SlideShare ist ein Scribd-Unternehmen logo
PUBLISHED ON 25 FEB, 2013 IN NEJM
MEDITERRANEAN DIET

 The Mediterranean diet is a modern nutritional
 recommendation inspired by the traditional dietary
 patterns of southern ITALY, GREECE, and SPAIN .

 On November 17, 2010, UNESCO recognized this diet
 pattern as an Intangible Cultural Heritage
 of Italy, Greece, Spain and Morocco
THESE COUNTRIES HAVE A VERY LOW INCIDENCE OF
CARDIOVASCULAR DISEASE .

THE MEDITERRANEAN FOOD PATTERN HAS BEEN THE FACTOR
MOST FREQUENTLY INVOKED TO EXPLAIN THIS HEALTH
ADVANTAGE
MEDITERRANEAN DIET
 Its major characteristics are:
    a high consumption of non-refined
     grains, legumes, nuts, fruits and vegetables;
    a relatively HIGH FAT INTAKE(>40% greater than
A RELATIVELY high-fat consumption (even OF TOTAL 40
     percent of total energy intake) mostly from MUFA, which
CALORIE INTAKE) IN FORM OF OLIVE OIL AND NUTS
     accounts for 20 percent or more of the total energy intake;
( MUFA ) IS THE HALLMARK OF MEDITERRANEAN
    olive oil used to cook and for dressing salads is the
DIET ,
     principal source of fat;
    fish consumption is moderate to high;
    poultry and dairy products (usually as yogurt or cheese) are
     consumed in moderate to small amounts;
    a low consumption of red meats, processed meats or meat
     products;
    a moderate alcohol intake, usually in the form of red wine
     consumed with meals
MEDITERRANEAN DIET
  Trials have shown that increasing adherence to the
   Mediterranean diet has been consistently beneficial
   with respect to the cardiovascular risk.
  A systematic review ranked the Mediterranean diet as
   the most likely dietary model to provide protection
   against coronary heart disease.
With this background, a randomized trial was
designed to test the efficacy of Mediterranean diet
on primary cardiovascular prevention.
STUDY DESIGN
STUDY DESIGN…

 The PREDIMED study (Prevención con Dieta
 Mediterránea) was a parallel-group, multicenter,
 randomized trial examining the potential benefits of a
 Mediterranean-style diet for primary prevention of
 cardiovascular disease (CVD).

 A total of 7,447 subjects aged 55 to 80 years were
  enrolled.
 57% were female.
STUDY DESIGN…inclusion criteria
 Patient should not have any cardiovascular disease at
  baseline.
 Patient should either have type 2 diabetes or
 three or more of the following major CVD risk factors:
   smoking,
   hypertension,
   elevated LDL-C,
   low HDL-C,
   overweight or obesity, or
   family history of premature coronary heart disease.
Subjects were randomized in a 1:1:1 fashion to 3 groups:

  1) Mediterranean diet + extra-virgin olive oil
     (≥4 tbsp/day; n=2,543)
  2) Mediterranean diet + nuts (30 g mixed nuts/day,
     including walnuts, almonds, and hazelnuts;
     n=2,454)
  3) Low-fat diet (control; n=2,450)



No total calorie restriction was advised and no physical
   activity was promoted.
 The primary endpoint = composite of myocardial
  infarction (MI), stroke, or CV mortality.
 Secondary endpoints included stroke, MI, CV
  mortality, and all-cause mortality.

 The trial was stopped after a median of 4.8 years based
 on an interim analysis showing benefits seen with
 Mediterranean diets.
BASELINE CHARACTERISTICS OF
THE STUDY GROUPS
BASELINE CHARACTERISTICS CONT…
RESULTS
PRIMARY ENDPOINT EVENTS
The primary endpoint, a composite of MI, stroke, or CV mortality,
occurred as follows:

 Mediterranean diet + extra-virgin olive oil:
96 events (3.8%)
hazard ratio (HR), 0.70
P=0.009 vs the control diet

 Mediterranean diet + nuts:
83 events (3.4%)
HR, 0.70
P=0.02 vs the control diet

 Control group: 109 events (4.4%)
PRIMARY ENDPOINT PER 1000 PERSON YEARS
The rate of the primary endpoint per 1,000 person-years
 was as follows:
  Mediterranean diet + extra-virgin olive oil:
   8.1 (95% CI, 6.6-9.9);
   P=0.009 vs the control diet
  Mediterranean diet + nuts: 8.0 (95% CI, 6.4-
   9.9);
   P=0.02 vs the control diet
  Control group: 11.2 (95% CI, 9.2-13.5)
SECONDARY END POINTS
Stroke
  Mediterranean diet + extra-virgin olive oil: 49 events;
  HR vs control, 0.67
  P=0.04 vs the control diet

  Mediterranean diet + nuts: 32 events
  HR vs control, 0.54
  P=0.006 vs the control diet

  Control group: 58 events
SECONDARY END POINTS
MYOCARDIAL INFARCTION
  Mediterranean diet + extra-virgin olive oil: 37 events;
   HR vs control, 0.80
   P=0.34 vs the control diet

  Mediterranean diet + nuts: 31 events;
   HR vs control, 0.74
   P=0.22 vs the control diet

  Control group: 38 events
SECONDARY END POINTS
CV MORTALITY
  Mediterranean diet + extra-virgin olive oil: 26 events;
   HR vs control, 0.69
   P=0.17 vs the control diet

  Mediterranean diet + nuts: 31 events;
   HR vs control, 1.01
   P=0.98 vs the control diet

  Control group: 30 events
SECONDARY END POINTS
ALL-CAUSE MORTALITY

   Mediterranean diet + extra-virgin olive oil: 118 events;
   HR vs control, 0.82 (95% CI, 0.64-1.07);
   P=0.15 vs the control diet

   Mediterranean diet + nuts: 116 events; HR vs control,
   0.97 (95% CI, 0.74-1.26);
   P=0.82 vs the control diet

   Control group: 114 events
Groups assigned to Mediterranean diets did
better than the low fat diet group in terms of
both primary and secondary end-points
 In this trial, an energy-unrestricted Mediterranean diet
  supplemented with either extra-virgin olive oil or nuts
  resulted in risk reduction of major cardiovascular events
  among high-risk persons who were initially free of
  cardiovascular disease.

 These results support the benefits of the Mediterranean
  diet for cardiovascular risk reduction.

 The results of our trial might explain, in part, the lower
  cardiovascular mortality in Mediterranean countries than
  in northern European countries or the United States.
PAST STUDIES
 Multiple trials in the past have demonstrated beneficial
 effects of mediterranian diet in

 Metabolic syndrome
 Diabetes mellitus
 Reducing markers of oxidation/inflammation and
 endothelial dysfunction

 Thus a causal role of mediterranian diet in
 cardiovascular prevention has high biological
 plausibility
ARCH INTERN MEDICINE 2009 Apr 13;169(7):659-69.


In applying a predefined algorithm, we identified strong evidence of a causal
relationship for protective factors, including intake of vegetables, nuts,
and monounsaturated fatty acids and Mediterranean, prudent, and highquality
dietary patterns, and harmful factors, including intake of trans– fatty acids and
foods with a high glycemic index or load and a western dietary pattern. Among
these dietary exposures, however, only a Mediterranean dietary
pattern has been studied in RCTs and significantly
associated with CHD.
lyon diet heart study (2001)showed a large
                                  reduction in
rates of coronary heart disease events with a
modified mediterranean diet enriched with alpha-
linolenic acid (a key constituent of walnuts).
CONCLUSION: The adherence to
the Mediterranean Diet seems to reduce
the incidence of metabolic syndrome
HOW DOES MEDITERRANEAN DIET HELP?

