Mediterranean diet postpones death: 5-year GISSI Prevenzione results

Shelley Wood

November 13, 2000

New Orleans, LA - Five years after an MI, people who stick to the so-called Mediterranean diet appear to have a much greater chance of surviving, although the true preventive powers of the diet itself are difficult to determine. New research on the much-lauded Mediterranean diet was presented on November 12, 2000, the opening day of the American Heart Association's Scientific Sessions 2000 in New Orleans, LA.

Dr Roberto Marchioli (S. Maria Imbaro, Italy) presented long-term follow-up data on the effects of dietary changes in 11324 patients recruited in the Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto miocardico (GISSI) -Prevenzione study. The GISSI researchers assessed eating habits in relation to prognosis using a food questionnaire administered at 5 different time points, with the primary outcome measure of total mortality assessed at approximately 5 years.

New Orleans, LA - A second analysis of the GISSI Prevenzione data, presented at the AHA meeting in New Orleans, LA, indicates that early administration of N-3 polyunsaturated fatty acids in doses of 1g/day can reduce the risk of sudden death, and death from all causes. Half of the 11324 post-MI patients in the trial were randomized to receive PUFAs within 16 days after their MI. As Dr Roberto Marchioli reported earlier, the beneficial effects of N-3 PUFAs were evident very early and appeared to increase over a 360 day period, with a probability of survival that was 14% higher in the PUFA group than in the control patients.


Marchioli reported that people who ate more vegetables, fruit, fish, but little butter, were less likely to die than people who reported eating higher amounts of butter, cheese, and vegetable oils other than olive oil. However, although participants, on average, ate in an increasingly healthy manner over the course of the follow-up period, average BMI did not change.

Marchioli pointed out that the people who were more likely to follow the dietary recommendations set by the study were also more likely to be nonsmokers, and were also more likely to have complied with other aspects of the GISSI study which included examinations of dietary polyunsaturated fatty acids and vitamin E intake. Although the prevention study controlled for standard risk factors it did not specifically address lifestyle changes and drug compliance. As such, says Marchioli, it is difficult to separate the true effects of the diet from other lifestyle improvements.

Media agrees: Eat your veggies

New York, NY - Behavioral change is the bread-and-butter of media coverage of heart disease prevention, and the Mediterranean diet comes up often as a way to reduce cardiac risk factors. Several media reports on November 13, 2000 highlighted the "life-saving" abilities of a diet rich in olive oil, fruit, vegetables, and fish for MI patients. "A Mediterranean diet has long been associated with a low rate of heart disease in countries such as Spain, Greece, and Italy. But whether or not it can benefit patients who have already suffered a heart attack has not been clearly tested before," writes John von Radowitz, PA News science correspondent. He reports the GISSI-Prevenzione Study findings, noting, "Those who ate the classic Mediterranean diet were nearly three times more likely to stay alive than those who consumed high-cholesterol foods." The Los Angeles Times notes that, although the diet is already known to lower MI risks, this is the first study to examine its potential in preventing second MIs. Reuters proclaims you "still have to eat your veggies": "The main news (from AHA) is that the best way to deal with heart disease is to avoid it in the first place. People living around the Mediterranean had it right, with their traditional diet rich in olive oil instead of animal fats, plenty of fruits and vegetables, and a little wine. Such a diet may not only help prevent heart disease but may help people who have had heart attacks." Reuters also points out other AHA highlights that look into the role of trans-fatty acids and how much one needs to exercise, including the safety of starting an exercise program in old age as well as starting one after an MI.

- Mark L Fuerst

Mushrooming interest in veggie-rich diet

Interest in the Mediterranean diet has mushroomed in recent years, after observations that people living in regions bordering the Mediterranean appeared to live longer and suffer less from cardiovascular disease. Mediterranean cuisine is characterized by low intake of total and saturated fats, combined with increased intake of omega-3 fatty acids (found in fish and plants), fresh fruits, vegetables, legumes, and cereals containing large amounts of fibers, antioxidants, minerals, vegetable proteins, and B-group vitamins./p>

The prevention data from the GISSI investigators comes almost 2 years after the results of the Lyon Diet Heart Study were published in Circulation. The randomized secondary prevention trial by French investigators found "a striking protective effect" of the Mediterranean-type diet, citing, in their intermediary analysis, a 70% reduction in all-cause mortality in participants eating la Mediterranée, as compared to those eating a more Northern European diet.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.