Abstract
The Mediterranean diet (MD) prevents cardiovascular disease by different putative mechanisms, including modifications in the blood fatty acid (FA) profile. Polytherapy for secondary cardiovascular prevention might mask the effect of MD on the FA profile. This study was aimed to assess whether MD, in comparison with a low-fat diet (LFD), favorably modifies the blood FA profile in patients with coronary heart disease (CHD) on polytherapy. One hundred and twenty patients with a recent history of coronary stenting, randomized to MD or to LFD, completed 3 months of this open-label dietary intervention study. Diet Mediterranean-ness was evaluated using the Mediterranean Diet Adherence Screener (MeDAS) score. Both diets significantly reduced saturated FA (p < 0.01). Putative favorable changes in total n-3 FA (p = 0.03) and eicosapentaenoic acid plus docosahexaenoic acid (EPA + DHA; p = 0.04) were significantly larger with MD than with LFD. At 3 months, in the whole cohort, the MeDAS score correlated inversely with palmitic acid (R = −0.21, p = 0.02), and with palmitoleic acid (R = −0.32, p = 0.007), and positively with total n-3 FA (R = 0.19, p = 0.03), EPA (R = 0.28, p = 0.002), and EPA + DHA (R = 0.21, p = 0.02). In CHD patients on polytherapy, both MD and LFD shift FA blood composition towards a healthier profile, with a more favorable effect of MD on omega−3 levels.
Highlights
Numerous observational studies [1,2,3,4] and one large interventional study in highrisk subjects [5] consistently supported a role of Mediterranean Diet (MD) in the primary prevention of cardiovascular disease (CVD)
This study shows that, in patients with coronary heart disease (CHD), diet Mediterranean-ness exerts some distinctive favorable effects on the blood fatty acids (FA) profile beyond those that may be obtained with a “prudent” low-fat diet (LFD)
Though the magnitude of dietary-induced changes in the distribution of individual FA in blood is relatively small, it is in line with that observed in previous studies [15,20]
Summary
Numerous observational studies [1,2,3,4] and one large interventional study in highrisk subjects [5] consistently supported a role of Mediterranean Diet (MD) in the primary prevention of cardiovascular disease (CVD). Putative mechanisms by which MD may improve cardiovascular health include favorable changes in the blood FA composition and in lipoprotein levels, protection from oxidative stress, inflammation and platelet aggregation as well as increased production of beneficial metabolites or reduced production of harmful metabolites by the intestinal microbiota [8,9,10]. The relative contribution of each of these mechanisms to the cardiovascular benefits is unknown, changes in the blood FA composition might play a significant role, as FA themselves modulate pathways implicated in atherothrombosis, such as oxidative stress and inflammation. The blood FA composition was proposed as a non-traditional and potentially modifiable cardiovascular risk factor [11]
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