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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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“26 Long-chain saturated fat consumption over the long term may lead to dysbiosis and increased lipopolysaccharide-bearing bacteria species that promote inflammation through the induction of TLR4.”
Handayani, D. R., Rakhmat, I. I., Septiadi, E., Faradina, M. A., Nugraha, R. F., Prawira, A. H., & Anugrah, R. A. (2021) · Advances in health sciences research/Advances in Health Sciences Research · doi:10.2991/ahsr.k.210723.003 · Cited by 4
The Role of Nut and Seed Consumption in Colorectal Cancer: A Narrative Review
Roman, D., Timar, B., Avram, V. F., Braha, A., Săftescu, S., Negru, S. M., & Timar, R. Z. (2022) · Medicina · doi:10.3390/medicina58070932 · Cited by 4
“Furthermore, multiple servings of fruits and vegetables have also proven to be a beneficial attribute of this diet, with particular emphasis on the consumption of nuts [10].”
BackgroundThe Mediterranean diet and One Health: A study in synergies
Tangredi, B. P. (2022) · CABI One Health · doi:10.1079/cabionehealth.2022.0012 · Cited by 5
Adherence to the Mediterranean Diet and Depression: A Systematic Review of Recent Studies
Liu, L. (2023) · SHS Web of Conferences · doi:10.1051/shsconf/202315704003 · Cited by 4
Tsiampalis, T., Kouvari, M., Belitsi, V., Kalantzi, V., Androutsos, O., Bonoti, F., Panagiotakos, D. B., & Kosti, R. I. (2023) · Healthcare · doi:10.3390/healthcare11222982 · Cited by 4
“In recent years, the Mediterranean diet (MD) has gained prominence as a pivotal component in preventive cardiology, emphasizing the significance of dietary patterns in maintaining cardiovascular health [9].”
BackgroundKoenig, H. G., VanderWeele, T. J., & Peteet, J. R. (2023) · Oxford University Press eBooks · doi:10.1093/oso/9780190088859.003.0002 · Cited by 5
Papassotiriou, I., Riza, E., Benetou, V., & Orfanos, P. (2024) · Nutrition Metabolism and Cardiovascular Diseases · doi:10.1016/j.numecd.2024.01.004 · Cited by 4
de Luis, D. A., Primo, D., Izaola, O., & Aller, R. (2022) · Disease Markers · doi:10.1155/2022/3706753 · Cited by 5
“The Mediterranean dietary pattern has demonstrated multiple cardio metabolic improvements such as lipid control and glucose improvement [20].”
BackgroundPrevention and Treatment of Obesity-Related Diseases by Diet and Medicinal Plants
Saad, B., Zaid, H., Shanak, S., & Kadan, S. (2017) · Springer eBooks · doi:10.1007/978-3-319-54102-0_4 · Cited by 4
THE MEDITERRANEAN DIET: CARDIOPROTECTIVE EFFECTS IN DIFFERENT COUNTRIES
Цыганкова, Д. П., Евгеньевна, К. К., & Барбараш, О. Л. (2018) · Russian Journal of Cardiology · doi:10.15829/1560-4071-2018-6-207-211 · Cited by 4
“Кроме того, средиземноморская диета была связана с положительным эффектом на многие факторы риска ССЗ, включая липопротеины, ожирение, сахарный диабет и гипертонию [5, 11, 18].”
Kashtanova, D. A., & Ткачева, О. Н. (2020) · CARDIOVASCULAR THERAPY AND PREVENTION · doi:10.15829/1728-8800-2020-2474 · Cited by 4
Nutrition and dietary inflammatory indices of the eight major cuisines of China
Zhao, W., Jia, Z., & Shi, H. (2025) · BMC Nutrition · doi:10.1186/s40795-025-00999-2 · Cited by 3
“The Mediterranean diet and the Dietary Approaches to Stop Hypertension (DASH) diet are recognized as exemplary dietary patterns that provide benefits for cardiovascular health [5].”
Sani, L., Astier, J., Ould‐Ali, D., Borel, P., & Landrier, J. (2025) · Molecular Nutrition & Food Research · doi:10.1002/mnfr.70115 · Cited by 3
“Several epidemiological studies have shown that this diet is inversely correlated with the onset of NCDs [8–11].”
