Dietary Prevention of Coronary Heart Disease

This issue of Circulation contains an article1 that I believe deserves special attention from cardiologists and physicians. It reports the 46-month mean follow-up findings on the original report of the study on “Mediterranean α-linolenic acid–rich diet in secondary prevention of coronary heart disease,” the so-called Lyon Diet Heart Study. This study was undertaken because of the interest of the investigators in explaining the very much lower mortality from cardiovascular disease, mainly coronary heart disease, in the countries bordering the Mediterranean compared with that in northern Europe. The initial report2 was published in Lancet in 1994 after the study was terminated by its Scientific and Ethics Committee at 27 months mean follow-up time of what had been planned as a 5-year study, because the benefits in the experimental group at that time were so favorable. Despite the striking findings in the first report of a 70% reduction in all-cause mortality due to a reduction in coronary heart disease (CHD) mortality and comparable large reductions in nonfatal sequelae, I have encountered few cardiologists here who are aware of that study.It is much to the credit of Dr de Lorgeril and associates that they persisted in following the original enrollees despite the official termination of the study and publication of the initial findings so that they are now able to report their more extended observations. With the mean follow-up time of 46 months per patient, the initial remarkably beneficial effects of the experimental dietary program persisted compared with the control group consuming the “prudent Western-type diet.”Let me list the several important messages I believe are inherent in the results that are clearly and modestly presented in this article.1. At a time when health professionals, the pharmaceutical industries, and the research funding and regulatory agencies are almost totally focused …