A Mediterranean diet is Heart Healthy


The PREDIMED trial 

Among persons at high cardiovascular risk, a Mediterranean diet supplemented with extra-virgin olive oil or nuts reduces the incidence of major cardiovascular events.

Kaplan–Meier Estimates of the Incidence of Outcome Events in the Total Study Population.

Panel A shows the incidence of the primary end point (a composite of acute myocardial infarction, stroke, and death from cardiovascular causes), and Panel B shows total mortality. Hazard ratios were stratified according to center (Cox model with robust variance estimators). CI denotes confidence interval, EVOO extra-virgin olive oil, and Med Mediterranean.

Results of Subgroup Analyses.

Shown are adjusted hazard ratios for the primary end point within specific subgroups. Squares denote hazard ratios; horizontal lines represent 95% confidence intervals. Hazard ratios indicate the relative risk in both intervention groups merged together (vs. the control group) within each stratum. Hazard ratios were stratified according to recruiting center and were adjusted for sex, age (continuous variable), family history of premature coronary heart disease (CHD) (yes or no), smoking (never smoked, former smoker, or current smoker), body-mass index (BMI) (continuous variable), waist-to-height ratio (continuous variable), hypertension at baseline (yes or no), dyslipidemia at baseline (yes or no), and diabetes at baseline (yes or no). Scores for adherence to the Mediterranean diet range from 0 to 14, with higher scores indicating greater adherence.


Eligible participants were mostly Caucasian women with no (evidence of) cardiovascular disease at enrollment with either type II diabetes mellitus or at least three of the following major risk factors: smoking, hypertension, elevated LDL levels, low HDL levels, overweight or obesity, or a family history of premature coronary heart disease:

Baseline Characteristics

Female gender


Mean Age

67 yo

Race (Caucasian)


Smoking (Never)


BMI Mean


BMI > 30




Diabetes II




FH of Heart Disease



  • While the Predimed trial excluded participants with a documented history of previous cardiovascular disease, including CAD, stroke  or clinical peripheral artery disease, to my knowledge they were not tested.
  • The high percentage of almost all white female non-smokers, with multiple risk factors for heart disease, but with an essentially negative family history.
  • At a mean age of 67yo, it is unlikely that coronary artery disease was yet to develop. It is also unclear how CAD was excluded in the study groups prior to enrollment.
  • It is therefore reasonable to assume that a significant number of these participants had prior asymptomatic CAD.
  • The outcome, a Mediterranean diet supplemented with extra-virgin olive oil or nuts reduced the incidence of major cardiovascular events by 30%, is remarkable.


Primary Prevention of Cardiovascular Disease with a Mediterranean Diet, Ramón Estruch, M.D., Ph.D., et al, NE J Med, 2/25/2013