Adherence to the Mediterranean Diet and Risk of Coronary Heart Disease in the Spanish EPIC Cohort Study
Abstract
No known cohort study has investigated whether the Mediterranean diet can reduce incident coronary heart disease (CHD) events in a Mediterranean population. This study examined the relation between Mediterranean diet adherence and risk of incident CHD events in the 5 Spanish centers of the European Prospective Investigation into Cancer and Nutrition. Analysis included 41,078 participants aged 29-69 years, recruited in 1992-1996 and followed up until December 2004 (mean follow-up:10.4 years). Confirmed incident fatal and nonfatal CHD events were analyzed according to Mediterranean diet adherence, measured by using an 18-unit relative Mediterranean diet score. A total of 609 participants (79% male) had a fatal or nonfatal confirmed acute myocardial infarction (n = 468) or unstable angina requiring revascularization (n = 141). After stratification by center and age and adjustment for recognized CHD risk factors, high compared with low relative Mediterranean diet score was associated with a significant reduction in CHD risk (hazard ratio = 0.60, 95% confidence interval: 0.47, 0.77). A 1-unit increase in relative Mediterranean diet score was associated with a 6% reduced risk of CHD (95% confidence interval: 0.91, 0.97), with similar risk reductions by sex. Mediterranean diet adherence was associated with a significantly reduced CHD risk in this Mediterranean country, supporting its role in primary prevention of CHD in healthy populations.
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Similar evidence has been collected for non-fatal cardiovascular disease.
“Subsequently, similar evidences have been collected for 'non-fatal' CVD.[3][4][5]”
From Cohort Profile: Design and methods of the PREDIMED study (2012) · cites this paper as [4]
Mediterranean-style diets tend to be relatively high in unsaturated fat, particularly from extra-virgin olive oil.
“They tend to be relatively high in unsaturated fat, particularly from extravirgin olive oil.”
From Popular dietary patterns: alignment with American Heart Association 2021 dietary guidance: a scientific statement from the American Heart Association. (2023) · cites this paper as [23]
A Mediterranean diet including nuts lowers CVD risk in observational studies and RCTs.
“In observational studies (133,217–220) and RCTs (164,221–223) a Mediterranean diet including nuts lowers CVD risk.”
From Food Consumption and its Impact on Cardiovascular Disease: Importance of Solutions Focused on the Globalized Food System (2015) · cites this paper as [220]
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- Authors
- Buckland, G., Gonzalez, C. A., Agudo, A., Vilardell, M., Berenguer, A., Amiano, P., Ardanaz, E., Arriola, L., Barricarte, A., Basterretxea, M., Chirlaque, M. D., Cirera, L., Dorronsoro, M., Egues, N., Huerta, J. M., Larranaga, N., Marin, P., Martinez, C., Molina, E., Navarro, C., Quiros, J. R., Rodriguez, L., Sanchez, M.-J., Tormo, M.-J., & Moreno-Iribas, C.
- Affiliations
- Institut Català d'Oncologia (ES)
- ORCID
- Venue
- American Journal of Epidemiology
- Publisher
- Oxford University Press (OUP)
- Published
- 2009-11-10
- Volume
- 170
- Issue
- 12
- Pages
- 1518-1529
- ISSN
- 0002-9262 (ISSN-L)
- 1476-6256
- OpenAlex
- W2102678568
- Cited by
- 344
- References
- 52
- Citations by year
- 2026: 10 · 2025: 26 · 2024: 25 · 2023: 12 · 2022: 21 · 2021: 33 · 2020: 23 · 2019: 23 · 2018: 23 · 2017: 16 · 2016: 19 · 2015: 15 · 2014: 26 · 2013: 17 · 2012: 18
- FWCI
- 18.07
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- American Journal of Epidemiology (publishedVersion)
- PubMed (publishedVersion)
- 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, dietary adherence, coronary artery disease, myocardial infarction, unstable angina, primary prevention, EPIC cohort, dietary risk factors
- MeSH terms
- Adult, Aged, Body Weights and Measures, Coronary Disease, Female, Humans, Male, Middle Aged, Prospective Studies, Risk Factors, Sex Factors, Socioeconomic Factors, Spain, Health Behavior, Diet, Mediterranean
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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