Mediterranean Diet for Primary and Secondary Prevention of Cardiovascular Disease and Mortality: An Updated Systematic Review
Abstract
:1. Introduction
2. Materials and Methods
2.1. Search Question
2.2. Search Strategy
2.3. Study Selection
2.4. Risk of Bias Assessment
3. Results
3.1. Study Selection
3.2. Study Characteristics
3.3. Impact of Mediterranean Diet on Cardiovascular Outcomes and Death in the General Population (Primary Prevention)
3.3.1. All-Cause Mortality
3.3.2. Cardiovascular Mortality
3.3.3. Major Cardiovascular Events
3.4. Impact of Mediterranean Diet on Cardiovascular Outcomes and Death in Patients with a Prior Cardiovascular Disease (Secondary Prevention)
3.4.1. All-Cause Mortality
3.4.2. Cardiovascular Mortality
3.4.3. Composite Cardiovascular Outcomes
3.5. Methodological Quality and Risk of Bias
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Author (Year) | Participants n, Age (Years) | Country | MD Assessment | Design and Follow-Up | Outcomes |
---|---|---|---|---|---|
Buckland G et al., (2009) [25] | 41,078 29–69 (range); 49.3 (mean) | Spain | rMED (0–18) | Prospective cohort 10.4 years (mean) | Fatal and non-fatal MI, angina requiring revascularization |
Buckland G et al., (2011) [26] | 40,622 29–69 (range); 49.3 (mean) | Spain | rMED (0–18) | Prospective cohort 13.4 years (mean) | All-cause and cardiovascular mortality |
Estruch R et al., (2013) [27] | 7447 participants with high CVD risk 50–80 (range); 67 (mean) | Spain | Quantitative score (0–14) Biomarkers | RCT (MD with EVOO/nuts vs. control) 4.8 years (median) | Composite of MI, stroke, and cardiovascular mortality |
Fung TT et al., (2009) [28] | 74,886 women 38–63 (range) | USA | Alternate MDS | Prospective cohort 20 years | CAD mortality, CAD |
Gardener H et al., (2011) [29] | 2568 >40; 68.6 (mean) | USA | MDS (0–9) | Prospective cohort 9 years | Composite of ischemic stroke, MI, or cardiovascular mortality |
Hoevenaar-Blom MP et al., (2012) [30] | 34,708 20–70 (range) | Netherlands | MDS (0–9) | Prospective cohort 11.8 years (mean) | Cardiovascular mortality, CVD, MI, and stroke |
Knoops KTB et al., (2004) [31] | 2339 70–90 (range) | Europe | mMDS (0–8) | Prospective cohort 10 years | All-cause, CVD and CAD mortality |
Lagiou P et al., (2006) [32] | 42,237 women 30–49 (range) | Sweden | MDS (0–9) | Prospective cohort 12 years | All-cause mortality |
Martínez-González MA et al., (2011) [33] | 13,609 38 (mean) | Spain | MDS (0–9) | Prospective cohort 4.9 years | Cardiovascular disease |
Martínez-González MA et al., (2012) [34] | 15,535 38 (mean) | Spain | MDS (0–9) | Prospective cohort 6.8 years | All-cause mortality |
Mitrou PN et al., (2007) [35] | 380,296 50–71 (range) | USA | aMDS (0–9) | Prospective cohort 10 years | All-cause and CVD mortality |
Tektonidis TG et al., (2015) [36] | 32,921 women 48–83 (range) | Sweden | mMDS (0–8) | Prospective cohort 10 years | MI, heart failure and stroke |
Tong TYN et al., (2016) [37] | 23,902 40–79 (range) | UK | tMDS (0–18) MDS (0–9) Others | Prospective cohort 17 years | Cardiovascular mortality, CVD |