 IMPROVES THE LIPID PROFILE



   Replacing saturated fat with MUFA from
   olive oil produces a decline in total and LDL
   cholesterol, and maintains HDL cholesterol at
   higher levels, thus obtaining a net advantage on
   the overall lipid profile.
HOW DOES MEDITERRANEAN DIET HELP?

 DECREASES THE OXIDATIVE STRESS



   olive oil is resistant to oxidative
   modification, thus it does not lead to
   formation of oxidation products like
   peroxides, hydroxyperoxides etc , which
   have a causal implication in heart diseases.
HOW DOES MEDITERRANEAN DIET HELP?

 NEGATIVE EFFECT ON THROMBOGENECITY AND
 ATHEROMA PLAQUE FORMATION
   incorporation of oleic acid into cultured endothelial cells
    has shown to decrease the expression of endothelial
    leukocyte adhesion molecules with reductions in VCAM-
    1 and inhibition of nuclear factor-kappa B activation.
   Postprandial factor VII is significantly lower after a
    MUFA-rich diet.
   Olive oil is also associated with a reduced DNA synthesis
    in human coronary smooth muscle cells.
EFFECTS OF HIGH MUFA CONTENT
IN MEDITERRANEAN DIET
CONCLUSION
 This primary prevention trial showed that an energy-
 unrestricted Mediterranean diet, supplemented with
 extra-virgin olive oil or nuts, resulted in a substantial
 reduction in the risk of major cardiovascular events
 among high-risk persons. The results support the
 benefits of the Mediterranean diet for the
 primary prevention of cardiovascular disease
THANKYOU

           FOR A
           HEALTHY
           HEART
Salient components of the Mediterranean diet reportedly
  associated with better survival include

     moderate consumption of ethanol (mostly from wine),
     low consumption of meat and meat products, and
     high consumption of vegetables, fruits, nuts,
     legumes, fish, and olive oil

  Perhaps there is a synergy among the nutrient-rich foods
  included in the Mediterranean diet that fosters favourable
  changes in intermediate pathways of cardio-metabolic risk,
  such as blood lipids, insulin sensitivity, resistance to
  oxidation, inflammation, and vaso-reactivity.
MEDITERRANEAN DIET
 The principal aspects of this diet include
  proportionally high consumption of OLIVE OIL,
  LEGUMES, UNREFINED CEREALS, FRUITS,
  and VEGETABLES, moderate to high consumption of
  fish, moderate consumption of dairy products (mostly
  as cheese and yogurt), moderate wine consumption,
  and low consumption of meat and meat products.
 there are discrepancies among nutrition experts
  because of the high-fat content of Mediterranean Diets
  (up to >40% of total energy intake), which is in
  conflict with the usual recommendation to follow a
  low-fat diet in order to avoid overweight/obesity and to
  prevent coronary heart disease (CHD)
 In its simplest form the hazard ratio can be interpreted
 as the chance of an event occurring in the treatment
 arm divided by the chance of the event occurring in
 the control arm, or vice versa, of a study.
Our results compare favourably with those of
the Women’s Health Initiative Dietary
Modification Trial, wherein a low-fat dietary
approach resulted in no cardiovascular benefit.
Participants with hypertension, dyslipidemia and
higher BMI responded better to Mediterranean Diets
Exclusion criteria
 Documented history of previous cardiovascular disease, including CHD
    (angina, myocardial infarction, coronary revascularization procedures or
    existence of abnormal Q waves in the electrocardiogram (EKG)), stroke
    (either ischemic or hemorrhagic, including transient ischemic attacks), and
    clinical peripheral artery disease with symptoms of intermittent
    claudication.
    Severe medical condition that may impair the ability of the person to
    participate in a nutrition intervention study (e.g. digestive disease with fat
    intolerance, advanced malignancy, or major neurological, psychiatric or
    endocrine disease)
    Any other medical condition thought to limit survival to less than 1 year.
    Immunodeficiency or HIV-positive status.
    Illegal drug use or chronic alcoholism or total daily alcohol intake >80 g/d.
    Body mass index > 40 kg/m2.
    Difficulties or major inconvenience to change dietary habits
Exclusion criteria
 Impossibility to follow a Mediterranean-type diet, for
    religious reasons or due to the presence of disorders of
    chewing or swallowing (e.g., difficulties to consume nuts)
   History of food allergy with hypersensitivity to any of the
    components of olive oil or nuts.
    Participation in any drug trial or use of any
    investigational drug within the last year.
    Institutionalized patients for chronic care, those who lack
    autonomy, are unable to walk, lack a stable address, or are
    unable to attend visits in the PCC every 3 months.
    Illiteracy.
    Patients with an acute infection or inflammation (e.g.,
    pneumonia) are allowed to participate in the study 3
    months after the resolution of their condition.

Weitere ähnliche Inhalte

Was ist angesagt?

Heart Disease Presentation
Heart Disease PresentationHeart Disease Presentation
Heart Disease Presentation
Andrew Blumenreich
 
Healthy heart - Life's simple 7 presentation
Healthy heart - Life's simple 7 presentationHealthy heart - Life's simple 7 presentation
Healthy heart - Life's simple 7 presentation
Dr. Nagu Penakacherla
 
Heart Failure
Heart FailureHeart Failure
Heart Failure
Harmeet Kaur
 
Prevention and treatment of heart disease
Prevention and treatment of heart diseasePrevention and treatment of heart disease
Prevention and treatment of heart disease
shanikrupa
 
Preventing Heart Disease
Preventing Heart DiseasePreventing Heart Disease
Preventing Heart Disease
air
 
Heart Disease, Prevention of Heart Disease
Heart Disease, Prevention of Heart DiseaseHeart Disease, Prevention of Heart Disease
Heart Disease, Prevention of Heart Disease
Jack Frost
 
world Hypertension day 2023.pdf
world Hypertension  day 2023.pdfworld Hypertension  day 2023.pdf
world Hypertension day 2023.pdf
PROFESSOR DR. MD. TOUFIQUR RAHMAN
 
Women and Heart Disease: New Concepts in Prevention and Management
Women and Heart Disease: New Concepts in Prevention and ManagementWomen and Heart Disease: New Concepts in Prevention and Management
Women and Heart Disease: New Concepts in Prevention and Management
Summit Health
 
Cardiomyopathy
CardiomyopathyCardiomyopathy
Women and Heart Disease
Women and Heart DiseaseWomen and Heart Disease
Women and Heart Disease
Via Christi Health
 
Lifestyle diseases
Lifestyle diseasesLifestyle diseases
Lifestyle diseases
collink411
 
(Prevention And Control Of Coronary Heart Diseases
(Prevention And Control Of Coronary Heart Diseases(Prevention And Control Of Coronary Heart Diseases
(Prevention And Control Of Coronary Heart Diseases
Tamanna Rahman
 
Cardiovascular Disease and Public Health Promotion.pptx
Cardiovascular Disease and Public Health Promotion.pptxCardiovascular Disease and Public Health Promotion.pptx
Cardiovascular Disease and Public Health Promotion.pptx
Adeeba Aslam
 
Global Burden of Coronary Heart Disease
Global Burden of Coronary Heart DiseaseGlobal Burden of Coronary Heart Disease
Global Burden of Coronary Heart Disease
PERKI Pekanbaru
 
Acute aortic syndromes
Acute aortic syndromesAcute aortic syndromes
Acute aortic syndromes
Tamer Taha
 
Hypertension guidelines comparison.pptx
Hypertension guidelines comparison.pptxHypertension guidelines comparison.pptx
Hypertension guidelines comparison.pptx
desktoppc
 
SYSTEMIC HYPERTENSION
SYSTEMIC HYPERTENSIONSYSTEMIC HYPERTENSION
SYSTEMIC HYPERTENSION
sahar Hamdy
 
dyslipidemia6.ppt
dyslipidemia6.pptdyslipidemia6.ppt
dyslipidemia6.ppt
BALASUBRAMANIAM IYER
 
