The objective of this manuscript was to review the evidence on the association between adherence to a Mediterranean diet (MeDiet) and the risk of cardiovascular disease (CVD). We also updated the results of the last available meta-analysis.
In 2013, a landmark study in the field, the PREvención con DIeta MEDiterránea randomized trial, with 7447 high-risk participants, published its final results. They provided a strong support to the beneficial role of a traditional MeDiet for primary cardiovascular prevention. When these results were combined with those of the Lyon Diet Heart Study (a secondary prevention trial), we found that an intervention with a MeDiet was associated with a 38% relative reduction in the risk of CVD clinical events (pooled random-effects risk ratio: 0.62; 95% confidence interval, CI: 0.45–0.85). Regarding observational studies assessing clinical end-points as outcome, we identified seven new cohort studies published after the last meta-analysis. After removing studies that only assessed fatal outcomes, a two-point increase in adherence to the MeDiet (0–9 score) was associated with a significant reduction in cardiovascular events (pooled risk ratio: 0.87; 95% CI: 0.85–0.90) with no evidence of heterogeneity.
Consistent evidence suggests that the promotion of the Mediterranean dietary pattern is an effective and feasible tool for the prevention of CVD.
aDepartment Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain
bCIBERobn, Instituto de Salud Carlos III, Madrid, Spain
Correspondence to Miguel Angel Martinez-Gonzalez, MD, MPH, PhD, Dept. of Preventive Medicine and Public Health, School of Medicine, c/ Irunlarrea, 1 (Ed. Investigación), 31008 Pamplona, Navarra, Spain. Tel: +34 948425600x806463; fax: +34 948425649; e-mail: firstname.lastname@example.org