Cited by 963Nutritional Studies and DietCardiovascular Health and Risk FactorsFatty Acid Research and Health

The Mediterranean Diet, its Components, and Cardiovascular Disease

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Widmer, R. Jay, Flammer, Andreas J., Lerman, Lilach O., Lerman, Amir·2015·The American Journal of Medicine

Abstract

One of the best-studied diets for cardiovascular health is the Mediterranean diet. This consists of fish, monounsaturated fats from olive oil, fruits, vegetables, whole grains, legumes/nuts, and moderate alcohol consumption. The Mediterranean diet has been shown to reduce the burden, or even prevent the development, of cardiovascular disease, breast cancer, depression, colorectal cancer, diabetes, obesity, asthma, erectile dysfunction, and cognitive decline. This diet is also known to improve surrogates of cardiovascular disease, such as waist-to-hip ratio, lipids, and markers of inflammation, as well as primary cardiovascular disease outcomes such as death and events in both observational and randomized controlled trial data. These enhancements easily rival those seen with more established tools used to fight cardiovascular disease such as aspirin, beta-blockers, angiotensin-converting enzyme inhibitors, and exercise. However, it is unclear if the Mediterranean diet offers cardiovascular disease benefit from its individual constituents or in aggregate. Furthermore, the potential benefit of the Mediterranean diet or its components is not yet validated by concrete cardiovascular disease endpoints in randomized trials or observational studies. This review will focus on the effects of the whole and parts of the Mediterranean diet with regard to both population-based and experimental data highlighting cardiovascular disease morbidity or mortality and cardiovascular disease surrogates when hard outcomes are not available. Our synthesis will highlight the potential for the Mediterranean diet to act as a key player in cardiovascular disease prevention, and attempt to identify certain aspects of the diet that are particularly beneficial for cardioprotection.

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Crossref · 10.1016/j.amjmed.2014.10.014

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120 of 120 references verified0 citation errors · 0 not checkable

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  • Low-glycemic index, Mediterranean, and ketogenic diets have shown promise in improving insulin sensitivity and hormonal balance in PCOS.

    “Specific dietary patterns, such as low-glycemic index (GI), Mediterranean, and ketogenic diets, have shown promise in improving insulin sensitivity and hormonal balance in PCOS [10–12].”

    From Nutritional and herbal interventions for polycystic ovary syndrome (PCOS): a comprehensive review of dietary approaches, macronutrient impact, and herbal medicine in management (2025) · cites this paper as [12]

    The ‘Mediterranean Diet, in toto’ section reports benefits for metabolic syndrome, diabetes, and glucose-related risk factors, offering limited support for the Mediterranean-diet portion of the claim. It does not establish improved insulin sensitivity or hormonal balance in people with PCOS, and it does not evaluate low-GI or ketogenic diets. Page numbers were not available in our copy. (LLM, conf=0.82)

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  • The Mediterranean diet is associated with a 25% reduction in overall mortality and significantly lower rates of cardiovascular diseases.

    “This diet, characterized by olive oil [63], abundant fruits and vegetables, whole grains, legumes, nuts, fish, and moderate wine consumption, is associated with a 25% reduction in overall mortality and significantly lower rates of cardiovascular diseases [64].”

    From The Power of Environment: A Comprehensive Review of the Exposome's Role in Healthy Aging, Longevity, and Preventive Medicine-Lessons from Blue Zones and Cilento (2025) · cites this paper as [64]

    The Introduction (page unavailable) says the Mediterranean diet has consistently been shown to reduce cardiovascular morbidity and mortality, and “The Mediterranean Diet, in toto” reports significantly fewer cardiovascular events in a trial. Our copy does not give a 25% reduction in overall mortality, so the specific magnitude is unsupported. (LLM, conf=0.88)

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  • The Mediterranean diet is characterized by high intake of polyphenols and unsaturated fats, with most of the beneficial effects from this diet being attributed to the high polyphenol intake.

    “The Mediterranean diet is characterized by high intake of polyphenols and unsaturated fats, with most of the beneficial effects from this diet being attributed to the high polyphenol intake [6,7].”

