The Mediterranean Diet was inversely associated with mortality from all-causes in several observational cohort studies. A secondary prevention trial found a remarkable reduction in reinfarction or death when coronary patients were assigned to a so-called "Mediterranean diet" (De Lorgeril, 1999). It was the Lyon Diet Heart Study which found a 50%-70% relative reduction in the risk of mortality or reinfarction when patients who had suffered a myocardial infarction were assigned to an experimental diet rich in bread, vegetables, fish, and fruit and low in red meat (replaced with poultry). Butter and cream were replaced with a special margarine rich in alpha-linolenic acid.
The 50% to 70% observed reduction in cardiac events in the experimental group of the Lyon trial after 46 months led us to think that, if these results were generalized to non-Mediterranean populations, substantially enhanced and efficient methods to reduce coronary heart disease would be available. It would be shortsighted not to acknowledge the vast public health benefit that a Mediterranean Diet could provide with the adoption by the healthy population-at-large if the findings of the secondary trials are also confirmed in primary prevention trials. This was the evidence finally obtained with the PREDIMED trial.