Key result
Low-fat diet increases MACE risk ~45% vs. Mediterranean diet in CHD patients with moderate endotoxemia.
Why the study?
Translocation of proinflammatory bacterial components such as lipopolysaccharide into systemic circulation has been linked to CVD, but its association with MACE recurrence in CHD patients and the influence of diet remained to be evaluated.
Does the Mediterranean diet compared to a low-fat diet reduce the risk of major adverse cardiovascular events in patients with coronary heart disease and postprandial endotoxemia?
RCT (n=1,002)
randomly assigned
Does the Mediterranean diet compared to a low-fat diet reduce the risk of major adverse cardiovascular events in patients with coronary heart disease and postprandial endotoxemia?
Hazard Ratio: 1.45 (95% CI 1.01–2.09)
Postprandial endotoxemia predicts recurrent MACE in CHD patients, and the Mediterranean diet provides better secondary prevention than a low-fat diet in those with moderate endotoxemia.
Elevated postprandial LPS signals higher recurrent MACE risk in CHD; confirms endotoxemia as a prognostic biomarker warranting targeted dietary trials.
Background The translocation into the systemic circulation of proinflammatory bacterial components such as lipopolysaccharide (LPS) has been linked to cardiovascular disease (CVD). Objectives We aimed to evaluate the association between baseline postprandial endotoxemia and the risk of suffering major adverse cardiovascular events (MACE) in patients with coronary heart disease (CHD), as well as the influence of consuming a low-fat (LF) diet or the Mediterranean (MED) diet on the associated risk. Methods Our research was conducted within the framework of the CORDIOPREV Study, a clinical trial which involved 1002 patients with CHD randomly assigned to consume an LF diet or the MED diet for 7 y. A mixed meal was administered at the beginning of the study and after 3 y of follow-up. LPS plasma concentrations were measured by Limulus Amebocyte Lysate (LAL) colorimetric assay and gut microbiota was analyzed using 16S metagenomics. Results Baseline postprandial increase in LPS plasma concentrations were associated with recurrence of MACE after a follow-up of 7 y, using Cox regression analysis [hazard ratio (HR):1.42 (1.01, 2.00)]. Patients with moderate LPS postprandial increase and consuming LF diet had higher risk of suffering MACE compared with the MED diet [HR: 1.45 (1.01, 2.09)]. Both diets reduced LPS plasma concentrations and formed a gut microbiota profile associated with a postprandial LPS decrease. Conclusions Our results suggest that the magnitude of postprandial endotoxemia is associated with suffering new MACE in patients with CHD, with the MED diet exercising a higher preventive role than an LF diet. Our results especially are relevant to clinical practice, supporting the measurement of postprandial endotoxemia as a tool for personalized medicine in secondary prevention. This study was registered at clinicaltrials.gov as NCT00924937.
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Arenas‐Montes et al. (2026) conducted an RCT in coronary heart disease (CHD) (n=1,002). Low-fat (LF) diet vs. Mediterranean (MED) diet was evaluated on major adverse cardiovascular events (MACE) (HR 1.45, 95% CI 1.01-2.09). Among patients with coronary heart disease and moderate postprandial endotoxemia, a low-fat diet increased the risk of MACE compared with a Mediterranean diet (HR 1.45; 95% CI 1.01-2.09).
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