NEW ORLEANS, Nov. 12 – For individuals who have already had a heart attack, a “Mediterranean” style diet – rich in olive oil, fruit, vegetables and fish – might be one of the best prescriptions for a longer life, researchers report today at the American Heart Association’s Scientific Sessions 2000.
“Despite the fact that good dietary habits are known to be the cornerstone of heart health, there is limited data demonstrating the amount of benefit for individuals who have had a heart attack,” says Roberto Marchioli, M.D., co-coordinator of the GISSI-Prevenzione Study at the department of clinical pharmacology and epidemiology of Consorzio Mario Negri Sud, Santa Maria Imbaro, Italy.
“A significantly lower risk of death was associated with eating more Mediterranean- style foods and fewer foods containing saturated fats, such as butter,” says Marchioli. “People in the study who had the most butter and vegetable oils in their diet had a risk of death almost triple that of people who ate more fresh fruits and vegetables and used olive oil.”
Though relatively high in fat, the Mediterranean diet is considered healthy because it is rich in potentially protective nutrients: antioxidants such as vitamin E from fruits and vegetables, monounsaturated fatty acids from olive oil and polyunsaturated fatty acids (PUFA) from fish. In general, fewer residents of Mediterranean countries, including Spain, Greece and Italy, die from coronary heart disease than their northern neighbors. Marchioli’s team was curious about the benefits of following the Mediterranean diet after a heart attack.
The GISSI-Prevenzione study, a large-scale clinical trial organized by the Italian National Association of Hospital Cardiologists and the Mario Negri Institute, evaluated the long-term changes in dietary habits of 11,324 Italians after their heart attacks. The study also assessed the effectiveness of prescribing extra amounts of substances they usually get from their diet – specifically, n-3 PUFA and vitamin E.
“N-3 polyunsaturated fatty acids include a particular kind of fat that is typically found in cold-water fish such as salmon, tuna and herring. The amount of n-3 PUFA in other foods is minimal,” says Marchioli. “This study demonstrated that taking one gram of n-3 PUFA daily, in addition to following their doctors’ lifestyle and dietary recommendations, could lower the risk of death after heart attack by 20 percent.”
GISSI-Prevenzione participants had experienced heart attacks within the three months before the study began, and received routine examinations from their cardiologists for three and a half years. Their intake of certain foods was tracked with a questionnaire given just after their heart attack and again six, 12, 18 and 42 months later.
Study participants were divided into five categories according to how much of their diet consisted of fresh and cooked vegetables, fruit, fish, olive oil and butter. The number of patient deaths in each category was noted over the duration of the study. Compared to those with “ideal” dietary habits, those who consumed the most butter had a 2.6 times greater risk of dying within 42 months after their heart attack.
The dietary benefits extended to individuals who were obese, as defined by a body mass index greater than 30. Body mass index is a formula to assess a person’s body weight relative to height.
“Though the body mass index of overweight people did not change significantly during follow-up, their dietary habits improved after their heart attacks,” says Marchioli. “Their intake of healthy foods was relatively high at baseline and further improved during follow-up.”
Researchers found that improving life-style habits – such as eliminating stress, getting more exercise, stopping smoking and eating a healthy diet – and compliance to prescribed drug treatment are the keys to preventing the recurrence of cardiovascular disease.
“Particular attention should be paid to having good dietary habits and maintaining them as time goes by,” says Marchioli. “Eat foods such as fruit, vegetables, fish and olive oil, which are rich in protective nutrients and eat few potentially harmful foods such as butter, red meat and foods rich in animal fat. You can still enjoy your life and your food without being on a strict diet. This approach could increase the feasibility of adopting healthy dietary habits that will be maintained in the long term.”
Other authors include Franco Valagussa, Maurizio Del Pinto, Luigi Nicolosi, Enrico Geraci, Francesco Mancino, Nicola Maurea, Luciano Marino, Donato Messina and Rosamaria Marfisi.
NR00-1179 (SS2000-Marchioli)