1. ¹Laboratory of Clinical Epidemology of Cardiovascular Disease, Department of Clinical Pharmacology and Epidemiology, Consorzio Mario Negri Sud, Santa Maria Imbaro, Italy
2. ²Institute for International Health, University of Sydney, Sydney, Australia
3. ³Policlinico San Matteo, Pavia, Italy
4. ⁴Ospedale San Gerardo Nuovo, Monza, Italy

Correspondence: F Barzi, Institute for International Health, University of Sydney, PO Box 576, 144 Burren Street, Newtown, Sydney, NSW 2042, Australia. E-mail: barzi@iih.usyd.edu.au

Guarantor: F Barzi.

Contributors: BF was responsible for the data analysis and statistical expertise. MW was responsible for statistical expertise and supervision. RMM contributed to data analysis and statistical expertise. LT contributed to conception and design, to obtain funding and supervision. GT was responsible for conception and design and supervision. FV contributed to conception and design and was responsible for obtaining funding. RM was responsible for conception and design, acquisition of data and supervision. All the authors contributed to manuscript editing.

^†The names of GISSI-Prevenzione Investigators are given in GISSI-Prevenzione Investigators, Lancet, 1999.

Received 28 May 2002; Revised 18 June 2002; Accepted 18 June 2002.

Abstract

Objective: To ascertain whether simple dietary advice to increase the consumption of Mediterranean foods, given in a clinical setting, leads to reduced mortality after a myocardial infarction.

Design: Data were used from the GISSI-Prevenzione clinical trial, analysed as a cohort study with adjustment for treatment allocation.

Setting: A total of 172 centres in Italy.

Subjects: A total of 11 323 men and women with myocardial infarction. All subjects received advice to increase their consumption of fish, fruit, raw and cooked vegetables and olive oil.

Measurements: The intakes of the five foods were assessed at baseline, 6, 18 and 42 months. Associations of food intakes, a combined dietary score, and the risk of death over 6.5 y were estimated adjusting for several non-dietary variables, using pooled logistic regression.

Results: Subjects generally improved their diet according to the advice given. All foods were associated with a significant reduction in risk of death. Compared with people in the worst dietary score quarter, the odds ratio for those in the best score quarter was 0.51 (95% CI 0.44–0.59). A good diet had a protective effect in sub-groups defined by age, sex, smoking, randomized treatment and concomitant drug therapy.

Conclusions: Myocardial infarction patients can respond positively to simple dietary advice, and this can be expected to lead to a substantial reduction in the risk of early death. Regardless of any drug treatment prescribed, clinicians should routinely advise patients with myocardial infarction to increase their frequency of consumption of Mediterranean foods.