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. 2025 Feb;82(1):8-41.
doi: 10.1111/1747-0080.12891. Epub 2024 Aug 14.

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

Laima W Hareer  1 , Yan Ying Lau  1 , Frances Mole  1 , Dianne P Reidlinger  1 , Hayley M O'Neill  1 , Hannah L Mayr  1   2   3 , Hannah Greenwood  4 , Loai Albarqouni  1   4
Affiliations

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

Laima W Hareer et al. Nutr Diet. 2025 Feb.

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.

Keywords: Mediterranean Diet; cardiovascular disease; chronic disease; dietary; nutrition; umbrella review.

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Conflict of interest statement

Dianne Reidlinger is Editor of Nutrition & Dietetics. She was excluded from the peer review process and all decision‐making regarding this article. The Journal's Editor‐in‐Chief has managed this manuscript throughout the review process. The Journal operates a blinded peer review process, and the peer reviewers for this manuscript were unaware of the authors of the manuscript. This process prevents authors who also hold an editorial role to influence the editorial decisions made. The authors report no other conflicts of interest.

Figures

FIGURE 1
FIGURE 1
PRISMA flow chart for search strategy exploring the effects of the MedDiet on cardiovascular disease end points and surrogate outcomes. MedDiet, Mediterranean Diet; PRISMA, Preferred Reporting Items for Systematic Reviews and Meta‐Analyses.
FIGURE 2
FIGURE 2
Meta‐analysis of two or more systematic reviews (data from individual RCTs reported) for CVD deaths. CVD, cardiovascular disease; RCT, randomised control trial.
FIGURE 3
FIGURE 3
Meta‐analysis of two or more systematic reviews (data from individual RCTs reported) for non‐fatal MI. MI, myocardial infraction; RCT, randomised control trial.
FIGURE 4
FIGURE 4
Meta‐analysis of two or more systematic reviews (data from individual RCTs reported) for stroke. RCT, randomised control trial.
See this image and copyright information in PMC

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