Cardiovascular and mortality benefits of the Mediterranean diet in women

By Rebecca Jenkins

Closely following a Mediterranean diet cuts women’s risk of cardiovascular disease (CVD) and early death by almost 25%, according to Australian researchers who are calling for more sex-specific research to guide cardiovascular clinical practice.

The University of Sydney-led team screened 190 studies on the Mediterranean diet and incident CVD and total mortality that included sex-specific data or were female-only. They then included 16 of these trials in their meta-analysis, which were all prospective cohort studies published between 2006 and 2021.

The dataset involved more than 700,000 adult women without previous or subclinical CVD, who were followed up for an average of 12.5 years.

Higher adherence to the Mediterranean diet was linked with a 24% reduced risk of incident CVD and a 23% reduced risk of total mortality compared with lower adherence, they reported in Heart.

Of the 16 studies, four reported on coronary heart disease finding higher adherence to the Mediterranean diet was linked to a 25% risk reduction compared with lower adherence.

Three studies reported on the incidence of stroke with the meta-analysis finding there was a risk reduction with higher adherence to the Mediterranean diet, but this did not reach statistical significance.

Lead author Ms Anushriya Pant, PhD candidate at the University of Sydney’s Westmead Applied Research Centre, said this was the first meta-analysis focused on the association between Mediterranean diet and incident CVD and death, specific to women.

‘Future research should focus on designing sex-specific research on the Mediterranean diet that is more inclusive of women and women of diverse backgrounds. This ensures dietary guidelines for CVD prevention are tailored for women,’ she told Medicine Today.

Professor Catherine Itsiopoulos, Professor of Nutrition and Dietetics at RMIT University, Melbourne, welcomed the ‘novel’ study and supported calls for more sex-specific research.

She noted the researchers had also performed a subanalysis finding the protective CVD effect of a Mediterranean diet was of a similar magnitude in men as in women, which could suggest similar pathological mechanisms at play. But she told Medicine Today there remained many knowledge gaps about women’s diets and heart health, including the interplay with body fat distribution and the effects of dietary phytoestrogens on CVD risk.

‘We also know there are differences between men and women in dietary behaviours, physical activity and other lifestyle behaviours and health priorities,’ she said.

‘Therefore, more studies that examine these different behaviours between the sexes and evaluate the impacts on health outcomes will provide valuable insights into more effective and targeted treatments or guidelines.’

Meanwhile, Professor Itsiopoulos recommended patients take small steps to introduce key principles of the Mediterranean-style diet, such as using extra virgin olive oil in cooking and on salads and having a serve of natural yoghurt most days.

Heart 2023; doi: 10.1136/heartjnl-2022-321930.