Skip to main content

Ischemic Heart Disease and the Mediterranean Diet


Lifestyle modification is primary in cardiovascular (CV) disease prevention. A major contribution is the Mediterranean diet (MedDiet), defined by two of seven components. Italian investigators determined a significant decrease in peripheral arterial disease of 56 % for a high score. Multiple specific CV risk factors are also favorably modified by the MedDiet. This includes beneficial effect on inflammation, vascular endothelium, and insulin resistance. There is also evidence that coronary heart disease, diabetes mellitus, and metabolic syndrome are decreased. Benefit appears to extend to new migrants in France. The economics of dietary adherence are favorable with decreased total lifetime health costs. Although mixed nuts appear to be a major factor in the MedDiet, special emphasis goes to extra virgin olive oil. Benefit also extends to other noncommunicable diseases with a decrease in cancer, Parkinson’s disease, and Alzheimer’s disease. Further quantitation of benefit and understanding of mechanisms involved in dietary benefit is essential.

This is a preview of subscription content, access via your institution.



apolipoprotein B


Coronary heart disease


Confidence interval




Diabetes mellitus


Glycated hemoglobin


High-density lipoprotein cholesterol


Homeostatic model assessment-insulin resistance


Hazard ratio


Low-density lipoprotein cholesterol


Mediterranean diet


Myocardial infarction


Metabolic syndrome


Peripheral arterial disease


Prevención con Dieta Mediterránea


Relative risk


Very low-density lipoprotein cholesterol


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

  1. Rees K, Hartley L, Flowers N, et al. ‘Mediterranean’ dietary pattern for the primary prevention of cardiovascular disease. Cochrane Database Syst Rev. 2013;8, CD009825. This article by Rees et al. is an excellent initial reference that gives background information starting with the Seven Countries study and then goes on to define the MedDiet.

    PubMed  Google Scholar 

  2. Bautista MC, Engler MM. The Mediterranean diet: is it cardioprotective? Prog Cardiovasc Nurs. 2005;20(2):70–6.

    Article  PubMed  Google Scholar 

  3. Ruiz-Canela M, Estruch R, Corella D, et al. Association of Mediterranean diet with peripheral artery disease: the PREDIMED randomized trial. JAMA. 2014;311(4):415–7.

    Article  CAS  PubMed  Google Scholar 

  4. Martinez-Gonzalez MA, Corella D, Salas-Salvado J, et al. Cohort profile: design and methods of the PREDIMED study. Int J Epidemiol. 2012;41(2):377–85. This description of the PREDIMED study is key in assessing the current status of the MedDiet.

    Article  PubMed  Google Scholar 

  5. Estruch R, Ros E, Salas-Salvado J, et al. Primary prevention of cardiovascular disease with a Mediterranean diet. N Engl J Med. 2013;368(14):1279–90. Estruch et al. define the importance of extra virgin olive oil and/or mixed nuts assessed as supplements to the MedDiet.

    Article  CAS  PubMed  Google Scholar 

  6. Estruch R, Martinez-Gonzalez MA, Corella D, et al. Effects of a Mediterranean-style diet on cardiovascular risk factors: a randomized trial. Ann Intern Med. 2006;145(1):1–11.

    Article  PubMed  Google Scholar 

  7. 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.

    Article  CAS  PubMed  Google Scholar 

  8. Bach A, Serra-Majem L, Carrasco JL, et al. The use of indexes evaluating the adherence to the Mediterranean diet in epidemiological studies: a review. Public Health Nutr. 2006;9(1A):132–46.

    Article  PubMed  Google Scholar 

  9. Ciccarone E, Di Castelnuovo A, Salcuni M, et al. A high-score Mediterranean dietary pattern is associated with a reduced risk of peripheral arterial disease in Italian patients with Type 2 diabetes. J Thromb Haemost. 2003;1(8):1744–52.