Coronary heart diseases chd
Coronary heart diseases  chdCoronary heart diseases  chd
Coronary heart diseases chd
Dr.Hemant Kumar
 
Hypertension: New Concepts, Guidelines, and Clinical Management Hypertensio...
Hypertension: New Concepts, Guidelines, and Clinical Management 	 Hypertensio...Hypertension: New Concepts, Guidelines, and Clinical Management 	 Hypertensio...
Hypertension: New Concepts, Guidelines, and Clinical Management Hypertensio...
MedicineAndFamily
 

Was ist angesagt? (20)

Heart Disease Presentation
Heart Disease PresentationHeart Disease Presentation
Heart Disease Presentation
 
Healthy heart - Life's simple 7 presentation
Healthy heart - Life's simple 7 presentationHealthy heart - Life's simple 7 presentation
Healthy heart - Life's simple 7 presentation
 
Heart Failure
Heart FailureHeart Failure
Heart Failure
 
Prevention and treatment of heart disease
Prevention and treatment of heart diseasePrevention and treatment of heart disease
Prevention and treatment of heart disease
 
Preventing Heart Disease
Preventing Heart DiseasePreventing Heart Disease
Preventing Heart Disease
 
Heart Disease, Prevention of Heart Disease
Heart Disease, Prevention of Heart DiseaseHeart Disease, Prevention of Heart Disease
Heart Disease, Prevention of Heart Disease
 
world Hypertension day 2023.pdf
world Hypertension  day 2023.pdfworld Hypertension  day 2023.pdf
world Hypertension day 2023.pdf
 
Women and Heart Disease: New Concepts in Prevention and Management
Women and Heart Disease: New Concepts in Prevention and ManagementWomen and Heart Disease: New Concepts in Prevention and Management
Women and Heart Disease: New Concepts in Prevention and Management
 
Cardiomyopathy
CardiomyopathyCardiomyopathy
Cardiomyopathy
 
Women and Heart Disease
Women and Heart DiseaseWomen and Heart Disease
Women and Heart Disease
 
Lifestyle diseases
Lifestyle diseasesLifestyle diseases
Lifestyle diseases
 
(Prevention And Control Of Coronary Heart Diseases
(Prevention And Control Of Coronary Heart Diseases(Prevention And Control Of Coronary Heart Diseases
(Prevention And Control Of Coronary Heart Diseases
 
Cardiovascular Disease and Public Health Promotion.pptx
Cardiovascular Disease and Public Health Promotion.pptxCardiovascular Disease and Public Health Promotion.pptx
Cardiovascular Disease and Public Health Promotion.pptx
 
Global Burden of Coronary Heart Disease
Global Burden of Coronary Heart DiseaseGlobal Burden of Coronary Heart Disease
Global Burden of Coronary Heart Disease
 
Acute aortic syndromes
Acute aortic syndromesAcute aortic syndromes
Acute aortic syndromes
 
Hypertension guidelines comparison.pptx
Hypertension guidelines comparison.pptxHypertension guidelines comparison.pptx
Hypertension guidelines comparison.pptx
 
SYSTEMIC HYPERTENSION
SYSTEMIC HYPERTENSIONSYSTEMIC HYPERTENSION
SYSTEMIC HYPERTENSION
 
dyslipidemia6.ppt
dyslipidemia6.pptdyslipidemia6.ppt
dyslipidemia6.ppt
 
Coronary heart diseases chd
Coronary heart diseases  chdCoronary heart diseases  chd
Coronary heart diseases chd
 
Hypertension: New Concepts, Guidelines, and Clinical Management Hypertensio...
Hypertension: New Concepts, Guidelines, and Clinical Management 	 Hypertensio...Hypertension: New Concepts, Guidelines, and Clinical Management 	 Hypertensio...
Hypertension: New Concepts, Guidelines, and Clinical Management Hypertensio...
 

Andere mochten auch

Prevention and Treatment of the Heart diseases
Prevention and Treatment of the Heart diseasesPrevention and Treatment of the Heart diseases
Prevention and Treatment of the Heart diseases
drmanojpradhan
 
Dr ranjith mp.statins for primary prevention of coronary heart disease
Dr ranjith mp.statins for primary prevention of coronary heart disease Dr ranjith mp.statins for primary prevention of coronary heart disease
Dr ranjith mp.statins for primary prevention of coronary heart disease
drranjithmp
 
Heart Disease
Heart DiseaseHeart Disease
Heart Disease
Severus Prime
 
Curriculum Vitae
Curriculum VitaeCurriculum Vitae
Curriculum Vitae
Ceri Jones
 
Coronary artery disease & its prevention
Coronary artery disease & its preventionCoronary artery disease & its prevention
Coronary artery disease & its prevention
ashraf uddin chowdhury
 
Journal club cad in women
Journal club cad in womenJournal club cad in women
Journal club cad in women
Kunal Mahajan
 
Journal club may 2016
Journal club may 2016Journal club may 2016
Journal club may 2016
Kunal Mahajan
 
Journal club-bioresorbable scaffolds
Journal club-bioresorbable scaffoldsJournal club-bioresorbable scaffolds
Journal club-bioresorbable scaffolds
Kunal Mahajan
 
Levosimendan in acs
Levosimendan in acsLevosimendan in acs
Levosimendan in acs
Kunal Mahajan
 
Natural history and treatment of aortic stenosis
Natural history and treatment of aortic stenosisNatural history and treatment of aortic stenosis
Natural history and treatment of aortic stenosis
Kunal Mahajan
 
current status of GP2B3A inhibitors in PCI
current status of GP2B3A inhibitors in PCIcurrent status of GP2B3A inhibitors in PCI
current status of GP2B3A inhibitors in PCI
Kunal Mahajan
 
Primary prevention of stroke
Primary prevention of strokePrimary prevention of stroke
Primary prevention of stroke
Usama Ragab
 
nutrition & cardiovascular disease
nutrition & cardiovascular disease nutrition & cardiovascular disease
nutrition & cardiovascular disease
College of nursing
 
Glucose triad
Glucose triadGlucose triad
Glucose triad
Kunal Mahajan
 
Journal club 19 08-2015
Journal club 19 08-2015Journal club 19 08-2015
Journal club 19 08-2015
Kunal Mahajan
 
Noncompaction cardiomyopathy
Noncompaction cardiomyopathyNoncompaction cardiomyopathy
Noncompaction cardiomyopathy
Kunal Mahajan
 
Cardiovascular disease inequalities: causes and consequences
Cardiovascular disease inequalities: causes and consequencesCardiovascular disease inequalities: causes and consequences
Cardiovascular disease inequalities: causes and consequences
Plan de Calidad para el SNS
 
Primary prevention stroke
Primary prevention strokePrimary prevention stroke
Primary prevention stroke
NeurologyKota
 
In stent neoatherosclerosis
In stent neoatherosclerosis In stent neoatherosclerosis
In stent neoatherosclerosis
Kunal Mahajan
 
The vascular biology of atherosclerosis
The vascular biology of atherosclerosisThe vascular biology of atherosclerosis
The vascular biology of atherosclerosis
Kunal Mahajan
 

Andere mochten auch (20)

Prevention and Treatment of the Heart diseases
Prevention and Treatment of the Heart diseasesPrevention and Treatment of the Heart diseases
Prevention and Treatment of the Heart diseases
 
Dr ranjith mp.statins for primary prevention of coronary heart disease
Dr ranjith mp.statins for primary prevention of coronary heart disease Dr ranjith mp.statins for primary prevention of coronary heart disease
Dr ranjith mp.statins for primary prevention of coronary heart disease
 
Heart Disease
Heart DiseaseHeart Disease
Heart Disease
 
Curriculum Vitae
Curriculum VitaeCurriculum Vitae
Curriculum Vitae
 
Coronary artery disease & its prevention
Coronary artery disease & its preventionCoronary artery disease & its prevention
Coronary artery disease & its prevention
 
