If you’ve ever have the misfortune of a heart attack or are considered at risk of heart disease or stroke, your doctor will probably prescribe a statin drug, such as atorvastatin (Lipitor), to lower your blood cholesterol levels.

Recent reports of an Italian study have suggested adhering to a Mediterranean-style diet may actually better protect people from a heart attack or stroke than taking a statin.

Such a claim can’t really be made. To do so, we’d need a trial in which a large number of well-matched participants were randomly given either statins or a Mediterranean-style diet, and followed faithfully to see the comparative results.

Such a trial is unlikely to occur, as withholding medication from people at risk of heart attack or stroke would be regarded as unethical.

But I also suspect ethics committees would be unlikely to recommend anyone avoid following the healthy features of a Mediterranean-style diet, which so many studies have shown to be protective.

The Italian study and statins

The recent Italian study randomly enrolled more than 25,000 people, about 1,200 of whom reported a prior history of heart attack, stroke or blocked arteries at enrolment. Each person recorded their usual diet over the next seven years. Researchers recorded deaths from any cause.

Participants’ diets were given a score out of nine, based on how many features of a healthy Mediterranean-style diet they followed. Those with higher scores had a 37% lower risk of premature death compared with those with lower scores.

These results were controlled for confounding factors, including age, sex, smoking, exercise, energy intake, waist-to-hip ratio, blood pressure, blood cholesterol levels and diabetes.

The benefits of statins on various levels of heart health have also been extensively researched. A recent randomised controlled trial compared statins with a placebo in 21 countries in 12,705 people who were at higher-than-average risk of heart disease.

Over the more than five years of this study, those on statins had a 23% reduction in heart attack, stroke or heart-related death compared with those on placebo. There were no differences in diabetes or cancers, but those on statins were 20% more likely to have muscle symptoms, such as weakness or pain, and 18% more likely to have cataract surgery.