    Article  CAS  PubMed  Google Scholar 

  10. Willett WC. The Mediterranean diet: science and practice. Public Health Nutr. 2006;9(1A):105–10.

    Article  PubMed  Google Scholar 

  11. Nordmann AJ, Suter-Zimmermann K, Bucher HC, et al. Meta-analysis comparing Mediterranean to low-fat diets for modification of cardiovascular risk factors. Am J Med. 2011;124(9):841–51. e2.

    Article  PubMed  Google Scholar 

  12. Martinez-Gonzalez MA, de la Fuente-Arrillaga C, Lopez-Del-Burgo C, et al. Low consumption of fruit and vegetables and risk of chronic disease: a review of the epidemiological evidence and temporal trends among Spanish graduates. Public Health Nutr. 2011;14(12A):2309–15.

    Article  PubMed  Google Scholar 

  13. Sofi F. The Mediterranean diet revisited: evidence of its effectiveness grows. Curr Opin Cardiol. 2009;24(5):442–6.

    Article  PubMed  Google Scholar 

  14. Estruch R, Martinez-Gonzalez MA, Corella D, et al. Effects of dietary fibre intake on risk factors for cardiovascular disease in subjects at high risk. J Epidemiol Community Health. 2009;63(7):582–8.

    Article  CAS  PubMed  Google Scholar 

  15. Nordmann A. Mediterranean or low-fat diets to reduce cardiovascular risk? Praxis (Bern 1994). 2011;100(21):1283–8.

    Article  CAS  Google Scholar 

  16. Grosso G, Mistretta A, Frigiola A, et al. Mediterranean diet and cardiovascular risk factors: a systematic review. Crit Rev Food Sci Nutr. 2014;54(5):593–610. This reference by Grosso et al. is important in assessing the epidemiological evidence for the role of the MedDiet in CV disease prevention.

    Article  CAS  PubMed  Google Scholar 

  17. Serra-Majem L, Roman B, Estruch R. Scientific evidence of interventions using the Mediterranean diet: a systematic review. Nutr Rev. 2006;64(2 Pt 2):S27–47.

    Article  PubMed  Google Scholar 

  18. 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.

    Article  CAS  PubMed  Google Scholar 

  19. Fernandez LC, Serra JD, Alvarez JR, et al. Dietary fats and cardiovascular health. Aten Primaria. 2011;43(3):157 e1–16.

    Google Scholar 

  20. Benito M, Oria R, Sanchez-Gimeno AC. Characterization of the olive oil from three potentially interesting varieties from Aragon (Spain). Food Sci Technol Res. 2010;16(6):523–30.

    Article  CAS  Google Scholar 

  21. Van Horn L, McCoin M, Kris-Etherton PM, et al. The evidence for dietary prevention and treatment of cardiovascular disease. J Am Diet Assoc. 2008;108(2):287–331.

    Article  PubMed  Google Scholar 

  22. Babio N, Bullo M, Salas-Salvado J. Mediterranean diet and metabolic syndrome: the evidence. Public Health Nutr. 2009;12(9A):1607–17.

    Article  PubMed  Google Scholar 

  23. Kastorini CM, Milionis HJ, Goudevenos JA, Panagiotakos DB. Mediterranean diet and coronary heart disease: is obesity a link? - A systematic review. Nutr Metab Cardiovasc Dis. 2010;20(7):536–51.

    Article  CAS  PubMed  Google Scholar 

  24. Richard C, Couture P, Ooi EM, et al. Effect of mediterranean diet with and without weight loss on apolipoprotein b100 metabolism in men with metabolic syndrome. Arterioscler Thromb Vasc Biol. 2014;34(2):433–8.

    Article  CAS  PubMed  Google Scholar 

  25. Kastorini CM, Milionis HJ, Esposito K, et al. 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.

    Article  CAS  PubMed  Google Scholar 

  26. Champagne CM. The usefulness of a Mediterranean-based diet in individuals with type 2 diabetes. Curr Diab Rep. 2009;9(5):389–95.

