The effectiveness of the Mediterranean Diet for primary and secondary prevention of cardiovascular disease: An umbrella review

Laima W Hareer; Yan Ying Lau; Frances Mole; Dianne P Reidlinger; Hayley M O'Neill; Hannah L Mayr; Hannah Greenwood; Loai Albarqouni

doi:10.1111/1747-0080.12891

The effectiveness of the Mediterranean Diet for primary and secondary prevention of cardiovascular disease: An umbrella review

Laima W Hareer
, Yan Ying Lau
, Frances Mole
, Dianne P Reidlinger
, Hayley M O'Neill
, Hannah L Mayr
, Hannah Greenwood
, Loai Albarqouni

Research output: Contribution to journal › Review article › Research › peer-review

11 Citations (Scopus)

222 Downloads (Pure)

Abstract

AIMS: This study aimed to review meta-analyses of randomised controlled trials that evaluated the effectiveness of the Mediterranean Diet for the primary and secondary prevention of cardiovascular disease.

METHODS: Five databases (Medline, Embase, Cochrane, CINAHL and ProQuest) were searched from inception to November 2022. Inclusion criteria were: (i) systematic review of randomised controlled studies with metanalysis; (ii) adults ≥18 years from the general population with (secondary prevention) and without (primary prevention) established cardiovascular disease; (iii) Mediterranean Diet compared with another dietary intervention or usual care. Review selection and quality assessment using AMSTAR-2 were completed in duplicate. GRADE was extracted from each review, and results were synthesised narratively.

RESULTS: Eighteen meta-analyses of 238 randomised controlled trials were included, with an 8% overlap of primary studies. Compared to usual care, the Mediterranean Diet was associated with reduced cardiovascular disease mortality (n = 4 reviews, GRADE low certainty; risk ratio range: 0.35 [95% confidence interval: 0.15-0.82] to 0.90 [95% confidence interval: 0.72-1.11]). Non-fatal myocardial infarctions were reduced (n = 4 reviews, risk ratio range: 0.47 [95% confidence interval: 0.28-0.79] to 0.60 [95% confidence interval: 0.44-0.82]) when compared with another active intervention. The methodological quality of most reviews (n = 16/18; 84%) was low or critically low and strength of evidence was generally weak.

CONCLUSIONS: This review showed that the Mediterranean Diet can reduce fatal cardiovascular disease outcome risk by 10%-67% and non-fatal cardiovascular disease outcome risk by 21%-70%. This preventive effect was more significant in studies that included populations with established cardiovascular disease. Better quality reviews are needed.

Original language	English
Pages (from-to)	8-41
Number of pages	34
Journal	Nutrition and Dietetics
Volume	82
Issue number	1
Early online date	14 Aug 2024
DOIs	https://doi.org/10.1111/1747-0080.12891
Publication status	Published - Feb 2025

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The effectiveness of the Mediterranean Diet for primary and secondary prevention of cardiovascular disease An umbrella reviewFinal published version, 3.13 MBLicence: CC BY

Cite this

@article{8003631f99b84d5da481432ad69f6ded,

title = "The effectiveness of the Mediterranean Diet for primary and secondary prevention of cardiovascular disease: An umbrella review",

abstract = "AIMS: This study aimed to review meta-analyses of randomised controlled trials that evaluated the effectiveness of the Mediterranean Diet for the primary and secondary prevention of cardiovascular disease.METHODS: Five databases (Medline, Embase, Cochrane, CINAHL and ProQuest) were searched from inception to November 2022. Inclusion criteria were: (i) systematic review of randomised controlled studies with metanalysis; (ii) adults ≥18 years from the general population with (secondary prevention) and without (primary prevention) established cardiovascular disease; (iii) Mediterranean Diet compared with another dietary intervention or usual care. Review selection and quality assessment using AMSTAR-2 were completed in duplicate. GRADE was extracted from each review, and results were synthesised narratively.RESULTS: Eighteen meta-analyses of 238 randomised controlled trials were included, with an 8\% overlap of primary studies. Compared to usual care, the Mediterranean Diet was associated with reduced cardiovascular disease mortality (n = 4 reviews, GRADE low certainty; risk ratio range: 0.35 [95\% confidence interval: 0.15-0.82] to 0.90 [95\% confidence interval: 0.72-1.11]). Non-fatal myocardial infarctions were reduced (n = 4 reviews, risk ratio range: 0.47 [95\% confidence interval: 0.28-0.79] to 0.60 [95\% confidence interval: 0.44-0.82]) when compared with another active intervention. The methodological quality of most reviews (n = 16/18; 84\%) was low or critically low and strength of evidence was generally weak.CONCLUSIONS: This review showed that the Mediterranean Diet can reduce fatal cardiovascular disease outcome risk by 10\%-67\% and non-fatal cardiovascular disease outcome risk by 21\%-70\%. This preventive effect was more significant in studies that included populations with established cardiovascular disease. Better quality reviews are needed.",

author = "Hareer, \{Laima W\} and Lau, \{Yan Ying\} and Frances Mole and Reidlinger, \{Dianne P\} and O'Neill, \{Hayley M\} and Mayr, \{Hannah L\} and Hannah Greenwood and Loai Albarqouni",

note = "{\textcopyright} 2024 The Author(s). Nutrition \& Dietetics published by John Wiley \& Sons Australia, Ltd on behalf of Dietitians Australia.",

year = "2025",

month = feb,

doi = "10.1111/1747-0080.12891",

language = "English",

volume = "82",

pages = "8--41",

journal = "Nutrition and Dietetics",

issn = "1446-6368",

publisher = "Wiley-Academy",

number = "1",

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T1 - The effectiveness of the Mediterranean Diet for primary and secondary prevention of cardiovascular disease: An umbrella review

