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Randomized trials designed to assess possible effects of a dietary intervention on hard outcomes such as cardiovascular disease (CVD) events, cancer incidence, or all-cause mortality are nearly nonexistent. Clinical end point studies such as these require large sample sizes, long-term follow-up measured in years, and high levels of dietary adherence to attain a valid result. These studies are difficult and expensive to conduct and are consequently rare. An important exception was the PREDIMED Study wherein a Mediterranean diet supplemented with extravirgin olive oil or nuts reduced the incidence of major CVD events (mostly stroke) at 4.8 years in persons at high CVD risk.1 Based on many short-term studies and the few long-term studies such as PREDIMED, dietary recommendations currently favor an overall diet similar to the Mediterranean diet for CVD prevention.2,3
Eckel RH. Role of Glycemic Index in the Context of an Overall Heart-Healthy Diet. JAMA. 2014;312(23):2508-2509. doi:10.1001/jama.2014.15338