediterranean diet group versus 94 (22.8%) of 413 men in the low-fat diet group (multiadjusted HR 0.669 [95% CI 0.489-0.915], log-rank p=0.013), than in 175 women for whom no difference was found between groups.
Interpretation In secondary prevention, the Mediterranean diet was superior to the low-fat diet in preventing major cardiovascular events. Our results are relevant to clinical practice, supporting the use of the Mediterranean diet in secondary prevention. Copyright (C) 2022 Elsevier Ltd. All rights reserved.
Filiaciones:
Delgado-Lista J.:
Lipids and Atherosclerosis Unit, Department of Internal Medicine, Hospital Universitario Reina Sofía, Córdoba, Spain
Department of Medical and Surgical Sciences, Universidad de Córdoba, Córdoba, Spain
Maimonides Institute for Biomedical Research in Córdoba (IMIBIC), Córdoba, Spain
CIBER Fisiopatologia Obesidad y Nutricion (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
Alcala-Diaz J.F.:
Lipids and Atherosclerosis Unit, Department of Internal Medicine, Hospital Universitario Reina Sofía, Córdoba, Spain
Department of Medical and Surgical Sciences, Universidad de Córdoba, Córdoba, Spain
Maimonides Institute for Biomedical Research in Córdoba (IMIBIC), Córdoba, Spain
CIBER Fisiopatologia Obesidad y Nutricion (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
Torres-Peña J.D.:
Lipids and Atherosclerosis Unit, Department of Internal Medicine, Hospital Universitario Reina Sofía, Córdoba, Spain
Maimonides Institute for Biomedical Research in Córdoba (IMIBIC), Córdoba, Spain
CIBER Fisiopatologia Obesidad y Nutricion (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
Quintana-Navarro G.M.:
Lipids and Atherosclerosis Unit, Department of Internal Medicine, Hospital Universitario Reina Sofía, Córdoba, Spain
Maimonides Institute for Biomedical Research in Córdoba (IMIBIC), Córdoba, Spain
Fuentes F.:
Lipids and Atherosclerosis Unit, Department of Internal Medicine, Hospital Universitario Reina Sofía, Córdoba, Spain
Department of Medical and Surgical Sciences, Universidad de Córdoba, Córdoba, Spain
Maimonides Institute for Biomedical Research in Córdoba (IMIBIC), Córdoba, Spain
CIBER Fisiopatologia Obesidad y Nutricion (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
Garcia-Rios A.:
Lipids and Atherosclerosis Unit, Department of Internal Medicine, Hospital Universitario Reina Sofía, Córdoba, Spain
Department of Medical and Surgical Sciences, Universidad de Córdoba, Córdoba, Spain
Maimonides Institute for Biomedical Research in Córdoba (IMIBIC), Córdoba, Spain
CIBER Fisiopatologia Obesidad y Nutricion (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
Ortiz-Morales A.M.:
Lipids and Atherosclerosis Unit, Department of Internal Medicine, Hospital Universitario Reina Sofía, Córdoba, Spain
Perez-Caballero A.I.:
Lipids and Atherosclerosis Unit, Department of Internal Medicine, Hospital Universitario Reina Sofía, Córdoba, Spain
Yubero-Serrano E.M.:
Lipids and Atherosclerosis Unit, Department of Internal Medicine, Hospital Universitario Reina Sofía, Córdoba, Spain
Maimonides Institute for Biomedical Research in Córdoba (IMIBIC), Córdoba, Spain
CIBER Fisiopatologia Obesidad y Nutricion (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
Rangel-Zuñiga O.A.:
Lipids and Atherosclerosis Unit, Department of Internal Medicine, Hospital Universitario Reina Sofía, Córdoba, Spain
Maimonides Institute for Biomedical Research in Córdoba (IMIBIC), Córdoba, Spain
CIBER Fisiopatologia Obesidad y Nutricion (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
Camargo A.:
Lipids and Atherosclerosis Unit, Department of Internal Medicine, Hospital Universitario Reina Sofía, Córdoba, Spain
Maimonides Institute for Biomedical Research in Córdoba (IMIBIC), Córdoba, Spain
CIBER Fisiopatologia Obesidad y Nutricion (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
Rodriguez-Cantalejo F.:
Biochemical Laboratory, Reina Sofia University Hospital, Córdoba, Spain
Lopez-Segura F.:
Lipids and Atherosclerosis Unit, Department of Internal Medicine, Hospital Universitario Reina Sofía, Córdoba, Spain
Maimonides Institute for Biomedical Research in Córdoba (IMIBIC), Córdoba, Spain
CIBER Fisiopatologia Obesidad y Nutricion (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
Badimon L.:
Cardiovascular Program ICCC, Hospital de la Santa Creu i Sant Pau Research Institute, IIB-Sant Pau, Barcelona, Spain
CIBER-CV, Instituto de Salud Carlos III, Spain
Cardiovascular Research Chair, UAB, Barcelona, Spain
Ordovas J.M.:
Nutrition and Genomics Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, United States
IMDEA Food Institute, Madrid, Spain
Perez-Jimenez F.:
Lipids and Atherosclerosis Unit, Department of Internal Medicine, Hospital Universitario Reina Sofía, Córdoba, Spain
Department of Medical and Surgical Sciences, Universidad de Córdoba, Córdoba, Spain
Maimonides Institute for Biomedical Research in Córdoba (IMIBIC), Córdoba, Spain
CIBER Fisiopatologia Obesidad y Nutricion (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
Perez-Martinez P.:
Lipids and Atherosclerosis Unit, Department of Internal Medicine, Hospital Universitario Reina Sofía, Córdoba, Spain
Department of Medical and Surgical Sciences, Universidad de Córdoba, Córdoba, Spain
Maimonides Institute for Biomedical Research in Córdoba (IMIBIC), Córdoba, Spain
CIBER Fisiopatologia Obesidad y Nutricion (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
Lopez-Miranda J.:
Lipids and Atherosclerosis Unit, Department of Internal Medicine, Hospital Universitario Reina Sofía, Córdoba, Spain
Department of Medical and Surgical Sciences, Universidad de Córdoba, Córdoba, Spain
Maimonides Institute for Biomedical Research in Córdoba (IMIBIC), Córdoba, Spain
CIBER Fisiopatologia Obesidad y Nutricion (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
Fuentes-Jimenez F.:
Lipids and Atherosclerosis Unit, Department of Internal Medicine, Hospital Universitario Reina Sofía, Córdoba, Spain
Department of Medical and Surgical Sciences, Universidad de Córdoba, Córdoba, Spain
Maimonides Institute for Biomedical Research in Córdoba (IMIBIC), Córdoba, Spain
CIBER Fisiopatologia Obesidad y Nutricion (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
Gonzalez-Requero A.I.:
Lipids and Atherosclerosis Unit, Department of Internal Medicine, Hospital Universitario Reina Sofía, Córdoba, Spain
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