Tian, R.-N., Zhang, S., Zhang, N., Wu, W.-J., Guo, H.-Q., Wang, C., & Duan, Z.-G. (2025) · Frontiers in Nutrition · doi:10.3389/fnut.2025.1623482 · Cited by 3
“In contrast, the Mediterranean diet, rich in whole grains, vegetables, and healthy fats, is related to reduced inflammation levels (13), offering a protective effect against CKM development.”
Medical Management of Coronary Artery Disease: An Update
Hullon, D., Bilal, M., & Shammas, N. W. (2025) · International Journal of Angiology · doi:10.1055/a-2645-8838 · Cited by 3
“…antithrombotic therapy beyond 1 year may be bene fi cial in selected high-risk patients but requires careful assessment of bleeding risk Individualized therapy based on clinical risk strati fi cation remains essential for optimizing long-term cardiovascular outcomes in CAD patients ( ► Table 2”
An Indian adapted Mediterranean diet: A feasibility study
Singh, A., Ghosh‐Jerath, S., Suresh, M., Anudeep, P. P., Bakshi, N., Khan, S., Aseem Basha, M., Yadav, S., Singh, S., Ali, K., et al. (2025) · Journal of clinical lipidology · doi:10.1016/j.jacl.2025.08.013 · Cited by 3
Capasso, L., Mele, D., Casalino, R., Favale, G., Rollo, G., Verrilli, G., Conte, M., Bontempo, P., Carafa, V., Altucci, L., et al. (2025) · Nutrients · doi:10.3390/nu18010093 · Cited by 5
“The combination of a Mediterranean diet and statin therapy is an example of this interaction, as it has been shown to improve endothelial function and ventricular compliance by reducing circulating levels of TMAO and pro-inflammatory cytokines [118,128].”
AMPK Signalling in Heart Failure: From Metabolic Sensor to Context-Dependent Therapeutic Target
Arzouni, R., Aazar, R. F. M., Asakrieh, S., Cattan, S., & Jovanović, A. (2026) · Biomedicines · doi:10.3390/biomedicines14061362 · Cited by 4
“Mediterranean dietary patterns, diets rich in polyphenols, and certain ketogenic interventions have been associated with activation of AMPK-related pathways and improvements in metabolic health [75,76].”
Varteresian, T. C., & Lavretsky, H. (2016) · Springer eBooks · doi:10.1007/978-3-319-32480-7_25 · Cited by 3
Olavarría, V. V., Navia, V. H., Mazzon, E., Rojo, A., Brunser, A. M., & Lavados, P. M. (2021) · Journal of Stroke and Cerebrovascular Diseases · doi:10.1016/j.jstrokecerebrovasdis.2021.106154 · Cited by 3
Kusmy, P., Pal, R. S., Chaitanya, M., & Pal, Y. (2023) · Current Nutrition & Food Science · doi:10.2174/1573401319666230705122237 · Cited by 3
Understanding the Religion, Mental, and Social Health Relationship
Koenig, H. G., VanderWeele, T. J., & Peteet, J. R. (2023) · Oxford University Press eBooks · doi:10.1093/oso/9780190088859.003.0016 · Cited by 7
Zhang, Z., Zhang, J., Jiao, H., Tian, W., & Zhai, X. (2024) · European journal of medical research · doi:10.1186/s40001-024-01781-z · Cited by 3
“A traditional Mediterranean diet emphasizing high-quality carbohydrates and proteins and a controlled intake of high fats benefits cardiovascular protection [9, 10].”
BackgroundBaxevanis, G. K., & Kanellos, P. T. (2024) · Journal of Medicinal Food · doi:10.1089/jmf.2023.0054 · Cited by 4
Li, L., Zheng, X., Ma, H., Zhu, M., Li, X., & Feng, X. (2025) · Frontiers in Aging Neuroscience · doi:10.3389/fnagi.2025.1556608 · Cited by 4
“It is widely recognized for its protective effects on the cardiovascular system (Widmer et al., 2015; Aznar de la Riera et al., 2025).”
