Journal Article

The impact of Mediterranean diet on coronary plaque vulnerability, microvascular function, inflammation and microbiome after an acute coronary syndrome: study protocol for the MEDIMACS randomized, controlled, mechanistic clinical trial

Fernández-Avilés, Francisco, Yotti, Raquel, Charron, Dominique, Al-Daccak, Reem, Fernández, Ana I., Bermejo, Javier, Gophna, Uri, Martín-Demiguel, Irene, Gutiérrez-Ibanes, Enrique, Martínez-Gonzalez, Miguel Ángel, Karlsson, Roger, Mira, Alex

2021

Overview

Background Primary prevention trials have demonstrated that the traditional Mediterranean diet is associated with a reduction in cardiovascular mortality and morbidity. However, this benefit has not been proven for secondary prevention after an acute coronary syndrome (ACS). We hypothesized that a high-intensity Mediterranean diet intervention after an ACS decreases the vulnerability of atherosclerotic plaques by complex interactions between anti-inflammatory effects, microbiota changes and modulation of gene expression. Methods The MEDIMACS project is an academically funded, prospective, randomized, controlled and mechanistic clinical trial designed to address the effects of an active randomized intervention with the Mediterranean diet on atherosclerotic plaque vulnerability, coronary endothelial dysfunction and other mechanistic endpoints. One hundred patients with ACS are randomized 1:1 to a monitored high-intensity Mediterranean diet intervention or to a standard-of-care arm. Adherence to diet is assessed in both arms using food frequency questionnaires and biomarkers of compliance. The primary endpoint is the change (from baseline to 12 months) in the thickness of the fibrous cap of a non-significant atherosclerotic plaque in a non-culprit vessel, as assessed by repeated optical coherence tomography intracoronary imaging. Indices of coronary vascular physiology and changes in gastrointestinal microbiota, immunological status and protein and metabolite profiles will be evaluated as secondary endpoints. Discussion The results of this trial will address the key effects of dietary habits on atherosclerotic risk and will provide initial data on the complex interplay of immunological, microbiome-, proteome- and metabolome-related mechanisms by which non-pharmacological factors may impact the progression of coronary atherosclerosis after an ACS. Trial registration ClinicalTrials.gov NCT03842319 . Registered on 13 May 2019

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: absorption / Acute coronary syndrome / Acute coronary syndromes / association / Atherosclerosis / Atherosclerotic plaque / Biomedicine / Cardiology and Cardiovascular Disease / Cardiovascular disease / Clinical trials / Complications and side effects / Coronary vessels / design / Diagnosis / Diet / Diet therapy / Dietitians / Disease prevention / endothelial dysfunction / Gene expression / Health care / Health Sciences / Hypotheses / Immune system / Inflammation / Intervention / Kardiologi och kardiovaskulära sjukdomar / Medicine / Medicine & Public Health / Mediterranean diet / Metabolism / Microbiota / Mortality / myocardial-infarction / Number systems / Nutrition and Dietetics / Näringslära och dietkunskap / Omics / Patients / Prevention / profile / Randomized controlled trial / Research & Experimental Medicine / Risk factors / score / Statistics for Life Sciences / Study Protocol / Vein & artery diseases