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



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).


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


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).


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.


Cardiovascular disease Coronary heart disease Mediterranean diet Meta-analysis Stroke 



Mediterranean diet


Cardiovascular disease


Coronary heart disease


Acute myocardial infarction


Mediterranean diet score


Relative risk


Trichopoulou score


Low-density lipoprotein


High-density lipoprotein


Compliance with ethical standards


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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© 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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