Søndergaard Eva, Møller Jacob E, Egstrup Kenneth
Department of Medicine, Svendborg Hospital, Svendborg, Denmark.
Am Heart J. 2003 May;145(5):E19. doi: 10.1016/S0002-8703(03)00078-4.
The "Mediterranean" diet and statin treatment have both independently been shown to improve survival and reduce the risk of cardiovascular events in patients with ischemic heart disease (IHD), but no studies have evaluated the effect of this combination on endothelial function. We therefore sought to evaluate the effect of the combination dietary intervention and lipid-lowering treatment on brachial vasoreactivity.
A total of 131 consecutive patients with documented IHD and a serum cholesterol level > or =5 mmol/L (193 mg/dL) were randomized to receive Mediterranean dietary advice (n = 68) or no specific dietary advice (n = 63). Endothelial function was assessed at baseline and after 12 months with noninvasive ultrasound scanning vessel-wall tracking of brachial artery flow-mediated vasodilatation (FMD). All patients started statin treatment with Fluvastatin (40 mg once daily) at baseline.
A total of 115 patients completed the study. At baseline, FMD was 4.30% +/- 4.89% in the control group versus 4.32% +/- 6.15% in the intervention group (P = not significant). After 12 months of follow-up, FMD was significantly higher in the intervention group (control group 5.72% +/- 4.87% vs intervention group 8.62% +/- 6.60%, P <.01). This was accompanied by a larger intake of fatty fish and a significant decrease in triglyceride levels. In multivariate analysis, randomization status was a significant predictor of FMD after adjustment for classic cardiovascular risk factors and vessel size (P =.02; beta = -2.66 [-4.91; -0.41]).
Dietary intervention with the Mediterranean diet and statin treatment improve FMD in the brachial artery in patients with IHD and hypercholesterolemia to a greater degree than statin treatment alone.
“地中海”饮食和他汀类药物治疗已分别被证明可改善缺血性心脏病（IHD）患者的生存率并降低心血管事件风险，但尚无研究评估这种联合治疗对内皮功能的影响。因此，我们试图评估饮食干预和降脂治疗联合应用对肱动脉血管反应性的影响。
总共131例有IHD记录且血清胆固醇水平≥5 mmol/L（193 mg/dL）的连续患者被随机分为接受地中海饮食建议组（n = 68）或无特定饮食建议组（n = 63）。在基线和12个月后，通过无创超声扫描追踪肱动脉血流介导的血管舒张（FMD）来评估内皮功能。所有患者在基线时开始使用氟伐他汀（40 mg，每日一次）进行他汀类药物治疗。
共有115例患者完成了研究。基线时，对照组的FMD为4.30%±4.89%，干预组为4.32%±6.15%（P无统计学意义）。随访12个月后，干预组的FMD显著更高（对照组为5.72%±4.87%，干预组为8.62%±6.60%，P<.01）。这伴随着脂肪鱼摄入量的增加和甘油三酯水平的显著降低。在多变量分析中，在调整经典心血管危险因素和血管大小后，随机分组状态是FMD的显著预测因素（P =.02；β = -2.66 [-4.91；-0.41]）。
对于IHD和高胆固醇血症患者，地中海饮食的饮食干预和他汀类药物治疗比单独使用他汀类药物治疗能更大程度地改善肱动脉的FMD。
