The Mediterranean Diet (MedDiet) stands out as a highly favorable dietary pattern when examined in relation to cardiovascular disease (CVD) risk and various health outcomes.1,2 Research has consistently shown MedDiet's positive impact on preventing both overall cardiovascular issues and specific types of CVD.1 The traditional MedDiet is distinguished by its specific dietary components. It involves a substantial consumption of olive oil (the main source of fat), fruits, nuts, vegetables, and cereals.3 The diet also includes a moderate intake of fish and poultry. In contrast, there is a limited consumption of dairy products, red meat, processed meats, and sweets. Additionally, wine is incorporated in moderation, typically consumed with meals.3 The health benefits associated with the MedDiet cannot be linked to any individual component; rather, they emerge from the synergistic interactions among the various elements of this dietary pattern.

In the historical Seven Countries Studies, numerous investigations across diverse populations have consistently demonstrated the beneficial impact of the key components of the Mediterranean dietary pattern on the development of risk factors and incidence of CVD.4 MedDiet, abundant in natural antioxidants, has been linked to reduced levels of systemic biomarkers of oxidative stress.5 Additionally, it has been shown to exert favorable effects on endothelial function.6 Through its positive influence on CVD risk factors, including substantial reductions in serum lipids, fasting blood glucose, blood pressure, insulin resistance, arterial stiffness, and oxidative stress, adherence to the MedDiet has been associated with a decrease in both CVD incidence and mortality.7 Longitudinal population studies provide evidence that maintaining a MedDiet not only enhances cardiometabolic profiles but also significantly contributes to favorable long-term cardiovascular outcomes.8,9

We conducted a meta-analysis, synthesizing the clinical effects of the MedDiet by systematically pooling and scrutinizing findings from RCTs, including data from the latest CORDIOPREV study, to provide updated insights and advance our understanding of the long-term clinical impact of MedDiet in primary and secondary CVD prevention. The study underscores the ongoing need for additional research to further explore the effect of MedDiet on clinical endpoints and CVD risk factors for primary and secondary prevention, reinforcing the importance of continuous investigation in this area.