Effects of a French Mediterranean diet on heart transplant recipients with hypercholesterolemia.

A ccelerated coronary artery disease is the main complication limiting long-term survival after heart transplantation.’ Hypercholesterolemia develops in many transplant recipients regardless of the cardiopathy (secondary to coronary artery disease or not) that necessitated heart transplantation.2 In the traditional view of coronary artery disease, hypercholesterolemia is a major risk factor that should be prevented. In recent years, however, other biological characteristics were reported in transplant recipients compared to in nonrecipients with coronary artery disease, which may explain, at least in part, the acceleration of graft vasculopathy. These characteristics include increased platelet aggregation and production of lipid peroxides.3-6 In addition to serum lipids, both platelet aggregation and lipid peroxidation are greatly influenced by diet. For example, a diet high in polyunsaturated fatty acids decreases blood cholesterol, but produces an increase in platelet aggregation7 which has been reported to be associated with coronary thrombosis in transplant recipients.8 Polyunsaturated fatty acids are a major source of lipid peroxides, and oxidative modification of lipoproteins is now considered a prerequisite for the development of arterial intima lipid deposition and foam cell formation.9 In contrast, the monounsaturated fatty acid, oleic acid, has been reported to protect lipoproteins against oxidation.1° Hence, although the reduction in intake of saturated fatty acids is associated with a beneficial effect on blood cholesterol, as well as platelet aggregation8 a dietary therapy based on an increase in polyunsaturated fat intake may be ultimately deleterious. The Mediterranean diet, as popularized by the Cretan cohort (one of 2 Greek cohorts) in the Seven Country Study is associated with a low cardiac mortality rate.” The Greek diet is characterized by a low intake of saturated fats and a high intake of oleic acid, producing a relatively high (approximately 40%) intake of energy as total lipids. t2 The basis of the French Mediterranean diet is low total lipid (~30% of calories) and saturatedfat (oleic acid. Thus, typically in the Mediterranean diet, polyunsaturated fat intake is not increased. In the present preliminary study the general goal was to test whether the beneJicia1 effects of this diet are reproducible in transplant recipients. The study was approved by the local ethical committee, and informed consent was obtained from each patient. Forty-one transplant recipients (all men; mean age 50 + 9 years, range 36 to 64) with hypercholes-