Adherence to a Mediterranean Diet is Associated With Reduced Risk of Heart Failure in Men
Open accessAbstract
Aims: We examined the hypothesis that high adherence to a Mediterranean diet reduces the risk of developing heart failure (HF) as well as the risk of death from HF. Methods and results: The study population comprised 37 308 men from the Cohort of Swedish Men who were free from cardiovascular disease at baseline. The modified Mediterranean diet (mMED) score was created from a self-administered food frequency questionnaire, based on consumption of presumed beneficial/detrimental foods, on a 0–8 scale. Incident HF events were ascertained by linkage to the Swedish National Patient and the Cause of Death Registers. Relative risks (RR) with 95% confidence intervals (CI), adjusted for potential confounders, were estimated by Cox proportional hazards regression models. We identified 146 deaths from HF and 1269 incident HF events over a median follow-up of 10.9 years (1998–2008). The mMED score was inversely associated with risk of HF (multivariable RR for the highest vs. lowest quartile 0.69, 95% CI 0.57, 0.83); the corresponding RR of HF mortality was 0.55 (95% CI 0.31, 0.98). The multivariable RR for every two-point increment in the mMED score was 0.85 (95% CI 0.78, 0.91) for incidence of HF and 0.78 (95% CI 0.62, 0.98) for mortality from HF, respectively. Conclusions: High adherence to a Mediterranean diet was associated with a lower risk of HF and mortality from HF in men. Further studies are needed to replicate these findings in other populations.
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Early primary prevention strategies and treatment of associated risk factors reduce incident, symptomatic heart failure.
“Early primary prevention strategies and treatment of associated risk factors reduce incident, symptomatic heart failure and should include lifestyle intervention with nutrition, physical activity, weight management, and smoking cessation (271-274) (Fig. 10.6).”
From 10. Cardiovascular Disease and Risk Management: Standards of Care in Diabetes—2025 (2025) · cites this paper as [273]
The Discussion (page not available) reports that greater adherence to a Mediterranean diet was associated with lower risk of developing heart failure in men. That supports the nutrition aspect of primary prevention, but this observational finding does not establish that interventions or treatment of risk factors reduce symptomatic heart failure. The paper does not report benefits from physical activity, weight management, or smoking cessation interventions. (LLM, conf=0.86)
Experimental — accuracy not yet measuredEarly primary prevention strategies and treatment of associated risk factors reduce incident, symptomatic heart failure.
“Early primary prevention strategies and treatment of associated risk factors reduce incident, symptomatic heart failure and should include lifestyle intervention with nutrition, physical activity, weight management, and smoking cessation (268–271) (Fig. 10.5).”
From 10. Cardiovascular Disease and Risk Management: Standards of Care in Diabetes—2026 (2026) · cites this paper as [270]
The Discussion (page unavailable in our copy) reports that greater adherence to a Mediterranean diet was associated with lower risk of developing heart failure in men, supporting the nutrition aspect of primary prevention. It does not establish that early interventions or treatment of risk factors reduce symptomatic heart failure, and it does not test physical activity, weight management, or smoking cessation as interventions. The observational association also does not establish the causal reduction asserted in the claim. (LLM, conf=0.88)
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“…al. 2011; Misirli et al. 2012; Nettleton et al. 2008; Patterson et al. 2013; Praagman et al. 2015; Soedamah-Muthu et al. 2013; Sonestedt et al. 2011; Tektonidis et al. 2015, 2016; Yaemsiri et al. 2012) (Supplemental Table 9), 47 for fi sh (47 reports) (Albert et al. 1998; Amiano et al. 2016a;…”
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Self-citation
- Authors
- Tektonidis, T. G., Åkesson, A., Gigante, B., Wolk, A., & Larsson, S. C.
- Affiliations
- Karolinska Institutet (SE)
- Danderyds sjukhus (SE)
- Corresponding author
- Larsson, Susanna C.
- Venue
- European Journal of Heart Failure
- Publisher
- Oxford University Press (OUP)
- Published
- 2016-01-18
- Volume
- 18
- Issue
- 3
- Pages
- 253-259
- ISSN
- 1388-9842 (ISSN-L)
- 1879-0844
- OpenAlex
- W2283593634
- Cited by
- 110
- References
- 3
- Citations by year
- 2026: 6 · 2025: 10 · 2024: 9 · 2023: 10 · 2022: 14 · 2021: 7 · 2020: 13 · 2019: 10 · 2018: 8 · 2017: 15 · 2016: 8
- FWCI
- 13.55
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- European Journal of Heart Failure (publishedVersion)
- PubMed (publishedVersion)
- Uppsala University Publications (Uppsala University) (submittedVersion, other-oa)
- Funders
- Swedish Research Council
- Karolinska Institutet
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
- Keywords
- Mediterranean diet, dietary adherence, heart failure, heart failure mortality, heart failure incidence, men, diet score, cardiovascular disease prevention
- MeSH terms
- Aged, Heart Failure, Humans, Male, Middle Aged, Patient Compliance, Registries, Risk Factors, Sweden, Diet, Mediterranean, Risk Reduction Behavior
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