Journal club cad in women
Journal club cad in womenJournal club cad in women
Journal club cad in women
 
Journal club may 2016
Journal club may 2016Journal club may 2016
Journal club may 2016
 
Journal club-bioresorbable scaffolds
Journal club-bioresorbable scaffoldsJournal club-bioresorbable scaffolds
Journal club-bioresorbable scaffolds
 
Levosimendan in acs
Levosimendan in acsLevosimendan in acs
Levosimendan in acs
 
Natural history and treatment of aortic stenosis
Natural history and treatment of aortic stenosisNatural history and treatment of aortic stenosis
Natural history and treatment of aortic stenosis
 
current status of GP2B3A inhibitors in PCI
current status of GP2B3A inhibitors in PCIcurrent status of GP2B3A inhibitors in PCI
current status of GP2B3A inhibitors in PCI
 
Primary prevention of stroke
Primary prevention of strokePrimary prevention of stroke
Primary prevention of stroke
 
nutrition & cardiovascular disease
nutrition & cardiovascular disease nutrition & cardiovascular disease
nutrition & cardiovascular disease
 
Glucose triad
Glucose triadGlucose triad
Glucose triad
 
Journal club 19 08-2015
Journal club 19 08-2015Journal club 19 08-2015
Journal club 19 08-2015
 
Noncompaction cardiomyopathy
Noncompaction cardiomyopathyNoncompaction cardiomyopathy
Noncompaction cardiomyopathy
 
Cardiovascular disease inequalities: causes and consequences
Cardiovascular disease inequalities: causes and consequencesCardiovascular disease inequalities: causes and consequences
Cardiovascular disease inequalities: causes and consequences
 
Primary prevention stroke
Primary prevention strokePrimary prevention stroke
Primary prevention stroke
 
In stent neoatherosclerosis
In stent neoatherosclerosis In stent neoatherosclerosis
In stent neoatherosclerosis
 
The vascular biology of atherosclerosis
The vascular biology of atherosclerosisThe vascular biology of atherosclerosis
The vascular biology of atherosclerosis
 

Ähnlich wie Primary prevention of cardiovascular

Mayo Clinic: Mediterranean Diet
Mayo Clinic: Mediterranean DietMayo Clinic: Mediterranean Diet
Mayo Clinic: Mediterranean Diet
Go BellaVita
 
Emili Ros - Impacte de l’alimentació saludable i sostenible en la prevenció d...
Emili Ros - Impacte de l’alimentació saludable i sostenible en la prevenció d...Emili Ros - Impacte de l’alimentació saludable i sostenible en la prevenció d...
Emili Ros - Impacte de l’alimentació saludable i sostenible en la prevenció d...
Agència de Salut Pública de Barcelona - ASPB
 
What is the mediterranean diet and what are its benefits
What is the mediterranean diet and what are its benefitsWhat is the mediterranean diet and what are its benefits
What is the mediterranean diet and what are its benefits
Juan Rodriguez Villà
 
Nutrition and cardiovascular disease
Nutrition and cardiovascular diseaseNutrition and cardiovascular disease
Nutrition and cardiovascular disease
Rabei Al-Ansi
 
Predimed study 2013
Predimed study 2013Predimed study 2013
Predimed study 2013
Reijo Laatikainen
 
Κολοβέρου E, Παναγιωτάκος Δ. Η Μεσογειακή δίαιτα στην πρωτογενή πρόληψη του ...
Κολοβέρου E, Παναγιωτάκος Δ.  Η Μεσογειακή δίαιτα στην πρωτογενή πρόληψη του ...Κολοβέρου E, Παναγιωτάκος Δ.  Η Μεσογειακή δίαιτα στην πρωτογενή πρόληψη του ...
Κολοβέρου E, Παναγιωτάκος Δ. Η Μεσογειακή δίαιτα στην πρωτογενή πρόληψη του ...
MedicalWeb.gr
 
Development and Standardisation of Nutri Bar using Oats, Wheat Bran and Flax ...
Development and Standardisation of Nutri Bar using Oats, Wheat Bran and Flax ...Development and Standardisation of Nutri Bar using Oats, Wheat Bran and Flax ...
Development and Standardisation of Nutri Bar using Oats, Wheat Bran and Flax ...
ijtsrd
 
Complementary and alternative therapies for Coronary Heart Disease (CHD)
Complementary and alternative  therapies for Coronary Heart Disease (CHD)Complementary and alternative  therapies for Coronary Heart Disease (CHD)
Complementary and alternative therapies for Coronary Heart Disease (CHD)
Naina Mohamed, PhD
 
Power Point Presentation by Soumya
Power Point Presentation by SoumyaPower Point Presentation by Soumya
Power Point Presentation by Soumya
jinulazer
 
Lchf cvd
Lchf cvdLchf cvd
Lchf cvd
JeredCook
 
Nutrition, Macronutrients and Micronutrients and their deficiency disorders
Nutrition, Macronutrients and Micronutrients and their deficiency disordersNutrition, Macronutrients and Micronutrients and their deficiency disorders
Nutrition, Macronutrients and Micronutrients and their deficiency disorders
Gaurav Kamboj
 
Lesson one 02/02/2010
Lesson one 02/02/2010Lesson one 02/02/2010
Lesson one 02/02/2010
Alberto Fatticcioni
 
1 yini salas-salvado - yogurt and diabetes - 2015 - san diego
1 yini   salas-salvado - yogurt and diabetes - 2015 - san diego1 yini   salas-salvado - yogurt and diabetes - 2015 - san diego
1 yini salas-salvado - yogurt and diabetes - 2015 - san diego
Charlotte Baecke
 
Nutraceuticals in dietary therapy copy
Nutraceuticals  in dietary therapy   copyNutraceuticals  in dietary therapy   copy
Nutraceuticals in dietary therapy copy
Anas Indabawa
 
Fats and Lippeds to every things........
Fats and Lippeds to every things........Fats and Lippeds to every things........
Fats and Lippeds to every things........
ronarona200
 
Nordic diet in metabolic syndrome, sysdiet
Nordic diet in metabolic syndrome, sysdietNordic diet in metabolic syndrome, sysdiet
Nordic diet in metabolic syndrome, sysdiet
Reijo Laatikainen
 
Margine or butter
Margine or butter Margine or butter
Margine or butter
Reijo Laatikainen
 
Medit. diet
Medit. dietMedit. diet
Medit. diet
ulazari
 
Mediterranean diet primary prevention of cvd journal club
Mediterranean diet primary prevention of cvd journal clubMediterranean diet primary prevention of cvd journal club
Mediterranean diet primary prevention of cvd journal club
pkhohl
 
Metabolic syndrome
Metabolic syndromeMetabolic syndrome
Metabolic syndrome
Ramadhan Ahmed
 

Ähnlich wie Primary prevention of cardiovascular (20)

Mayo Clinic: Mediterranean Diet
Mayo Clinic: Mediterranean DietMayo Clinic: Mediterranean Diet
Mayo Clinic: Mediterranean Diet
 
Emili Ros - Impacte de l’alimentació saludable i sostenible en la prevenció d...
Emili Ros - Impacte de l’alimentació saludable i sostenible en la prevenció d...Emili Ros - Impacte de l’alimentació saludable i sostenible en la prevenció d...
Emili Ros - Impacte de l’alimentació saludable i sostenible en la prevenció d...
 
