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

on behalf of the MEDIMACS research team

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Abstract

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.govNCT03842319.

Original languageEnglish
Article number795
JournalTrials
Volume22
Issue number1
DOIs
StatePublished - 1 Dec 2021

Funding

FundersFunder number
Arteoliva Company
Consorcio Centro de Investigación Biomédica en Red
Dominique Charron
HDHL-INTIMIC
National Institute of Health Carlos III
Swedish Research Council Formas (Sweden)
Center for International Business Education and Research, University of Illinois at Urbana-Champaign
Horizon 2020 Framework Programme
Agence Nationale de la Recherche
Ministry of Science, Technology and Space

    Keywords

    • -Omics
    • Atherosclerosis
    • Immune system
    • Mediterranean diet
    • Microbiota
    • Randomized controlled trial

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