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Effect of the Mediterranean diet in cardiovascular prevention
Efecto de la dieta mediterránea en la prevención cardiovascular
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Miguel Á. Martínez-Gonzáleza,b,c,
Corresponding author
mamartinez@unav.es

Corresponding author.
, Aitor Hernández Hernándeza,d
a Departamento de Medicina Preventiva y Salud Pública, Universidad de Navarra, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
b Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Spain
c Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, United States
d Departamento de Cardiología, Clínica Universidad de Navarra, Madrid, Spain
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Received 20 December 2023. Accepted 25 January 2024
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Table 1. Mediterranean diet scores commonly used in cardiovascular research
Table 2. Evidence about Mediterranean diet and cardiovascular disease
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Abstract

The Mediterranean diet is the best evidence-based model for cardiovascular prevention. In addition to 2 major randomized secondary prevention trials (Lyon Heart and CORDIOPREV) and 1 primary prevention trial (PREDIMED) that have demonstrated these benefits, there is an unprecedented body of high-quality prospective epidemiological evidence supporting these beneficial effects. The key elements of this traditional pattern are the abundant use of extra-virgin olive oil and high consumption of foods of natural plant-based origin (fruits, vegetables, nuts, and legumes) and fish, along with a reduction in processed meats, red meats, and ultraprocessed products. Moderate consumption of wine, preferably red wine, with meals is an essential element of this traditional pattern. Although removing wine consumption from the Mediterranean diet has been associated with a reduction in its preventive efficacy, doubts have recently arisen about the possible adverse effect of even low or moderate intake of any alcoholic beverages. A new large Spanish trial, UNATI, which will begin in June 2024, will randomize 10 000 drinkers aged 50 to 75 years to abstention or moderate consumption. UNATI aims to answer these doubts with the best possible evidence.

Keywords:
Mediterranean diet
Olive oil
Nutritional epidemiology
Alcohol drinking pattern
Abbreviations:
CVD
EVOO
MedDiet
MI
Resumen

La dieta mediterránea es el modelo mejor fundamentado en la evidencia científica para la prevención cardiovascular. Además de 2 importantes ensayos aleatorizados de prevención secundaria (Lyon Heart y CORDIOPREV) y un ensayo aleatorizado de prevención primaria (PREDIMED), que han demostrado estos beneficios, hay un cúmulo sin precedentes de evidencia epidemiológica prospectiva de alta calidad que respalda estos efectos beneficiosos. Los elementos clave de este patrón tradicional son el abundante consumo de aceite de oliva virgen extra y un alto consumo de alimentos de origen vegetal natural (frutas, verduras, frutos secos y legumbres) y pescado, junto con una reducción de las carnes procesadas, las carnes rojas y los productos ultraprocesados. El consumo moderado de vino, preferentemente tinto, en las comidas ha sido uno de los elementos imprescindibles de este patrón tradicional. A pesar de que suprimir el consumo de vino se ha asociado con menor eficacia preventiva de este patrón, recientemente han surgido diversas dudas sobre el posible efecto adverso incluso de un consumo bajo o moderado de cualquier bebida alcohólica. Un nuevo gran ensayo español, el estudio UNATI, que empezará en junio de 2024 a aleatorizar a 10.000 bebedores de 50-75 años a abstención o a consumo moderado, pretende responder con la mejor evidencia posible a estas dudas.

Palabras clave:
Dieta mediterránea
Aceite de oliva
Epidemiología nutricional
Patrón de consumo de alcohol

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