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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.
In the citing paper
“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
Estruch, R., Ros, E., Salas-Salvadó, J., Covas, M.-I., Corella, D., Arós, F., Gómez-Gracia, E., Ruiz-Gutiérrez, V., Fiol, M., Lapetra, J., et al. (2013) · New England Journal of Medicine · doi:10.1056/nejmoa1200303 · Cited by 4,257 · cited 2×
“However, recent RCT data mentioned early in the review offer evidence that the Mediterranean diet supplemented with nuts offers primary cardiovascular disease-prevention benefits.(21) Again, these benefits were seen in conjunction with the remainder of the Mediterranean diet, so ascribing the benefit solely to nuts wo…”
MethodResultRetractedEstruch, R., Ros, E., Salas-Salvadó, J., Covas, M.-I., Corella, D., Arós, F., Gómez-Gracia, E., Ruiz-Gutiérrez, V., Fiol, M., Lapetra, J., et al. (2018) · New England Journal of Medicine · doi:10.1056/nejmc1806491 · Cited by 1,008
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“Estimates of lifestyle modifications such as the Mediterranean diet as a whole (106), fruits and vegetables (59, 61, 62), smoking cessation (103), moderate alcohol (105), omega-3 fatty acids (110), and improved physical activity (102) have substantial benefits for CVD prevention not seen with commonly used standard me…”
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“numerous RCTs with the principal sources for these data are the Diet and reinfarction trial (DART), Gruppo Italiano per lo Studio della Sopravvivenza nell’Infarto Miocardico (GISSI)-Prevention, and Japan EPA Lipid Intervention Study JELIS studies (30-33).”
BackgroundFish Consumption, Fish Oil, Omega-3 Fatty Acids, and Cardiovascular Disease
Kris-Etherton, P. M., Harris, W. S., & Appel, L. J. (2002) · Circulation · doi:10.1161/01.cir.0000038493.65177.94 · Cited by 3,707
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Grave, R. D., Sartirana, M., & Calugi, S. (2024) · Springer eBooks · doi:10.1007/978-3-031-71456-6_12
Consumers’ Adherence to Mediterranean Diet to Revamp Italian Inner Areas
Uliano, A., Nazzaro, C., Lerro, M., & Stanco, M. (2024) · Springer proceedings in business and economics · doi:10.1007/978-3-031-65168-7_39
Nutrition and Cardiovascular Disease: Modulation by Plant-Based Diets
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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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