Extra-Virgin Olive Oil Consumption Reduces Risk of Atrial Fibrillation: The PREDIMED Trial

Study Questions:

Does a Mediterranean diet enriched with either extra-virgin olive oil or mixed nuts reduce the incidence of atrial fibrillation?

Methods:

PREDIMED (PREvención con DIeta MEDiterránea) is a randomized primary prevention trial comparing a Mediterranean diet enriched with either extra-virgin olive oil or mixed nuts with a control diet. In the present study, the outcome of interest was incident atrial fibrillation. Participants (recruited from 11 Spanish University hospitals) were randomly assigned to one of three diets: Mediterranean diet supplemented with extra-virgin olive oil, Mediterranean diet supplemented with mixed nuts, or advice to follow a low-fat diet (control group). Incident atrial fibrillation was adjudicated during follow-up by an events committee blinded to dietary group allocation. Participants were free of cardiovascular disease and atrial fibrillation at baseline, but were at increased risk for cardiovascular disease defined as having type 2 diabetes, or three or more risk factors (hypertension, current smoking, dyslipidemia, overweight or obesity, and/or family history of premature coronary artery disease).

Results:

Baseline characteristics were similar between the three groups. Among the 6,705 participants without prevalent atrial fibrillation at randomization, 72 new cases of atrial fibrillation in the Mediterranean diet with extra-virgin olive oil group, 82 in the Mediterranean diet with mixed nuts group, and 92 in the control group, were observed after median follow-up of 4.7 years. The Mediterranean diet with extra-virgin olive oil significantly reduced the risk of atrial fibrillation (hazard ratio [HR], 0.62; 95% confidence interval [CI], 0.45-0.85) compared to the control group. No effect was found for the Mediterranean diet with nuts (HR, 0.89; 95% CI, 0.65-1.20).

Conclusions:

The investigators concluded that in the absence of proven interventions for the primary prevention of atrial fibrillation, this post-hoc analysis of the PREDIMED trial suggests that extra-virgin olive oil in the context of a Mediterranean dietary pattern may reduce the risk of atrial fibrillation.

Perspective:

These data further support the recommendations for a Mediterranean dietary pattern with extra-virgin olive oil for reduction of cardiovascular risk including atrial fibrillation. Understanding the mechanisms of this dietary pattern in reducing incident atrial fibrillation would likely be scientifically important.

Clinical Topics: Arrhythmias and Clinical EP, Diabetes and Cardiometabolic Disease, Dyslipidemia, Prevention, Atherosclerotic Disease (CAD/PAD), Atrial Fibrillation/Supraventricular Arrhythmias, Lipid Metabolism, Diet, Hypertension, Smoking

Keywords: Coronary Artery Disease, Dietary Fats, Unsaturated, Overweight, Diabetes Mellitus, Type 2, Diet, Mediterranean, Smoking, Metabolic Syndrome X, Dyslipidemias, Plant Oils, Spain, Nuts, Cardiovascular Diseases, Obesity, Atrial Fibrillation, Diet, Fat-Restricted, Hypertension, Pregnancy


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