What is the mediterranean diet and what are its benefits
What is the mediterranean diet and what are its benefitsWhat is the mediterranean diet and what are its benefits
What is the mediterranean diet and what are its benefits
 
Nutrition and cardiovascular disease
Nutrition and cardiovascular diseaseNutrition and cardiovascular disease
Nutrition and cardiovascular disease
 
Predimed study 2013
Predimed study 2013Predimed study 2013
Predimed study 2013
 
Κολοβέρου E, Παναγιωτάκος Δ. Η Μεσογειακή δίαιτα στην πρωτογενή πρόληψη του ...
Κολοβέρου E, Παναγιωτάκος Δ.  Η Μεσογειακή δίαιτα στην πρωτογενή πρόληψη του ...Κολοβέρου E, Παναγιωτάκος Δ.  Η Μεσογειακή δίαιτα στην πρωτογενή πρόληψη του ...
Κολοβέρου E, Παναγιωτάκος Δ. Η Μεσογειακή δίαιτα στην πρωτογενή πρόληψη του ...
 
Development and Standardisation of Nutri Bar using Oats, Wheat Bran and Flax ...
Development and Standardisation of Nutri Bar using Oats, Wheat Bran and Flax ...Development and Standardisation of Nutri Bar using Oats, Wheat Bran and Flax ...
Development and Standardisation of Nutri Bar using Oats, Wheat Bran and Flax ...
 
Complementary and alternative therapies for Coronary Heart Disease (CHD)
Complementary and alternative  therapies for Coronary Heart Disease (CHD)Complementary and alternative  therapies for Coronary Heart Disease (CHD)
Complementary and alternative therapies for Coronary Heart Disease (CHD)
 
Power Point Presentation by Soumya
Power Point Presentation by SoumyaPower Point Presentation by Soumya
Power Point Presentation by Soumya
 
Lchf cvd
Lchf cvdLchf cvd
Lchf cvd
 
Nutrition, Macronutrients and Micronutrients and their deficiency disorders
Nutrition, Macronutrients and Micronutrients and their deficiency disordersNutrition, Macronutrients and Micronutrients and their deficiency disorders
Nutrition, Macronutrients and Micronutrients and their deficiency disorders
 
Lesson one 02/02/2010
Lesson one 02/02/2010Lesson one 02/02/2010
Lesson one 02/02/2010
 
1 yini salas-salvado - yogurt and diabetes - 2015 - san diego
1 yini   salas-salvado - yogurt and diabetes - 2015 - san diego1 yini   salas-salvado - yogurt and diabetes - 2015 - san diego
1 yini salas-salvado - yogurt and diabetes - 2015 - san diego
 
Nutraceuticals in dietary therapy copy
Nutraceuticals  in dietary therapy   copyNutraceuticals  in dietary therapy   copy
Nutraceuticals in dietary therapy copy
 
Fats and Lippeds to every things........
Fats and Lippeds to every things........Fats and Lippeds to every things........
Fats and Lippeds to every things........
 
Nordic diet in metabolic syndrome, sysdiet
Nordic diet in metabolic syndrome, sysdietNordic diet in metabolic syndrome, sysdiet
Nordic diet in metabolic syndrome, sysdiet
 
Margine or butter
Margine or butter Margine or butter
Margine or butter
 
Medit. diet
Medit. dietMedit. diet
Medit. diet
 
Mediterranean diet primary prevention of cvd journal club
Mediterranean diet primary prevention of cvd journal clubMediterranean diet primary prevention of cvd journal club
Mediterranean diet primary prevention of cvd journal club
 
Metabolic syndrome
Metabolic syndromeMetabolic syndrome
Metabolic syndrome
 

Mehr von Kunal Mahajan

Journal club drug eluting balloon for cad
Journal club   drug eluting balloon for cadJournal club   drug eluting balloon for cad
Journal club drug eluting balloon for cad
Kunal Mahajan
 
Journal club april 2015
Journal club april 2015Journal club april 2015
Journal club april 2015
Kunal Mahajan
 
Left main disease pci vs cabg excel trial 2016
Left main disease   pci vs cabg excel trial 2016Left main disease   pci vs cabg excel trial 2016
Left main disease pci vs cabg excel trial 2016
Kunal Mahajan
 
Takayasu arteritis
Takayasu arteritis Takayasu arteritis
Takayasu arteritis
Kunal Mahajan
 
Atrial septal defects
Atrial septal defectsAtrial septal defects
Atrial septal defects
Kunal Mahajan
 
Beta-blockers in cardiovascular diseases
Beta-blockers in cardiovascular diseasesBeta-blockers in cardiovascular diseases
Beta-blockers in cardiovascular diseases
Kunal Mahajan
 
Brainstem stroke syndromes ppt
Brainstem stroke syndromes pptBrainstem stroke syndromes ppt
Brainstem stroke syndromes ppt
Kunal Mahajan
 
BASICS of CT Head
BASICS of CT HeadBASICS of CT Head
BASICS of CT Head
Kunal Mahajan
 

Mehr von Kunal Mahajan (8)

Journal club drug eluting balloon for cad
Journal club   drug eluting balloon for cadJournal club   drug eluting balloon for cad
Journal club drug eluting balloon for cad
 
Journal club april 2015
Journal club april 2015Journal club april 2015
Journal club april 2015
 
Left main disease pci vs cabg excel trial 2016
Left main disease   pci vs cabg excel trial 2016Left main disease   pci vs cabg excel trial 2016
Left main disease pci vs cabg excel trial 2016
 
Takayasu arteritis
Takayasu arteritis Takayasu arteritis
Takayasu arteritis
 
Atrial septal defects
Atrial septal defectsAtrial septal defects
Atrial septal defects
 
Beta-blockers in cardiovascular diseases
Beta-blockers in cardiovascular diseasesBeta-blockers in cardiovascular diseases
Beta-blockers in cardiovascular diseases
 
Brainstem stroke syndromes ppt
Brainstem stroke syndromes pptBrainstem stroke syndromes ppt
Brainstem stroke syndromes ppt
 
BASICS of CT Head
BASICS of CT HeadBASICS of CT Head
BASICS of CT Head
 

Kürzlich hochgeladen

HD Video Player All Format - 4k & live stream
HD Video Player All Format - 4k & live streamHD Video Player All Format - 4k & live stream
HD Video Player All Format - 4k & live stream
HD Video Player
 
一比一原版(uw毕业证书)美国威斯康星大学麦迪逊分校毕业证如何办理
一比一原版(uw毕业证书)美国威斯康星大学麦迪逊分校毕业证如何办理一比一原版(uw毕业证书)美国威斯康星大学麦迪逊分校毕业证如何办理
一比一原版(uw毕业证书)美国威斯康星大学麦迪逊分校毕业证如何办理
sbewyav
 
What Going to the Doctor is Like as an Adult Comics
What Going to the Doctor is Like as an Adult ComicsWhat Going to the Doctor is Like as an Adult Comics
What Going to the Doctor is Like as an Adult Comics
Salty Vixen Stories & More
 
Chennai Call Girls 8824825030 High Calass Call Girl Chennai
Chennai Call Girls 8824825030 High Calass Call Girl ChennaiChennai Call Girls 8824825030 High Calass Call Girl Chennai
Chennai Call Girls 8824825030 High Calass Call Girl Chennai
Mobile Problem
 
SERV - Fun Things To Do In Overland Park
SERV - Fun Things To Do In Overland ParkSERV - Fun Things To Do In Overland Park
SERV - Fun Things To Do In Overland Park
SERV
 
ℂall Girls Lucknow (india) +91-7426014248 Lucknow ℂall Girls
ℂall Girls Lucknow (india) +91-7426014248 Lucknow ℂall Girlsℂall Girls Lucknow (india) +91-7426014248 Lucknow ℂall Girls
ℂall Girls Lucknow (india) +91-7426014248 Lucknow ℂall Girls
meherkumarescorts
 
Abraham Laboriel Records ‘The Bass Walk’ at Evergreen Stage
Abraham Laboriel Records ‘The Bass Walk’ at Evergreen StageAbraham Laboriel Records ‘The Bass Walk’ at Evergreen Stage
Abraham Laboriel Records ‘The Bass Walk’ at Evergreen Stage
DiaDan Holdings Ltd
 
