THE MEDITERRANEAN DIET:INSIGHTS INTO ITS ROLE IN SECONDARY CORONARY ARTERY DISEASE PREVENTION

Background: Coronary artery disease (CAD) is the leading cause of morbidity and mortality in developed countries. However, incidence rates have clear geographic differences that have been partly ascribed to dietary habits. The Mediterranean Diet (MD) has been proposed to explain this geographical differences. The positive effect of MD on CAD primary prevention is well established. On the contrary, evidence of the MD cardioprotective effect in secondary prevention is much less recognized. Aim: The primary aim of this study was to explore the effect of a MD in CAD patients in a comprehensive way that includes evaluation of classical CAD risk factors (total cholesterol, LDL and HDL cholesterol, triglycerides, blood pressure, weight, glucose levels) and “non classical” factors as inflammation, oxidative stress status, gut microbiota and alternative lipids classes. Secondary aims were to define the correlation between level of MD adherence and the induced modifications. In addition, the application of an untargeted metabolomics approach was used to evidence molecular mechanisms involved in MD cardioprotection. Materials and methods: This is a parallel-group, randomized, open-label, interventional trial to assess the effects of the MD, on CAD patients, compared to a low-fat diet (LFD). 130 CAD patients have been enrolled and randomized into the two groups (MD vs LFD). Diets effects have been evaluated comparing different features before (T0) and three months after the dietary treatments (T3). Results: The dietary treatments were able to reduce BMI, waist circumference and lipid peroxidation. Specifically, the MD allowed to decrease systolic and diastolic blood pressure, total cholesterol, LDL cholesterol and triglycerides levels. At T3 lower levels of C-reactive protein, reflecting inflammation, have been evidenced in the MD group. Furthermore, the MD intervention induced an increment of betaine, several phosphatidylcholines, lysophosphatidylcholines and phosphatidylethanolamines. These compounds have been previously correlated to lower CVD risk. Conclusions and relevance: These data suggest a positive effect of MD on CAD patients that can be the results of improving different antiatherogenic features. Their synergy could be the most important determinant of the MD positive effect. This study suggests that, a wider dissemination of Mediterranean diet should be advised as lifestyle change parallel to drug therapy in secondary CAD prevention.