Mediterranean diet, ω-3 fatty acids and secondary prevention of cardiovascular disease

Aim: Primary and secondary prevention of cardiovascular disease constitute a high priority field in nutrition research. The aim of the present review was to investigate the role of the Mediterranean diet and omega-3 fatty acids in the secondary prevention of cardiovascular disease.

Material-Methods: Articles were searched in Pubmed (up to December 2011).

Results: Ιnterventions with the Mediterranean Diet (Lyon Study, study of Singh et al, Indo-mediterranean Study, THIS Study) had beneficial effects, were conducted mainly in men but the total fat intake in these diets was 26–30% of total energy intake, which is much lower than the traditional Mediterranean diet. Fish consumption (2 days/week) (DART study) or 1–2 g/day omega-3 fatty acids (GISSI, GISSI-HF, JELIS) have also shown protective effects in secondary prevention of cardiovascular disease. However, three recent trials (Alpha Omega Trial, SU.FOL.OM3 and Omega Study) have not documented any benefit, probably due to the lower dose used (in the first two studies) and/or the high prescription of statins. The bioprotective mechanisms of the Mediterranean diet and omega-3 fatty acids are discussed and the official recommendations are presented. Conclusion: The recommendations on secondary prevention of cardiovascular disease emphasize the adoption of the Mediterranean diet and the intake of 1 g omega-3 fatty acids/day. However, more studies are needed to test the effects of the traditional Mediterranean diet, the effects of several kinds of omega-3 fatty acids and the role of diet in secondary prevention in women.