Mediterranean Diet and Cardiovascular Disease: Historical Perspective and Latest Evidence

Invited Commentary

Abstract

The concept that the Mediterranean diet was associated with a lower incidence of cardiovascular disease (CVD) was first proposed in the 1950s. Since then, there have been randomized controlled trials and large epidemiological studies that reported associations with lower CVD: in 1994 and 1999, the reports of the intermediate and final analyses of the trial Lyon Diet Heart Study; in 2003, a major epidemiological study in Greece showing a strong inverse association between a Mediterranean score and the risk of cardiovascular complications; in 2011–2012, several reports showing that even non-Mediterranean populations can gain benefits from long-term adhesion to the Mediterranean diet; and in 2013, the PREDIMED trial showing a significant risk reduction in a low-risk population. Contrary to the pharmacological approach of cardiovascular prevention, the adoption of the Mediterranean diet has been associated with a significant reduction in new cancers and overall mortality. Thus, in terms of evidence-based medicine, the full adoption of a modern version of the Mediterranean diet pattern can be considered one of the most effective approaches for the prevention of fatal and nonfatal CVD complications.

Keywords

Mediterranean diet Cardiovascular disease (CVD) Myocardial infarction Alcohol Wine Polyphenols Randomized controlled trial (RCT) Alpha-linolenic acid (ALA) Omega-3 and Omega-6 fatty acids 

