Coronary artery diseaseComparison of Low-Fat Versus Mediterranean-Style Dietary Intervention After First Myocardial Infarction (from The Heart Institute of Spokane Diet Intervention and Evaluation Trial)†
Section snippets
Methods
Patients were recruited for THIS-DIET <6 weeks after first MIs by referrals from their attending physicians. The study was approved by the Institutional Review Board–Spokane. Written informed consent was obtained from all dietary intervention participants. MI diagnosis was confirmed by ischemic symptoms and elevations in cardiac enzymes (creatine phosphokinase-MB 1.5 times or troponins 2 times the upper limit of normal) and/or electrocardiographic changes (Q waves ≥0.03 ms in contiguous leads).
Results
Of 705 patients screened, 101 participants were randomized into THIS-DIET intervention groups from July 2000 to June 2005 (Figure 1). Most study patients were middle-aged white men, which reflected the distribution of patients with MIs in the community (Table 2). Usual-care controls and dietary intervention patients were well matched for each of the prespecified characteristics (Table 2).
Survival free of the primary outcome did not differ between low-fat (42 of 50) and Mediterranean-style (43
Discussion
Survival free of major cardiovascular complications after first MI did not differ between patients who participated in a longitudinal intervention with either a conventional low-fat or a Mediterranean-style diet. However, dietary intervention participants had greater overall and cardiovascular-event-free survival compared with similar patients with MIs provided with usual care. The median duration of follow-up was approximately 4 years, indicating that dietary intervention had sustained
Acknowledgment
We are indebted to the patients who participated in THIS-DIET and provided us the opportunity to learn from them.
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The Heart Institute of Spokane Diet Intervention and Evaluation Trial (THIS-DIET) was supported by a Nutrition Grant from the Washington State Attorney General Vitamins Settlement Fund and intramural or in-kind support from the investigators' sponsoring institutions, The Heart Institute of Spokane and Providence Medical Research Center, Sacred Heart Medical Center, Spokane, Washington, and Deaconess Medical Center, Spokane, Washington.
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Conflicts of interest: Dr. Bibus has received consulting fees from companies that make fish oil, Coromega Co., Vista, CA, and Enreco, Inc., Newton, WI. He also has equity ownership in Lipid Technologies, LLC, Austin, MN, the company that performed the plasma fatty acid analysis. Dr. Bibus owns patents related to lipid therapy. He has served as an expert witness regarding lipids and fatty acids.