The Mediterranean diet in secondary prevention of coronary heart disease

Epidemiological studies as well as randomised dietary trials suggest that Mediterranean diet may be important in relation to the pathogenesis and prevention of coronary heart disease (CHD). A striking protective effect of a Mediterranean diet rich in alpha-linolenic acid (ALA) was reported in the Lyon Diet Heart Study with a 50 to 70% reduction of the risk of recurrence after four years of follow-up in CHD patients. According to current knowledge, dietary ALA should represent about 0.6 to 1% of total daily energy or about 2 g per day in patients who follow a traditional Mediterranean diet. Supplementation with very long chain omega-3 fatty acids (c.1g per day) in patients following a Mediterranean type of diet was shown to decrease the risk of cardiac death by 30% and of sudden cardiac death by 45% in the GISST trial. Thus, in the context of a diet rich in oleic acid, poor in saturated fats and not high in omega-6 fatty acids (a dietary pattern characterizing the traditional Mediterranean diet), even a small dose of very long chain omega-3 fatty acids (one gram under the form of capsules) might be very protective. These data underline the importance of the accompanying diet in any dietary strategy using fatty acid complements.