Clyde the cat and Space Poems by Basak Serin
Clyde the cat and Space Poems by Basak SerinClyde the cat and Space Poems by Basak Serin
Clyde the cat and Space Poems by Basak Serin
Basak24
 
一比一原版(AUT毕业证)奥克兰理工大学毕业证如何办理
一比一原版(AUT毕业证)奥克兰理工大学毕业证如何办理一比一原版(AUT毕业证)奥克兰理工大学毕业证如何办理
一比一原版(AUT毕业证)奥克兰理工大学毕业证如何办理
etycev
 
原版制作(MUN毕业证书)纽芬兰纪念大学毕业证PDF成绩单一模一样
原版制作(MUN毕业证书)纽芬兰纪念大学毕业证PDF成绩单一模一样原版制作(MUN毕业证书)纽芬兰纪念大学毕业证PDF成绩单一模一样
原版制作(MUN毕业证书)纽芬兰纪念大学毕业证PDF成绩单一模一样
sh8tjqt6
 
Anasuya Sengupta Cannes 2024 Award Winner
Anasuya Sengupta Cannes 2024 Award WinnerAnasuya Sengupta Cannes 2024 Award Winner
Anasuya Sengupta Cannes 2024 Award Winner
Diwitya Bajwa
 
How OTT Players Are Transforming Our TV Viewing Experience.pdf
How OTT Players Are Transforming Our TV Viewing Experience.pdfHow OTT Players Are Transforming Our TV Viewing Experience.pdf
How OTT Players Are Transforming Our TV Viewing Experience.pdf
Genny Knight
 
欧洲杯赌球-欧洲杯赌球竞猜官网-欧洲杯赌球竞猜网站|【​网址​🎉ac10.net🎉​】
欧洲杯赌球-欧洲杯赌球竞猜官网-欧洲杯赌球竞猜网站|【​网址​🎉ac10.net🎉​】欧洲杯赌球-欧洲杯赌球竞猜官网-欧洲杯赌球竞猜网站|【​网址​🎉ac10.net🎉​】
欧洲杯赌球-欧洲杯赌球竞猜官网-欧洲杯赌球竞猜网站|【​网址​🎉ac10.net🎉​】
juliancopeman444
 
美洲杯下注-美洲杯下注十六强-美洲杯下注买球网|【​网址​🎉ac22.net🎉​】
美洲杯下注-美洲杯下注十六强-美洲杯下注买球网|【​网址​🎉ac22.net🎉​】美洲杯下注-美洲杯下注十六强-美洲杯下注买球网|【​网址​🎉ac22.net🎉​】
美洲杯下注-美洲杯下注十六强-美洲杯下注买球网|【​网址​🎉ac22.net🎉​】
ahmedendrise81
 
欧洲杯买球-欧洲杯买球哪里可以投注-欧洲杯买球买球投注官网|【​网址​🎉ac123.net🎉​】
欧洲杯买球-欧洲杯买球哪里可以投注-欧洲杯买球买球投注官网|【​网址​🎉ac123.net🎉​】欧洲杯买球-欧洲杯买球哪里可以投注-欧洲杯买球买球投注官网|【​网址​🎉ac123.net🎉​】
欧洲杯买球-欧洲杯买球哪里可以投注-欧洲杯买球买球投注官网|【​网址​🎉ac123.net🎉​】
valvereliz227
 
一比一原版(mcmaste毕业证书)加拿大麦克马斯特大学毕业证如何办理
一比一原版(mcmaste毕业证书)加拿大麦克马斯特大学毕业证如何办理一比一原版(mcmaste毕业证书)加拿大麦克马斯特大学毕业证如何办理
一比一原版(mcmaste毕业证书)加拿大麦克马斯特大学毕业证如何办理
abqenm
 
Sunny and Rishi 3 Written by Basak Serin
Sunny and Rishi 3 Written by Basak SerinSunny and Rishi 3 Written by Basak Serin
Sunny and Rishi 3 Written by Basak Serin
Basak24
 
一比一原版(UCSF毕业证)旧金山分校毕业证如何办理
一比一原版(UCSF毕业证)旧金山分校毕业证如何办理一比一原版(UCSF毕业证)旧金山分校毕业证如何办理
一比一原版(UCSF毕业证)旧金山分校毕业证如何办理
ytunuq
 
The Midnight Sculptor.pdf writer by Ali alsiad
The Midnight Sculptor.pdf writer by Ali alsiadThe Midnight Sculptor.pdf writer by Ali alsiad
The Midnight Sculptor.pdf writer by Ali alsiad
ali345alghlay
 
Enhance Your Viewing Experience with Gold IPTV- Tips and Tricks for 2024.pdf
Enhance Your Viewing Experience with Gold IPTV- Tips and Tricks for 2024.pdfEnhance Your Viewing Experience with Gold IPTV- Tips and Tricks for 2024.pdf
Enhance Your Viewing Experience with Gold IPTV- Tips and Tricks for 2024.pdf
Xtreame HDTV
 

Kürzlich hochgeladen (20)

HD Video Player All Format - 4k & live stream
HD Video Player All Format - 4k & live streamHD Video Player All Format - 4k & live stream
HD Video Player All Format - 4k & live stream
 
一比一原版(uw毕业证书)美国威斯康星大学麦迪逊分校毕业证如何办理
一比一原版(uw毕业证书)美国威斯康星大学麦迪逊分校毕业证如何办理一比一原版(uw毕业证书)美国威斯康星大学麦迪逊分校毕业证如何办理
一比一原版(uw毕业证书)美国威斯康星大学麦迪逊分校毕业证如何办理
 
What Going to the Doctor is Like as an Adult Comics
What Going to the Doctor is Like as an Adult ComicsWhat Going to the Doctor is Like as an Adult Comics
What Going to the Doctor is Like as an Adult Comics
 
Chennai Call Girls 8824825030 High Calass Call Girl Chennai
Chennai Call Girls 8824825030 High Calass Call Girl ChennaiChennai Call Girls 8824825030 High Calass Call Girl Chennai
Chennai Call Girls 8824825030 High Calass Call Girl Chennai
 
SERV - Fun Things To Do In Overland Park
SERV - Fun Things To Do In Overland ParkSERV - Fun Things To Do In Overland Park
SERV - Fun Things To Do In Overland Park
 
ℂall Girls Lucknow (india) +91-7426014248 Lucknow ℂall Girls
ℂall Girls Lucknow (india) +91-7426014248 Lucknow ℂall Girlsℂall Girls Lucknow (india) +91-7426014248 Lucknow ℂall Girls
ℂall Girls Lucknow (india) +91-7426014248 Lucknow ℂall Girls
 
Abraham Laboriel Records ‘The Bass Walk’ at Evergreen Stage
Abraham Laboriel Records ‘The Bass Walk’ at Evergreen StageAbraham Laboriel Records ‘The Bass Walk’ at Evergreen Stage
Abraham Laboriel Records ‘The Bass Walk’ at Evergreen Stage
 
Clyde the cat and Space Poems by Basak Serin
Clyde the cat and Space Poems by Basak SerinClyde the cat and Space Poems by Basak Serin
Clyde the cat and Space Poems by Basak Serin
 
一比一原版(AUT毕业证)奥克兰理工大学毕业证如何办理
一比一原版(AUT毕业证)奥克兰理工大学毕业证如何办理一比一原版(AUT毕业证)奥克兰理工大学毕业证如何办理
一比一原版(AUT毕业证)奥克兰理工大学毕业证如何办理
 
原版制作(MUN毕业证书)纽芬兰纪念大学毕业证PDF成绩单一模一样
原版制作(MUN毕业证书)纽芬兰纪念大学毕业证PDF成绩单一模一样原版制作(MUN毕业证书)纽芬兰纪念大学毕业证PDF成绩单一模一样
原版制作(MUN毕业证书)纽芬兰纪念大学毕业证PDF成绩单一模一样
 
