Latest Evidence of the Effects of the Mediterranean Diet in Prevention of Cardiovascular Disease

Clinical Trials and Their Interpretations (JR Kizer, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Clinical Trials and Their Interpretations

Abstract

The first step in the prevention of cardiovascular disease is healthy lifestyle and diet. Recent systematic reviews of observational studies ranked Mediterranean diet as the most likely dietary model to provide cardiovascular protection. This review updates the knowledge on the effects of Mediterranean diet from observational and randomized trials published in the last year. The results of the PREDIMED study, a randomized trial providing a higher level of scientific evidence than cohort studies, confirmed that the Mediterranean diet reduces the incidence of cardiovascular events. This effect may be exerted by reducing blood pressure; improving glucose metabolism, lipid profile, and lipoprotein particle characteristics; and decreasing inflammation and oxidative stress. It may also stem from a favorable interaction between diet and gene polymorphisms related to cardiovascular risk factors and events. These recent results allow us to recommend Mediterranean diet to subjects at high risk for cardiovascular disease with the highest level of scientific evidence.

Keywords

Cardiovascular death Cardiovascular disease Diabetes Fish Fruits Hypertension Inflammation Lipids Mediterranean diet Nuts Obesity Olive oil Oxidative stress Polyphenols Risk factors Vegetables 