Squillante, J., Esposito, F., & Cirillo, T. (2025) · Food Bioscience · doi:10.1016/j.fbio.2025.106979 · Cited by 3
Klotho protein in Alzheimer's disease: Diet leading to immortality?
Walczak, K., Kołodziejczyk, W., Pszczołowska, M., Kozłowska, M., Beszłej, J. A., & Leszek, J. (2025) · Journal of Alzheimer s Disease · doi:10.1177/13872877251350125 · Cited by 3
“53,54 Correlation between type of eaten food and the level of Klotho protein It has been known for a long time that some types of diet have a bene fi cial impact on our health.”
Akdeniz Diyeti, Melatonin ve Sağlık
Eker, M. E., & Karakaya, S. (2018) · Turkish Journal of Agriculture - Food Science and Technology · doi:10.24925/turjaf.v6i9.1258-1266.2030 · Cited by 8
Healthy lifestyle as a decisive factor in the prevention of cardiovascular diseases
Sargsyan, V. D., Safaryan, A. S., Kamyshova, T. V., & Небиеридзе, Д. В. (2019) · Russian Journal of Preventive Medicine · doi:10.17116/profmed20192206256 · Cited by 3
Matsungo, T. M., & Siziba, L. P. (2020) · Elsevier eBooks · doi:10.1016/b978-0-12-817105-9.00001-x · Cited by 4
Izaola, O., Primo, D., & de Luis, D. A. (2022) · Disease Markers · doi:10.1155/2022/7058389 · Cited by 3
“The Mediterranean dietary pattern has demonstrated multiple cardiometabolic improvements such as lipid control and glucose improvement [13].”
BackgroundAssociation Between Dietary Quality Indices and Atherosclerosis Risk: A Case-Control Study
Samadani, M., Mansoori, A., Haybar, H., Haidari, F., & Mohammadshahi, M. (2022) · Nutrition and Metabolic Insights · doi:10.1177/11786388221111934 · Cited by 3
Rauchmann, B., Gross, P., Ersoezlue, E., Wagner, M., Ballarini, T., Kurz, C., Tatò, M., Utecht, J., Papazov, B., Guersel, S., et al. (2023) · Nutrition and Healthy Aging · doi:10.3233/nha-220190 · Cited by 4
Muscoli, S., Andreadi, A., Tamburro, C., Russo, M., Rosenfeld, R., Oro, P., Ifrim, M., Porzio, F., Barone, L., Barillà, F., et al. (2023) · Journal of Personalized Medicine · doi:10.3390/jpm13060882 · Cited by 3
“Additionally, this diet has been shown to improve primary CV diseases, such as death and events, as well as surrogates for CV disease, including the waist-to-hip ratio, lipids, and inflammatory markers in both observational and randomized controlled trials [29].”
BackgroundLópez‐Gil, J. F., Smith, L., Gaya, A. R., Victoria‐Montesinos, D., Gutiérrez‐Espinoza, H., Herrera-Gutiérrez, E., & García‐Hermoso, A. (2023) · Scientific Reports · doi:10.1038/s41598-023-37529-8 · Cited by 4
Contaminant and residue profiles in Lebanese food: a comparative analysis with global standards
Hawari, K. E., Khatib, M. E., Zeineh, M., Beh, D., Jaber, F., & Mokh, S. (2024) · Food Additives & Contaminants Part A · doi:10.1080/19440049.2024.2374358 · Cited by 4
“Lebanese fish, high in omega-3 fatty acids (Widmer et al. 2015), support heart health and mitigate chronic diseases like cancer, arthritis, and diabetes (Gammone et al. 2018).”
Quintiero, V., Crisafulli, O., Diotti, D., Tupler, R. G., Negro, M., Lavaselli, E., & D’Antona, G. (2025) · Nutrients · doi:10.3390/nu17061056 · Cited by 3
“All together, these dietary components may exert synergistic anti-inflammatory and antioxidant effects [50,51].”
Preventive and Therapeutic Effects of Dietary Fibers Against Cardiovascular Diseases
Raman, M., Ambalam, P. S., & Doble, M. (2018) · Elsevier eBooks · doi:10.1016/b978-0-12-811442-1.00012-2 · Cited by 3
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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