Anasuya Sengupta Cannes 2024 Award Winner
Anasuya Sengupta Cannes 2024 Award WinnerAnasuya Sengupta Cannes 2024 Award Winner
Anasuya Sengupta Cannes 2024 Award Winner
 
How OTT Players Are Transforming Our TV Viewing Experience.pdf
How OTT Players Are Transforming Our TV Viewing Experience.pdfHow OTT Players Are Transforming Our TV Viewing Experience.pdf
How OTT Players Are Transforming Our TV Viewing Experience.pdf
 
欧洲杯赌球-欧洲杯赌球竞猜官网-欧洲杯赌球竞猜网站|【​网址​🎉ac10.net🎉​】
欧洲杯赌球-欧洲杯赌球竞猜官网-欧洲杯赌球竞猜网站|【​网址​🎉ac10.net🎉​】欧洲杯赌球-欧洲杯赌球竞猜官网-欧洲杯赌球竞猜网站|【​网址​🎉ac10.net🎉​】
欧洲杯赌球-欧洲杯赌球竞猜官网-欧洲杯赌球竞猜网站|【​网址​🎉ac10.net🎉​】
 
美洲杯下注-美洲杯下注十六强-美洲杯下注买球网|【​网址​🎉ac22.net🎉​】
美洲杯下注-美洲杯下注十六强-美洲杯下注买球网|【​网址​🎉ac22.net🎉​】美洲杯下注-美洲杯下注十六强-美洲杯下注买球网|【​网址​🎉ac22.net🎉​】
美洲杯下注-美洲杯下注十六强-美洲杯下注买球网|【​网址​🎉ac22.net🎉​】
 
欧洲杯买球-欧洲杯买球哪里可以投注-欧洲杯买球买球投注官网|【​网址​🎉ac123.net🎉​】
欧洲杯买球-欧洲杯买球哪里可以投注-欧洲杯买球买球投注官网|【​网址​🎉ac123.net🎉​】欧洲杯买球-欧洲杯买球哪里可以投注-欧洲杯买球买球投注官网|【​网址​🎉ac123.net🎉​】
欧洲杯买球-欧洲杯买球哪里可以投注-欧洲杯买球买球投注官网|【​网址​🎉ac123.net🎉​】
 
一比一原版(mcmaste毕业证书)加拿大麦克马斯特大学毕业证如何办理
一比一原版(mcmaste毕业证书)加拿大麦克马斯特大学毕业证如何办理一比一原版(mcmaste毕业证书)加拿大麦克马斯特大学毕业证如何办理
一比一原版(mcmaste毕业证书)加拿大麦克马斯特大学毕业证如何办理
 
Sunny and Rishi 3 Written by Basak Serin
Sunny and Rishi 3 Written by Basak SerinSunny and Rishi 3 Written by Basak Serin
Sunny and Rishi 3 Written by Basak Serin
 
一比一原版(UCSF毕业证)旧金山分校毕业证如何办理
一比一原版(UCSF毕业证)旧金山分校毕业证如何办理一比一原版(UCSF毕业证)旧金山分校毕业证如何办理
一比一原版(UCSF毕业证)旧金山分校毕业证如何办理
 
The Midnight Sculptor.pdf writer by Ali alsiad
The Midnight Sculptor.pdf writer by Ali alsiadThe Midnight Sculptor.pdf writer by Ali alsiad
The Midnight Sculptor.pdf writer by Ali alsiad
 
Enhance Your Viewing Experience with Gold IPTV- Tips and Tricks for 2024.pdf
Enhance Your Viewing Experience with Gold IPTV- Tips and Tricks for 2024.pdfEnhance Your Viewing Experience with Gold IPTV- Tips and Tricks for 2024.pdf
Enhance Your Viewing Experience with Gold IPTV- Tips and Tricks for 2024.pdf
 

