In
the
Oslo
Diet
Heart
Study,
412
men
were
randomised
to
a
lipid-lowering
or
a
control
diet
1–2
years
after
a
first
myocardial
infarction
and
followed
for
5
years
[66].
The
experimental
diet
was
low
in
animal
saturated
fats
and
high
in
vegetable
polyunsaturated
fats.
A
dietician
assessed
the
concordance
of
a
selected
subgroup
through
direct
supervision.
At
the
end
of
the
study,
total
cholesterol
was
reduced
by
13%
in
the
experimental
group.
Two
patients
had
a
stroke
event
in
the
experimental
group
and
one
in
the
control
group.
Singh
et
al.
randomized
406
patients
with
suspected
acute
myocardial
infarction
to
two
groups,
both
consuming
a
diet
low
in
animal
fat,
but
group
A
were
also
asked
to
eat
fruit,
vegetable,
pulses,
nuts
and
fish
[67].
Concordance
was
assessed
during
hos-
pital
admissions
and
clinic
visits.
At
1
year,
total
cholesterol
was
reduced
significantly
more
in
group
A
(7.3%
reduction).
One
patient
had
a
fatal
stroke
in
group
A
compared
with
two
in
the
control
group. The
Dietary
Intervention
Randomized
Controlled
Trial-Carotid
(DIRECT-Carotid)
study
offered
some
more
insights
into
how
diet
may
affect
the
risk
of
stroke
[68].
In
this
2-year
study,
322
patients
with
obesity
were
randomised
to
a
low-fat
calorie-restricted
diet,
a
Mediterranean-calorie
restricted
diet
or
a
low-carbohydrate
calorie-unrestricted
diet
[69].
The
adherence
rates
were
sur-
prisingly
high,
at
84.6%
at
2
years.
The
Mediterranean
and
low-carbohydrate
diets
were
superior
to
the
low-fat
diet
in
terms
of
weight
loss.
The
Mediterranean
diet
had
superior
metabolic
effects,
by
reducing
fasting
glucose
and
insulin
levels,
whereas
the
pre-
dominant
effect
of
the
low-carbohydrate
diet
was
to
reduce
the
total
cholesterol/HDL
ratio
by
20%.
Follow-up
of
a
subset
of
175
participants
who
had
carotid
vessel
wall
volumes
quantified
by
ultrasonography
showed
that
the
three
diets
were
equally
effec-
tive
in
achieving
intima-media
thickness,
possibly
via
a
reduction
in
blood
pressure.
No
‘hard’
endpoints
in
terms
of
cardiovascular
outcomes
were
recorded.