Coronary heart disease (CHD) is largely preventable through a healthful lifestyle, particularly a healthy diet. However, CHD is the leading cause of death and disability worldwide. Dietary guidelines to promote good health and reduce major chronic diseases, including CHD, are based on data about foods, nutrients, and dietary patterns predictive of chronic disease risk in epidemiologic studies.
What is the best dietary pattern to avoid CHD and increase longevity? A systematic review1 of the evidence supporting the causal link between dietary factors and CHD ranked the Mediterranean diet as the most likely dietary model to provide protection against CHD. In prospective cohort studies,2 increasing adherence to the Mediterranean diet has been consistently beneficial for prevention of major chronic diseases, including fatal and nonfatal CHD, as well as all-cause mortality. The results of a large intervention study about the effects of a Mediterranean diet in the primary prevention of cardiovascular disease in high-risk subjects, the PREDIMED (Prevención con Dieta Mediterránea) trial, have been published recently.3 In this study, high–unsaturated-fat Mediterranean diets supplemented with extra-virgin olive oil or nuts for almost 5 years reduced by 30% the incidence of an aggregate of fatal and nonfatal cardiovascular disease events (CHD and stroke) compared with a control diet consisting of advice to reduce all types of dietary fat. Among components of the primary outcome, incident stroke, but not CHD, was significantly reduced in the 2 Mediterranean diet arms.3