Mediterranean alpha-linolenic acid-rich diet in secondary prevention of coronary heart disease

• Published in: The Lancet (British edition) 1994-06, Vol.343 (8911), p.1454-1459
• Main Authors: de Lorgeril, M, Renaud, S, Salen, P, Monjaud, I, Mamelle, N, Martin, J.L, Guidollet, J, Touboul, P, Delaye, J
• Format: Article
• Language: English
• Subjects: alpha-Linolenic Acid; alpha-Linolenic Acid - administration & dosage; Blood pressure; Cardiovascular disease; Cardiovascular diseases; Coronary Disease; Coronary Disease - mortality; Coronary Disease - prevention & control; Diet; Female; Follow-Up Studies; Food and Nutrition; Health risk assessment; Humans; Life Sciences; Lipids; Male; Medical research; Middle Aged; Myocardial infarction; Prevention; Proportional Hazards Models; Prospective Studies; Risk Factors; Single-Blind Method; Survival Analysis
• ISSN: 0140-6736; 1474-547X
• DOI: 10.1016/S0140-6736(94)92580-1

Summary In a prospective, randomised single-blinded secondary prevention trial we compared the effect of a Mediterranean alpha-linolenic acid-rich diet to the usual post-infarct prudent diet. After a first myocardial infarction, patients were randomly assigned to the experimental (n=302) or control group (n=303). Patients were seen again 8 weeks after randomisation, and each year for 5 years. The experimental group consumed significantly less lipids, saturated fat, cholesterol, and linoleic acid but more oleic and alpha-linolenic acids confirmed by measurements in plasma. Serum lipids, blood pressure, and body mass index remained similar in the 2 groups. In the experimental group, plasma levels of albumin, vitamin E, and vitamin C were increased, and granulocyte count decreased. After a mean follow up of 27 months, there were 16 cardiac deaths in the control and 3 in the experimental group; 17 non-fatal myocardial infarction in the control and 5 in the experimental groups: a risk ratio for these two main endpoints combined of 0·27 (95% Cl 0·12-0·59, p=0·001) after adjustment for prognostic variables. Overall mortality was 20 in the control, 8 in the experimental group, an adjusted risk ratio of 0·30 (95% Cl 0·11-0·82, p=0·02). An alpha-linolenic acid-rich Mediterranean diet seems to be more efficient than presently used diets in the secondary prevention of coronary events and death.