Hellenic Heart Failure Study: Impact of Mediterranean Diet on Recurrent ACS


Results of this study suggest a role for the anti-inflammatory diet in secondary prevention.

Survivors of myocardial infarction (MI) have higher risk for recurrent MI and have an annual death rate six times higher than people of the same age without heart disease.1 A number of clinical trials such as PREDIMED, GREECS, and EPIC have established a role for the Mediterranean diet (Med Diet) in primary prevention of CVD and results have suggested the Med diet may have anti-inflammatory properties. The role of nutrition in secondary prevention of acute coronary syndrome (ACS) is rarely investigated. The Hellenic Heart Failure Study2 specifically looked at whether patients with heart failure (HF) would benefit from the Med Diet.

This short slide show highlights the study and results.

Please click here for first slide.



The Hellenic Heart Study enrolled 1000 consecutive patients hospitalized for acute coronary syndrome at a university hospital in Athens, Greece between 2006-2009; 33% HFrEF, 29% HFmrEF (midrange), 38% HFpEF.

HFrEF, heart failure, redueced ejection fraction; HFmrEF, heart failure, mildly reduced ejection fraction; HFpEF, heart failure, preserved ejection fraction.  


Assessed adherence to Med Diet over time; adherence to Med Diet linked to longer positive outcomes in HFpEF and only to short-term impact in HFrEF, HFmrEF.

CRP, C-reactive protein


Study limitations include unreliable food frequency questionnaire, lack of recoreded change in observed metrics over time, no record of medication use, only assessed CRP as inflammatory marker.


Study authors suggest that Med Diet may be protective against recurrence of ACS in patients with HF and first MI, particularly in HFpEF; also suggest that diet may serve as adjunct to medical therapy in these patients. 


Take-home points from Hellenic Heart Failure Study: 10-year follow-up suggests Med Diet may improve outcomes in HFpEF; CRP may mediate relationship between Med Diet and lower recurrence of ACS. 

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