A randomized trial of the Mediterranean diet for primary prevention of cardiovascular events conducted by the University of Navarra in Bamplona, Spain, has shown that a Mediterraneandiet, rich in olive oil, nuts, fish and fresh fruits and vegetables, may help prevent heart disease and stroke. The study was published in the latest issue of the NewEnglandJournalofMedicine. In this Spanish multicenter trial, researchers assigned subjects at high cardiovascular risk but without cardiovascular disease at enrollment to be randomized to one of three diets: a Mediterranean diet supplemented with olive oil; a Mediterranean diet supplemented with nuts; and a control diet (with reduced fat intake recommended). Subjects received free olive oil, various nuts, or gifts (not food), and related medical education or dietary advice, depending on their group, on a quarterly basis. The primary endpoint of the trial was the incidence of major cardiovascular events (myocardial infarction, stroke, or death due to cardiovascular events). Based on the results of the interim analysis, the trial was terminated after 4.8 years of follow-up. Results showed that a total of 7447 subjects were enrolled (age distribution, 55 to 80 years); 57% of them were women. Subjects in both Mediterranean diet intervention groups had good compliance based on patient self-report and analysis of relevant biomarkers. The study found that 288 subjects had a primary endpoint event. Multivariate corrected risk ratios were 0.70 (95% confidence interval [CI],0.54to0.92) (96 events) and 0.72 (95% CI,0.54to0.96) (83 events) for patients in the Mediterranean diet supplemented with olive oil and Mediterranean diet supplemented with nuts groups, respectively, compared with 109 events in the control group. No diet-related adverse reactions were reported to occur. The researchers suggest that for people at high cardiovascular risk, a Mediterranean diet supplemented with olive oil or nuts may reduce the incidence of major cardiovascular events. Commentary: A new large, rigorous study found that about 30% of heart attacks, strokes and deaths from heart disease could be avoided if people at high risk would change their diets to embrace a diet rich in edible olive oil, nuts, legumes, fish, fruits and vegetables, and even drink wine with their meals. The findings are based on a trial designed to measure the effect of diet on the risk of heart disease and are the first large clinical trial on the subject. The results were published Monday on the website of the New England Journal of Medicine. Experts were struck by the magnitude of the benefits of the Mediterranean diet structure. The trial ended prematurely after nearly five years because the results were so clear that continuing it would have violated industry principles. The “Mediterranean diet” refers to a simple, light and nutrient-rich diet that is beneficial to health. This particular diet emphasizes the consumption of vegetables, fruits, fish, seafood, legumes, nuts and, to a lesser extent, cereals, and the use of vegetable oils (containing unsaturated fatty acids) instead of animal oils (containing satiated fatty acids) in cooking, especially olive oil. The Mediterranean diet is a special way of cooking based on natural nutrients, including olive oil, vegetables, fruits, fish, seafood, beans, with moderate amounts of red wine and garlic, and complemented by unique seasonings. This diet is very beneficial to people, even if they do not lose weight as a result, and most of them are already taking statin lipid-lowering drugs, or medications for high blood pressure and diabetes to reduce their risk of heart disease. The first group of subjects on the Mediterranean diet received extra virgin olive oil weekly and were required to consume at least four tablespoons per day. The other group of subjects received a nut mix consisting of pecans, almonds and hazelnuts and were required to consume about one ounce (about 28 grams) per day. In the case of pecans, for example, one ounce is almost a quarter cup, and a handful is a large handful. The main components of this diet also included eating fruit at least three times a day and vegetables at least twice a day. Subjects also ate fish at least three times a week and legumes (including fava beans, peas and lentils) at least three times a week. They replaced red meat in their diet with white meat, and habitual drinkers would have at least seven glasses of wine with their meals each week.