Primary prevention of cardiovascular

  • 1.
  • 2. PUBLISHED ON 25 FEB, 2013 IN NEJM
  • 3. MEDITERRANEAN DIET  The Mediterranean diet is a modern nutritional recommendation inspired by the traditional dietary patterns of southern ITALY, GREECE, and SPAIN .  On November 17, 2010, UNESCO recognized this diet pattern as an Intangible Cultural Heritage of Italy, Greece, Spain and Morocco
  • 4. THESE COUNTRIES HAVE A VERY LOW INCIDENCE OF CARDIOVASCULAR DISEASE . THE MEDITERRANEAN FOOD PATTERN HAS BEEN THE FACTOR MOST FREQUENTLY INVOKED TO EXPLAIN THIS HEALTH ADVANTAGE
  • 5. MEDITERRANEAN DIET  Its major characteristics are:  a high consumption of non-refined grains, legumes, nuts, fruits and vegetables;  a relatively HIGH FAT INTAKE(>40% greater than A RELATIVELY high-fat consumption (even OF TOTAL 40 percent of total energy intake) mostly from MUFA, which CALORIE INTAKE) IN FORM OF OLIVE OIL AND NUTS accounts for 20 percent or more of the total energy intake; ( MUFA ) IS THE HALLMARK OF MEDITERRANEAN  olive oil used to cook and for dressing salads is the DIET , principal source of fat;  fish consumption is moderate to high;  poultry and dairy products (usually as yogurt or cheese) are consumed in moderate to small amounts;  a low consumption of red meats, processed meats or meat products;  a moderate alcohol intake, usually in the form of red wine consumed with meals
  • 6. MEDITERRANEAN DIET  Trials have shown that increasing adherence to the Mediterranean diet has been consistently beneficial with respect to the cardiovascular risk.  A systematic review ranked the Mediterranean diet as the most likely dietary model to provide protection against coronary heart disease. With this background, a randomized trial was designed to test the efficacy of Mediterranean diet on primary cardiovascular prevention.
  • 8. STUDY DESIGN…  The PREDIMED study (Prevención con Dieta Mediterránea) was a parallel-group, multicenter, randomized trial examining the potential benefits of a Mediterranean-style diet for primary prevention of cardiovascular disease (CVD).  A total of 7,447 subjects aged 55 to 80 years were enrolled.  57% were female.
  • 9. STUDY DESIGN…inclusion criteria  Patient should not have any cardiovascular disease at baseline.  Patient should either have type 2 diabetes or  three or more of the following major CVD risk factors:  smoking,  hypertension,  elevated LDL-C,  low HDL-C,  overweight or obesity, or  family history of premature coronary heart disease.
  • 10. Subjects were randomized in a 1:1:1 fashion to 3 groups: 1) Mediterranean diet + extra-virgin olive oil (≥4 tbsp/day; n=2,543) 2) Mediterranean diet + nuts (30 g mixed nuts/day, including walnuts, almonds, and hazelnuts; n=2,454) 3) Low-fat diet (control; n=2,450) No total calorie restriction was advised and no physical activity was promoted.
  • 11.
  • 12.  The primary endpoint = composite of myocardial infarction (MI), stroke, or CV mortality.  Secondary endpoints included stroke, MI, CV mortality, and all-cause mortality.  The trial was stopped after a median of 4.8 years based on an interim analysis showing benefits seen with Mediterranean diets.
  • 14.
  • 17. PRIMARY ENDPOINT EVENTS The primary endpoint, a composite of MI, stroke, or CV mortality, occurred as follows:  Mediterranean diet + extra-virgin olive oil: 96 events (3.8%) hazard ratio (HR), 0.70 P=0.009 vs the control diet  Mediterranean diet + nuts: 83 events (3.4%) HR, 0.70 P=0.02 vs the control diet  Control group: 109 events (4.4%)
  • 18.
  • 19.
  • 20. PRIMARY ENDPOINT PER 1000 PERSON YEARS The rate of the primary endpoint per 1,000 person-years was as follows: Mediterranean diet + extra-virgin olive oil: 8.1 (95% CI, 6.6-9.9); P=0.009 vs the control diet Mediterranean diet + nuts: 8.0 (95% CI, 6.4- 9.9); P=0.02 vs the control diet Control group: 11.2 (95% CI, 9.2-13.5)
  • 21.
  • 22. SECONDARY END POINTS Stroke  Mediterranean diet + extra-virgin olive oil: 49 events; HR vs control, 0.67 P=0.04 vs the control diet  Mediterranean diet + nuts: 32 events HR vs control, 0.54 P=0.006 vs the control diet  Control group: 58 events
  • 23. SECONDARY END POINTS MYOCARDIAL INFARCTION  Mediterranean diet + extra-virgin olive oil: 37 events; HR vs control, 0.80 P=0.34 vs the control diet  Mediterranean diet + nuts: 31 events; HR vs control, 0.74 P=0.22 vs the control diet  Control group: 38 events
  • 24. SECONDARY END POINTS CV MORTALITY  Mediterranean diet + extra-virgin olive oil: 26 events; HR vs control, 0.69 P=0.17 vs the control diet  Mediterranean diet + nuts: 31 events; HR vs control, 1.01 P=0.98 vs the control diet  Control group: 30 events
  • 25. SECONDARY END POINTS ALL-CAUSE MORTALITY  Mediterranean diet + extra-virgin olive oil: 118 events; HR vs control, 0.82 (95% CI, 0.64-1.07); P=0.15 vs the control diet  Mediterranean diet + nuts: 116 events; HR vs control, 0.97 (95% CI, 0.74-1.26); P=0.82 vs the control diet  Control group: 114 events
  • 26.
  • 27. Groups assigned to Mediterranean diets did better than the low fat diet group in terms of both primary and secondary end-points
  • 28.  In this trial, an energy-unrestricted Mediterranean diet supplemented with either extra-virgin olive oil or nuts resulted in risk reduction of major cardiovascular events among high-risk persons who were initially free of cardiovascular disease.  These results support the benefits of the Mediterranean diet for cardiovascular risk reduction.  The results of our trial might explain, in part, the lower cardiovascular mortality in Mediterranean countries than in northern European countries or the United States.
  • 29. PAST STUDIES Multiple trials in the past have demonstrated beneficial effects of mediterranian diet in  Metabolic syndrome  Diabetes mellitus  Reducing markers of oxidation/inflammation and endothelial dysfunction Thus a causal role of mediterranian diet in cardiovascular prevention has high biological plausibility
  • 30. ARCH INTERN MEDICINE 2009 Apr 13;169(7):659-69. In applying a predefined algorithm, we identified strong evidence of a causal relationship for protective factors, including intake of vegetables, nuts, and monounsaturated fatty acids and Mediterranean, prudent, and highquality dietary patterns, and harmful factors, including intake of trans– fatty acids and foods with a high glycemic index or load and a western dietary pattern. Among these dietary exposures, however, only a Mediterranean dietary pattern has been studied in RCTs and significantly associated with CHD.
  • 31. lyon diet heart study (2001)showed a large reduction in rates of coronary heart disease events with a modified mediterranean diet enriched with alpha- linolenic acid (a key constituent of walnuts).
  • 32. CONCLUSION: The adherence to the Mediterranean Diet seems to reduce the incidence of metabolic syndrome
  • 33. HOW DOES MEDITERRANEAN DIET HELP?  IMPROVES THE LIPID PROFILE Replacing saturated fat with MUFA from olive oil produces a decline in total and LDL cholesterol, and maintains HDL cholesterol at higher levels, thus obtaining a net advantage on the overall lipid profile.
  • 34. HOW DOES MEDITERRANEAN DIET HELP?  DECREASES THE OXIDATIVE STRESS olive oil is resistant to oxidative modification, thus it does not lead to formation of oxidation products like peroxides, hydroxyperoxides etc , which have a causal implication in heart diseases.
  • 35. HOW DOES MEDITERRANEAN DIET HELP? NEGATIVE EFFECT ON THROMBOGENECITY AND ATHEROMA PLAQUE FORMATION  incorporation of oleic acid into cultured endothelial cells has shown to decrease the expression of endothelial leukocyte adhesion molecules with reductions in VCAM- 1 and inhibition of nuclear factor-kappa B activation.  Postprandial factor VII is significantly lower after a MUFA-rich diet.  Olive oil is also associated with a reduced DNA synthesis in human coronary smooth muscle cells.
  • 36. EFFECTS OF HIGH MUFA CONTENT IN MEDITERRANEAN DIET
  • 37. CONCLUSION  This primary prevention trial showed that an energy- unrestricted Mediterranean diet, supplemented with extra-virgin olive oil or nuts, resulted in a substantial reduction in the risk of major cardiovascular events among high-risk persons. The results support the benefits of the Mediterranean diet for the primary prevention of cardiovascular disease
  • 38. THANKYOU FOR A HEALTHY HEART
  • 39.
  • 40. Salient components of the Mediterranean diet reportedly associated with better survival include  moderate consumption of ethanol (mostly from wine),  low consumption of meat and meat products, and  high consumption of vegetables, fruits, nuts,  legumes, fish, and olive oil Perhaps there is a synergy among the nutrient-rich foods included in the Mediterranean diet that fosters favourable changes in intermediate pathways of cardio-metabolic risk, such as blood lipids, insulin sensitivity, resistance to oxidation, inflammation, and vaso-reactivity.
  • 41. MEDITERRANEAN DIET  The principal aspects of this diet include proportionally high consumption of OLIVE OIL, LEGUMES, UNREFINED CEREALS, FRUITS, and VEGETABLES, moderate to high consumption of fish, moderate consumption of dairy products (mostly as cheese and yogurt), moderate wine consumption, and low consumption of meat and meat products.  there are discrepancies among nutrition experts because of the high-fat content of Mediterranean Diets (up to >40% of total energy intake), which is in conflict with the usual recommendation to follow a low-fat diet in order to avoid overweight/obesity and to prevent coronary heart disease (CHD)
  • 42.
  • 43.  In its simplest form the hazard ratio can be interpreted as the chance of an event occurring in the treatment arm divided by the chance of the event occurring in the control arm, or vice versa, of a study.
  • 44. Our results compare favourably with those of the Women’s Health Initiative Dietary Modification Trial, wherein a low-fat dietary approach resulted in no cardiovascular benefit.
  • 45.
  • 46.
  • 47.
  • 48. Participants with hypertension, dyslipidemia and higher BMI responded better to Mediterranean Diets
  • 49. Exclusion criteria  Documented history of previous cardiovascular disease, including CHD (angina, myocardial infarction, coronary revascularization procedures or existence of abnormal Q waves in the electrocardiogram (EKG)), stroke (either ischemic or hemorrhagic, including transient ischemic attacks), and clinical peripheral artery disease with symptoms of intermittent claudication.  Severe medical condition that may impair the ability of the person to participate in a nutrition intervention study (e.g. digestive disease with fat intolerance, advanced malignancy, or major neurological, psychiatric or endocrine disease)  Any other medical condition thought to limit survival to less than 1 year.  Immunodeficiency or HIV-positive status.  Illegal drug use or chronic alcoholism or total daily alcohol intake >80 g/d.  Body mass index > 40 kg/m2.  Difficulties or major inconvenience to change dietary habits
  • 50. Exclusion criteria  Impossibility to follow a Mediterranean-type diet, for religious reasons or due to the presence of disorders of chewing or swallowing (e.g., difficulties to consume nuts)  History of food allergy with hypersensitivity to any of the components of olive oil or nuts.  Participation in any drug trial or use of any investigational drug within the last year.  Institutionalized patients for chronic care, those who lack autonomy, are unable to walk, lack a stable address, or are unable to attend visits in the PCC every 3 months.  Illiteracy.  Patients with an acute infection or inflammation (e.g., pneumonia) are allowed to participate in the study 3 months after the resolution of their condition.