In this work we evaluated the effect of the adoption of Mediterranean diet on the development of acute coronary syndromes, in subject with the metabolic syndrome. The data analysis revealed that the adoption of the Mediterranean diet is associated with a considerable reduction of the coronary risk, in these people, after adjustment for several potential confounders.
The metabolic syndrome is a condition well established in nowadays, and it is associated with the promotion of atherosclerosis and increase of the cardiovascular risk. Moreover, there is extensive scientific evidence, especially in countries with better and long lasting national health programs, that the prevalence of metabolic syndrome has increased in the last decade, which suggest that the disease burden (including type 2 diabetes) has increased as well [1
]. Despite its multiple origins, obesity, sedentary life coupled with unhealthy diet and genetic factors interact to produce this syndrome. ATP III raised the significance of diagnosing and treating the metabolic syndrome, focusing on physical activity, lowering excess body fat and on specific dietary patterns. During the past years several epidemiological studies have underlined the relation between diet and incidence of coronary heart disease, and other diseases [16
]. Dietary factors exert their influence largely through their effects on blood lipids and lipoproteins, as well as on the other established modifiable risk factors, with the exception of cigarette smoking. Our findings support the hypothesis that adoption of Mediterranean diet by subjects who met the criteria for the metabolic syndrome is associated with a significant reduction of the risk of developing acute coronary events. The investigated type of diet is low in saturated fat, high in monounsaturated fat, mainly from olive oil, high in complex carbohydrates, from legumes, and high in fibre, mostly from vegetables and fruits. Also, epidemiological studies suggest that the Mediterranean diet is associated with lower coronary heart disease risk, especially through the reduction of blood pressures, body mass index, and levels of several thrombogenic factors [12
]. Recently, the findings from the Lyon Diet Heart study illustrate the potential importance of the Mediterranean dietary pattern, especially when compared to other recommended diets, like Step-I diet [19
]. Also, results from a Spanish Study suggest that the monounsaturated fatty acids diets are associated with a significant reduction and a better control of both systolic and diastolic blood pressure [20
]. However it still remains a matter of debate if the protective influence is primarily caused by single nutrients, e.g. dietary fatty acids, potassium or dietary fibre or if it can be attributed to the Mediterranean diet as a whole [12
EUROASPIRE Study group investigators suggest to the cardiologists, physicians and public health policy makers to moderate the prevalence of the cardiovascular risk factors in order to further reduce coronary heart disease morbidity and mortality and improve patient's chances of survival [21
]. This reduction may be achieved through the adoption of a healthier lifestyle, including stopping smoking, initiation of physical activities and adoption of a healthy diet. Recently the NCEP ATP III recommended for Therapeutic Lifestyle Changes
] in order to reduce the prevalence of the metabolic syndrome among populations. These changes underlined the importance of low-saturated diet consumption (<7% of total fat) and physical exercise. In our work we found that the adoption of Mediterranean diet seems to be associated with a considerable reduction of acute coronary events (i.e. 30%) in people with the metabolic syndrome. Interestingly, is that the adoption of Mediterranean diet by physically active people is associated with much higher reduction of the odds of developing acute coronary event, than diet or exercise achieve alone. A plausible explanation could be the low concentration of this type of diet in saturated fat and the non-lipid-lowering benefits that physical activities and Mediterranean diet have been reported to produce (including antithrombotic and anti-inflammatory effects) [22
]. In accordance to that, several investigators have reported that non-pharmacological lifestyle interventions, like diet and exercise, could be useful in the management of hypertensive subjects [24
This is the first study concerning the prevalence of the metabolic syndrome in Greece and the effect of the Mediterranean diet on the related coronary risk. The results of our study suggest that one third of the acute coronary events could be prevented by the adoption of the Mediterranean diet in subjects with the metabolic syndrome. Education and training will be critical to ensure that physicians have knowledge to diagnose and treat patients with the metabolic syndrome. So the early identification, treatment (with non pharmacological interventions) and prevention of the metabolic syndrome seems to be extremely challenging and provoking for the health policy makers, in order to reduce the epidemic of overweight, improper nutrition and sedentary lifestyle. However, even the observed association is independent from several potential confounders it is hard to claim that our findings suggest causal evidence and much remains to be learned about this "ecological" effect on coronary risk in people with the metabolic syndrome.