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地中海饮食对心血管疾病的一级预防
Primary Prevention of Cardiovascular Disease with a Mediterranean Diet


Ramón Estruch ... 心脑血管疾病 • 2013.04.04
相关阅读
• 撤稿和重发:地中海饮食对心血管疾病的一级预防。N Engl J Med 2013;368:1279-90 • 辅以特级初榨橄榄油或坚果的地中海饮食用于心血管疾病的一级预防 • 饮食质量改变与总死亡率和死因别死亡率之间的关系

本文已被撤稿并重发,详细情况请查看相关阅读


摘要


背景

观察性队列研究和二级预防试验均表明坚持地中海饮食习惯和心血管疾病风险呈负相关。我们实施了一项随机试验,探讨地中海饮食方式对心血管事件的一级预防效果。

 

方法

本研究是一项在西班牙进行的多中心试验,我们将具有高度心血管疾病风险、但在纳入时未患有心血管疾病的参与者随机分配到三个饮食组之一,即地中海饮食辅以特级初榨橄榄油组、地中海饮食辅以混合坚果组、对照饮食组(建议减少膳食脂肪摄入)。参与者接受每季度一次的个人或团体性的教育课程。根据分组情况,分别向参与者提供免费的特级初榨橄榄油、混合坚果或非食品小礼物。主要终点为严重心血管事件(包括心肌梗死、卒中或心血管原因所致死亡)的发生率。基于中期分析结果,经过平均4.8年的随访,试验终止。

 

结果

本研究共纳入7,447例参与者(年龄55~80岁),其中57%为女性。根据自报饮食摄入和生物标志物分析,两个地中海饮食组对饮食干预的依从性很好。共有288例参与者发生主要终点事件,与对照组(共发生109例终点事件)相比,地中海饮食辅以特级初榨橄榄油组(96事件)参与者的多因素调整的风险比为0.70(95% CI,0.54~0.92),地中海饮食辅以混合坚果组(共发生83例终点事件)的多因素调整的风险比为0.72(95% CI,0.54~0.96)。三组均未报告饮食相关的不良反应。

 

结论

对于心血管疾病高危人群,一种地中海饮食辅以特级初榨橄榄油或坚果降低了严重心血管疾病的发病率(本研究由西班牙政府de Salud Carlos Ⅲ研究所等资助,在Controlled-Trials.com注册号为ISRCTN35739639)。





作者信息

Ramón Estruch, M.D., Ph.D., Emilio Ros, M.D., Ph.D., Jordi Salas-Salvadó, M.D., Ph.D., Maria-Isabel Covas, D.Pharm., Ph.D., Dolores Corella, D.Pharm., Ph.D., Fernando Arós, M.D., Ph.D., Enrique Gómez-Gracia, M.D., Ph.D., Valentina Ruiz-Gutiérrez, Ph.D., Miquel Fiol, M.D., Ph.D., José Lapetra, M.D., Ph.D., Rosa Maria Lamuela-Raventos, D.Pharm., Ph.D., Lluís Serra-Majem, M.D., Ph.D., Xavier Pintó, M.D., Ph.D., Josep Basora, M.D., Ph.D., Miguel Angel Muñoz, M.D., Ph.D., José V. Sorlí, M.D., Ph.D., José Alfredo Martínez, D.Pharm, M.D., Ph.D., and Miguel Angel Martínez-González, M.D., Ph.D., for the PREDIMED Study Investigators*
The authors' affiliations are listed in the Appendix. Address reprint requests to Dr. Estruch at the Department of Internal Medicine, Hospital Clinic, Villarroel 170, 08036 Barcelona, Spain, or at restruch@clinic.ub.es, or to Dr. Martínez-González at the Department of Preventive Medicine and Public Health, Facultad de Medicina–Clínica Universidad de Navarra, Irunlarrea 1, 31008 Pamplona, Spain, or at mamartinez@unav.es. *The PREDIMED (Prevención con Dieta Mediterránea) study investigators are listed in the Supplementary Appendix, available at NEJM.org.

 

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