After a median follow-up of 4.8 years, there was a significant reduction in the primary end point (a composite of MI, stroke, or death resulting from cardiovascular causes) in both Mediterranean diet groups compared with the control group with a low-fat diet. When the components of the primary end point were assessed individually, there was a significant reduction in the rate of stroke but no significant impact on the risk of MI or mortality (from cardiovascular or all-cause). Although there are no data specifically addressing the impact of the Mediter- ranean diet on the development of HF or established HF, both Mediterranean diets in the PREDIMED diet resulted in significant decreases in plasma N-terminal pro-brain natriuretic peptide levels, suggesting mitigation against Similarly, the Lyon Diet Heart Study, a small, random- ized, secondary prevention trial of the Mediterranean diet performed in patients after first MI (n=423),324 showed that the Mediterranean diet group had fewer cardiac deaths, nonfatal MIs, or HF development compared with the control group after a mean follow-up of 46 months. Although these data are provocative, the Mediterranean diet has not been widely implemented or incorporated into the metabolic syndrome guidelines and needs to be further studied in the HF population. 