The Mediterranean Diet: Is It Cardioprotective?

Marita C. Bautista, RN; Marguerite M. Engler, PhD, RN, MS

Disclosures

Prog Cardiovasc Nurs. 2005;20(2):70-76. 

In This Article

Abstract and Introduction

Coronary heart disease is one of the leading causes of morbidity and mortality in the United States. Dietary interventions are first-line therapy for coronary heart disease prevention and treatment. Increasing scientific evidence suggests that the traditional Mediterranean diet may reduce the risk of cardiovascular disease. The cardiovascular benefits of this whole-diet approach may outweigh those of typically prescribed low-fat diets. The burden of coronary heart disease is enormous, and nutritional approaches that optimize cardiovascular health are essential. Clinical trial evidence supporting the role of the Mediterranean diet in cardiovascular health is presented with an emphasis on the physiological effects of omega-3 fatty acids. Implications for clinical practice and future research are also discussed.

Coronary heart disease (CHD) is one of the leading causes of morbidity and mortality in the United States. According to thelatest American Heart Association (AHA) statistics, one out of every five deaths in the United States is due to CHD.[1] The estimated combined direct and indirect cost of CHD for 2005 is $142.1 billion.[1] The relationship between diet and CHD has been investigated extensively over the last century. Early epidemiologic and clinical investigations were based on the diet-heart hypothesis, implicating dietary saturated fat and cholesterol as the principal contributors in the development of atherosclerosis and CHD.[2] Previous dietary trials have focused on reducing cholesterol through a low cholesterol, low saturated fat, high polyunsaturated fat dietary intervention, but they have failed to demonstrate significant improvements in long-term outcomes.[3]

Dietary interventions are first-line therapy for CHD prevention and treatment.[4] The current spectrum of dietary recommendations is broad. The public is often confused by the high variability of dietary advice, and most consumers are concerned about the scientific basis for the recommended diets.[5] Popular dietary plans range from diets that are very low in fat and very high in carbohydrates (Ornish and Pritikin diets) to those that are very high in protein and fat but extremely low in carbohydrates (Atkins and protein powder diets).[6]

Low-fat diets have been recommended by the National Cholesterol Education Program (NCEP) and the AHA for primary and secondary prevention of CHD. In 2001, the Adult Treatment Panel III (ATP III) guidelines were developed, with the "Eating Plan for Healthy Americans" designed for healthy individuals and the Total Lifestyle Change (TLC) diet (replacing the AHA Step II diet) directed at those with or at high risk for heart disease.[7] These diets are characterized by reduced intake of saturated fat and cholesterol, and increased consumption of fruits, vegetables, and whole grain products. Despite evidence supporting the effectiveness of current dietary recommendations, the incidence of CHD continues to rise, and other nutritional strategies need to be explored.[5]

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