Incidence of major adverse cardiovascular events decreases with greater adherence to both Mediterranean and low-fat dietary patterns in secondary prevention patients: a randomized controlled trial

BACKGROUND Recent guidelines emphasize a healthy diet as a key element in secondary cardiovascular prevention. METHODS This study included 1002 patients with cardiovascular disease from the CORDIOPREV Study (NCT00924937). Participants were randomized to follow a Mediterranean or low-fat diet for 7 years. We assessed whether the degree of dietary adherence, measured by the 14-point Mediterranean Diet Adherence Screener (MEDAS) and a 9-point low-fat diet adherence questionnaire, influenced the incidence of major cardiovascular events (MACE) in each diet and whether any diet proved superior when excluding the least adherent patients. FINDINGS MACE incidence significantly decreased with higher adherence in both diet groups (log-rank p 12, respectively. Similarly, in the low-fat diet group (n = 500), MACE rates were 37 %, 35.4 %, 32.2 %, 18.5 %, 17.4 % and 9.1 % in patients achieving an adherence score of 7, respectively. The multivariate-adjusted hazard ratios (HR) for the highest versus lowest adherence categories ranged from 0.142 to 0.148 for the Mediterranean Diet and 0.127 to 0.142 for the low-fat diet. INTERPRETATION Adherence to both dietary patterns was inversely associated with MACE recurrence over 7 years, with reductions of up to 30-35 %. High adherence to either the Mediterranean or the low-fat diet was associated with significant reductions in cardiovascular risk compared to the lowest adherence categories within each group. FUNDING Fundacion Patrimonio Comunal Olivarero; Fundacion Centro para la Excelencia en Investigacion sobre Aceite de Oliva y Salud; local, regional, and national Spanish Governments; European Union. CORDIOPREV TRIAL REGISTRATION NUMBER ClinicalTrials.gov, NCT00924937.