Two Heart-Smart Diets: Mediterranean and Low-Fat

Though research has shown certain eating habits may improve heart health, people with heart disease are often not given much dietary instruction or follow-up support. A new study suggests that both a Mediterranean-style diet and a low-fat diet—when properly taught and supported—can protect people who have had one heart attack from future serious cardiac events.

The study, published in the American Journal of Cardiology, looked at the medical progress of 101 people who had experienced a first heart attack and were assigned to either a low-fat diet group or a Mediterranean-style diet group. They were followed for about four years and their medical progress was compared to that of 101 others who had had a first heart attack and received only standard dietary advice, which included only short-term instruction.

The diets and how they worked

The goal of both diets was to reduce intake of calories from saturated fat to 7% or less of daily calories, and cholesterol intake to 200 mg per day or less. Additionally, the Mediterranean diet group got more omega-3 fatty acids from fish and monounsaturated fatty acids from olive oil, canola oil, and soy. Both diets emphasized fruits, vegetables, and whole grains, and participants in both groups received regular individual dietary counseling and attended at least six group classes during the first two years of the study.

The low-fat and Mediterranean diets were equally protective: people eating these diets were 72% less likely to die or have a serious cardiac event—heart attack, stroke, heart failure, or unstable angina—than people who received standard care.

Support may save lives

“Survival without major cardiovascular complications after a first heart attack was the same for people in the low-fat diet intervention group and those in the Mediterranean-style diet intervention group,” said lead study author Dr. Katherine Tuttle at the Heart Institute of Spokane in Spokane, Washington. “However, people in both intervention groups fared significantly better than people with similar characteristics and medical histories who received standard dietary advice and short-term support.”

The results suggest that long-term support is an important part of effective dietary intervention for people with advanced heart disease. Standard dietary recommendations were based on the American Heart Association Step II guidelines, and were the same as those for the low-fat diet intervention group. The difference was in the follow-up: standard care involved short-term instruction, whereas the low-fat diet group received regular support for two years.

Based on these findings, a comprehensive program for people who want to prevent serious problems from heart disease, even after a first heart attack, should include exercise, weight management, and no smoking, as well as either a heart-healthy diet—low-fat or Mediterranean-style—and plenty of group and individual support.

(Am J Cardiol 2008;101:1523–30)

Maureen Williams, ND

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