References

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

  1. 1.
    Keys A, Menotti A, Karvonen MJ, Aravanis C, Blackburn H, Buzina R, et al. The diet and 15-year death rate in the seven countries study. Am J Epidemiol. 1986;124(6):903–15.PubMedGoogle Scholar
  2. 2.
    Trichopoulou A. Mediterranean diet: the past and the present. Nutr Metab Cardiovasc Dis. 2001;11(4 Suppl):1–4.PubMedGoogle Scholar
  3. 3.
    Trichopoulou A, Lagiou P. Healthy traditional Mediterranean diet: an expression of culture, history, and lifestyle. Nutr Rev. 1997;55(11 Pt 1):383–9.PubMedGoogle Scholar
  4. 4.
    Mente A, de Koning L, Shannon HS, Anand SS. A systematic review of the evidence supporting a causal link between dietary factors and coronary heart disease. Arch Intern Med. 2009;69(7):659–69.CrossRefGoogle Scholar
  5. 5.
    World Health Organization; World Heart Federation; World Stroke Organization. Global Atlas on cardiovascular disease prevention and control. France: WHO; 2011.Google Scholar
  6. 6.
    Badimon L, Storey RF, Vilahur G. Update on lipids, inflammation and atherothrombosis. Thromb Haemost. 2011;105 Suppl 1:S34–42.PubMedCrossRefGoogle Scholar
  7. 7.
    Hansson GK, Hermansson A. The immune system in atherosclerosis. Nat Immunol. 2011;12(3):204–12.PubMedCrossRefGoogle Scholar
  8. 8.
    Libby P, Ridker PM, Hansson GK. Progress and challenges in translating the biology of atherosclerosis. Nature. 2011;473:317–25.PubMedCrossRefGoogle Scholar
  9. 9.
    Weiss R, Bremer AA, Lustig RH. What is metabolic syndrome, and why are children getting it? Ann N Y Acad Sci. 2013;1281:123–40.PubMedCentralPubMedCrossRefGoogle Scholar
  10. 10.
    Salas-Salvadó J, Fernández-Ballart J, Ros E, Martínez-González MA, Fitó M, Estruch R, et al. Effect of a Mediterranean diet supplemented with nuts on metabolic syndrome status: one-year results of the PREDIMED randomized trial. Arch Intern Med. 2008;168(22):2449–58. doi:10.1001/archinte.168.22.2449.PubMedCrossRefGoogle Scholar
  11. 11.
    Gouveri ET, Tzavara C, Drakopanagiotakis F, Tsaoussoglou M, Marakomichelakis GE, Tountas Y, et al. Mediterranean diet and metabolic syndrome in an urban population: the Athens Study. Nutr Clin Pract. 2011;26(5):598–606. doi:10.1177/0884533611416821.PubMedCrossRefGoogle Scholar
  12. 12.
    Kastorini CM, Milionis HJ, Esposito K, Giugliano D, Goudevenos JA, Panagiotakos DB. The effect of Mediterranean diet on metabolic syndrome and its components: a meta-analysis of 50 studies and 534,906 individuals. J Am Coll Cardiol. 2011;57(11):1299–313. doi:10.1016/j.jacc.2010.09.073.PubMedCrossRefGoogle Scholar
  13. 13.
    Rumawas ME, Meigs JB, Dwyer JT, McKeown NM, Jacques PF. Mediterranean-style dietary pattern, reduced risk of metabolic syndrome traits, and incidence in the Framingham Offspring Cohort. Am J Clin Nutr. 2009;90(6):1608–14. doi:10.3945/ajcn.2009.27908.PubMedCentralPubMedCrossRefGoogle Scholar
  14. 14.
    Babio N, Bulló M, Basora J, Martínez-González MA, Fernández-Ballart J, Márquez-Sandoval F, et al. Adherence to the Mediterranean diet and risk of metabolic syndrome and its components. Nutr Metab Cardiovasc Dis. 2009;19(8):563–70. doi:10.1016/j.numecd.2008.10.007.PubMedCrossRefGoogle Scholar
  15. 15.
    Bonaccio M, Di Castelnuovo A, Costanzo S, De Lucia F, Olivieri M, Donati MB, et al. Nutrition knowledge is associated with higher adherence to Mediterranean diet and lower prevalence of obesity. Results from the Moli-sani study. Appetite. 2013;68:139–46. doi:10.1016/j.appet.2013.04.026.PubMedCrossRefGoogle Scholar
  16. 16.
