Mediterranean Diet and the Heart

Mediterranean Diet and the Heart


Mediterranean Diet & Cardiovascular Health

  E.Roehm, M.D.

The Mediterranean diet is the only comprehensive dietary approach that has been proven to reduce mortality and heart attack in a randomized trial.1 This was shown in a randomized trial of 605 patients who had recently experienced a heart attack. The Mediterranean diet group had fewer additional heart attacks and a reduction in cardiac mortality.

The cardiac disease free survival curves from the trial show an increasing benefit for the Mediterranean diet group with time. (The top solid black line is the experimental diet which was a Mediterranean diet1-2. The bottom solid black line is the control diet, and the red arrow shows the separation between the curves which represents differences in outcome.)

The Mediterranean diet was found to result in a significant reduction in the total death rate1-2. The only other dietary intervention shown by randomized trial to decrease overall mortality is fish omega-3 fat intake3-5. The use of fish and fish omega-3 fats in cardiac patients who have had a prior recent heart attack3-4 or congestive heart failure5 has been shown to reduce the overall death rate. (See fish omega-3 fat video).

Though there are observational studies showing the benefit of a Mediterranean diet6,7, these types of studies can only show an association of benefit, not a proof of benefit that can be demonstrated with a randomized trial.


1. de Lorgeril M, Renaud S, Mamelle N, Salen P, Martin JL, Monjaud I, Guidollet J, Touboul P, Delaye J. Mediterranean alpha-linolenic acid-rich diet in secondary prevention of coronary heart disease. Lancet. 1994;343:1454-9.

2. Renaud S, de Lorgeril M, Delaye J, Guidollet J, Jacquard F, Mamelle N, Martin JL, Monjaud I, Salen P, Toubol P. Cretan Mediterranean diet for prevention of coronary heart disease. Am J Clin Nutr 1995;61(suppl):1360S-7S.

3. Burr ML, Fehily AM, Gilbert JF, et al. Effects of changes in fat, fish, and fibre intakes on death and myocardial reinfarction: diet and reinfarction trial (DART). Lancet 1989;ii:757-61.

4. GISSI-Prevenzione Investigators. Dietary supplementation with n-3 polyunsaturated fatty acids and vitamin E after myocardial infarction: results of the GISSI-Prevenzione trial. Lancet 1999;354:447-55.

5. Gissi-HF Investigators, Tavazzi L, Maggioni AP, Marchioli R, Barlera S, et al. Effect of n-3 polyunsaturated fatty acids in patients with chronic heart failure (the GISSI-HF trial): a randomised, double-blind, placebo-controlled trial. Lancet. 2008;372:1223-30.

6. Buckland G, González CA, Agudo A, et al. Adherence to the Mediterranean diet and risk of coronary heart disease in the Spanish EPIC Cohort Study. Am J Epidemiol. 2009;170:1518-29.

7. 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.