Background: Heart disease and stroke are two leading causes of disability and death in the United States. The Mediterranean diet has been shown to reduce recurrent cardiovascular events and decrease inflammatory biomarkers that contribute to atherosclerotic progression. Should the Mediterranean diet be recommended to patients with known risk factors for cardiovascular disease to reduce risk of first incident or mortality associated with cardiovascular and cerebrovascular disease?
Methods: An exhaustive search of available medical literature was conducted using Medline-OVID, CINAHL and EBSCO-Host. The key words that were used individually and in combination included: Mediterranean diet, vascular inflammation, cardiovascular disease treatment, cerebrovascular disease, coronary heart disease, myocardial infarction, CRP and IL-6. Relevant articles were assessed for quality using GRADE.
Results: Three studies met inclusion and exclusion criteria and were used in this review. The first is a large prospective Greek-population cohort study, which found a decrease in mortality from coronary heart disease with greater Mediterranean diet adherence. The second is a large prospective Manhattan-population cohort study, which found no association for diet adherence and ischemic stroke and a reduced risk of myocardial infarction and vascular death up to a score of four. The third is a large prospective Mediterranean-population based cohort study, which found a reduction in cerebrovascular incident with diet scores greater than four.
Conclusion: The Mediterranean diet has been shown to reduce the risk of cardiovascular disease incidence and mortality. There is conflicting evidence regarding reduction of cerebrovascular disease incidence and mortality. The overall study quality is very low due to design and follow up time, however, a dose response gradient is evident in each study. Providers should advise patients without disease but with known risk factors to implement complete adherence to the Mediterranean diet for best risk reduction.
Keywords: Mediterranean diet, myocardial infarction, cerebrovascular disease, coronary heart disease, vascular inflammation.
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