Mediterranean and Low-Fat Diets Improve Endothelial Function in Hypercholesterolemic Men

  1. Francisco Fuentes, MD, PhD;
  2. José López-Miranda, MD, PhD;
  3. Elias Sánchez, MD, PhD;
  4. Francisco Sánchez, MD, PhD;
  5. José Paez, MD;
  6. Elier Paz-Rojas, BSc;
  7. Carmen Marín, PhD;
  8. Purificación Gómez, BSc;
  9. José Jimenez-Perepérez, MD, PhD;
  10. José M. Ordovás, MD, PhD; and
  11. Francisco Pérez-Jiménez, MD, PhD
  1. From Hospital Universitario Reina Sofía, Córdoba, Spain, and Jean Mayer–U.S. Department of Agriculture Human Nutrition Research Center on Aging at Tufts University, Boston, Massachusetts.

    Abstract

    Background: The regulatory function of the endothelium is altered in hypercholesterolemia, and the subsequent endothelial dysfunction plays a central role in the development of atherosclerosis.

    Objective: To determine whether endothelial function in hypercholesterolemic patients is affected by replacing a saturated fat–enriched diet with a low-fat, low–saturated fat diet (the U.S. National Cholesterol Education Program stage 1 [NCEP-1] diet) or a diet rich in monounsaturated fat (such as that common in Mediterranean countries).

    Design: Intervention dietary study with a baseline phase and two randomized crossover dietary periods.

    Setting: Hospital Universitario Reina Sofía, Córdoba, Spain.

    Patients: 22 hypercholesterolemic men.

    Intervention: Patients followed a diet high in saturated fat, then were assigned in a crossover design to the NCEP-1 diet or a Mediterranean diet. Each dietary period lasted 28 days.

    Measurements: Plasma P-selectin levels, lipid concentrations, and endothelial function.

    Results: Compared with the saturated fat diet, flow-mediated dilatation increased during the Mediterranean diet but not during the NCEP-1 diet. In addition, levels of plasma cholesterol, low-density lipoprotein cholesterol, apolipoprotein B, and P-selectin decreased during the NCEP-1 and Mediterranean diets.

    Conclusion: In hypercholesterolemic men, diets low in fat (especially saturated fat) and diets rich in monounsaturated fats improve endothelial function.

    Article and Author Information

    • Acknowledgments: The authors thank Beatriz Pérez for help in preparing the manuscript.

    • Grant Support: By research grants from the Comisión Interministerial de Ciencia y Tecnologia (OLI 96/2146) (Dr. Pérez-Jiménez), the Spanish Ministry of Health (FIS 96/1540, 98/1531 [Dr. López-Miranda], FIS 99/0949 [Dr. Pérez-Jiménez]), Fundación Cultural “Hospital Reina Sofía-Cajasur” (Dr. Marin and Ms. Gómez), Agencia Española de Cooperación Internacional (Mr. Paz-Rojas), Consejería de Salud, Servicio Andaluz de Salud (PAI 97/58, 98/126, 99/116), Consejería de Agricultura y Pesca de la Junta de Andalucía, Patrimonio Comunal Olivarero (Dr. Pérez-Jiménez), and the National Institutes of Health (HL 54776) (Dr. Ordovás).

    • Requests for Reprints: Francisco Pérez-Jiménez, MD, PhD, Unidad de Lípidos y Arteriosclerosis, Hospital Universitario Reina Sofía, Avda Menéndez Pidal, s/n 14004 Córdoba, Spain; e-mail, fperez{at}sofia.hrs.sas.cica.es.

    • Current Author Addresses: Drs. Fuentes, López-Miranda, Sánchez, Marín, Jimenez-Perepérez, and Pérez-Jiménez, Mr. Paz-Rojas, and Ms. Gómez: Unidad de Lípidos y Arteriosclerosis, Hospital Universitario Reina Sofía, Avenida Menéndez Pidal, s/n 14004 Córdoba, Spain.

    • Drs. Sánchez and Paez: Servicio de Radiodiagnóstico, Hospital Universitario Reina Sofía, Avenida Menendez Pedal, s/n 14004 Córdoba, Spain.

    • Dr. Ordovás: Lipid Metabolism Laboratory, Jean Mayer–U.S. Department of Agriculture Human Nutrition Research Center on Aging at Tufts University, 711 Washington Street, Boston, MA 02111.

    • Author Contributions: Conception and design: F. Fuentes, J. López-Miranda, J.M. Ordovás, F. Pérez-Jiménez.

    • Analysis and interpretation of the data: F. Fuentes, J. López-Miranda, E. Sánchez, E. Paz-Rojas, C. Marin, P. Gómez, J.M. Ordovás, F. Pérez-Jiménez.

    • Drafting of the article: F. Fuentes, J. López-Miranda, J. Jimenez-Perepérez, J.M. Ordovás, F. Pérez-Jiménez.

    • Critical revision of the article for important intellectual content: J. López-Miranda, J. Jimenez-Perepérez, J.M. Ordovás, F. Pérez-Jiménez.

    • Final approval of the article: J. López-Miranda, E. Paz-Rojas, C. Marin, P. Gómez, J.M. Ordovás, F. Pérez-Jiménez.

    • Provision of study materials or patients: F. Fuentes, J. López-Miranda, E. Sánchez, F. Sánchez, J. Paez.

    • Statistical expertise: J. López-Miranda, E. Paz-Rojas, P. Gómez.

    • Obtaining of funding: J. López-Miranda, F. Pérez-Jiménez.

    • Administrative, technical, or logistic support: F. Sánchez, J. Paez, E. Paz-Rojas, C. Marin, P. Gómez.

    • Collection and assembly of data: F. Fuentes, E. Sánchez, F. Sánchez, J. Paez, E. Paz-Rojas, C. Marin, P. Gómez.

    Summary for Patients

    • Summaries for Patients:Two Types of Diets Improve Blood Vessel Function in Men with High Cholesterol Ann Intern Med June 19, 2001 134:S15
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    1. Ann Intern Med June 19, 2001 vol. 134 no. 12 1115-1119
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