심장&혈관

Empirically-Derived Food Patterns And The Risk Of Total Mortality And Cardiovascular Events In The PREDIMED Study

By Martínez-González M.A., Zazpe I., Razquin C., Sánchez-Tainta A., Corella D., Salas-Salvadó J., Toledo E., Ros E., Muñoz M.A., Recondo J., Gómez-Gracia E., Fiol M., Lapetra J., Buil-Cosiales P., Serra-Majem L., Pinto X., Schröder H., Tur J.A., Sorli J.V., Lamuela-Raventós R.M., Estruch R.

BACKGROUND
There is little evidence on post hoc-derived dietary patterns (DP) and all-cause mortality in Southern-European populations. Furthermore, the potential effect modification of a DP by a nutritional intervention has not been sufficiently assessed.

OBJECTIVE
We assessed the association between a posteriori defined baseline major DP and total mortality or cardiovascular events within each of the three arms of a large primary prevention trial (PREDIMED) where participants were randomized to two active interventions with Mediterranean-type diets or to a control group (allocated to a low-fat diet).

METHOD
We followed-up 7216 participants for a median of 4.3 years. A validated 137-item food-frequency questionnaire was administered. Baseline DP were ascertained through factor analysis based on 34 predefined groups. Cox regression models were used to estimate multivariable-adjusted hazard ratios (HR) for cardiovascular disease (CVD) or mortality across quartiles of DP within each of the three arms of the trial.

RESULT
We identified two major baseline DP: the first DP was rich in red and processed meats, alcohol, refined grains and whole dairy products and was labeled Western dietary pattern (WDP). The second DP corresponded to a “Mediterranean-type” dietary pattern (MDP). During follow-up, 328 participants died. After controlling for potential confounders, higher baseline adherence to the MDP was associated with lower risk of CVD (adjusted HR for fourth vs. first quartile: 0.52; 95% CI (Confidence Interval): 0.36, 0.74; p-trend <0.001) and all-cause mortality (adjusted HR: 0.53; 95% CI: 0.38, 0.75; p-trend <0.001), regardless of the allocated arm of the trial. An increasing mortality rate was found across increasing quartiles of the WDP in the control group (allocated to a low-fat diet), though the linear trend was not statistically significant (p = 0.098).

CONCLUSION
Higher adherence to an empirically-derived MDP at baseline was associated with a reduced risk of CVD and mortality in the PREDIMED trial regardless of the allocated arm. The WDP was not associated with higher risk of mortality or cardiovascular events.

PUBLISHED : SEPTEMBER 16, 2014
STUDY TYPE : EPIDEMIOLOGY STUDY
TOPICS:HEART HEALTH, MEDITERRANEAN DIET, PREDIMED

The Evidence For Α-Linolenic Acid And Cardiovascular Disease Benefits: Comparisons With Eicosapentaenoic Acid And Docosahexaenoic Acid

By Jennifer A. Fleming, Penny M. Kris-Etherton

BACKGROUND
Our understanding of the cardiovascular disease (CVD) benefits of α-linolenic acid (ALA, 18:3n–3) has advanced markedly during the past decade. It is now evident that ALA benefits CVD risk. The expansion of the ALA evidence base has occurred in parallel with ongoing research on eicosapentaenoic acid (EPA, 20:5n–3) and docosahexaenoic acid (DHA, 22:6n–3) and CVD.

RESULT
The available evidence enables comparisons to be made for ALA vs. EPA + DHA for CVD risk reduction. The epidemiologic evidence suggests comparable benefits of plant-based and marine-derived n–3 (omega-3) PUFAs. The clinical trial evidence for ALA is not as extensive; however, there have been CVD event benefits reported. Those that have been reported for EPA + DHA are stronger because only EPA + DHA differed between the treatment and control groups, whereas in the ALA studies there were diet differences beyond ALA between the treatment and control groups. Despite this, the evidence suggests many comparable CVD benefits of ALA vs. EPA + DHA. Thus, we believe that it is time to revisit what the contemporary dietary recommendation should be for ALA to decrease the risk of CVD.

CONCLUSION
Our perspective is that increasing dietary ALA will decrease CVD risk; however, randomized controlled clinical trials are necessary to confirm this and to determine what the recommendation should be. With a stronger evidence base, the nutrition community will be better positioned to revise the dietary recommendation for ALA for CVD risk reduction.

