Effects of an avocado-based mediterranean diet on serum lipids for secondary prevention after ischemic stroke trial (ADD-SPISE) Study protocol

Abstract

Background: A poor or unhealthy diet is responsible for an important fraction of ischemic stroke risk. Adherence to dietary patterns, such as the Mediterranean diet, rich in monounsaturated fatty acids mainly from olive oil, is associated with a lower stroke risk. Furthermore, lowering low-density cholesterol (LDL-C) levels decreases stroke recurrence. Interestingly, Avocado-substituted diets, which are also rich in monounsaturated fatty acids, significantly decrease LDL cholesterol levels. This study aims to evaluate whether a Mediterranean diet based on Avocados reduces LDL-C compared to a low-fat high-complex carbohydrate diet after 3 months of the intervention in patients who had a recent acute ischemic stroke. The trial will also assess safety and feasibility. Patientsandmethods:Prospective, randomized open-label, blinded outcome assessment clinical trial. Participants are patients within a month of being admitted with an ischemic stroke, who consent and fulfil the eligibility criteria. Patients are randomly assigned to either diet intervention in a 1:1 ratio on top of the usual secondary prevention treatment. The intervention diet is: A) Avocado-based Mediterranean diet with intake of 1/2 portion of Avocado per day and B) The control diet is a low-fat high-complex carbohydrate diet. The main efficacy outcome is a reduction in plasma LDL-C levels at 3months of the dietary intervention. Secondary outcomes include changes in the levels of serum lipid profile and serum inflammation markers, safety, and feasibility. A sample size of 200 patients was estimated to provide 80% power and 5% level of significance (10% loss and 5% crossover) to detect a minimum difference of 4.6mg/dL in LDL-C after 3months of intervention. Conclusion: We hypothesize that an Avocado-based Mediterranean diet will further reduce the levels of LDL-cholesterol at 3 months compared to the control diet, and that the intervention is safe and feasible. Registration: The study is registered under ADDSPISE at www.clinicaltrials.gov. Identifier NCT03524742. Protocol ID CAS-605 version 3.0 (May 2nd, 2019). Abbreviations: AE = adverse events, BMI = body mass index, HDL-C = high density lipoprotein cholesterol, IS = ischemic stroke, LDL-C = lowering low-density cholesterol, MEDAS = Mediterranean Diet Adherence Screener, MeDi = Mediterranean Diet, MUFA = monounsaturated fatty acids, PUFA = polyunsaturated fatty acids, SAE = serious adverse events, TC = total cholesterol.