Dietary strategies for risk-factor modification to prevent cardiovascular diseases

To study the role of diet in cardiovascular risk-factor intervention, 458 high-risk individuals were asked to eat for either a cardiovasoprotective diet (group A, n = 228) or their usual diet (group B, n = 230) in a randomized single-blind fashion. Ages varied between 25 and 63 yr, and 414 were men. Group A received significantly more calories in relation to the amount of complex carbohydrates, vegetable proteins, polyunsaturated fats, fiber, potassium, magnesium, and vitamin C and fewer calories in saturated fat and cholesterol compared with group B. Age, risk factors, nutritional factors, complications, and laboratory data were similar at entry to the study. Dietary adherence was obtained by questionnaire. After 1 yr, there was a significant (P less than 0.02) decrease in total risk factors (32.0%) in group A compared with group B, and 1-yr mean serum cholesterol was significantly lower than the initial mean cholesterol in group A. There was a significant (P less than 0.02) decrease in total complications (38.3%) in group A compared with group B in association with a significant (P less than 0.02) decrease in cardiovascular end points (38.3%), including postexercise electrocardiographic changes, fatal and nonfatal myocardial infarction, and sudden death. Overall mortality and mortality due to ischemic heart disease was less in group A (8 and 3.5%) than group B (11 and 4.8%). However, because of the few cases, differences were insignificant. It is possible that diet causes a significant reduction in blood cholesterol and modification of other risk factors leading to a decrease in complications and cardiovascular end points in patients with risk factors of coronary heart disease.