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The Mediterranean Diet and Cardiovascular Disease

The Mediterranean Diet and Cardiovascular Disease

The Mediterranean diet represents the most notable overall dietary pattern in nutritional epidemiology that has been extensively studied over the last 2 decades. Research has shown that among individuals without cardiovascular disease (CVD), a Mediterranean diet reduced the risk of stroke, but did not reduce overall or cardiovascular mortality. Yet, among patients with known CVD, a Mediterranean diet reduced both total and cardiovascular mortality. In fact, a meta-analysis of more than 1.5 million healthy adults demonstrated that when following this diet there was an associated reduced risk of cardiovascular mortality as well as overall mortality. It is also associated with a reduced incidence of cancer, Parkinson's, and Alzheimer's diseases. The diet has been associated with a lower level of oxidized low-density lipoprotein (LDL) cholesterol. Additionally, women who eat a Mediterranean diet supplemented with extra-virgin olive oil and mixed nuts may have a reduced risk of breast cancer.

There's no one "Mediterranean" diet but the common Mediterranean dietary pattern has these characteristics:

  • High consumption of fruits, vegetables, bread and other cereals, potatoes, beans, nuts, and seeds
  • Olive oil is an important monounsaturated fat source
  • Dairy products, fish, and poultry are consumed in low to moderate amounts, and little red meat is eaten
  • Eggs are consumed 0 to 4 times a week
  • Wine is consumed in low to moderate amounts

Multiple studies (even after the initial positive study was retracted and re-written) have shown that there is a large, strong, plausible, and consistent body of available prospective evidence to support the benefits of the Mediterranean diet on cardiovascular health. Moreover, in the era of assessing overall food patterns, no other dietary pattern has undergone such a comprehensive, repeated, and international assessment of its cardiovascular effects. The Mediterranean diet has successfully passed all the needed tests and it approaches the gold standard for cardiovascular health.

The Mediterranean diet can be adapted to many different geographic settings by tailoring it to individual characteristics such as food and cultural preferences and health conditions. If it’s difficult to adhere to all components of the diet, experts recommend incorporating a few aspects that are easier to maintain, like eating nuts or increasing fish intake. As experts explain, even small changes in a diet can have significant health benefits when maintained over time.

  • Dinu M, Pagliai G, Casini A, et al. Mediterranean diet and multiple health outcomes: an umbrella review of meta-analyses of observational studies and randomized trials. Eur J Clin Nutr. 2018;72:30-43.
  • Estruch R, Ros E, Salas-Salvadó J, et al. PREDIMED Study Investigators. Primary prevention of cardiovascular disease with a Mediterranean diet. N Engl J Med. 2013;368:1279-1290.
  • Estruch R, Ros E, Salas-Salvadó J, et al. Primary prevention of cardiovascular disease with a Mediterranean diet supplemented with extra-virgin olive oil or nuts. N Engl J Med. 2018;378:e34.
  • Galbete C, Schwingshackl L, Schwedhelm C, Boeing H, Schulze MB. Evaluating Mediterranean diet and risk of chronic disease in cohort studies: an umbrella review of meta-analyses. Eur J Epidemiol. 2018;33:909-931.
  • Lloyd-Jones DM, Hong Y, Labarthe D, et al. Defining and setting national goals for cardiovascular health promotion and disease reduction: the American Heart Association’s strategic Impact Goal through 2020 and beyond. Circulation. 2010;121:586-613.

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