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Effect of an Indo-Mediterranean diet on progression of coronary artery disease in high-risk patients (Indo-Mediterranean diet heart study): a randomized single-blind trial
treatment and other covariable risk factors. There was no significant association between fish or omega-3 PUFA intake and risk of hemorrhagic stroke. There was no effect on stroke risk by fish oil use (2.7% of men) and intake of alpha linolenic acid. Conclusions: Eating fish once per month or more can reduce the risk of ischemic stroke in men. Perspective: The results are similar to other studies in men and women but differ in that very little cold water fish was necessary to reduce the risk of ischemic stroke. The benefits attributable to fish and omega-3 PUFA could be related to a favorable effect on lipids, platelet activity, endothelial function and threshold for ventricular dysrhythmias. Too few men were taking fish oil or alpha linolenic acid (flax seed, which is converted to EPA) supplements to determine their benefit. Whether EPA with or without aspirin increases the risk of hemorrhagic strokes is not yet clear. MR
group did not change their caloric distribution from baseline and differed significantly from the Indo-Med diet for each nutrient variable. The Indo-Med diet was associated with more weight loss, a decrease in waist to hip ratio, lower blood pressure and a greater improvement in lipids and blood sugar, but less smoking cessation. The Indo-Med diet was associated with a decrease in fatal and nonfatal MIs and sudden cardiac death, less CV events (10 vs. 19%, p⬍0.0001), significantly less heart failure, angina and CABG or PCIs, fewer positive stress tests, less LVH and strain on ECG and a borderline decrease in total deaths (5% vs. 8%, p⫽0.06). Conclusions: An Indo-Mediterranean diet that is rich in alpha-linolenic acid appears to be more effective in the primary and secondary prevention of CAD than the conventional NCEP 1 prudent diet. Perspective: There has been convincing evidence of a cardioprotective effect from omega-3 PUFAs from marine oils in cold water fish or supplements. This study shows a marked benefit of alpha-linolenic acid contained omega-3 PUFAs from grains and nuts in a high-risk undertreated Asian Indian population. MR
Effect of an Indo-Mediterranean Diet on Progression of Coronary Artery Disease in HighRisk Patients (Indo-Mediterranean Diet Heart Study): A Randomized Single-Blind Trial
Major Outcomes in Moderately Hypercholesterolemic, Hypertensive Patients Randomized to Pravastatin vs. Usual Care. The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT-LLT)
Singh RB, Dubnov G, Niaz MA, et al. Lancet 2002;360:1455– 61. Study Question: Does the Mediterranean-style diet, which is high in alpha linolenic acid, provide a cardioprotective effect in high-risk people of south-Asian origin? Methods: A randomized single-blind diet trial conducted in 1000 men and women recruited by advertisement in India. Eligible participants were older than 25 years, had CAD defined as a previous MI or angina or hypercholesterolemia, hypertension or diabetes. Groups were balanced for age ⬎50 years, a history of CAD and a cholesterol ⬎200 mg/dL. 499 were allocated to the Indo-Mediterranean (Indo-Med) diet designed to be high in phytochemicals, antioxidants, and alpha linolenic acid a major omega-3 fatty in these foods. The Indo-Med diet contained 400 –500 g of fruits, vegetables, and nuts (25–50 gms) per day, whole grains (legumes, rice, maize, wheat), and mustard seed or soybean oil in 3 or 4 servings. The control group of 501 subjects was recommended the NCEP step I diet. All were advised exercise, mental relaxation techniques, and smoking cessation. Dietary counseling and monitoring was frequent and regular for the 2 years of follow-up. Results: The average age was 49 years, BMI 24 kg/m2, 90% were male, 72% had a cholesterol ⬎200 mg/dL, 35% hypertension, 20% diabetes and nearly 50% smoked. Regular ASA was used in 55% and a statin in 6%. Nearly 60% had CAD and 35% had a MI ⬍4 weeks prior to the study. Mean LDL-C was 140 mg/dL and HDL-C 44 mg/dL. About 65% of each group was vegetarian at baseline and consumed milk, butter, clarified butter and trans fatty acids. At 2 years, the Indo-Med diet group averaged 2015 calories of which 60% were carbohydrates, 14% protein and 26% fat of which 10% was MUFAs and 2% n-3 fatty acids. The control
The ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group. JAMA 2002;288:2998 –3007. Study Question: To determine whether pravastatin compared to usual care reduces all-cause mortality in older, moderately hypercholesterolemic and hypertensive participants with at least one additional CHD risk factor. Methods: ALLHAT-LLT (Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial) was a community-based multicenter randomized non-blind trial in a subset of participants from ALLHAT, whose major objective was to compare the efficacy of chlorthalidone, lisinopril, doxazosin and amlodipine in moderate hypertension. 10,355 men and women aged 55 years or older with an LDL-C between 120 and 189 mg/dL (100 –129 mg/dL if known CHD) and triglycerides ⬍350 mg/dL were randomized to pravastatin 40 mg or usual care. The primary outcome was all-cause mortality with planned follow-up of 8 years. Secondary outcomes included nonfatal MI or fatal CHD combined, q-wave MI, cause-specific mortality, cancer and cost of health care. Results: The mean follow-up was 4.8 years. There were no between-group differences for the following: mean age 66 years, 48% women, 34% black, 15% Hispanic, 35% diabetic, 14% CHD, 23% smokers, 30% ASA use, mean FBS 122 mg/dL, mean BP 145/84 mm Hg and antihypertensive treatment groups. Baseline mean cholesterol in those without CHD was 224 mg/dL, HDL-C 48 mg/dL, triglycerides
