AHA Science Advisory: Lyon Diet Heart Study. Benefits of a Mediterranean-style, National Cholesterol Education Program/American Heart Association Step I Dietary Pattern on Cardiovascular Disease.

Abstract

Diet is a cornerstone of cardiovascular disease (CVD) prevention and treatment efforts. Step I and Step II diets are widely recommended as the first line of CVD intervention.1 At the core of this dietary guidance are the recommendations to decrease saturated fat and cholesterol and to consume more fruits, vegetables, and whole grain products. Information from an extensive database, especially regarding saturated fat, indicates that these diets significantly lower blood cholesterol levels, a major risk factor for CVD. Consequently, it is beyond debate that these diets reduce CVD risk. Since the advent of Step I and Step II diets, nutritionists have sought to develop effective implementation strategies, including identifying dietary patterns that augment the beneficial effects of these diets. Recent findings indicate that we are making impressive progress in attaining these goals. There is provocative evidence from the Lyon Diet Heart Study2 suggesting that a Mediterranean-style, Step I diet (emphasizing more bread, more root vegetables and green vegetables, more fish, less beef, lamb and pork replaced with poultry, no day without fruit, and butter and cream replaced with margarine high in α-linolenic acid) has effects that may be superior to those observed for the usual Step I diet. These findings raise the interesting, but not yet corroborated, question of whether a modified Step I diet (ie, a Mediterranean-style Step I diet) that features a dietary pattern consistent with the new American Heart Association (AHA) Dietary Guidelines may augment the Step I or Step II diets that are presently implemented in clinical practice. Defining a Mediterranean-style diet is challenging given the broad geographical region, including at least 16 countries, that borders the Mediterranean Sea. As would be expected, there are cultural, ethnic, religious, economic, and agricultural production differences that result in different dietary practices in these areas and that …