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The Mediterranean Diet, its Components, and Cardiovascular Disease
Open accessAbstract
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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“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]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
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“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]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
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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 [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]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
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“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]
Experimental — accuracy not yet measuredIn the citing paper
“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”
From Mediterranean Diet as an Antioxidant: The Impact on Metabolic Health and Overall Wellbeing (2021) · cites this paper as [12]
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3 retracted
RETRACTED: Primary Prevention of Cardiovascular Disease with a Mediterranean Diet
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BackgroundEffects of Mediterranean diets and nutrigenomics on cardiovascular health
Bakrim, S., Aboulaghras, S., Aanniz, T., Benali, T., Omari, N. E., El‐Shazly, M., Lee, L., Mustafa, S. K., Sahib, N., Ребезов, М. Б., et al. (2023) · Critical Reviews in Food Science and Nutrition · doi:10.1080/10408398.2023.2187622 · Cited by 12
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“…grains, vegetables, legumes, and olive oil, moderate- to-high intake of fish and seafood, and low consumption of meat products, dairy and sweets (Widmer et al., 2015), while western/fast food dietary pattern is characterized by high levels of fat and sugars and low intake of greens (Christ et…”
BackgroundImpact of a short-term Mediterranean diet intervention on plasma metabolites: a pilot study
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“Current European Society of Cardiology (ESC) guidelines advocate its daily adoption for CVD prevention (Visseren et al., 2021; Widmer et al., 2015).”
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“Similarly, a Mediterranean diet was found to prevent and decrease mortality from cardiovascular disease.(63) Features of the Mediterranean diet are relatively high intake of grains, vegetables, fruits, nuts, and olive oil, moderate”
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“Med-Diet emphasizes the consumption of healthy unsaturated and omega-3 fats found in foods such as extra virgin olive oil and fish [41].”
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Lifestyle Interventions to Prevent Cardiovascular Events After Stroke and Transient Ischemic Attack
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“Inhibiting the development of cardiovascular disease, neurodegenerative disease, and cancer by this diet has been well proved [2,3].”
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“Due to the fact that former athletes often face this problem, they can use this diet both as part of dietary prophylaxis and as support to the pharmacological treatment [42,47,48].”
BackgroundSala, L. L., Tagliabue, E., Mrakic‐Sposta, S., Uccellatore, A. C., Senesi, P., Terruzzi, I., Trabucchi, E., Rossi-Bernardi, L., & Luzi, L. (2022) · Cardiovascular Diabetology · doi:10.1186/s12933-022-01465-0 · Cited by 8
“Mediterranean diet (MedDiet)—largely based on plant foods and therefore includes a lot of fruits and vegetables, beans and pulses, nuts and seeds, whole grains and olive oil—notoriously demonstrated beneficial effects on intermediate markers of cardiovascular risk [36].”
BackgroundSourdough: A Tool for Non-conventional Fermentations and to Recover Side Streams
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Asthma and diet: could food be thy medicine?
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“…investigated Mediterranean diet, with high intakes of fish, fruit, vegetables, legumes, nuts, whole grains, and monounsaturated fats from olive oil, has been shown to reduce, or even prevent, CVD, diabetes, obesity, metabolic syndrome, and cancer in the general population [37-41] and in CCSs [5].”
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“These effects are due to its high amounts of fish, olive oil, whole grains, fruits and vegetables, nuts, and legumes (Trichopoulou & Lagiou, 1997; Widmer et al., 2015).”
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“The Mediterranean diet has been shown to reduce the burden or even prevent the development of cardiovascular disease, diabetes, obesity, and cognitive decline, among other e ff ects [41].”
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Association Between Nutrients and Cardiovascular Diseases
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“…characterized by a large consumption of fruits, vegetables, whole grains, legumes, fish, monounsaturated fats (in particular olive oil), and nuts [38], there are many possible biological pathways whereby a variety of substances in the MDP could exert a beneficial role on CVD; for instance,…”
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“Dyslipidemic patients should increase their fiber intake as study showed that low fiber intake is associated with higher blood cholesterol level [26].”
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“Since traditional MeDi contains high amounts of monosaturated fats and omega-3 fatty acids, dietary fibers, polyphenols, vitamins, and antioxidants, the synergic effect of mentioned nutrients with significant impact on WC, HDL, triglycerides, fasting blood glucose, blood pressure, as well as systemic inflammation was…”
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Low Potassium Intake: A Common Risk Factor for Nephrolithiasis in Patients with High Blood Pressure
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“The Med diet consists of fish, monounsaturated fats from olive oil, fruits, vegetables, whole grains, legumes and/or nuts, and moderate alcohol consumption [33].”
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Pediatric Anti-Inflammatory Diet
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“There is a demand for a nutritional supplement or diet that can reduce CVD risk.”
BackgroundInfluentialComedores preescolares y escolares. Guías, recomendaciones y normativa en España
González, M. Á. S. J., Baviera, L. C. B., & Moreno-Villares, J. M. (2021) · Anales de Pediatría · doi:10.1016/j.anpedi.2021.01.010 · Cited by 7
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“Although our analyses did not control specifically for saturated fat consumption, they controlled for an indicator of diet quality based on adherence to the Mediterranean diet, which considers the lower frequency of consumption of saturated fats and higher frequency of unsaturated fat–rich foods such as olive oil and…”
MethodReproducibilidad, correlación y concordancia de un cuestionario abreviado del Dietary Score
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Olive Oil: Its Role in the Diet
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Fueling the Heart: What Are the Optimal Dietary Strategies in Heart Failure?
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“Importantly, like the DASH diet, no singular aspect of the Mediterranean diet has been found to be as beneficial as the overall diet [46].”
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“46–49 Nuts have high vitamin, mineral, and heart-healthy fat contents, which are essential for sustaining cardiovascular health, a key factor in sexual function.”
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“Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in the world [1].”
From Gut Inflammation to Cardiovascular Conflagration: Mapping IBD’s Cardiometabolic Risks
Noble, O., Jeon, D., Lewis, M., Fan, C., Nasir, K., & Abraham, B. P. (2025) · Current Atherosclerosis Reports · doi:10.1007/s11883-025-01329-4 · Cited by 6
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“179 In addition to its MUFA content, EVOO contains abundant polyphenols, which exhibit antioxidant anti-inflammatory properties, further supporting endothelial function and improved lipid profiles.”
Metadata
- 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)
- PMC
- PMC4339461
- 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
- FWCI
- 5.35
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- 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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