Women who adhere to Mediterranean diet have 24% lower CVD risk

Key takeaways:

• For women, the Mediterranean diet has a beneficial effect on the primary prevention of CVD and mortality.
• Higher adherence to the diet was linked to lower total mortality and heart disease incidence.

Women with greater adherence to the Mediterranean diet had a significantly reduced risk for CVD and total mortality, according to the results of a systematic review and meta-analysis published in Heart.

Anushriya Pant, a PhD candidate at Westmead Applied Research Centre in Sydney, Australia, and colleagues wrote that “dietary modification is a cornerstone of CVD prevention.” Although the Mediterranean diet — which includes high intake of fruits, leafy green vegetables, nuts, cereal and extra virgin olive oil and moderate intake of dairy products, fish and other meat — has previously been linked to a lowered risk for CVD, no systematic reviews have specifically evaluated the relationship in women.

“CVD is the primary cause of mortality in women, accounting for [about] 35% of all female deaths globally,” they wrote. “Due to sex disparities in treatment and prognostic outcomes for CVD, there have been international calls for sex-specific cardiovascular research.”

To that end, the researchers searched the CINAHL, Embase, Medline, Scopus and Web of Science databases for randomized controlled trials and prospective cohort studies of women who did not have CVD, published between 2003 and 2021. Their analysis ultimately included 16 prospective cohort studies representing 722,495 women. They sought to determine the association between higher vs. lower adherence to the Mediterranean diet and incident CVD and total mortality.

Pant and colleagues found that women who more strictly adhered to the diet had a lower incidence of the following:

• total mortality (HR = 0.77; 95% CI, 0.74-0.8);
• CVD (HR = 0.76; 95% CI, 0.72-0.81); and
• coronary heart disease (HR = 0.75; 95% CI, 0.65-0.87).

“This first meta-analysis of female-only studies ... found that a Mediterranean diet is equally beneficial in women as it is in men, with a 24% lower hazard of CVD and 23% lower hazard of total mortality,” they wrote.

Additionally, higher adherence was linked to lower stroke incidence (HR = 0.87; 95% CI, 0.76-1.01), but the researchers wrote that the result was not statistically significant.

“We were unable to demonstrate a benefit of stroke reduction in women, but this was likely due to the smaller number of studies reporting this secondary outcome,” Pant and colleagues wrote.

The researchers noted that the Mediterranean diet’s different parts “may contribute to a better cardiovascular risk profile.”

“For example, polyphenols, nitrates, omega-3 fats, increased fiber from plant foods and reduced glycemic load,” they wrote. “However, mechanisms explaining the sex-specific effect of the Mediterranean diet on CVD and death remain unclear.”

Pant and colleagues concluded that “future research should adopt more sex-aggregated research designs to develop tailored dietary guidelines for CVD prevention,” and that their study is an important step for sex-specific guidelines.

“Female specific cardiovascular risk factors, including premature menopause, pre-eclampsia and gestational diabetes, or female predominant risk factors, such as systemic lupus, can all independently increase CVD risk. Common forms of CVD (eg, myocardial infarction) can also have different etiologies in women compared with men,” they wrote. “It is possible that preventative measures, such as a Mediterranean diet, that targets inflammation and CVD risk factors, impose differing effects in women compared with men.”

Editor’s note: For more information on the cardiometabolic benefits of the Mediterranean diet and those of other popular dietary approaches, check out our special report on nutrition .