Statins with Mediterranean diet reduces cardiovascular mortality risk

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For those who have already had a heart attack or a stroke, the combination of statins and Mediterranean diet appears to be the most effective choice to reduce the risk of mortality, especially from cardiovascular causes. It is the result of an Italian study conducted at the IRCCS Neuromed, Pozzilli, Italy on over 1,000 adults recruited in the Moli-sani Study.

The traditional Mediterranean diet is rich in fruit, vegetables, legumes, cereals, olive oil, wine in moderation, fish and low in meat and dairy products

“We found – Marialaura Bonaccio, epidemiologist at the department of epidemiology and prevention and first author of the study says – that statins and Mediterranean diet together were more effective, as compared to one or the other considered separately, in reducing the risk of cardiovascular mortality. Likely, a Mediterranean diet facilitated the beneficial effect of statins, that in our real-life study were generally used at low doses.”

Researchers also analysed the potential underlying mechanisms of this positive interaction, so far poorly explored, between drugs and eating habits.

“The favourable combination of statins and Mediterranean diet – explains Licia Iacoviello, head of the laboratory of molecular and nutritional epidemiology of the same department and professor of hygiene at the University of Insubria – appeared to act, rather than on cholesterol levels, by reducing sub-clinical inflammation, a condition that predisposes to a higher risk of illness and mortality. This finding is of particular interest especially in the light of our observation that a high level of sub-clinical inflammation doubled the risk of mortality in patients who already had a heart attack or stroke.”

“Our data – says Giovanni de Gaetano, director of the department of epidemiology and prevention – suggest that we should focus more on the possible interactions between food and drugs, an aspect largely neglected in epidemiological research. Of course, controlled clinical trials will be needed to clarify these findings. If our data will be confirmed, new therapeutic possibilities could be designed for those who have already had a cardiovascular event, allowing a better modulation of the pharmacological intervention in relation to life habits. This is a new aspect of personalised medicine.”

Abstract
Background: Statins are prescribed for patients with cardiovascular disease (CVD), along with the recommendation of adopting healthy diets. We evaluated the independent and the combined effect of statins and Mediterranean diet (MD) towards mortality risk in patients with previous CVD by using real-life data from a population-based prospective cohort.
Methods: Longitudinal analysis on 1180 subjects (mean age 67.7 ± 10) with prior CVD at enrollment in the Moli-sani Study and followed up for 7.9 y (median). Adherence to MD was appraised by a Mediterranean diet score. Hazard ratios (HR) with 95% confidence intervals (95% CI) were calculated by multivariable Cox regression and competing risk models.
Results: Multivariable risk estimates associated with a 2-point increase in MD score were 0.84 (95% CI 0.70–1.00), 0.77 (0.61–0.97) and 0.70 (0.52–0.93) for overall, cardiovascular and coronary artery disease (CAD)/cerebrovascular deaths, respectively. Statins were not associated with death risk. Subjects combining statins and average-high adherence to MD had much lower than expected risk of cardiovascular and CAD/cerebrovascular mortality (p for interaction = 0.045 and 0.0015, respectively) as compared to those neither using statins nor having average-high MD.
The combination of average-high MD and statins was associated in a likely synergistic way with reduced low-grade inflammation, but not with blood cholesterol.
Conclusions: MD lowered the risk of all-cause, cardiovascular and CAD/cerebrovascular mortality CVD patients, net of statins. In the same population, statins reduced CVD death risk only in combination with MD. Low-grade inflammation, rather than lipids, is likely to be on the pathway of the interaction between MD and statins towards mortality risk.

Authors
Marialaura Bonaccio, Augusto Di Castelnuovo, Simona Costanzo, Mariarosaria Persichillo, Amalia De Curtis, Chiara Cerletti, Maria Benedetta Donati, Giovanni de Gaetano, Licia Iacoviello

Istituto Neurologico Mediterraneo Neuromed IRCCS material
International Journal of Cardiology abstract


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