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May 14, 2024

The Mediterranean Diet Scores Again and Reduces CVD Risk

Meta-analysis of 21 independent data sets concluded that the Mediterranean diet can reduce the risk of cardiovascular disease by improving endothelial function through several different mechanisms, including:

  • Protecting against oxidative stress, inflammation, and platelet aggregation
  • Modifying cancer-related hormones and growth factors
  • Having a lipid-lowering effect
  • Modulating gut microbiota-mediated production of metabolites influencing metabolic health

Additionally, it can significantly decrease low-density lipoprotein (LDL), apolipoprotein B, and oxidized LDL, the promoter of endothelial dysfunction, inflammation, arterial lipid accumulation, and atherosclerosis.

The MedDiet improves vasomotor function and decreases LDL cholesterol levels by decreasing P-selectin in plasma. In addition, monounsaturated fatty acid (MUFA), a major component of MedDiet, also improves endothelial function in hypercholesterolemia, reduces the risk of atherosclerotic plaque formation, and decreases cholesterol levels

The MedDiet decreases LDL oxidation and increases protective high-density lipoprotein-cholesterol (HDL-C) due to its olive oil content. Therefore, the MedDiet can be used for both primary and secondary prevention of CVD.

The MedDiet is a complex diet containing nuts, legumes, and fish, all of which are key sources of l-arginine, an amino acid that can be utilized to enhance nitric oxide (NO) bioavailability. NO relaxes vascular tone and inhibits platelet aggregation and platelet adhesion. Approximately 4–24 grams of arginine can help reduce blood pressure. Vegetables consumed in the MedDiet provide nitrate, a precursor to nitric oxide.

The MedDiet can also downregulate inflammatory markers related to atherosclerosis, such as serum C-reactive protein (CRP), interleukin 6 (IL-6), cell adhesion molecule-1 (CAM-1), and intercellular adhesion molecule-1 (ICAM-1).

CRP reduces endothelial nitric oxide synthase (eNOS) activity and reduces the vasodilator effects of NO. CRP also increases the vasoconstrictor effects of Endothelin-1 (ET-1). All of these actions increase the risk of atherosclerosis and clot formation. The MedDiet downregulation of inflammatory markers leads to improvements in endothelial function.


Fatima, Kaneez et al. “Mediterranean Diet and its Effect on Endothelial Function: A Meta-analysis and Systematic Review.” Irish journal of medical science vol. 192,1 (2023): 105-113. doi:10.1007/s11845-022-02944-9 This article is licensed under a Creative Commons Attribution 4.0 International License http://creativecommons.org/licenses/by/4.0/.

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