Mediterranean diet, traditional risk factors, and the rate of cardiovascular complications after myocardial infarction - Final report of the Lyon Diet Heart Study
Mediterranean diet, traditional risk factors, and the rate of cardiovascular complications after myocardial infarction - Final report of the Lyon Diet Heart Study
复制标题
DOI：
10.1161/01.cir.99.6.779
复制
发表时间：
1999-02-16
期刊：
影响因子：
37.8
通讯作者：
Mamelle, N
中科院分区：
文献类型：
--
作者：
de Lorgeril, M;Salen, P;Mamelle, N
里昂饮食心脏研究是一项随机二级预防试验，旨在测试地中海式饮食是否可以降低首次心肌梗死后的复发率。一项中期分析显示，在27个月的随访后，有显著的保护作用。本报告介绍了一项长期随访的结果方法和结果--三个复合终点（CO）结合心源性死亡和非致死性心肌梗死（CO 1），或先前加上主要次要终点（不稳定型心绞痛、中风、心力衰竭、肺栓塞或外周栓塞）（CO2），或上述事件加上需要住院的轻微事件（CO 3）。在地中海饮食组中，CO 1减少（14例事件比谨慎西式饮食组的44例，P=0.0001），CO2减少（27例事件比90例，P=0.0001），CO 3减少（95例事件比180例，P=0.0002）。校正后的危险比为0.28 ~ 0.53。在传统的危险因素中，总胆固醇（1 mmol/L与18%至28%的风险增加相关），收缩压（1 mm Hg与1%至2%的风险增加相关），白细胞计数（调整后的风险比范围为1.64至2.86，计数> 9 x10（9）/L），女性（调整后的风险比，0.27至0.46），和阿司匹林的使用（调整后的风险比率，0.59至0.82）均与复发显著且独立相关。地中海饮食模式的保护作用在首次梗死后维持了4年，证实了先前的中期分析。主要的传统危险因素，如高血胆固醇和血压，被证明是独立的和联合复发的预测因子，表明地中海饮食模式没有改变，至少在定性上，主要危险因素和复发之间的通常关系。因此，降低心血管病发病率和死亡率的综合策略应主要包括心脏保护性饮食。它应该与其他（药理学？）旨在减少可改变的风险因素的手段。结合这两种方法的进一步试验是必要的。
Background-The Lyon Diet Heart Study is a randomized secondary prevention trial aimed at testing whether a Mediterranean-type diet may reduce the rate of recurrence after a first myocardial infarction. An intermediate analysis showed a striking protective effect after 27 months of follow-up. This report presents results of an extended follow-up (with a mean of 46 months per patient) and deals with the relationships of dietary patterns and traditional risk factors with recurrence.Methods and Results-Three composite outcomes (COs) combining either cardiac death and nonfatal myocardial infarction (CO 1), or the preceding plus major secondary end points (unstable angina, stroke, heart failure, pulmonary or peripheral embolism) (CO 2), or the preceding plus minor events requiring hospital admission (CO 3) were studied. In the Mediterranean diet group, CO 1 was reduced (14 events versus 44 in the prudent Western-type diet group, P=0.0001), as were CO 2 (27 events versus 90, P=0.0001) and CO 3 (95 events versus 180, P=0.0002). Adjusted risk ratios ranged from 0.28 to 0.53, Among the traditional risk factors, total cholesterol (1 mmol/L being associated with an increased risk of 18% to 28%), systolic blood pressure (1 mm Hg being associated with an increased risk of 1% to 2%), leukocyte count (adjusted risk ratios ranging from 1.64 to 2.86 with count >9x10(9)/L), female sex (adjusted risk ratios, 0.27 to 0.46), and aspirin use (adjusted risk ratios, 0.59 to 0.82) were each significantly and independently associated with recurrence.Conclusions-The protective effect of the Mediterranean dietary pattern was maintained up to 4 years after the first infarction, confirming previous intermediate analyses. Major traditional risk factors, such as high blood cholesterol and blood pressure, were shown to be independent and joint predictors of recurrence, indicating that the Mediterranean dietary pattern did not alter, at least qualitatively, the usual relationships between major risk factors and recurrence. Thus, a comprehensive strategy to decrease cardiovascular morbidity and mortality should include primarily a cardioprotective diet. It should be associated with other (pharmacological?) means aimed at reducing modifiable risk factors. Further trials combining the 2 approaches are warranted.