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. - 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.

Description:

The goal of this study was to assess the Mediterranean style diet, which is high in alpha linolenic acid, and its association with cardioprotective effects in high-risk people of south-Asian origin.

Study Design

Study Design:

Patients Enrolled: 1000
Mean Follow Up: 2 years
Female: 10

Patient Populations:

Older than 25 years of age Have CAD defined as a previous MI or Angina or hypercholesterolemia, hypertension or diabetes

Drug/Procedures Used:

A randomized single blind diet trial conducted in 1,000 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 gms 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 to follow 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.

Principal Findings:

The average age was 49 years, BMI 24 kg/m2, 90% were male, 72% had a cholesterol >200 mg/dl, 35% had 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 2,015 calories of which 60% were carbohydrates, 14% protein, and 26% fat of which 10% was MUFA’s and 2% n-3 fatty acids. The control 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 non-fatal MI’s and sudden cardiac death, less CV events (10 vs 19%, p<0.0001), significantly less heart failure, angina, and CABG or PCI’s, fewer positive stress tests, less LVH and strain on ECG, and a borderline decrease in total deaths (5% vs 8%, p 0.06).

Interpretation:

Among high-risk people of south-Asian origin, an Indo-Mediterranean diet that is rich in alpha-linolenic acid appears to be associated with a greater effectivenes in the primary and secondary prevention of CAD than the conventional NCEP 1 prudent diet. There has been other evidence of the cardioprotective benefits from omega-3 PUFA's consumed via marine oils in cold water fish or supplements. This study shows a marked benefit of alpha-linolenic acid containing omega-3 PUFA's from grains and nuts in a high risk under treated Asian Indian population.

References:

Singh RB, Dubnov G, Niaz MA, et al. 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. Lancet 2002;360:1455-61.

Clinical Topics: Arrhythmias and Clinical EP, Diabetes and Cardiometabolic Disease, Dyslipidemia, Heart Failure and Cardiomyopathies, Prevention, SCD/Ventricular Arrhythmias, Homozygous Familial Hypercholesterolemia, Lipid Metabolism, Nonstatins, Acute Heart Failure, Diet, Hypertension

Keywords: alpha-Linolenic Acid, Relaxation Therapy, Weight Loss, Milk, Counseling, Blood Pressure, Electrocardiography, Butter, Hypercholesterolemia, Diet, Mediterranean, Trans Fatty Acids, Cholesterol, Waist-Hip Ratio, Body Mass Index, Blood Glucose, Heart Failure, India, Hypertension, Death, Sudden, Cardiac, Smoking Cessation, Diabetes Mellitus, Exercise Test


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