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Arterioscler Thromb Vasc Biol. 2014 Feb;34(2):439-45. doi: 10.1161/ATVBAHA.113.302327. Epub 2013 Nov 27.

Changes in ultrasound-assessed carotid intima-media thickness and plaque with a Mediterranean diet: a substudy of the PREDIMED trial.

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From the Lipid Clinic, Endocrinology and Nutrition Service, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, Barcelona, Spain (A.S.-V., E.R.); Ciber Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III (ISCIII), Madrid, Spain (A.S.-V., E.-S.R.-M., I.N., R.d.l.T., D.C., V.R.-G., M.-C.L.-S., X.P., J.R., M.-Á.M.-G., R.E., E.R.); Department of Internal Medicine, IDIBAPS, Hospital Clinic, Barcelona, Spain (E.-S.R.-M., R.E.); Diagnostic Imaging Centre, IDIBAPS, Hospital Clínic, Barcelona, Spain (R.G., I.N.); Human Pharmacology and Clinical Neurosciences Research Group, Institut de Investigacions Mèdiques Hospital del Mar, Barcelona, Spain (R.d.l.T.); Department of Preventive Medicine, University of Valencia, Valencia, Spain (D.C.); Instituto de la Grasa, Consejo Superior de Investigaciones Cientificas, Sevilla, Spain (V.R.-G.); Department of Nutrition and Food Science, School of Pharmacy, XaRTA, INSA, University of Barcelona, Barcelona, Spain (M.-C.L.-S.); Lipids and Vascular Risk Unit, Internal Medicine, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain (X.P.); Department of Cardiology, University Hospital of Alava, Vitoria, Spain (J.R.); and Department of Preventive Medicine and Public Health, School of Medicine, University of Navarra-Clínica Universidad de Navarra, Pamplona, Spain (M.-Á.M.-G.).



The Prevención con Dieta Mediterránea (PREDIMED) trial showed that a Mediterranean diet (MedDiet) supplemented with either extra virgin olive oil or 30 g/d of mixed nuts reduced incident cardiovascular events compared with a control (low fat) diet. The mechanisms of cardiovascular protection afforded by MedDiets remain to be uncovered. We assessed the effect of both supplemented MedDiets on internal carotid intima-media thickness (ICA-IMT) and plaque height, the ultrasound features that best predict future cardiovascular events, in subjects at high cardiovascular risk.


In a PREDIMED subcohort (n=175), plaque height and carotid IMT of 3 prespecified segments (ICA, bifurcation, and common) were sonographically assessed at baseline and after intervention for a mean of 2.4 years. We evaluated 164 subjects with complete data. In a multivariate model, mean ICA-IMT progressed in the control diet group (mean [95% confidence interval], 0.052 mm [-0.014 to 0.118 mm]), whereas it regressed in the MedDiet+nuts group (-0.084 mm [-0.158 to -0.010 mm]; P=0.024 versus control). Similar results were observed for maximum ICA-IMT (control, 0.188 mm [0.077 to 0.299 mm]; MedDiet+nuts, -0.030 mm [-0.153 to 0.093 mm]; P=0.034) and maximum plaque height (control, 0.106 mm [0.001 to 0.210 mm]; MedDiet+nuts, -0.091 mm [-0.206 to 0.023 mm]; P=0.047). There were no changes in ICA-IMT or plaque after the MedDiet+extra virgin olive oil.


Compared with a control diet, consumption of a MedDiet supplemented with nuts is associated with delayed progression of ICA-IMT and plaque. The results contribute mechanistic evidence for the reduction of cardiovascular events observed in the PREDIMED trial.



carotid intima-media thickness; carotid stenosis; diet, Mediterranean; nuts; olive oil

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