Extravirgin Olive Oil Consumption Reduces Risk of Atrial Fibrillation The PREDIMED (Prevención con Dieta Mediterránea) Trial

Background —The PREDIMED (Prevención con Dieta Mediterránea) randomized primary prevention trial showed that a Mediterranean diet enriched with either extravirgin olive oil or mixed nuts reduces the incidence of stroke, myocardial infarction, and cardiovascular mortality. We assessed the effect of these diets on the incidence of atrial fibrillation in the PREDIMED trial. Methods and Results —Participants were randomly assigned to 1 of 3 diets: Mediterranean diet supplemented with extravirgin olive oil, Mediterranean diet supplemented with mixed nuts, or advice to follow a low-fat diet (control group). Incident atrial fibrillation was adjudicated during follow-up by an events committee blinded to dietary group allocation. Among 6705 participants without prevalent atrial fibrillation at randomization, we observed 72 new cases of atrial fibrillation in the Mediterranean diet with extravirgin olive oil group, 82 in the Mediterranean diet with mixed nuts group, and 92 in the control group after median follow-up of 4.7 years. The Mediterranean diet with extravirgin olive oil significantly reduced the risk of atrial fibrillation (hazard ratio, 0.62; 95% confidence interval, 0.45–0.85 compared with the control group). No effect was found for the Mediterranean diet with nuts (hazard ratio, 0.89; 95% confidence interval, 0.65–1.20). Conclusions —In the absence of proven interventions for the primary prevention of atrial fibrillation, this post hoc analysis of the PREDIMED trial suggests that extravirgin olive oil in the context of a Mediterranean dietary pattern may reduce the risk of atrial fibrillation. Clinical Trial Registration— URL: Unique AF diagnosis or end of follow-up. repeated these analyses after including either AF or the primary end point as outcome. evaluated effect modifi- cation according to subgroups of sex, age, diabetes mellitus, body mass index, statin use, antihypertensive medication, baseline adherence to the MeDiet. whether any effect of the on AF risk was through reduc- tions in overall CVD, analyses with AF the with inclusion of the nonfatal component of the primary end point infarction stroke) as a time-dependent censoring of participants at the time of the primary CVD end point.