Objective-The Prevención con Dieta Mediterránea (PREDIMED) trial showed that a Mediterranean diet (MedDiet) supplemented with either extra virgin olive oil or 30 g/d of mixed nuts reduced incident cardiovascular events compared with a control (low fat) diet. The mechanisms of cardiovascular protection afforded by MedDiets remain to be uncovered.We assessed the effect of both supplemented MedDiets on internal carotid intima-media thickness (ICA-IMT) and plaque height, the ultrasound features that best predict future cardiovascular events, in subjects at high cardiovascular risk. Approach and Results-In a PREDIMED subcohort (n=175), plaque height and carotid IMT of 3 prespecified segments (ICA, bifurcation, and common) were sonographically assessed at baseline and after intervention for a mean of 2.4 years. We evaluated 164 subjects with complete data. In a multivariate model, mean ICA-IMT progressed in the control diet group ( The biological mechanisms by which EVOO and nuts, main components of the MedDiet intervention in PREDIMED, 6 protect against CVD remain to be uncovered. Both foods have a favorable fatty acid profile. 7,8 Their richness in bioactive phytochemicals with antioxidant and anti-inflammatory properties probably explains why their consumption decreases circulating inflammatory biomarkers related to atherogenesis.9 Thus, it is plausible that EVOO and nuts might reduce CVD via an antiatherogenic effect, thus delaying the development of atherosclerosis, the pathological basis of most CVD events.Artery vessel wall enlargement, an early feature of atherosclerosis, can be easily evaluated by ultrasound determination of carotid artery intima-media thickness (IMT), a noninvasive, well-standardized, and validated imaging technique. 10IMT has been usually measured in the common carotid artery (CCA) because this carotid segment is easily visualized and Data are expressed as mean (95% confidence interval) except for quantitative variables, expressed as n (%). BIF-IMT indicates intima-media thickness of bifurcation; BMI, body mass index; CCA-IMT, intima-media thickness of common carotid artery; CVD, cardiovascular disease; EVOO, extra virgin olive oil; HDL, high-density lipoprotein; ICA-IMT, intima-media thickness of internal carotid artery; LDL, low-density lipoprotein; MedDiet, Mediterranean diet; and MET-min, minutes at a given metabolic equivalent level (units of energy expenditure in physical activity, 1 MET-min is roughly equivalent to 1 kcal).*χ 2 test and ANOVA, as appropriate. †Adjusted for sex, age, ever smoking, BMI, energy intake, use of statins, use of antidiabetic drugs, and use of antihypertensive drugs. ‡Measured in 155 participants (n=58, n=55, and n=42, respectively). §Measured in subjects with focal intrusions into the lumen ≥1.2-mm thick (n=46, n=46, and n=34, respectively). CCA-IMT is a more reproducible measure than IMT of other carotid segments, such as the bifurcation or internal carotid artery (ICA). 11 CCA-IMT has been widely used as a surrogate marker of future coronary even...

Supplemental marine omega-3 eicosapentaenoic acid (EPA) has an anti-atherosclerotic effect. Clinical research on EPA supplied by the regular diet and atherosclerosis is scarce. In the framework of the PREvención con DIeta MEDiterránea (PREDIMED) trial, we conducted a cross-sectional study in 161 older individuals at high vascular risk grouped into different stages of carotid atherosclerosis severity, including those without ultrasound-detected atheroma plaque (n = 38), with plaques <2.0 mm thick (n = 65), and with plaques ≥2.0 mm (n = 79). The latter were asked to undergo contrast-enhanced 3T magnetic resonance imaging (MRI) and were subsequently grouped into absence (n = 31) or presence (n = 27) of MRI-detectable plaque lipid, a main feature of unstable atheroma plaques. We determined the red blood cell (RBC) proportion of EPA (a valid marker of long-term EPA intake) at enrolment by gas chromatography. In multivariate models, EPA related inversely to MRI-assessed plaque lipid volume, but not to maximum intima-media thickness of internal carotid artery, plaque burden, or MRI-assessed normalized wall index. The inverse association between EPA and plaque lipid content in patients with advanced atherosclerosis supports the notion that this fatty acid might improve cardiovascular health through stabilization of advanced atheroma plaques.

No abstract