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group did not change their caloric distribution from baseline and differed significantly from the Indo-Med diet for each nutrient variable. The Indo-Med diet was associated with more weight loss, a decrease in waist to hip ratio, lower blood pressure and a greater improvement in lipids and blood sugar, but less smoking cessation. The Indo-Med diet was associated with a decrease in fatal and nonfatal MIs and sudden cardiac death, less CV events (10 vs. 19%, p⬍0.0001), significantly less heart failure, angina and CABG or PCIs, fewer positive stress tests, less LVH and strain on ECG and a borderline decrease in total deaths (5% vs. 8%, p⫽0.06). Conclusions: An Indo-Mediterranean diet that is rich in alpha-linolenic acid appears to be more effective in the primary and secondary prevention of CAD than the conventional NCEP 1 prudent diet. Perspective: There has been convincing evidence of a cardioprotective effect from omega-3 PUFAs from marine oils in cold water fish or supplements. This study shows a marked benefit of alpha-linolenic acid contained omega-3 PUFAs from grains and nuts in a high-risk undertreated Asian Indian population. MR
Effect of an Indo-Mediterranean Diet on Progression of Coronary Artery Disease in HighRisk Patients (Indo-Mediterranean Diet Heart Study): A Randomized Single-Blind Trial
Major Outcomes in Moderately Hypercholesterolemic, Hypertensive Patients Randomized to Pravastatin vs. Usual Care. The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT-LLT)
Singh RB, Dubnov G, Niaz MA, et al. Lancet 2002;360:1455– 61. Study Question: Does the Mediterranean-style diet, which is high in alpha linolenic acid, provide a cardioprotective effect in high-risk people of south-Asian origin? Methods: A randomized single-blind diet trial conducted in 1000 men and women recruited by advertisement in India. Eligible participants were older than 25 years, had CAD defined as a previous MI or angina or hypercholesterolemia, hypertension or diabetes. Groups were balanced for age ⬎50 years, a history of CAD and a cholesterol ⬎200 mg/dL. 499 were allocated to the Indo-Mediterranean (Indo-Med) diet designed to be high in phytochemicals, antioxidants, and alpha linolenic acid a major omega-3 fatty in these foods. The Indo-Med diet contained 400 –500 g of fruits, vegetables, and nuts (25–50 gms) per day, whole grains (legumes, rice, maize, wheat), and mustard seed or soybean oil in 3 or 4 servings. The control group of 501 subjects was recommended the NCEP step I diet. All were advised exercise, mental relaxation techniques, and smoking cessation. Dietary counseling and monitoring was frequent and regular for the 2 years of follow-up. Results: The average age was 49 years, BMI 24 kg/m2, 90% were male, 72% had a cholesterol ⬎200 mg/dL, 35% hypertension, 20% diabetes and nearly 50% smoked. Regular ASA was used in 55% and a statin in 6%. Nearly 60% had CAD and 35% had a MI ⬍4 weeks prior to the study. Mean LDL-C was 140 mg/dL and HDL-C 44 mg/dL. About 65% of each group was vegetarian at baseline and consumed milk, butter, clarified butter and trans fatty acids. At 2 years, the Indo-Med diet group averaged 2015 calories of which 60% were carbohydrates, 14% protein and 26% fat of which 10% was MUFAs and 2% n-3 fatty acids. The control
The ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group. JAMA 2002;288:2998 –3007. Study Question: To determine whether pravastatin compared to usual care reduces all-cause mortality in older, moderately hypercholesterolemic and hypertensive participants with at least one additional CHD risk factor. Methods: ALLHAT-LLT (Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial) was a community-based multicenter randomized non-blind trial in a subset of participants from ALLHAT, whose major objective was to compare the efficacy of chlorthalidone, lisinopril, doxazosin and amlodipine in moderate hypertension. 10,355 men and women aged 55 years or older with an LDL-C between 120 and 189 mg/dL (100 –129 mg/dL if known CHD) and triglycerides ⬍350 mg/dL were randomized to pravastatin 40 mg or usual care. The primary outcome was all-cause mortality with planned follow-up of 8 years. Secondary outcomes included nonfatal MI or fatal CHD combined, q-wave MI, cause-specific mortality, cancer and cost of health care. Results: The mean follow-up was 4.8 years. There were no between-group differences for the following: mean age 66 years, 48% women, 34% black, 15% Hispanic, 35% diabetic, 14% CHD, 23% smokers, 30% ASA use, mean FBS 122 mg/dL, mean BP 145/84 mm Hg and antihypertensive treatment groups. Baseline mean cholesterol in those without CHD was 224 mg/dL, HDL-C 48 mg/dL, triglycerides
ACC CURRENT JOURNAL REVIEW Mar/Apr 2003
44