A recently completed trial conducted in India, the Indo-Mediterranean Diet Heart Study,25 complements findings from the Lyon Diet Heart Study. The study population consisted primarily of men (~90%) who were at high-risk for either a first myocardial infarction or a recurrence; approximately 60% had a history of myocardial infarction at baseline, and 35% had a recent (<4 weeks) myocardial infarction. In contrast to the Lyon Diet Heart Study, two-thirds of participants were vegetarian at baseline. All participants were given advice to reduce their intake of fat, saturated fat, and cholesterol (<30% kcal from fat, <10% kcal from saturated fat, and <300 mg cholesterol/day). Those participants in the intervention arm were also advised to increase their consumption of fruits, vegetables, and nuts and to use mustard seed and soybean oil (3-4 servings/day), both of which are rich in ALA.
It is noteworthy that approximately 60% of calories came from carbohydrates, of which a substantial proportion was presumably from fruit, vegetable, and grain consumption. In contrast to the Lyon Diet Heart Study, consumption of the Indo-Mediterranean diet resulted in significant reductions in total and LDL cholesterol, and an increase in HDL-cholesterol. In addition, blood pressure and body mass index were reduced with the Indo-Mediterranean diet compared to controls. A common feature of both the Lyon Diet Heart study and Indo-Mediterranean Diet Heart study was the emphasis on ALA consumption. In the latter study, increased consumption was achieved by emphasizing foods and oils rich in ALA (nuts, soybean oil, and mustard seed oil).
After 2years of follow-up, there was a 50% reduction in total cardiovascular endpoints (fatal myocardial infarction, non-fatal myocardial infarction, and sudden cardiac death) in the intervention group (39 events) compared to the control group (76 events). Both non-fatal myocardial infarction and sudden death were reduced in the intervention group; however, there was no significant difference in fatal myocardial infarction. These results are consistent with results from the Lyon Diet Heart Study, where there were significant reductions in sudden death and non-fatal myocardial infarctions. Still, these impressive results are somewhat surprising, because, at baseline, two-thirds of participants were vegetarians.
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