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The Mediterranean Diet and Cardiovascular Health: A Critical Review
Open accessAbstract
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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“Examples of heart-healthy diets are the Mediterranean, DASH (Dietary Approaches to Stop Hypertension) and MIND (Mediterranean-DASH Intervention for Neurodegenerative Delay) diets.135-137”
From 2023 Alzheimer's disease facts and figures (2023) · cites this paper as [135]
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“provided bene fi ts for cardiovascular health (76,77).”
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“In a systematic review of trials of > 6 months ' duration, compared with a low-fat diet, the Mediterranean diet demonstrated greater reductions in body weight and HbA1c levels”
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“delayed the requirement for diabetes medication”
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Metadata
- 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
- Published
- 2019-03
- Volume
- 124
- Issue
- 5
- Pages
- 779-798
- ISSN
- 0009-7330 (ISSN-L)
- 1524-4571
- 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
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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