AU - Hareer, Laima W

AU - Lau, Yan Ying

AU - Mole, Frances

AU - Reidlinger, Dianne P

AU - O'Neill, Hayley M

AU - Mayr, Hannah L

AU - Greenwood, Hannah

AU - Albarqouni, Loai

PY - 2025/2

Y1 - 2025/2

N2 - AIMS: This study aimed to review meta-analyses of randomised controlled trials that evaluated the effectiveness of the Mediterranean Diet for the primary and secondary prevention of cardiovascular disease.METHODS: Five databases (Medline, Embase, Cochrane, CINAHL and ProQuest) were searched from inception to November 2022. Inclusion criteria were: (i) systematic review of randomised controlled studies with metanalysis; (ii) adults ≥18 years from the general population with (secondary prevention) and without (primary prevention) established cardiovascular disease; (iii) Mediterranean Diet compared with another dietary intervention or usual care. Review selection and quality assessment using AMSTAR-2 were completed in duplicate. GRADE was extracted from each review, and results were synthesised narratively.RESULTS: Eighteen meta-analyses of 238 randomised controlled trials were included, with an 8% overlap of primary studies. Compared to usual care, the Mediterranean Diet was associated with reduced cardiovascular disease mortality (n = 4 reviews, GRADE low certainty; risk ratio range: 0.35 [95% confidence interval: 0.15-0.82] to 0.90 [95% confidence interval: 0.72-1.11]). Non-fatal myocardial infarctions were reduced (n = 4 reviews, risk ratio range: 0.47 [95% confidence interval: 0.28-0.79] to 0.60 [95% confidence interval: 0.44-0.82]) when compared with another active intervention. The methodological quality of most reviews (n = 16/18; 84%) was low or critically low and strength of evidence was generally weak.CONCLUSIONS: This review showed that the Mediterranean Diet can reduce fatal cardiovascular disease outcome risk by 10%-67% and non-fatal cardiovascular disease outcome risk by 21%-70%. This preventive effect was more significant in studies that included populations with established cardiovascular disease. Better quality reviews are needed.

AB - AIMS: This study aimed to review meta-analyses of randomised controlled trials that evaluated the effectiveness of the Mediterranean Diet for the primary and secondary prevention of cardiovascular disease.METHODS: Five databases (Medline, Embase, Cochrane, CINAHL and ProQuest) were searched from inception to November 2022. Inclusion criteria were: (i) systematic review of randomised controlled studies with metanalysis; (ii) adults ≥18 years from the general population with (secondary prevention) and without (primary prevention) established cardiovascular disease; (iii) Mediterranean Diet compared with another dietary intervention or usual care. Review selection and quality assessment using AMSTAR-2 were completed in duplicate. GRADE was extracted from each review, and results were synthesised narratively.RESULTS: Eighteen meta-analyses of 238 randomised controlled trials were included, with an 8% overlap of primary studies. Compared to usual care, the Mediterranean Diet was associated with reduced cardiovascular disease mortality (n = 4 reviews, GRADE low certainty; risk ratio range: 0.35 [95% confidence interval: 0.15-0.82] to 0.90 [95% confidence interval: 0.72-1.11]). Non-fatal myocardial infarctions were reduced (n = 4 reviews, risk ratio range: 0.47 [95% confidence interval: 0.28-0.79] to 0.60 [95% confidence interval: 0.44-0.82]) when compared with another active intervention. The methodological quality of most reviews (n = 16/18; 84%) was low or critically low and strength of evidence was generally weak.CONCLUSIONS: This review showed that the Mediterranean Diet can reduce fatal cardiovascular disease outcome risk by 10%-67% and non-fatal cardiovascular disease outcome risk by 21%-70%. This preventive effect was more significant in studies that included populations with established cardiovascular disease. Better quality reviews are needed.

UR - https://www.scopus.com/pages/publications/85201145723

U2 - 10.1111/1747-0080.12891

DO - 10.1111/1747-0080.12891

M3 - Review article

C2 - 39143663

AN - SCOPUS:85201145723

SN - 1446-6368

VL - 82

SP - 8

EP - 41

JO - Nutrition and Dietetics

JF - Nutrition and Dietetics

IS - 1

ER -

The effectiveness of the Mediterranean Diet for primary and secondary prevention of cardiovascular disease: An umbrella review

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