Effects of a Mediterranean Diet and physical activity on atherothrombosis biomarkers in high cardiovascular risk individuals

Objective. Following a Mediterranean diet (MedDiet) and being physically active decrease cardiovascular risk. However, their individual and combined effects on atherothrombosis biomarkers are unexplored. Approach and Results. In 358 random volunteers from the PREDIMED trial (Prevencion con Dieta Mediterranea), we assessed the 1-year effects of an intervention with MedDiet, enriched with virgin olive oil (MedDiet-VOO; N=120) or nuts (MedDiet-Nuts; N=119) versus a low-fat control diet (N=119), on atherothrombosis markers. In a secondary, observational approach, we studied the associations of 1-year changes in MedDiet adherence, physical activity (PA) levels, and their combination, with 1-year differences in atherothrombosis biomarkers. The MedDiet-VOO intervention increased HDL platelet activating factor-acetylhydrolase activity by 8.2% (95% CI: 0.92; 15.6) and decreased HDL-bound α1-antitrypsin levels by 5.8% (95% CI: -11.6; -0.046) versus control diet. The MedDiet-Nuts intervention reduced non-esterified fatty acid levels by 9.1% (95% CI: -18.0; -0.19) relative to control. Only the low-fat diet was associated with increases in platelet factor-4 and prothrombin factor 1+2 concentrations versus baseline (P=0.012 and P=0.003, respectively). Increments in MedDiet adherence (+1 point) were associated with lower fibrinogen levels (-1.8%, 95% CI: -3.38; -0.17). Increases in PA (+100 METs.min/d) were linked to lower prothrombin factor1+2 (-5.2%, 95% CI: -10.4; -0.077) and plasminogen activator inhibitor-1 concentrations (-3.0%, 95% CI: -5.93; -0.12). Finally, 1-point increments in MedDiet adherence plus 100 METs.min/d of PA were related to lower D-dimer levels (-1.52%, 95% CI: -3.10; 0.026; P-interaction=0.047). Conclusions. Following a MedDiet and increasing PA were associated with improvements in atherothrombosis biomarkers in high cardiovascular risk individuals.