    Article  PubMed  Google Scholar 

  27. Esposito K, Maiorino MI, Ceriello A, Giugliano D. Prevention and control of type 2 diabetes by Mediterranean diet: a systematic review. Diabetes Res Clin Pract. 2010;89(2):97–102.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  29. Lasa A, Miranda J, Bullo M, et al. Comparative effect of two Mediterranean diets versus a low-fat diet on glycaemic control in individuals with type 2 diabetes. Eur J Clin Nutr 2014. doi:10.1038/ejcn.2014.1.

  30. Darmon N, Khlat M. An overview of the health status of migrants in France, in relation to their dietary practices. Public Health Nutr. 2001;4(2):163–72.

    CAS  PubMed  Google Scholar 

  31. Mead A, Atkinson G, Albin D, et al. Dietetic guidelines on food and nutrition in the secondary prevention of cardiovascular disease - evidence from systematic reviews of randomized controlled trials (second update, January 2006). J Hum Nutr Diet. 2006;19(6):401–19.

    Article  CAS  PubMed  Google Scholar 

  32. Hooper L. Primary prevention of CVD: diet and weight loss. Clin Evid (Online). 2007;2007:0219.

    Google Scholar 

  33. Badimon L, Vilahur G, Padro T. Nutraceuticals and atherosclerosis: human trials. Cardiovasc Ther. 2010;28(4):202–15.

    Article  CAS  PubMed  Google Scholar 

  34. Von Schacky C. Coronary artery disease. Dtsch Med Wochenschr. 2002;127(46):2429–31.

    Article  Google Scholar 

  35. Saulle R, Semyonov L, La Torre G. Cost and cost-effectiveness of the Mediterranean diet: results of a systematic review. Nutrients. 2013;5(11):4566–86.

    Article  PubMed Central  PubMed  Google Scholar 

  36. Perez-Jimenez F, AlvarezdeCienfuegos G, Badimon L, et al. International conference on the healthy effect of virgin olive oil. Eur J Clin Investig. 2005;35(7):421–4.

    Article  CAS  Google Scholar 

  37. Faine LA, Rodrigues HG, Galhardi CM, et al. Effects of olive oil and its minor constituents on serum lipids, oxidative stress, and energy metabolism in cardiac muscle. Can J Physiol Pharmacol. 2006;84(2):239–45.

    Article  CAS  PubMed  Google Scholar 

  38. Brzosko S, De Curtis A, Murzilli S, et al. Effect of extra virgin olive oil on experimental thrombosis and primary hemostasis in rats. Nutr Metab Cardiovasc Dis. 2002;12(6):337–42.

    CAS  PubMed  Google Scholar 

  39. Tyrovolas S, Panagiotakos DB. The role of Mediterranean type of diet on the development of cancer and cardiovascular disease, in the elderly: a systematic review. Maturitas. 2010;65(2):122–30.

    Article  CAS  PubMed  Google Scholar 

  40. Proietti AR, del Balzo V, Dernini S, et al. Mediterranean diet and prevention of non-communicable diseases: scientific evidences. Ann Ig. 2009;21(3):197–210.

    CAS  PubMed  Google Scholar 

Download references

Compliance with Ethics Guidelines

Conflict of Interest

Thomas F. Whayne, Jr. declares that he has no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Author information

Authors and Affiliations


Corresponding author

Correspondence to Thomas F. Whayne Jr..

Additional information

This article is part of the Topical Collection on Ischemic Heart Disease

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Whayne, T.F. Ischemic Heart Disease and the Mediterranean Diet. Curr Cardiol Rep 16, 491 (2014).

Download citation

  • Published:

  • DOI:


  • Cardiovascular risk
  • Coronary heart disease
  • Ischemic heart disease
  • Lipoproteins
  • Mediterranean diet
  • Metabolic syndrome
  • Myocardial infarction
  • Peripheral arterial disease