Effect of a traditional Mediterranean diet on apolipoproteins B, A-I, and their ratio: A randomized, controlled trial

ObjectivesApolipoprotein (Apo)B, ApoA-I, and their ratio could predict coronary heart disease (CHD) risk more accurately than conventional lipid measurements. Our aim was to assess the effect of a traditional Mediterranean diet (TMD) on apolipoproteins.MethodsHigh-cardiovascular risk subjects (n = 551, 308 women and 243 men), aged 55-80 years, were recruited into a large, multicenter, randomized, controlled, parallel-group, clinical trial (The PREDIMED Study) aimed at testing the efficacy of TMD on primary cardiovascular disease prevention. Participants assigned to a low-fat diet (control) (n = 177), or TMDs (TMD + virgin olive oil (VOO), n = 181 or TMD + nuts, n = 193) received nutritional education and either free VOO (ad libitum) or nuts (dose: 30 g/day). A 3-month evaluation was performed.ResultsBoth TMDs promoted beneficial changes on classical cardiovascular risk factors. ApoA-I increased, and ApoB and ApoB/ApoA-I ratio decreased after TMD + VOO, the changes promoting a lower cardiometabolic risk. Changes in TMD + VOO versus low-fat diet were −2.9 mg/dL (95% CI, −5.6 to −0.08), 3.3 mg/dL (95% CI, 0.84 to 5.8), and −0.03 mg/dL (−0.05 to −0.01) for ApoB, ApoA-I, and ApoB/ApoA-I ratio, respectively.ConclusionsIndividuals at high-cardiovascular risk who improved their diet toward a TMD pattern rich in virgin olive oil, reduced their Apo B and ApoB/ApoA-I ratio and improved ApoA-I concentrations.