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Mediterranean Diet Augments Benefits of Statins and Reduces Insulin Levels

Hypercholesterolemic men can benefit by supplementing statin therapy with a Mediterranean-style diet.

Taking statins and eating a Mediterranean diet each reduce mortality and morbidity risks in patients with, or at risk for, coronary heart disease. However, little is known about the combined effects of diet and statins on insulin sensitivity, circulating antioxidant levels, lipids, and lipoproteins. In this trial from Finland (1997-1999), 120 previously untreated hypercholesterolemic men (age range, 35 to 64; minimum fasting cholesterol level, 232 mg/dL [6.0 mmol/L]) were randomized to either a standard diet or a modified Mediterranean diet (10% of calories from saturated and transunsaturated fatty acids, 250 mg/day of cholesterol, and 4 g/day of -3 fatty acids). In a crossover phase, all patients were further randomized to receive simvastatin (20 mg/day) or placebo.

Dietary treatment alone decreased levels of total cholesterol, LDL-c, HDL-c, apolipoprotein B, and insulin. Statin therapy alone decreased total cholesterol, LDL-c, triglycerides, and apolipoprotein B, but increased HDL-c, apolipoprotein A1, and insulin levels. Neither therapy alone affected glucose levels. In participants who received both diet and statin therapy, lipid effects were additive; also, diet appeared to negate simvastatin's insulin-elevating effects. Furthermore, simvastatin alone decreased antioxidant levels, whereas diet alone produced small increases in beta-carotene and ubiquinol-10 levels.

Comment: In this small, randomized trial, a modified Mediterranean-style diet potentiated the lipid-lowering benefits of simvastatin and reduced the drug's insulin-elevating effects in hypercholesterolemic men. Although only biochemical markers, not clinical events, were assessed in this study, a combined approach with diet and statins to treat hypercholesterolemia is clinically sound, as the authors note.

— JoAnne M. Foody, MD

Published in Journal Watch Cardiology March 15, 2002

Citation(s):

Jula A et al. Effects of diet and simvastatin on serum lipids, insulin, and antioxidants in hypercholesterolemic men: A randomized controlled trial. JAMA 2002 Feb 6; 287:598-605.

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