Adherence to the Mediterranean Diet in Relation to Acute Coronary Syndrome or Stroke Nonfatal Events

A Comparative Analysis of a Case/Case-Control Study

Christina-Maria Kastorini, MSc; Haralampos J. Milionis, MD, PhD; Aggeliki Ioannidi, MSc; Kallirroi Kalantzi, MD; Vassilios Nikolaou, MD; Konstantinos N. Vemmos, MD; John A. Goudevenos, MD, PhD; Demosthenes B. Panagiotakos, PhD


Am Heart J. 2011;162(4):717-724. 

In This Article

Abstract and Introduction


Background Although the role of Mediterranean diet on cardiovascular disease prevention has long been evaluated and understood, its association with the development of stroke has been rarely examined. The aim of the present work was to comparatively evaluate the association between adherence to the Mediterranean diet and the development of an acute coronary syndrome (ACS) or ischemic stroke.
Methods During the period from 2009 to 2010, 1,000 participants were enrolled; 250 were consecutive patients with a first ACS, 250 were consecutive patients with a first ischemic stroke, and 500 population-based, control subjects, 1-for-1 matched to the patients by age and sex. Sociodemographic, clinical, psychological, dietary, and other lifestyle characteristics were measured. Adherence to the Mediterranean diet was assessed by the validated MedDietScore (theoretical range 0–55).
Results After various adjustments were made, it was observed that for each 1-of-55-unit increase of the MedDietScore, the corresponding odds ratio for having an ACS was 0.91 (95% CI 0.87–0.96), whereas regarding stroke, it was 0.88 (95% CI 0.82–0.94).
Conclusions The present work extended the current knowledge about the cardioprotective benefits from the adoption of the Mediterranean diet by showing an additional protective effect on ischemic stroke development.


According to the World Health Organization, 17.1 million people died from cardiovascular disease (CVD) in 2004; 7.2 million, from coronary heart disease (CHD); and 5.7 million, from stroke. Also, there is an increasing trend globally.[1] Thus, prevention of CVD is considered of major public health importance, not only because of its increasing prevalence but also because of its negative impact on quality of life.[2]

Lifestyle changes and, especially, dietary interventions are cost-effective means for the prevention of CVD and the reduction of the social and economic burden of this condition.[1,3,4] The Mediterranean dietary pattern is one of the most well-known dietary patterns regarding its cardioprotective effects.[5] This pattern is characterized by high consumption of monounsaturated fatty acids, primarily from olives and olive oil. It encourages daily consumption of fruits, vegetables, whole grain cereals, and low-fat dairy products; weekly consumption of fish, poultry, tree nuts, and legumes; monthly consumption of red meat; and a moderate daily consumption of alcohol, normally with meals. The beneficial role of the Mediterranean diet regarding mortality from all causes, CHD, some types of cancer, and metabolic disorders, has already been reported.[6–9] In a recent meta-analysis of 530,000 participants from 50 studies, greater adherence to the Mediterranean diet was associated with a lower risk for metabolic syndrome and its constituents.[10] The main mechanism for this cardiometabolic protection is the antioxidant and anti-inflammatory effects that the aforementioned pattern has.[11,12] However, despite the fact that many studies have underlined the beneficial role of the Mediterranean diet regarding the development of CHD, the role of this diet on the development of stroke has not been thoroughly examined.[13,14] To the best of our knowledge, only one study has evaluated and attempted to compare the effect of the Mediterranean diet on the development of both acute coronary syndromes (ACS) and stroke.[13]

Thus, the aims of the present work were to evaluate the role of adherence to the Mediterranean dietary pattern on the likelihood of developing an ACS or stroke and to perform a comparative analysis between these 2 outcomes as regards the effect size of this potential cardioprotection. The significance of this work is of major importance for public health care planners, since it would test the Mediterranean diet–stroke hypothesis at population basis and may provide an additional, non pharmacologic means for the prevention of ischemic stroke.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.