    Di Daniele N, Petramala L, Di Renzo L, Sarlo F, Della Rocca DG, Rizzo M, et al. Body composition changes and cardiometabolic benefits of a balanced Italian Mediterranean Diet in obese patients with metabolic syndrome. Acta Diabetol. 2013;50(3):409–16. doi:10.1007/s00592-012-0445-7.PubMedCrossRefGoogle Scholar
  17. 17.
    Tognon G, Hebestreit A, Lanfer A, Moreno LA, Pala V, Siani A, et al. Mediterranean diet, overweight and body composition in children from eight European countries: cross-sectional and prospective results from the IDEFICS study. Nutr Metab Cardiovasc Dis. 2014;24(2):205–13. doi:10.1016/j.numecd.2013.04.013.PubMedCrossRefGoogle Scholar
  18. 18.
    Kesse-Guyot E, Ahluwalia N, Lassale C, Hercberg S, Fezeu L, Lairon D. Adherence to Mediterranean diet reduces the risk of metabolic syndrome: a 6-year prospective study. Nutr Metab Cardiovasc Dis. 2013;23(7):677–83. doi:10.1016/j.numecd.2012.02.005.PubMedCrossRefGoogle Scholar
  19. 19.
    Bekkouche L, Bouchenak M, Malaisse WJ, Yahia DA. The Mediterranean diet adoption improves metabolic, oxidative, and inflammatory abnormalities in Algerian metabolic syndrome patients. Horm Metab Res. 2014;46(4):274–82. doi:10.1055/s-0033-1363657.PubMedCrossRefGoogle Scholar
  20. 20.
    Richard C, Couture P, Desroches S, Lamarche B. Effect of the Mediterranean diet with and without weight loss on markers of inflammation in men with metabolic syndrome. Obesity (Silver Spring). 2013;21(1):51–7. doi:10.1002/oby.20239.CrossRefGoogle Scholar
  21. 21.
    Mitjavila MT, Fandos M, Salas-Salvadó J, Covas MI, Borrego S, Estruch R, et al. The Mediterranean diet improves the systemic lipid and DNA oxidative damage in metabolic syndrome individuals. A randomized controlled trial. Clin Nutr. 2013;32(2):172–8. doi:10.1016/j.clnu.2012.08.002.PubMedCrossRefGoogle Scholar
  22. 22.
    Mayneris-Perxachs J, Sala-Vila A, Chisaguano M, Castellote AI, Estruch R, Covas MI, et al. Effects of 1-year intervention with a Mediterranean diet on plasma fatty acid composition and metabolic syndrome in a population at high cardiovascular risk. PLoS One. 2014;9(3):e85202.PubMedCentralPubMedCrossRefGoogle Scholar
  23. 23.
    Authors/Task Force Members, Rydén L, Grant PJ, et al. ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD: the Task Force on diabetes, pre-diabetes, and cardiovascular diseases of the European Society of Cardiology (ESC) and developed in collaboration with the European Association for the Study of Diabetes (EASD). Eur Heart J. 2013;34(39):3035–87.PubMedCrossRefGoogle Scholar
  24. 24.
    Gillies GL, Abrams KR, Lambert PC, Cooper NJ, Sutton AJ, Hsu RT, et al. Pharmacological and lifestyle interventions to prevent or delay type 2 diabetes in people with impaired glucose tolerance: systematic review and meta-analysis. BMJ. 2007;334:299.PubMedCentralPubMedCrossRefGoogle Scholar
  25. 25.
    Abiemo EE, Alonso A, Nettleton JA, Steffen LM, Bertoni AG, Jain A, et al. Relationships of the Mediterranean dietary pattern with insulin resistance and diabetes incidence in the Multi-Ethnic Study of Atherosclerosis (MESA). Br J Nutr. 2013;109(8):1490–7. doi:10.1017/S0007114512003339.PubMedCentralPubMedCrossRefGoogle Scholar
  26. 26.
    Grosso G, Pajak A, Mistretta A, Marventano S, Raciti T, Buscemi S, et al. Protective role of the Mediterranean diet on several cardiovascular risk factors: evidence from Sicily, southern Italy. Nutr Metab Cardiovasc Dis. 2014;24(4):370–7. doi:10.1016/j.numecd.2013.09.020.PubMedCrossRefGoogle Scholar
  27. 27.
    Rossi M, Turati F, Lagiou P, Trichopoulos D, Augustin LS, La Vecchia C, et al. Mediterranean diet and glycaemic load in relation to incidence of type 2 diabetes: results from the Greek cohort of the population-based European Prospective Investigation into Cancer and Nutrition (EPIC). Diabetologia. 2013;56(11):2405–13. doi:10.1007/s00125-013-3013-y.PubMedCrossRefGoogle Scholar
