Mediterranean diet and reduced cardiovascular risk: An all-female study

These new observational data, published in Heart, suggest that the Mediterranean diet is associated with a lower incidence of cardiovascular disease (CVD) and mortality in women.
Those who adhered most closely to the Mediterranean diet had a 24% lower risk of CVD and a 23% lower risk of death.
"A healthy diet is a key factor in the prevention of heart disease. However, current recommendations on heart disease prevention do not include gender-specific recommendations," said Dr Sarah Zaman, University of Sydney, one of the study's referring physicians.

"Historically, research and studies have included predominantly male participants or have not been specifically analyzed; Our results will pave the way to fill this gap and also highlight the need for further research to ensure that health recommendations and policies take diversity into account."

Analysis of results

Systematic analysis of 16 studies published between 2006 and 2021 that reported on the Mediterranean diet and included either women or gender-stratified results. Studies that referred only to certain components of the Mediterranean diet or combined it with other lifestyle factors were excluded.
The studies, conducted mainly in the USA and Europe, included 722,495 adult women without a history of CVD, with a median follow-up of 12.5 years.
Better adherence to the Mediterranean diet was defined as the highest category of adherence to the Mediterranean diet. Incident CVD included coronary heart disease, myocardial infarction, stroke, heart failure, cardiovascular death, major cardiac and cerebrovascular events and patient-acquired cardiovascular disease.
Overall, greater adherence to a Mediterranean diet was associated with a lower incidence of CVD: HR = 0.76 (95% CI 0.72 - 0.81), total mortality: HR = 0.77 (95% CI 0.74 - 0.80) and coronary heart disease:HR = 0.75 (95% CI 0.65 - 0.87).
The incidence of stroke was also lower in women following the Mediterranean diet, although this was not statistically significant: HR = 0.87 (95% CI 0.76-1.01).



Further analyses revealed similar risk reductions in women of different ethnicities. At the same time, the authors highlighted several limitations, including the observational nature of all the studies, the use of self-reported food frequency questionnaires and the heterogeneity of adjustments for risk factors across studies.
Future directions

The researchers called for more research in cardiology, including risk factors related to early menopause, preeclampsia, gestational diabetes and autoimmune diseases such as systemic lupus.
Future studies should also explore the underlying mechanisms that may explain the links between the Mediterranean diet and CVD.
For example, the diet may reduce inflammation and cardiovascular risk factors through antioxidants and beneficial pathways in the gut microbiome. Other components of the diet, such as polyphenols, omega-3 fatty acids, higher fiber intake and reduced glycemic load; may also play a role.

"It's striking how powerful the long-term cardio-protective properties of a Mediterranean-style diet are," said Dr Samia Mora, Professor of Medicine at Harvard Medical School (Boston). The authors also note that women who adhere strongly to the Mediterranean diet are more likely to have less inflammation, lower insulin resistance, lower body mass index and blood pressure, as well as improved lipid and metabolic profiles .

"This could represent an opportunity to intervene earlier and more intensively on improving inflammation, insulin resistance and cardiometabolic health through evidence-based dietary approaches such as the Mediterranean diet," she said.
Reference:
Pant A., Gribbin S., McIntyre D. et al. Primary prevention of cardiovascular disease in women with a Mediterranean diet: systematic review and meta-analysis. Heart, March 14, 2023.