PUBLISHED : NOVEMBER 14, 2014
STUDY TYPE : META-ANALYSIS AND/OR SYSTEMATIC REVIEW
TOPIC : HEART HEALTH
SOURCE : http://advances.nutrition.org/content/5/6/863S.abstract?etoc

Effects Of Total Dietary Polyphenols On Plasma Nitric Oxide And Blood Pressure In A High Cardiovascular Risk Cohort. The PREDIMED Randomized Trial

By Medina-Remón A., Tresserra-Rimbau A., Pons A., Tur J.A., Martorell M., Ros E., Buil-Cosiales P., Sacanella E., Covas M.I., Corella D., Salas-Salvadó J., Gómez-Gracia E., Ruiz-Gutiérrez V., Ortega-Calvo M., García-Valdueza M., Arós F., Saez G.T., Serra-Majem L., Pinto X., Vinyoles E., Estruch R., Lamuela-Raventos R.M.

BACKGROUND
Hypertension is one of the main cardiovascular risk factors in the elderly.

OBJECTIVE
The aims of this work were to evaluate if a one-year intervention with two Mediterranean diets (Med-diet) could decrease blood pressure (BP) due to a high polyphenol consumption, and if the decrease in BP was mediated by plasma nitric oxide (NO) production.

METHOD
An intervention substudy of 200 participants at high cardiovascular risk was carried out within the PREDIMED trial. They were randomly assigned to a low-fat control diet or to two Med-diets, one supplemented with extra virgin olive oil (Med-EVOO) and the other with nuts (Med-nuts). Anthropometrics and clinical parameters were measured at baseline and after one year of intervention, as well as BP, plasma NO and total polyphenol excretion (TPE) in urine samples.

RESULT
Systolic and diastolic BP decreased significantly after a one-year dietary intervention with Med-EVOO and Med-nuts. These changes were associated with a significant increase in TPE and plasma NO. Additionally, a significant positive correlation was observed between changes in urinary TPE, a biomarker of TP intake, and in plasma NO (Beta = 4.84; 95% CI: 0.57-9.10).

CONCLUSION
TPE in spot urine sample was positively correlated with plasma NO in Med-diets supplemented with either EVOO or nuts. The statistically significant increases in plasma NO were associated with a reduction in systolic and diastolic BP levels, adding to the growing evidence that polyphenols might protect the cardiovascular system by improving the endothelial function and enhancing endothelial synthesis of NO.

PUBLISHED : JANUARY 25, 2015
STUDY TYPE : RANDOMIZED CONTROLLED CLINICAL TRIAL
TOPIC : HEART HEALTH, MEDITERRANEAN DIET, PREDIMED

Dietary Total Antioxidant Capacity And Mortality In The PREDIMED Study

By P. Henriquez‑Sanchez, A. Sanchez‑Villegas, C. Ruano‑Rodriguez, A. Gea, R. M. Lamuela‑Raventos, R. Estruch, J. Salas‑Salvado, M. I. Covas, D. Corella, H. Schröder, M. Gutierrez‑Bedmar, J. M. Santos‑Lozano, X. Pintó, F. Arós, M. Fiol, A. Tresserra‑Rimbau, E. Ros, M. A. Martinez‑Gonzalez, L. Serra‑Majem

OBJECTIVE
The aim of the present study was to assess the association between the dietary total antioxidant capacity, the dietary intake of different antioxidants and mortality in a Mediterranean population at high cardiovascular disease risk.

METHOD
A total of 7,447 subjects from the PREDIMED study (multicenter, parallel group, randomized controlled clinical trial), were analyzed treating data as an observational cohort. Different antioxidant vitamin intake and total dietary antioxidant capacity were calculated from a validated 137-item food frequency questionnaire at baseline and updated yearly. Deaths were ascertained through contact with families and general practitioners, review of medical records and consultation of the National Death Index. Cox regression models were fitted to assess the relationship between dietary total antioxidant capacity and mortality. Dietary total antioxidant capacity was estimated using ferric-reducing antioxidant power assays.

RESULT
A total of 319 deaths were recorded after a median follow-up of 4.3 years. Subjects belonging to the upper quintile of antioxidant capacity were younger, ex-smokers, with high educational level, and more active and had higher alcohol intake. Multivariable-adjusted models revealed no statistically significant difference between total dietary antioxidant capacity and mortality (Q5 vs. Q1 ref HR 0.85; 95 % CI 0.60-1.20) neither for the intake of all the vitamins studied.

CONCLUSION
No statistically significant association was found between antioxidant capacity and total mortality in elderly subjects at high cardiovascular risk.

PUBLISHED : FEBRUARY 7, 2015
STUDY TYPE : EPIDEMIOLOGY STUDY
TOPIC : HEART HEALTH, MEDITERRANEAN DIET, PREDIMED
SOURCE : http://link.springer.com/article/10.1007%2Fs00394-015-0840-