An Indian experiment with nutritional modulation in acute myocardial infarction

Abstract

In a randomized, single-blind intervention trial, 406 patients 24 to 48 hours after acute myocardial infarction (AMI) were assigned to either diet A (204 patients, group A) or B (202 patients, group B) for 6 weeks. At entry to the study, mean age, male sex, risk factors, complications, possible and definite AMI, and drug therapy were comparable between the 2 groups. Dietary adherence to intervention and control diets was checked by questionnaire, and drug therapy by tablet count. Group A received significantly lower calories, a higher percentage of calories from complex carbohydrates, vegetable/fish proteins, polyunsaturated fatty acids, and a higher polyunsaturated/saturated fat ratio diet than did group B (higher total calories and saturated fatty acids). Group A also received less dietary cholesterol, salt and caffeine, and higher soluble dietary fiber, vitamins and minerals than did group B. After 6 weeks, group A had a significant decrease in mean serum total (−20.5 vs −8.6 mg/dl) and low-density lipoprotein (−16.6 vs −6.4 mg/dl) cholesterols, and triglycerides (−15.5 vs −7.6 mg/dl), with no decrease in high-density lipoprotein cholesterol (−1.5 vs −1.3 mg/dl) compared with the initial levels and changes in group B. Group A also had a greater decrease in mean body weight (3.4 vs 1.3 kg) than that of group B. A significant decrease in body weight and better modulation of blood lipids in group A were translated into a significant decrease (34.5%) in total cardiac end points including nonfatal (17 vs 25) and fatal (8 vs 12) AMI, and sudden cardiac death (4 vs 7) compared with that in group B (29 vs 44, p < 0.01, 2-tailed). Total mortality, including cardiac mortality (12 vs 21), showed no significant difference between groups A and B during 6-week follow-up. This needs further confirmation owing to the small number of events.