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Because This Particular Study Was Of Secondary Prevention (after The Initial ...


Because this particular study was of secondary prevention (after the initial event) the majority of smokers (prior to the initial event) had already given up smoking and less than 20% were still smoking after the randomisation phase of the trial. This meant that there were too few smokers to be able to detect a statistically significant difference in this particular trial.

The authors were able to point to a significant effect of daily aspirin in the reduction of further cardiac events over the course of the trial and this was an effect that was independent of the particular diet followed

A positive protective effect was established with higher levels of gamma linolenic acid which agrees with the findings of the Ascherio study (A et al. 1996)

The positive link between omega 3 fatty acids and recurrence of cardiovascular events that had been found in other studies (see above) was not substantiated in the Lyon Study. The authors make the comment that there are a number of significant factors that may be relevant in this regard. Firstly, although there are a number of studies that appear to show this benefit (viz. Burr M L et al. 1999), other studies have suggested that they may have a negative effect if taken in too high a dose. (Katan M B 1995). The Mediterranean Diet requires only moderate amounts of omega 3 fatty acid intake and as such, these levels are thought to act in modifying the cascade of events that lead to both acute myocardial ischaemia, its various complications and sudden death. (Leaf A 1990).

Other predictive factors were quantified. The authors reported that an increased leukocyte count above 9x109/L almost doubled the risk of a cardiac event (from a factor of 1.6 to 2.9) and also that each increase of 1 mmol/L of serum cholesterol would be associated with an increase of risk of cardiovascular mortality of between 20-30%. The significance of this finding is that it is directly in line with other epidemiological studies that have taken serum cholesterol levels as the prime outcome marker (viz. Verschuren W M M et al. 1995) and this indicates that the benefits apparently conferred by the Mediterranean Diet are independent of the total serum cholesterol levels.

The study reported by Schröder (H et al. 2004) makes a rather more radical suggestion and finds that the cardioprotective effect of the Mediterranean Diet can be accounted for by the fact that the diet tends to produce a population with both lower levels of obesity and a lower average BMI, both factors which are known to be independent risk factors for the development of cardiovascular disease . A critical analysis of this paper however, suggests that it was not a particularly big study and may therefore have lacked the statistical power to determine any other causes.


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