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Keys A. Seven countries: a multivariate analysis of death and coronary heart disease. Harvard University Press; 1980.Google Scholar
  2. 2.
    Keys A, Menotti A, Karvonen MJ, et al. The diet and 15-year death rate in the seven countries study. Am J Epidemiol. 1986;124(6):903–15.PubMedGoogle Scholar
  3. 3.
    Keys A. Mediterranean diet and public health: personal reflections. Am J Clin Nutr. 1995;61(6 Suppl):1321S–3S.PubMedGoogle Scholar
  4. 4.
    •• de Lorgeril M, Renaud S, Mamelle N, Salen P, et al. Mediterranean alpha-linolenic acid-rich diet in secondary prevention of coronary heart disease. Lancet. 1994;343(8911):1454–9. Erratum in: Lancet 1995;345(8951):738. This is the first trial demonstrating the protective effect of the Mediterranean diet. It also explains why it is critical to advise patients to increase their intake in plant omega-3 alpha-linolenic. Google Scholar
  5. 5.
    •• de Lorgeril M, Salen P, Martin JL, Monjaud I, Delaye J, Mamelle N. Mediterranean diet, traditional risk factors, and the rate of cardiovascular complications after myocardial infarction: final report of the Lyon Diet Heart Study. Circulation. 1999;99(6):779–85. This is the full report of the trial showing the striking protective effect of the Mediterranean diet. These results open the way to a full recognition of the concept and practices covering the Mediterranean diet issue.PubMedCrossRefGoogle Scholar
  6. 6.
    de Lorgeril M, Salen P, Martin JL, et al. Mediterranean dietary pattern in a randomized trial: prolonged survival and possible reduced cancer rate. Arch Intern Med. 1998;158(11):1181–7.PubMedCrossRefGoogle Scholar
  7. 7.
    de Lorgeril M, Salen P, Caillat-Vallet E, et al. Control of bias in dietary trial to prevent coronary recurrences: The Lyon Diet Heart Study. Eur J Clin Nutr. 1997;51(2):116–22.PubMedCrossRefGoogle Scholar
  8. 8.
    • Sandker GW, Kromhout D, Aravanis C, et al. Serum cholesteryl ester fatty acids and their relation with serum lipids in elderly men in Crete and The Netherlands. Eur J Clin Nutr. 1993;47(3):201–8. The study that showed the high intake in plant omega-3 by the Mediterranean people.PubMedGoogle Scholar
  9. 9.
    Simopoulos AP. Omega-3 fatty acids and antioxidants in edible wild plants. Biol Res. 2004;37(2):263–77.PubMedCrossRefGoogle Scholar
  10. 10.
    Zeghichi S, Kallithraka S, Simopoulos AP, Kypriotakis Z. Nutritional composition of selected wild plants in the diet of Crete. World Rev Nutr Diet. 2003;91:22–40.PubMedCrossRefGoogle Scholar
  11. 11.
    Willett WC. The Mediterranean diet: science and practice. Public Health Nutr. 2006;9(1A):105–10.PubMedCrossRefGoogle Scholar
  12. 12.
    Willett WC. Eat, drink, and be healthy: the harvard medical school guide to healthy eating. Free Press; 2005Google Scholar
  13. 13.
    Ascherio A, Willett WC. New directions in dietary studies of coronary heart disease. J Nutr. 1995;125(3 Suppl):647S–55S.PubMedGoogle Scholar
  14. 14.
    Trichopoulos D. In defense of the Mediterranean diet. Eur J Clin Nutr. 2002;56(9):928–9.PubMedCrossRefGoogle Scholar
  15. 15.
    Ferro-Luzzi A, James WP, Kafatos A. The high-fat Greek diet: a recipe for all? Eur J Clin Nutr. 2002;56(9):796–809.PubMedCrossRefGoogle Scholar
  16. 16.
    •• Trichopoulou A, Costacou T, Bamia C, Trichopoulos D. Adherence to a Mediterranean diet and survival in a Greek population. N Engl J Med. 2003;348(26):2599–608. The first epidemiological study using a Mediterranean diet-score and showing that adhesion to that diet is highly protective.PubMedCrossRefGoogle Scholar
  17. 17.
    Knoops KT, de Groot LC, Kromhout D, et al. Mediterranean diet, lifestyle factors, and 10-year mortality in elderly European men and women. JAMA. 2004;292:1433–9.PubMedCrossRefGoogle Scholar
  18. 18.
    Mitrou PN, Kipnis V, Thiébaut AC, et al. Mediterranean dietary pattern and prediction of all-cause mortality in a US population. Arch Intern Med. 2007;167:2461–8.PubMedCrossRefGoogle Scholar
  19. 19.
    Fung TT, Rexrode KM, Mantzoros CS, Manson JE, Willett WC, Hu FB. Mediterranean diet and incidence of and mortality from coronary heart disease and stroke in women. Circulation. 2009;119:1093–100.PubMedCrossRefGoogle Scholar
  20. 20.
    Sofi F, Abbate R, Gensini GF, Casini A. Accruing evidence on benefits of adherence to the Mediterranean diet on health: an updated systematic review and meta-analysis. Am J Clin Nutr. 2010;92(5):1189–96.PubMedCrossRefGoogle Scholar
  21. 21.
  22. 22.
    Shai I, Schwarzfuchs D, Henkin Y, et al. Dietary Intervention Randomized Controlled Trial (DIRECT) Group. Weight loss with a low-carbohydrate, Mediterranean, or low-fat diet. N Engl J Med. 2008;359(3):229–41.PubMedCrossRefGoogle Scholar
  23. 23.
  24. 24.
    Estruch R, Ros E, Salas-Salvadó J, PREDIMED Study Investigators, et al. Primary prevention of cardiovascular disease with a Mediterranean diet. N Engl J Med. 2013;368(14):1279–90.PubMedCrossRefGoogle Scholar
  25. 25.
    Appel LJ, Van Horn L. Did the PREDIMED trial test a Mediterranean diet? N Engl J Med. 2013;368(14):1353–4.PubMedCrossRefGoogle Scholar
  26. 26.
    Tracy SW. Something new under the sun? The Mediterranean diet and cardiovascular health. N Engl J Med. 2013;368(14):1274–6.PubMedCrossRefGoogle Scholar
  27. 27.
    Hoevenaar-Blom MP, Nooyens AC, Kromhout D, et al. Mediterranean style diet and 12-year incidence of cardiovascular diseases: the EPIC-NL cohort study. PLoS One. 2012;7(9):e45458.PubMedCrossRefGoogle Scholar
  28. 28.
    Martínez-González MA, Guillén-Grima F, De Irala J, et al. The Mediterranean diet is associated with a reduction in premature mortality among middle-aged adults. J Nutr. 2012;142(9):1672–8.PubMedCrossRefGoogle Scholar
  29. 29.
    Gardener H, Wright CB, Gu Y, et al. Mediterranean-style diet and risk of ischemic stroke, myocardial infarction, and vascular death: the Northern Manhattan Study. Am J Clin Nutr. 2011;94(6):1458–64.PubMedCrossRefGoogle Scholar
  30. 30.
    Tognon G, Lissner L, Sæbye D, Walker KZ, Heitmann BL. The Mediterranean diet in relation to mortality and CVD: a Danish cohort study. Br J Nutr. 2013;3:1–9.CrossRefGoogle Scholar
  31. 31.
    Hodge AM, English DR, Itsiopoulos C, O'Dea K, Giles GG. Does a Mediterranean diet reduce the mortality risk associated with diabetes: evidence from the Melbourne Collaborative Cohort Study. Nutr Metab Cardiovasc Dis. 2011;21(9):733–9.PubMedCrossRefGoogle Scholar
  32. 32.
    Misirli G, Benetou V, Lagiou P, et al. Relation of the traditional Mediterranean diet to cerebrovascular disease in a Mediterranean population. Am J Epidemiol. 2012;176(12):1185–92.PubMedCrossRefGoogle Scholar
  33. 33.
    Lourida I, Soni M, Thompson-Coon J, et al. Mediterranean diet, cognitive function, and dementia: a systematic review. Epidemiology. 2013;24(4):479–89.PubMedCrossRefGoogle Scholar
  34. 34.
    Hedden P. The genes of the Green Revolution. Trends Genet. 2003;19(1):5–9.PubMedCrossRefGoogle Scholar
  35. 35.
    Song X, Ni Z, Yao Y, et al. Wheat (Triticum aestivum L.) root proteome and differentially expressed root proteins between hybrid and parents. Proteomics. 2007;7(19):3538–57.PubMedCrossRefGoogle Scholar
  36. 36.
    Hu EA, Toledo E, Diez-Espino J, et al. Lifestyles and risk factors associated with adherence to the Mediterranean diet: a baseline assessment of the PREDIMED trial. PLoS One. 2013;8(4):e60166.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  1. 1.Laboratoire Cœur et Nutrition, TIMC-IMAG CNRS 5525, Faculté de Médecine de GrenobleUniversité Joseph FourierLa TroncheFrance

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