The role of the Mediterranean diet in secondary cardiovascular disease prevention: a systematic review and meta-analysis of cohort studies.
Evdoxia Gitsi, Costas Anastasiou, Mary Yannakoulia et al.
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In 30 seconds
This systematic review and meta-analysis of prospective cohort studies examined Mediterranean diet adherence and clinical outcomes among adults with established cardiovascular disease. Thirteen studies included 54,034 patients, with follow-up ranging from 2 to 10 years. Higher adherence was associated with lower all-cause mortality (RR 0.74, 95% CI 0.65-0.84), cardiovascular mortality (RR 0.84, 95% CI 0.75-0.94), and recurrent cardiovascular events (RR 0.60, 95% CI 0.39-0.92). These observational findings support an association, not proof that the diet caused the lower risks.
Key findings
- Higher Mediterranean diet adherence was associated with lower all-cause mortality (RR 0.74, 95% CI 0.65-0.84).
- Cardiovascular mortality was lower with higher adherence (RR 0.84, 95% CI 0.75-0.94).
- Higher adherence was associated with fewer recurrent cardiovascular events (RR 0.60, 95% CI 0.39-0.92); publication bias was detected for this outcome.
Why it matters
People with established cardiovascular disease remain at risk of further events and death. The pooled cohort findings suggest that Mediterranean dietary patterns may be relevant to secondary prevention, alongside pharmacological care. The results add evidence about clinical outcomes in this population, while the observational design means they cannot establish that dietary adherence itself produced the observed risk reductions.
What to keep in mind
The evidence comes from prospective cohort studies, so residual confounding cannot be excluded. Heterogeneity was moderate to high, and publication bias was detected for recurrent cardiovascular events.