Response to Letter Regarding Article, "Extravirgin Olive Oil Consumption Reduces Risk of Atrial Fibrillation: The PREDIMED (Prevención con Dieta Mediterránea) Trial".

Abstract

We appreciate the interest and kind comments by Gonzalez-Salvado et al regarding our published article on extravirgin olive oil (EVOO) consumption and a reduced risk of atrial fibrillation (AF).1 The answer to their questions about the quantity of EVOO that should be consumed to observe a reduction in the risk of AF and the between-subject variability in EVOO consumption can be found in our online-only Data Supplement published in Circulation . In the per protocol analyses shown in Table II in the online-only Data Supplement (including the 3 arms of the trial together), we demonstrated that the risk of AF was only 6.6 cases/1000 person-years when the attained consumption reached the 3 upper quintiles of consumption, whereas it was 15.5 when the consumption was in the 2 lower quintiles. This cutoff corresponded to a consumption of at least 25 g/d. More specifically, and taking into account the between-subject variability in total energy intake and after controlling for other potential confounding factors, we observed a significant reduction in the risk of AF when EVOO consumption represented ≥15% of total energy intake (please check Figure IB in the online-only Data Supplement). We acknowledge that we did not specify whether EVOO was consumed raw or cooked. Specifically we included both possibilities in our educational recommendations to participants, but we also gave the advice to our participants to frequently consume EVOO for salad dressings and as a spread. Please check http://www.predimed.es, and previous articles on our interventions in the Prevencion con Dieta Mediterranea (PREDIMED) trial.2,3 Furthermore, it is well known that EVOO is more resistant than other oils to the high-temperature heating process while cooking, …