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The Mediterranean Diet and Cardiovascular Health: A Critical Review

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Martínez-González, Miguel A., Gea, Alfredo, Ruiz-Canela, Miguel·2019·Circulation Research

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Abstract

The Mediterranean diet (MedDiet), abundant in minimally processed plant-based foods, rich in monounsaturated fat from olive oil, but lower in saturated fat, meats, and dairy products, seems an ideal nutritional model for cardiovascular health. Methodological aspects of Mediterranean intervention trials, limitations in the quality of some meta-analyses, and other issues may have raised recent controversies. It remains unclear whether such limitations are important enough as to attenuate the postulated cardiovascular benefits of the MedDiet. We aimed to critically review current evidence on the role of the MedDiet in cardiovascular health. We systematically searched observational prospective cohorts and randomized controlled trials which explicitly reported to assess the effect of the MedDiet on hard cardiovascular end points. We critically assessed all the original cohorts and randomized controlled trials included in the 5 most comprehensive meta-analyses published between 2014 and 2018 and additional prospective studies not included in these meta-analyses, totaling 45 reports of prospective studies (including 4 randomized controlled trials and 32 independent observational cohorts). We addressed the existing controversies on methodology and other issues. Some departures from individual randomization in a subsample of the landmark Spanish trial (PREDIMED [Prevención con Dieta Mediterránea]) did not represent any clinically meaningful attenuation in the strength of its findings and the results of PREDIMED were robust in a wide range of sensitivity analyses. The criteria for causality were met and potential sources of controversies did not represent any reason to compromise the main findings of the available observational studies and randomized controlled trials. The available evidence is large, strong, and consistent. Better conformity with the traditional MedDiet is associated with better cardiovascular health outcomes, including clinically meaningful reductions in rates of coronary heart disease, ischemic stroke, and total cardiovascular disease.

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Martínez-González, MA, García-López, M, Bes-Rastrollo, M, Toledo, E, Martínez-Lapiscina, EH, Delgado-Rodriguez, M, Vazquez, Z, Benito, S, Beunza, JJ. Mediterranean diet and the incidence of cardiovascular disease: a Spanish cohort. Nutr Metab Cardiovasc Dis. 2011;21:237–44.

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Authors: Martínez-González, M. A., Gea, A., & Ruiz-Canela, M.
Affiliations: From the Department of Preventive Medicine and Public Health, IdiSNA, Navarra Institute for Health Research, University of Navarra, Pamplona, Spain (M.A.M.-G., A.G., M.R.-C.)
Instituto de Salud Carlos III (ES)
ORCID: Gea, Alfredo
Venue: Circulation Research
Publisher: Ovid Technologies (Wolters Kluwer Health)
Published: 2019-03
Volume: 124
Issue: 5
Pages: 779-798
ISSN: 0009-7330 (ISSN-L)
1524-4571
DOI: 10.1161/circresaha.118.313348
OpenAlex: W2917793655
Semantic Scholar: 0490ad755099677273d0356336ce3b4b40f7f8bc
Cited by: 878
References: 175
Citations by year: 2026: 103 · 2025: 149 · 2024: 143 · 2023: 120 · 2022: 136 · 2021: 121 · 2020: 80 · 2019: 25
FWCI: 14.79
Type: journal article
Language: en
Open access: bronze
doi.org
Locations: Circulation Research (publishedVersion)
PubMed (publishedVersion)
Funders: Instituto de Salud Carlos III
Topics: Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
Health Sciences › Nursing › Nutrition and Dietetics › Fatty Acid Research and Health
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
Keywords: Mediterranean diet, cardiovascular health, PREDIMED trial, coronary artery disease, ischemic stroke, olive oil, monounsaturated fatty acids, dietary intervention, randomized controlled trials, prospective cohort
MeSH terms: Diet, Healthy, Cardiovascular Diseases, Female, Humans, Male, Nutritional Status, Nutritive Value, Risk Factors, Meta-Analysis as Topic, Randomized Controlled Trials as Topic, Risk Assessment, Evidence-Based Medicine, Diet, Mediterranean, Risk Reduction Behavior, Recommended Dietary Allowances, Observational Studies as Topic, Protective Factors

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