Mediterranean diets are considered to be one of the healthiest diets in the world.
A Mediterranean diet could be better than statins at reducing the risk of an early death for millions of Britons, research suggests.
Leading heart experts said patients should be prescribed the diet - rich in fruit, vegetables, fish, nuts, whole grains and olive oil - before being put on drugs.
In the first major study to look at the impact of the Med diet on survival of heart patients, experts found it cut the chances of early death by 37 per cent.
Previous research has found just taking statins cuts mortality by 18 per cent. Experts said the figures were not directly comparable, and that many heart patients could get maximum benefit by doing both.
But they said the results were so remarkable that the state should consider handing out free fruit and vegetables, or subsidising such produce, to encourage the public to change its eating habits. Seven million people in Britain live with heart disease.
The diet regime is already known to have a powerful protective effect against a number of diseases, including diabetes and cancer.
Experts hailed the new findings, presented at the world's biggest heart conference in Rome, Italy, as “extraordinary”, showing that the diet was “more powerful than any drug”.
High consumption of vegetables had the greatest impact on survival, followed by oily fish intake, amount of fruit eaten and consumption of mono-unsaturated fat, found in olive oil.
Professor Giovanni de Gaetano, head of the Department of Epidemiology and Prevention at the IRCCS Neuromed Institute in Italy, said: "We found that among those with a higher adherence to the Mediterranean diet, death from any cause was reduced by 37 per cent in comparison to those who poorly adhered to this dietary regime.
"The Mediterranean diet is widely recognised as one of the healthier nutrition habits in the world.
"In fact, many scientific studies have shown that a traditional Mediterranean lifestyle is associated with a lower risk of various chronic diseases and, more importantly, of death from any cause.
"But so far research has focused on the general population, which is mainly composed of healthy people. What happens to people who have already suffered from cardiovascular disease? Is the Mediterranean diet optimal for them too?”
He said the research suggested exactly this, with the Mediterranean diet showing a "powerful" effect, cutting deaths from all causes.
Doctors should "consider diet before drugs" and the state should subsidise fruit and vegetables to encourage Britons towards healthier diets, he said.
“The National Health Service pays for drugs, but it doesn’t pay for vegetables,” he said. “The state should consider contributing towards those foods that make up the Mediterranean diet.”
While many patients might still need statins, those sticking to such habits might be able to have a far lower dose, reducing the risk of any side-effects such as muscle pain.
"It could allow patients to get the benefits of statins but without the side-effects," he said, urging doctors and patients to think far more about lifestyle.
The study tracked 1,200 Italians with heart disease over seven years, and participants recorded their food intake. Adherence to the Mediterranean diet was appraised under a nine-point scoring system. Over seven years, there were 208 deaths.
After controlling for age, sex, education, exercise, smoking, blood pressure, cholesterol levels, diabetes and cancer, a two-point increase in the Mediterranean diet score was linked with a 21 per cent reduced risk of death.
The closest adherence to the Mediterranean diet was associated with a 37 per cent lower risk of death compared with the bottom category.
A previous study of 92 trials involving 200,000 patients found that people with heart disease were 18 per cent less likely to die early if they took statins.
Researchers said the next step would be to investigate why exactly the Mediterranean diet appears to reduce the risk of dying early.
Prof de Gaetano said: ”This was an observational study so we cannot say that the effect is causal. We expect that dietary effects on mediators common to chronic diseases such as inflammation might result in the reduction of mortality from any cause but further research is needed."
British experts said the "powerful anti-inflammatory effects" of foods such as olive oil, oily fish, nuts and vegetables was likely to make the difference.
Dr Aseem Malhotra, a London cardiologist, said: "The results of this robust observational study are quite extraordinary.
“The Mediterranean diet is more powerful than any drug at reducing death rates in patients with cardiovascular disease.”
Prof Jeremy Pearson, Associate Medical Director of the British Heart Foundation, said: "It is good to know that even if you already have a history of cardiovascular disease, adhering to a Mediterranean diet reduces the risk of death.
"This study suggests that even if you are already receiving medical care, if you add a Mediterranean diet, it will have further benefit. Maintaining a healthy lifestyle, even if you have had a heart attack or stroke is really important and continues to benefit you.”
Statins at a glance
What are statins?
Statins are a group of medicines that can help lower the level of low-density lipoprotein (LDL) cholesterol in the blood. LDL cholesterol is often referred to as "bad cholesterol", and statins reduce the production of it inside the liver.
Who should take statins?
Having a high level of LDL cholesterol is potentially dangerous, as it can lead to a hardening and narrowing of the arteries (atherosclerosis) and cardiovascular disease (CVD).
CVD is a general term that describes a disease of the heart or blood vessels. It's the most common cause of death in the UK. The main types of CVD are:
- coronary heart disease
- angina
- heart attacks
- stroke
Your doctor may recommend taking statins if either: you've been diagnosed with a form of CVD or your personal and family medical history suggests you're likely to develop CVD at some point over the next 10 years and lifestyle measures haven't reduced this risk.
Side effects
Many people who take statins experience no or very few side effects. Others experience some troublesome – but usually minor – side effects, such as an upset stomach, headache or feeling sick.
Your doctor should discuss the risks and benefits of taking statins if they're offered to you.
Cases that involve more serious side effects, such as kidney failure, tend to get a great deal of media coverage, but these are rare.
Alternatives to statins
If you're at risk of developing CVD in the near future, your doctor will usually recommend lifestyle measures to reduce this risk before they suggest that you take statins.
Lifestyle measures that can reduce your cholesterol level and CVD risk include:
- eating a healthy, balanced diet
- exercising regularly
- maintaining a healthy weight
- limiting the amount of alcohol you drink
- stopping smoking
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