  28. 28.
    Ajala O, English P, Pinkney J. Systematic review and meta-analysis of different dietary approaches to the management of type 2 diabetes. Am J Clin Nutr. 2013;97(3):505–16. doi:10.3945/ajcn.112.042457.PubMedCrossRefGoogle Scholar
  29. 29.
    Esposito K, Maiorino MI, Petrizzo M, Bellastella G, Giugliano D. The effects of a Mediterranean diet on need for diabetes drugs and remission of newly diagnosed type 2 diabetes: follow-up of a randomized trial. Diabetes Care. 2014. In press.Google Scholar
  30. 30.
    Salas-Salvadó J, Bulló M, Babio N, Martínez-González MÁ, Ibarrola-Jurado N, Basora J, et al. Reduction in the incidence of type 2 diabetes with the Mediterranean diet: results of the PREDIMED-Reus nutrition intervention randomized trial. Diabetes Care. 2011;34(1):14–9. doi:10.2337/dc10-1288.PubMedCentralPubMedCrossRefGoogle Scholar
  31. 31.•
    Salas-Salvadó J, Bulló M, Estruch R, Ros E, Covas MI, Ibarrola-Jurado N, et al. Prevention of diabetes with Mediterranean diets: a subgroup analysis of a randomized trial. Ann Intern Med. 2014;160(1):1–10. doi:10.7326/M13-1725. Strong evidence that long-term MD supplemented with extra virgin olive oil without energy restriction reduces the risk for type 2 diabetes among older persons.PubMedCrossRefGoogle Scholar
  32. 32.
    Toledo E, Hu FB, Estruch R, Buil-Cosiales P, Corella D, Salas-Salvadó J, et al. Effect of the Mediterranean diet on blood pressure in the PREDIMED trial: results from a randomized controlled trial. BMC Med. 2013;11:207. doi:10.1186/1741-7015-11-207.PubMedCentralPubMedCrossRefGoogle Scholar
  33. 33.
    Doménech M, Roman P, Lapetra J, García de la Corte FJ, Sala-Vila A, de la Torre R, et al. Mediterranean diet reduces 24-hour ambulatory blood pressure, blood glucose, and lipids: one-year randomized, clinical trial. Hypertension. 2014. In press.Google Scholar
  34. 34.
    Giannini C, Diesse L, D’Adamo E, Chiavaroli V, de Giorgis T, Di Iorio C, et al. Influence of the Mediterranean diet on carotid intima-media thickness in hypercholesterolaemic children: a 12-month intervention study. Nutr Metab Cardiovasc Dis. 2014;24(1):75–82. doi:10.1016/j.numecd.2013.04.005.PubMedCrossRefGoogle Scholar
  35. 35.
    Sala-Vila A, Romero-Mamani ES, Gilabert R, et al. Changes in ultrasound-assessed carotid intima-media thickness and plaque with a Mediterranean diet: a substudy of the PREDIMED trial. Arterioscler Thromb Vasc Biol. 2014;34(2):439–45.PubMedCrossRefGoogle Scholar
  36. 36.
    Schwingshackl L, Hoffmann G. Mediterranean dietary pattern, inflammation and endothelial function: a systematic review and meta-analysis of intervention trials. Nutr Metab Cardiovasc Dis. 2014. doi:10.1016/j.numecd.2014.03.003.PubMedGoogle Scholar
  37. 37.
    Mena MP, Sacanella E, Vazquez-Agell M, Morales M, Fitó M, Escoda R, et al. Inhibition of circulating immune cell activation: a molecular antiinflammatory effect of the Mediterranean diet. Am J Clin Nutr. 2009;89(1):248–56. doi:10.3945/ajcn.2008.26094.PubMedCrossRefGoogle Scholar
  38. 38.
    Llorente-Cortés V, Estruch R, Mena MP, Ros E, González MA, Fitó M, et al. Effect of Mediterranean diet on the expression of pro-atherogenic genes in a population at high cardiovascular risk. Atherosclerosis. 2010;208(2):442–50. doi:10.1016/j.atherosclerosis.2009.08.004.PubMedCrossRefGoogle Scholar
  39. 39.
    Urpi-Sarda M, Casas R, Chiva-Blanch G, Romero-Mamani ES, Valderas-Martínez P, Salas-Salvadó J, et al. The Mediterranean diet pattern and its main components are associated with lower plasma concentrations of tumor necrosis factor receptor 60 in patients at high risk for cardiovascular disease. J Nutr. 2012;142(6):1019–25. doi:10.3945/jn.111.148726.PubMedCrossRefGoogle Scholar
