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Feb 13

Today, I will briefly discuss two papers that report reduced mortality by either following the Mediterranean diet, or taking statins.

I wrote a piece early this week about how a Mediterranean diet decreases the chances of the elderly developing mild dementia and Alzheimer’s disease (and an earlier post on how dietary restriction improves memory performance in the elderly). Now I will give the summary of a paper that examine the effects of the Mediterranean diet on all causes of mortality.

Mediterranean diet:

Sofi et. al., 2008 (complete paper freely available here) did a meta-analysis of 12 paper that covered over 500,000 people and found that a two point difference (scores ranged from 0 to 7-9) in adherence to the diet was associated with reduced risk of mortality. They also found that those having that more strictly followed the diet had lower risk of mortality from cardiovascular disease, cancer along with reduced incidences of Alzheimer’s and Parkinson’s disease.

Conclusions Greater adherence to a Mediterranean diet is
associated with a significant improvement in health
status, as seen by a significant reduction in overall
mortality (9%), mortality from cardiovascular diseases
(9%), incidence of or mortality from cancer (6%), and
incidence of Parkinson’s disease and Alzheimer’s disease
(13%). These results seem to be clinically relevant for
public health, in particular for encouraging a
Mediterranean-like dietary pattern for primary prevention
of major chronic diseases.

But you might ask yourself the pertient question - what the heck is a two point difference in adherence scale mean?

Adherence to a Mediterranean diet was defined
through scores that estimated the conformity of the
dietary pattern of the studied population with the
traditional Mediterranean dietary pattern. Values of
zero or one were assigned to each dietary component
by using as cut offs the overall sex specific medians
among the study participants. Specifically, people
whose consumption of components considered to be
part of a Mediterranean diet (vegetables, fruits,
legumes, cereals, fish, and a moderate intake of red
wine during meals) was above the median consumption
of the population were assigned a value of one,
whereas a value of zero was given to those with
consumptions below the median. By contrast, people
whose consumption of components presumed not to
form part of a Mediterranean diet (red and processed
meats, dairy products) was above the median consumption
of the population had a value of zero
assigned, and the others had a value of one.

Okay, does that make sense? Are you above or below the median for these categories and who are we comparing ourselves against?

Statins:

Shalev et. al., 2009 examined over 200,000 patients taking statins that included one group that had coronary heart disease, but a second group that had no indication of cardiovascular disease. Those subjects that had > 90% adherence to taking their statin medication had a 45% reduction in risk of death compared to those with < 10 % adherence. And this result held up for both groups - meaning that taking statins also reduced or risk of dying even if you didn’t have any indications of cardiovascular disease.

A stronger risk reduction was calculated among patients with high baseline low-density lipoprotein cholesterol level and patients initially treated with high-efficacy statins. CONCLUSIONS: Better continuity of statin treatment provided an ongoing reduction in mortality among patients with and without a known history of CHD. The observed benefits from statins were greater than expected from randomized clinical trials.

Like the Mediterranean diet reported meta-analysis the statin results do not come from a randomized clinical trial - however they are both interesting. I haven’t yet acquired the full statin paper but would like to see the further breakdown of the data - are the patients that are less likely to adhere to taking their medication just less interested in their health in general - but maybe the same could be said about those that do not adhere to the Mediterranean diet.

And the futurepunduit sums it up well:

If you have high cholesterol do something to lower it. Take statins if you can’t be bothered to radically change your diet. Or take statins and radically change your diet. Or at least change your diet. On the other hand, if you have a death wish I don’t have any arguments to offer for why to take statins. But maybe if you changed your diet for the better you might feel better and less inclined to die.

But I would wonder if we should diet or consider taking statins even if you don’t have high cholesterol since these two paper suggest they both will lower your risk of dying  - though I would do more research before deciding to take statins - there is still ongoing controversy regarding the long term safety of statin use - see my articles here, and here).

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