Abstract
Objective: To ascertain whether simple dietary advice to increase the consumption of Mediterranean foods, given in a clinical setting, leads to reduced mortality after a myocardial infarction.
Design: Data were used from the GISSI-Prevenzione clinical trial, analysed as a cohort study with adjustment for treatment allocation.
Setting: A total of 172 centres in Italy.
Subjects: A total of 11 323 men and women with myocardial infarction. All subjects received advice to increase their consumption of fish, fruit, raw and cooked vegetables and olive oil.
Measurements: The intakes of the five foods were assessed at baseline, 6, 18 and 42 months. Associations of food intakes, a combined dietary score, and the risk of death over 6.5 y were estimated adjusting for several non-dietary variables, using pooled logistic regression.
Results: Subjects generally improved their diet according to the advice given. All foods were associated with a significant reduction in risk of death. Compared with people in the worst dietary score quarter, the odds ratio for those in the best score quarter was 0.51 (95% CI 0.44–0.59). A good diet had a protective effect in sub-groups defined by age, sex, smoking, randomized treatment and concomitant drug therapy.
Conclusions: Myocardial infarction patients can respond positively to simple dietary advice, and this can be expected to lead to a substantial reduction in the risk of early death. Regardless of any drug treatment prescribed, clinicians should routinely advise patients with myocardial infarction to increase their frequency of consumption of Mediterranean foods.
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Acknowledgements
GISSI is endorsed by Associazione Nazionale Medici Cardiologi Ospedalieri (ANMCO), Firenze, Italy and by Istituto di Ricerche Farmacologiche Mario Negri, Consorzio Mario Negri Sud, Santa Maria Imbaro, Italy. GISSI-Prevenzione was supported by Bristol-Myers Squibb, Pharmacia-Upjohn, Societá Prodotti Antibiotici, Pfizer and Bracco. We thank C Pera, B Ferri, A Flamminio, A Polidoro and R Zama for invaluable secretarial help during the course of the study. Federica Barzi was the recipient of a research fellowship from Instituto di Ricerche Farmacologiche M. Negri, Milano, Italy.
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Guarantor: F Barzi.
Contributors: BF was responsible for the data analysis and statistical expertise. MW was responsible for statistical expertise and supervision. RMM contributed to data analysis and statistical expertise. LT contributed to conception and design, to obtain funding and supervision. GT was responsible for conception and design and supervision. FV contributed to conception and design and was responsible for obtaining funding. RM was responsible for conception and design, acquisition of data and supervision. All the authors contributed to manuscript editing.
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Appendix
Appendix
Let the food frequency recorded at the ith visit (i=1, 2, 3, 4) be Di. Let the time between the ith and the i+1th visit be Ti (i=1,2,3) and let T4 be the time from the last visit to the end of follow-up (death or censoring). The food consumption Cj (j=1,2,3,4) for the jth time interval was calculated as: Cj=j=1, 2, 3, 4.
When Di was missing it was estimated by the most recent non-missing value of D (i.e. last information carried forward).
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Barzi, F., Woodward, M., Marfisi, R. et al. Mediterranean diet and all-causes mortality after myocardial infarction: results from the GISSI-Prevenzione trial. Eur J Clin Nutr 57, 604–611 (2003). https://doi.org/10.1038/sj.ejcn.1601575
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DOI: https://doi.org/10.1038/sj.ejcn.1601575
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