  40. 40.
    Damasceno NR, Sala-Vila A, Cofán M, Pérez-Heras AM, Fitó M, Ruiz-Gutiérrez V, et al. Mediterranean diet supplemented with nuts reduces waist circumference and shifts lipoprotein subfractions to a less atherogenic pattern in subjects at high cardiovascular risk. Atherosclerosis. 2013;230(2):347–53. doi:10.1016/j.atherosclerosis.2013.08.014.PubMedCrossRefGoogle Scholar
  41. 41.
    Domínguez LJ, Bes-Rastrollo M, de la Fuente-Arrillaga C, Toledo E, Beunza JJ, Barbagallo M, et al. Similar prediction of total mortality, diabetes incidence and cardiovascular events using relative- and absolute-component Mediterranean diet score: the SUN cohort. Nutr Metab Cardiovasc Dis. 2013;23(5):451–8. doi:10.1016/j.numecd.2011.10.009.PubMedCrossRefGoogle Scholar
  42. 42.••
    Estruch R, Ros E, Salas-Salvadó J, Covas MI, Corella D, Arós F, et al. Primary prevention of cardiovascular disease with a Mediterranean diet. N Engl J Med. 2013;368(14):1279–90. doi:10.1056/NEJMoa1200303. For the first time, traditional MD has demonstrated to protect against cardiovascular events (myocardial infarction, stroke, and cardiovascular death) in asymptomatic subjects at high risk (primary prevention).PubMedCrossRefGoogle Scholar
  43. 43.
    Ruiz-Canela M, Estruch R, Corella D, Salas-Salvadó J, Martínez-González MA. Association of Mediterranean diet with peripheral artery disease. The PREDIMED randomized trial. JAMA. 2014;311(4):415–7. doi:10.1001/jama.2013.280618.PubMedCrossRefGoogle Scholar
  44. 44.
    Martínez-González MA, Toledo E, Arós F, Fiol M, Corella D, Salas-Salvadó J, et al. Extra-virgin olive oil consumption reduces risk of atrial fibrillation. The PREDIMED trial. Circulation. 2014. In press.Google Scholar
  45. 45.
    Atkins JL, Whincup PH, Morris RW, Lennon LT, Papacosta O, Wannamethee SG. High diet quality is associated with a lower risk of cardiovascular disease and all-cause mortality in older men. J Nutr. 2014;144(5):673–80. doi:10.3945/jn.113.186486.PubMedCentralPubMedCrossRefGoogle Scholar
  46. 46.
    Corella D, Ortega-Azorín C, Sorlí JV, Covas MI, Carrasco P, Salas-Salvadó J, et al. Statistical and biological gene-lifestyle interactions of MC4R and FTO with diet and physical activity on obesity: new effects on alcohol consumption. PLoS One. 2012;7(12):e52344. doi:10.1371/journal.pone.0052344.PubMedCentralPubMedCrossRefGoogle Scholar
  47. 47.•
    Corella D, Carrasco P, Sorlí JV, Estruch R, Rico-Sanz J, Martínez-González MÁ, et al. Mediterranean diet reduces the adverse effect of the TCF7L2-rs7903146 polymorphism on cardiovascular risk factors and stroke incidence: a randomized controlled trial in a high-cardiovascular-risk population. Diabetes Care. 2013;36(11):3803–11. doi:10.2337/dc13-0955. Demonstration that MD is able to blunt the development of cardiometabolic phenotypes (including stroke incidence) in genetically susceptible individuals.PubMedCrossRefGoogle Scholar
  48. 48.
    Estruch R, Martínez-González MA, Corella D, Salas-Salvadó J, Ruiz-Gutiérrez V, Covas MI, et al. Effects of a Mediterranean-style diet on cardiovascular risk factors: a randomized trial. Ann Intern Med. 2006;145(1):1–11.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  1. 1.Cardiovascular Research Center (CSIC-ICCC)BarcelonaSpain
  2. 2.Biomedical Research Institute Sant Pau (IIB-Sant Pau)BarcelonaSpain
  3. 3.Department of Internal Medicine, Hospital Clínic, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)University of BarcelonaBarcelonaSpain
  4. 4.CIBER CB06/03 Fisiopatología de la Obesidad y la Nutrición, (CIBERobn) and RETIC RD06/0045BarcelonaSpain

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