    From Polyphenol Microbial Metabolites Exhibit Gut and Blood–Brain Barrier Permeability and Protect Murine Microglia against LPS-Induced Inflammation (2019) · cites this paper as [7]

    The “Unsaturated Fats, Such as Olive Oil” section describes unsaturated fats as a prominent feature of the diet and discusses beneficial effects of olive-oil phenols. It does not attribute most benefits of the Mediterranean diet to polyphenols: the Conclusions instead say its primary advantage appears to lie in synergy among various nutrients and foods. Page numbers are not available in our copy. (LLM, conf=0.88)

    Experimental — accuracy not yet measured
  • Diets such as the Mediterranean diet or the DASH diet may further enhance these effects.

    “Diets such as the Mediterranean diet or the DASH diet may further enhance these effects [257].”

    From Dietary Nitrate-Rich Vegetables as Natural Modulators of Health: Mechanisms and Benefits in Ageing Populations (2026) · cites this paper as [257]

    The Conclusions (page not provided) report that the Mediterranean diet reduces cardiovascular risk and improves risk markers. The passages found do not address the DASH diet or whether either diet further enhances the unspecified effects in the citing sentence. (LLM, conf=0.83)

    Experimental — accuracy not yet measured
  • The Mediterranean diet consists of many components rich in mono-unsaturated fatty acid such as oleic acid, omega-3-polyunsaturated fatty acid such as alpha-linolenic acid, flavonoids and antioxidants, and dietary fibers that impact gut microbiota, all considered health-promoting and to enhance longevity.

    “Moreover, the MD consists of many components rich in mono-unsaturated fatty acid such as oleic acid, in olive oil, omega-3-polyunsaturated fatty acid, such as alpha- linolenic acid in tree nuts, like walnuts, high amounts of flavonoids and antioxidants found in fruits and vegetables and high amounts of dietary fibers that have a great impact on the composition of gut microbiota—all considered to”

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3 retracted

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2 of the 122 references couldn’t be matched to a known paper.

Research works printed but not linked: 1

  1. [45]Lichtenstein A Appel LJ Brands M Carnethon M Daniels S Franch HA Franklin B Kris-Etherton P Harris WS Howard B Karanja N Lefevre M Rudel L Sacks F Van Horn L Winston M Wylie-Rosett J American Heart Association Nutrition Committee Diet and lifestyle recommendations revision 2006: a scientific statement from the American Heart Association Nutrition Committee Circulation 2009 114 82 96 16785338

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Authors
Widmer, R. J., Flammer, A. J., Lerman, L. O., & Lerman, A.
Affiliations
Mayo Clinic (US)
Corresponding author
Lerman, Amir
Venue
The American Journal of Medicine
Publisher
Elsevier BV
Published
2015-03
Volume
128
Issue
3
Pages
229-238
ISSN
0002-9343 (ISSN-L)
OpenAlex
W2066595212
Cited by
963
References
122
Citations by year
2026: 48 · 2025: 86 · 2024: 109 · 2023: 140 · 2022: 109 · 2021: 114 · 2020: 151 · 2019: 60 · 2018: 44 · 2017: 41 · 2016: 35 · 2015: 25 · 2014: 1
FWCI
5.35
Type
journal article
Language
en
Open access
Locations
  • The American Journal of Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
  • Zurich Open Repository and Archive (University of Zurich) (submittedVersion)
Funders
  • Schweizerischer Nationalfonds zur Förderung der Wissenschaftlichen Forschung (PASMP3_132551)
  • National Institutes of Health (92954, 085307)
  • Swiss Re Foundation
  • Universität Zürich
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 › Nursing › Nutrition and Dietetics › Fatty Acid Research and Health
Keywords
Mediterranean diet, cardiovascular disease prevention, cardioprotection, olive oil, monounsaturated fatty acids, fish consumption, whole grains, Fabaceae, nuts, moderate drinking, cardiovascular risk factors, inflammatory markers, cardiovascular mortality, food components
MeSH terms
Cardiovascular Diseases, Humans, Metabolism, Randomized Controlled Trials as Topic, Outcome Assessment, Health Care, Diet, Mediterranean, Observational Studies as Topic

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