Uncertainty of Mediterranean-style diet for prevention of cardiovascular disease

Despite the relatively large number of studies included in this review, there is still some uncertainty regarding the effects of a Mediterraneanstyle diet on clinical endpoints and CVD risk factors for both primary and secondary prevention. A large trial in people at high risk of CVD found a benefit of Mediterranean dietary intervention compared with a low‐fat diet on the risk of having a stroke, but not on heart attacks or death from heart disease or other causes.

A further study in people with CVD found a benefit of Mediterranean dietary intervention on death from heart disease or other causes.

Both these studies were rated as providing low to moderate‐quality evidence. There was low to moderate‐quality evidence for some beneficial changes in lipid levels and blood pressure in primary prevention, with a small number of studies reporting minimal harms. There was a paucity of evidence for secondary prevention.