Tognon G et al., (2013) [38] | 1849 | Denmark | mMDS (0–8) | Prospective cohort | All-cause mortality, cardiovascular mortality, CVD, MI |
Trichopoulou A et al., (2003) [39] | 41,078 29–69 (range); 49.3 (mean) | Greece | MDS (0–9) | Prospective cohort 44 months (median) | All-cause and cardiovascular mortality |
Author (Year) | Participants n, Age (Years) | Country | MD Assessment | Design and Follow-Up | Outcomes |
---|---|---|---|---|---|
Barzi F et al., (2003) [40] | 11,323 patients with MI 19–90 (range); 59.4 (mean) | Italy | Overall nutrition score 0–10 | Prospective cohort 6.5 years | All-cause mortality |
Bonaccio M et al., (2018) [41] | 1180 patients with prior CVD ≥35; 67.7 (mean) | Italy | MDS (0–9) | Prospective cohort 7.9 years | All-cause mortality, cardiovascular and CAD mortality |
Delgado-Lista J et al., (2022) [21] | 1002 patients with previous CAD (ACS or high-risk CAD) | Spain | Quantitative score 0–14 | RCT (MD vs. low-fat diet) 7 years | Composite of MI, revascularization, stroke, peripheral artery disease, and CVD death |
De Lorgeril M et al., (1999) [42] | 423 patients < 70 years with prior MI | France | NA | RCT (MD vs. control) 46 months | Composite outcome CVD death, MI, angina, stroke, heart failure, pulmonary, or peripheral embolism |
Iestra J et al., (2006) [43] | 426 patients with prior MI ≥70 | Europe | MDS (0–9) | Prospective cohort 10 years | All-cause mortality |
Lopez-Garcia E et al., (2014) [44] | 17,415 participants with prior MI, stroke, angina, bypass or angioplasty 40–75 (range); 69 (mean) | USA | Alternate MDS | Prospective cohort 7.7 years (median) | All-cause mortality, cardiovascular mortality |
Shikany JM et al., (2018) [45] | 3562 participants with previous CAD, ≥45; 68.9 (mean) | USA | MDS (0–9) | Prospective cohort 7.1 years | All-cause mortality, CAD (MI and CAD death) |
Trichopoulou A et al., (2005) [46] | 1302 participants with CAD 20–86 (range) | Greece | MDS (0–9) | Prospective cohort 3.78 years | All-cause mortality, cardiovascular mortality |
Trichopoulou A et al., (2007) [47] | 2671 patients with previous MI >60 | Europe | MDS (0–9) | Prospective cohort 6.7 years | All-cause mortality |
Prospective Cohort Studies | ||||
Author (Year) | Score | Medium vs. Low | High vs. Low | Per Point Increase |
Buckland G et al., (2011) [26] | rMED | 0.88 (0.79–0.99) | 0.79 (0.69–0.91) | 0.94 (0.9–0.97) every 2 points |
Martínez-González MA et al., (2012) [34] | MDS | 0.66 (0.39–1.11) | 0.44 (0.24–0.79) | 0.76 (0.61–0.94) every 2 points |
Knoops KTB et al., (2004) [31] | mMDS | NA | 0.77 (0.68–0.88) | NA |
Tong TYN, et al., (2016) [37] | rMED MDS | NA NA | NA NA | 0.97 (0.94–0.99) per SD 0.96 (0.93–0.98) per SD |
Tognon G, et al., (2013) [38] | mMDS | NA | NA | 0.95 (0.91–1.00) per point |
Trichopoulou A et al., (2003) [39] | MDS | NA | NA | 0.75 (0.64–0.87) every 2 points |
Randomized Clinical Trial | ||||
Author (Year) | MD with EVOO | MD with Nuts | Combined MD | |
Estruch R et al., (2013) [27] | 0.82 (0.64–1.07) | 0.97 (0.74–1.26) | 0.89 (0.71–1.12) |
