title: Dietary patterns, Mediterranean diet, and cardiovascular disease.
abstract: OBJECTIVE
  The objective of this manuscript was to review the evidence on the association between adherence to a Mediterranean diet (MeDiet) and the risk of cardiovascular disease (CVD). We also updated the results of the last available meta-analysis.
  
  
  RESULTS
  In 2013, a landmark study in the field, the PREvención con DIeta MEDiterránea randomized trial, with 7447 high-risk participants, published its final results. They provided a strong support to the beneficial role of a traditional MeDiet for primary cardiovascular prevention. When these results were combined with those of the Lyon Diet Heart Study (a secondary prevention trial), we found that an intervention with a MeDiet was associated with a 38% relative reduction in the risk of CVD clinical events (pooled random-effects risk ratio: 0.62; 95% confidence interval, CI: 0.45-0.85). Regarding observational studies assessing clinical end-points as outcome, we identified seven new cohort studies published after the last meta-analysis. After removing studies that only assessed fatal outcomes, a two-point increase in adherence to the MeDiet (0-9 score) was associated with a significant reduction in cardiovascular events (pooled risk ratio: 0.87; 95% CI: 0.85-0.90) with no evidence of heterogeneity.
  
  
  CONCLUSIONS
  Consistent evidence suggests that the promotion of the Mediterranean dietary pattern is an effective and feasible tool for the prevention of CVD.
authors.affiliation: aDepartment Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain bCIBERobn, Instituto de Salud Carlos III, Madrid, Spain.
authors.forename: Miguel Angel
authors.initials: MA
authors.lastname: Martinez-Gonzalez
authors.forename: Maira
authors.initials: M
authors.lastname: Bes-Rastrollo
mesh_terms: D002318:Cardiovascular Diseases / Q000453:epidemiology*; D015331:Cohort Studies; D038441:Diet, Mediterranean / Q000706:statistics & numerical data*; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D012306:Risk