Available studies show convincingly the health benefits of lifestyle changes in CAD patients .
Effect estimates of combined dietary changes look promising .
BACKGROUND Guidelines for lifestyle and dietary modification in patients with coronary artery disease ( CAD ) are mainly supported by evidence from general population studies .
CAD patients , however , differ from the general population in age ( older ) and treatment with preventive drugs .
This review seeks to provide evidence for a prognostic benefit of lifestyle and dietary recommendations from studies in CAD patients .
Dietary supplementation with n-3 polyunsaturated fatty acids and vitamin E after myocardial infarction: results of the GISSI-Prevenzione trial
BACKGROUND There is conflicting evidence on the benefits of foods rich in vitamin E ( alpha-tocopherol ) , n-3 polyunsaturated fatty acids ( PUFA ) , and their pharmacological substitutes . We investigated the effects of these substances as supplements in patients who had myocardial infa rct ion . METHODS From October , 1993 , to September , 1995 , 11,324 patients surviving recent ( < or = 3 months ) myocardial infa rct ion were r and omly assigned supplements of n-3 PUFA ( 1 g daily , n=2836 ) , vitamin E ( 300 mg daily , n=2830 ) , both ( n=2830 ) , or none ( control , n=2828 ) for 3.5 years . The primary combined efficacy endpoint was death , non-fatal myocardial infa rct ion , and stroke . Intention-to-treat analyses were done according to a factorial design ( two-way ) and by treatment group ( four-way ) . FINDINGS Treatment with n-3 PUFA , but not vitamin E , significantly lowered the risk of the primary endpoint ( relative-risk decrease 10 % [ 95 % CI 1 - 18 ] by two-way analysis , 15 % [ 2 - 26 ] by four-way analysis ) . Benefit was attributable to a decrease in the risk of death ( 14 % [ 3 - 24 ] two-way , 20 % [ 6 - 33 ] four-way ) and cardiovascular death ( 17 % [ 3 - 29 ] two-way , 30 % [ 13 - 44 ] four-way ) . The effect of the combined treatment was similar to that for n-3 PUFA for the primary endpoint ( 14 % [ 1 - 26 ] ) and for fatal events ( 20 % [ 5 - 33 ] ) . INTERPRETATION Dietary supplementation with n-3 PUFA led to a clinical ly important and statistically significant benefit . Vitamin E had no benefit . Its effects on fatal cardiovascular events require further exploration
Available studies show convincingly the health benefits of lifestyle changes in CAD patients .
Effect estimates of combined dietary changes look promising .
BACKGROUND Guidelines for lifestyle and dietary modification in patients with coronary artery disease ( CAD ) are mainly supported by evidence from general population studies .
CAD patients , however , differ from the general population in age ( older ) and treatment with preventive drugs .
This review seeks to provide evidence for a prognostic benefit of lifestyle and dietary recommendations from studies in CAD patients .