Prospective Cohort Studies | ||||
Author (Year) | Score | Medium vs. Low Risk | High vs. Low Risk | Per Point Increase |
Buckland G et al., (2011) [34] | rMED | 0.84 (0.66–1.09) | 0.66 (0.49–0.89) | 0.88 (0.81–0.95) every 2 points |
Gardener H et al., (2011) [29] | MDS | 4p: 0.70 (0.48–1.02) 5p: 0.69 (0.47–1.00) | 0.71 (0.49–1.04) | 0.91 (0.85–0.98) per point |
Hoevenaar-Blom MP et al., (2012) [30] | MDS | 0.60 (0.44–0.80) | 0.44 (0.30–0.66) | 0.78 (0.69–0.88) per point |
Knoops KTB et al., (2004) [31] | mMDS | NA | 0.71 (0.58–0.88) | NA |
Tong TYN, et al., (2016) [37] | rMED MDS | NA | NA | 0.94 (0.90–0.99) per SD 0.94 (0.89–0.98) per SD |
Tognon G, et al., (2013) [38] | mMDS | NA | NA | 0.96 (0.89–1.05) per unit |
Randomized Clinical Trial | ||||
Author (Year) | MD with EVOO | MD with Nuts | Combined MD | |
Estruch R et al., (2013) [26] | 0.69 (0.41–1.16) | 1.01 (0.61–1.66) | 0.83 (0.54–1.29) |
Prospective Cohort Studies | ||||
Author (Year) | Score | Medium vs. Low | High vs. Low | Per Point Increase |
Buckland G et al., (2009) [25] Fatal and non-fatal MI, angina requiring revascularization | rMED | 0.86 (0.7–1.04) | 0.6 (0.47–0.77) | 0.94 (0.91–0.97) |
Hoevenaar-Blom MP et al., (2012) [30] MI, stroke, CVD death | MDS | 0.72 (0.61–0.85) | 0.65 (0.53–0.80) | 0.85 (0.80–0.91) per point |
Randomized Clinical Trial | ||||
Author (Year) | MD with EVOO | MD with Nuts | Combined MD | |
Estruch R et al., (2013) [27] MI, stroke, CVD death | 0.70 (0.54–0.92) | 0.72 (0.54–0.96) | 0.71 (0.56–0.90) |
Author (Year) | Score | Medium vs. Low | High vs. Low | Per Point Increase |
---|---|---|---|---|
Barzi F et al., (2003) [40] | Other | 0.69 (0.61–0.79) | 0.51 (0.44–0.59) | 0.85 (0.82–0.88) per point |
Bonaccio M et al., (2018) [41] | MDS | 0.82 (0.60–1.12) | 0.69 (0.47–0.99) | 0.84 (0.70–1.00) every 2 points |
Iestra J et al., (2006) [43] | MDS | NA | 0.75 (0.57–0.97) | NA |
Lopez-Garcia E et al., (2014) [44] | aMDS | Q2: 0.98 (0.89, 1.08) Q3: 0.90 (0.81, 1.00) | Q4: 0.94 (0.81, 1.08) Q5: 0.81 (0.72–0.91) | 0.93 (0.89, 0.97) every 2 points |
Shikany JM et al., (2018) [45] | MDS | 0.98 (0.85–1.13) | 0.80 (0.67–0.95) | NA |
Trichopoulou A et al., (2005) [48] | MDS | NA | NA | 0.73 (0.58–0.93) every 2 points |
Trichopoulou A et al., (2007) [47] | MDS | NA | NA | 0.82 (0.73–0.93) every 2 points |
Prospective Cohort Studies | ||||
---|---|---|---|---|
Author (Year) | Score | Medium vs. Low | High vs. Low | Per Point Increase |
Bonaccio M et al., (2018) [41] | MDS | 0.73 (0.48–1.12) | 0.61 (0.35–1.01) | 0.77 (0.61–0.97) every 2 points |
Lopez-Garcia E et al., (2014) [44] | aMDS | Q2: 1.00 (0.79, 1.27) Q3: 0.99 (0.78, 1.25) | Q4: 1.02 (0.87, 1.21) Q5: 0.85 (0.67, 1.09) | 0.96 (0.89, 1.04) every 2 points |
Trichopoulou A et al., (2005) [48] | MDS | NA | NA | 0.69 (0.52–0.93) every 2 points |
Prospective Cohort Studies | |||
Author (Year) | Score | Medium vs. Low | High vs. Low |
Shikany JM et al., (2018) [45] MI, CAD mortality | MDS | 0.91 (0.76–1.10) | 0.78 (0.62–0.98) |
