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European Journal of Nutrition

, Volume 58, Issue 1, pp 173–191 | Cite as

Mediterranean diet and cardiovascular disease: a systematic review and meta-analysis of observational studies

  • Valentina Rosato
  • Norman J. Temple
  • Carlo La Vecchia
  • Giorgio Castellan
  • Alessandra Tavani
  • Valentina GuercioEmail author
Original Contribution

Abstract

Purpose

To provide evidence of the relationship of Mediterranean diet (MD) on incidence/mortality for cardiovascular disease (CVD), coronary/ischemic heart disease (CHD)/acute myocardial infarction (AMI) and stroke (ischemic/hemorrhagic) by sex, geographic region, study design and type of MD score (MDS).

Methods

We performed a systematic review and meta-analysis of observational studies. Pooled relative risks (RRs) were calculated using random-effects models.

Results

We identified 29 articles. The RR for the highest versus the lowest category of the MDS was 0.81 (95% CI 0.74–0.88) for the 11 studies that considered unspecified CVD, consistent across all strata. The corresponding pooled RR for CHD/AMI risk was 0.70 (95% CI 0.62–0.80), based on 11 studies. The inverse relationship was consistent across strata of study design, end point (incidence and mortality), sex, geographic area, and the MDS used. The overall RR for the six studies that considered unspecified stroke was 0.73 (95% CI 0.59–0.91) for the highest versus the lowest category of the MDS. The corresponding values were 0.82 (95% CI 0.73–0.92) for ischemic (five studies) and 1.01 (95% CI 0.74–1.37) for hemorrhagic stroke (four studies).

Conclusions

Our findings indicate and further quantify that MD exerts a protective effect on the risk of CVD. This inverse association includes CHD and ischemic stroke, but apparently not hemorrhagic stroke.

Keywords

Cardiovascular disease Coronary heart disease Mediterranean diet Meta-analysis Stroke 

Abbreviations

MD

Mediterranean diet

CVD

Cardiovascular disease

CHD

Coronary heart disease

AMI

Acute myocardial infarction

MDS

Mediterranean diet score

RR

Relative risk

TS

Trichopoulou score

LDL

Low-density lipoprotein

HDL

High-density lipoprotein

Notes

Compliance with ethical standards

Funding

For this systematic review and meta-analysis there were no funding sources.

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

394_2017_1582_MOESM1_ESM.doc (64 kb)
Supplementary material 1 (DOC 65 KB)

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2017

Authors and Affiliations

  • Valentina Rosato
    • 1
  • Norman J. Temple
    • 2
  • Carlo La Vecchia
    • 1
  • Giorgio Castellan
    • 3
  • Alessandra Tavani
    • 4
  • Valentina Guercio
    • 1
    Email author
  1. 1.Department of Clinical Sciences and Community HealthUniversità degli Studi di MilanoMilanItaly
  2. 2.Centre for ScienceAthabasca UniversityAlbertaCanada
  3. 3.Università degli Studi di Milano BicoccaMilanItaly
  4. 4.IRCCS-Istituto di Ricerche Farmacologiche “Mario Negri”MilanItaly

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