Adherence to Mediterranean Diet and Implications for Cardiovascular Risk Prevention

Abstract

Background/Objectives:Arterial hypertension, increased carotid intima-media thickness (cIMT), and arterial stiffness (AS) are recognized predictors of cardiovascular disease (CVD). Emerging evidence suggests that vascular remodeling may precede the full development of hypertension. Furthermore, body mass index (BMI), fat mass percentage (FM%), and visceral adipose tissue (VAT), are significant risk factors for cardiovascular events. Conversely, adherence to the Mediterranean diet is associated with reduced cardiovascular risk due to its beneficial effects on lipid metabolism, inflammation, and vascular health. Methods: This observational study explored the association between nutritional care and cardiovascular risk in 55 Italian adults (27 women, 28 men) consecutively evaluated at the Section of Clinical Nutrition and Nutrigenomics, University of Rome "Tor Vergata", in 2024. Nutritional and vascular assessments, including BMI, waist-to-hip ratio (WHR), BIA, DXA, lab tests, blood pressure (BP), pulse wave velocity (PWV), and cIMT, were recorded. Spearman's rank correlation coefficient was used to evaluate the relationship between vascular and nutritional parameters. Wilcoxon rank sum test; Fisher's exact test; and Pearson's Chi-squared test were performed for statistical analysis. Participants were divided into two groups based on cIMT > 0.90 mm and ≤0.90 mm. Results: Significant correlations emerged between higher MEDAS scores and BMI (r = -0.53, p < 0.01), FM% (r = -0.49, p < 0.01), VAT (r = -0.63, p < 0.01), and cIMT (r = -0.88, p < 0.01). Higher WHR and VAT were associated with increased brachial and central BP and PWV. Notable dietary differences were significantly higher between cIMT groups. Total cholesterol/C-HDL, C-LDL/C-HDL, the Atherogenic Index of Plasma, and the HOMA Index differed significantly between groups. Significant differences were also observed in the left ventricular diastolic function (p = 0.04), LVM/BSA, and LVM/h^2.7 in individuals with subclinical atherosclerosis (p < 0.05). Conclusions: These innovative findings underline the importance of multidisciplinary approaches to prevent CVD and suggest long-term benefits of Mediterranean diet adherence on vascular health.

Keywords: 4P medicine; Mediterranean diet; cardiovascular disease; carotid intima-media thickness.

Figure 1

Cardiometabolic risk parameters (lipid profile and (Homeostasis Model Assessment index) stratified by carotid intima-media thickness (cIMT). Wilcoxon rank sum test; Fisher’s exact test; and Pearson’s Chi-squared test were performed for statistical analysis. p < 0.05 *; p = 0.01 **. Abbreviation: AIP, Atherogenic Index of Plasma; C-HDL, Cholesterol—high-density lipoporotein; C-LDL, Cholesterol—low-density lipoporotein; C-TOT, Total Cholesterol; C-TOT/C-HDL, Total Cholesterol/high-density lipoporotein; C-LDL/C-HDL, Cholesterol—low-density lipoporotein/Cholesterol—high-density lipoporotein.

Figure 2

Answers and scoring of the MEDAS. The “YES” answer to the MEDAS items is compared between the sample with cIMT ≤ 0.90 mm and the group with cIMT > 0.90 mm. The radar chart shows for each MEDAS score item the affirmative responses of the sample with cIMT ≤ 0.90 mm compared to the group with cIMT > 0.90 mm with separate axes starting from the center of the draft (0% “YES” responses) and at the end of the last circle (100% “YES” responses). Values are in percentages. Abbreviations: EVO, extra virgin olive oil; cIMT, carotid intima-media thickness.

Figure 3

Blood Pressure Parameters stratified by carotid intima-media thickness (cIMT). Wilcoxon rank sum test; Fisher’s exact test; Pearson’s Chi-squared test was performed for statistical analysis. Abbreviation: AI@75, Augmentation Index; cIMT, intima-media thickness; PWV, pulse wave velocity.

Figure 4

Bioimpedentiometric (A) and ecocardiographic (B) parameters stratified by carotid intima-media thickness (cIMT). Wilcoxon rank sum test; Fisher’s exact test; Pearson’s Chi-squared test was performed for statistical analysis. p < 0.5 *; p < 0.01 **. Abbreviation: BSA, body surface area; FFM, Fat-Free Mass; FM, fat mass; LVM, left ventricular mass.

Figure 5

Matrix correlations. Abbreviations: BAI, Body Adiposity Index; BCM, Body Cell Mass; BMI, Body Mass Index; c-DIA BP, Central Diastolic Blood Pressure; c-SYS BP, Central Systolic Blood Pressure; CIMT, Carotid Intima-Media Thickness; FFM, Fat-Free Mass; FM, Fat Mass; FT3, Triiodothyronine; IMAT, Intramuscular Adipose Tissue; MEDAS, Mediterranean Diet Adherence Screener; PWV, Pulse Wave Velocity; Systolic BP, Systolic Blood Pressure; VAT, Visceral Adipose Tissue; WHR, Waist-to-Height ratio.