RCT | |||
Author (Year) | Mediterranean Diet vs. Control Diet | ||
Delgado-Lista J et al., (2022) [21] MI, revascularization, stroke, peripheral artery disease, and cardiovascular death | HR (7 models) ranged from 0.719 (95% CI 0.541–0.957) to 0.753 (0.568–0.998) | ||
De Lorgeril M et al., (1999) [42] | CO 1 (MI, CVD death): 0.23 (0.11–0.48) CO 2 (MI, CVD death, unstable angina, HF, stroke, embolism): 0.30 (0.18–0.51) |
Primary Prevention | |||||
Author (Year) | Medium vs. Low | High vs. Low | Per Point Increase | p | |
Buckland G et al., (2011) [26] | Men (15,324) | 0.88 (0.75–1.02) | 0.76 (0.63–0.9) | - | p-interaction: 0.512 |
Women (25,298) | 0.89 (0.75–1.06) | 0.85 (0.68–1.06) | - | ||
Martínez-González MA et al., (2012) [34] | Men (6271) | - | - | 0.67 (0.51–0.88) every 2 points | p-trend 0.004 |
Women (9264) | - | - | 0.83 (0.53–1.29) every 2 points | p-trend 0.41 | |
Mitrou PN et al., (2007) [35] | Men (214 284) | 0.91 (0.88–0.94) | 0.79 (0.76–0.83) | - | - |
Women (166 012) | 0.89 (0.85–0.93) | 0.80 (0.75–0.85) | - | - | |
Trichopoulou A et al., (2003) [39] | Men (8895) | - | - | 0.78 (0.65–0.94) every 2 points | - |
Women (13,148) | - | - | 0.69 (0.53–0.90) every 2 points | - | |
Secondary Prevention | |||||
Barzi F et al., (2003) [40] | Men (9625) | - | - | 0.86 (0.83–0.89) per point | p-interaction: 0.13 |
Women (1698) | - | - | 0.81 (0.74–0.87) per point | ||
Iestra J et al., (2006) [43] | Men (284) | - | 0.74 (0.55–1.00) | - | - |
Women (142) | - | 0.86 (0.46–1.61) | - | - | |
López-García E et al., (2014) [44] | Men (6137) | 0.85 (0.74, 0.98) * | 0.79 (0.68, 0.91) * | 0.92 (0.86, 0.97) every 2 points | p-trend: 0.003 |
Women (11,278) | 0.95 (0.81, 1.11) * | 0.85 (0.71, 1.02) * | 0.95 (0.88, 1.01) every 2 points | p-trend: 0.11 | |
Trichopoulou A et al., (2005) [48] | Men (726) | 0.69 (0.53–0.90) every 2 points | p-interaction: 0.33 | ||
Women (576) | 0.89 (0.56–1.41) every 2 points |
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Laffond, A.; Rivera-Picón, C.; Rodríguez-Muñoz, P.M.; Juárez-Vela, R.; Ruiz de Viñaspre-Hernández, R.; Navas-Echazarreta, N.; Sánchez-González, J.L. Mediterranean Diet for Primary and Secondary Prevention of Cardiovascular Disease and Mortality: An Updated Systematic Review. Nutrients 2023, 15, 3356. https://doi.org/10.3390/nu15153356
Laffond A, Rivera-Picón C, Rodríguez-Muñoz PM, Juárez-Vela R, Ruiz de Viñaspre-Hernández R, Navas-Echazarreta N, Sánchez-González JL. Mediterranean Diet for Primary and Secondary Prevention of Cardiovascular Disease and Mortality: An Updated Systematic Review. Nutrients. 2023; 15(15):3356. https://doi.org/10.3390/nu15153356
Chicago/Turabian StyleLaffond, Ana, Cristina Rivera-Picón, Pedro Manuel Rodríguez-Muñoz, Raúl Juárez-Vela, Regina Ruiz de Viñaspre-Hernández, Noelia Navas-Echazarreta, and Juan Luis Sánchez-González. 2023. "Mediterranean Diet for Primary and Secondary Prevention of Cardiovascular Disease and Mortality: An Updated Systematic Review" Nutrients 15, no. 15: 3356. https://doi.org/10.3390/nu15153356