de Lorgeril M, Salen P, Martin J L, Monjaud I, Delaye J, Mamelle N
Explorations Fonctionnelles Cardiorespiratoires et Métaboliques, CHU de Saint-Etienne, France.
Circulation. 1999 Feb 16;99(6):779-85. doi: 10.1161/01.cir.99.6.779.
The Lyon Diet Heart Study is a randomized secondary prevention trial aimed at testing whether a Mediterranean-type diet may reduce the rate of recurrence after a first myocardial infarction. An intermediate analysis showed a striking protective effect after 27 months of follow-up. This report presents results of an extended follow-up (with a mean of 46 months per patient) and deals with the relationships of dietary patterns and traditional risk factors with recurrence.
Three composite outcomes (COs) combining either cardiac death and nonfatal myocardial infarction (CO 1), or the preceding plus major secondary end points (unstable angina, stroke, heart failure, pulmonary or peripheral embolism) (CO 2), or the preceding plus minor events requiring hospital admission (CO 3) were studied. In the Mediterranean diet group, CO 1 was reduced (14 events versus 44 in the prudent Western-type diet group, P=0.0001), as were CO 2 (27 events versus 90, P=0.0001) and CO 3 (95 events versus 180, P=0. 0002). Adjusted risk ratios ranged from 0.28 to 0.53. Among the traditional risk factors, total cholesterol (1 mmol/L being associated with an increased risk of 18% to 28%), systolic blood pressure (1 mm Hg being associated with an increased risk of 1% to 2%), leukocyte count (adjusted risk ratios ranging from 1.64 to 2.86 with count >9x10(9)/L), female sex (adjusted risk ratios, 0.27 to 0. 46), and aspirin use (adjusted risk ratios, 0.59 to 0.82) were each significantly and independently associated with recurrence.
The protective effect of the Mediterranean dietary pattern was maintained up to 4 years after the first infarction, confirming previous intermediate analyses. Major traditional risk factors, such as high blood cholesterol and blood pressure, were shown to be independent and joint predictors of recurrence, indicating that the Mediterranean dietary pattern did not alter, at least qualitatively, the usual relationships between major risk factors and recurrence. Thus, a comprehensive strategy to decrease cardiovascular morbidity and mortality should include primarily a cardioprotective diet. It should be associated with other (pharmacological?) means aimed at reducing modifiable risk factors. Further trials combining the 2 approaches are warranted.
里昂饮食心脏研究是一项随机二级预防试验，旨在测试地中海式饮食是否可降低首次心肌梗死后的复发率。一项中期分析显示，在随访27个月后有显著的保护作用。本报告呈现了延长随访（每位患者平均随访46个月）的结果，并探讨了饮食模式和传统危险因素与复发之间的关系。
研究了三种复合结局（CO），分别为心脏性死亡与非致死性心肌梗死合并（CO 1），或上述情况加主要次要终点（不稳定型心绞痛、中风、心力衰竭、肺栓塞或外周栓塞）（CO 2），或上述情况加需要住院治疗的轻微事件（CO 3）。在地中海饮食组中，CO 1有所降低（14例事件对比谨慎西方型饮食组的44例，P = 0.0001），CO 2（27例事件对比90例，P = 0.0001）和CO 3（95例事件对比180例，P = 0.0002）也是如此。调整后的风险比范围为0.28至0.53。在传统危险因素中，总胆固醇（每升高1 mmol/L，风险增加18%至28%）、收缩压（每升高1 mmHg，风险增加1%至2%）、白细胞计数（计数>9×10⁹/L时，调整后的风险比范围为1.64至2.86）、女性性别（调整后的风险比为0.27至0.46）以及阿司匹林使用（调整后的风险比为0.59至0.82）均与复发显著且独立相关。
地中海饮食模式的保护作用在首次梗死后长达4年仍得以维持，证实了先前的中期分析结果。主要的传统危险因素，如高胆固醇血症和高血压，被证明是复发的独立且共同的预测因素，这表明地中海饮食模式至少在质量上并未改变主要危险因素与复发之间的通常关系。因此，降低心血管疾病发病率和死亡率的综合策略应主要包括心脏保护饮食。它应与旨在降低可改变危险因素的其他（药物？）手段相结合。有必要进行进一步的试验来结合这两种方法。
