Mediterranean diet and cardiovascular prevention.

Cardiovascular disease remains the main cause of morbidity and mortality in the 21st century, and the situation is not expected to change in the next 2 decades. This epidemic could be contained or even decreased if there were a social change in favor of a healthier lifestyle and diet, such as the Mediterranean diet (MedD). Several years ago, the low incidence of morbidity and mortality from coronary heart disease in Mediterranean countries created great interest. In fact, the number of PubMed publications on this topic increased from fewer than 10 in 1985 to about 300 in 2012. Many of these were observational studies (ecological, cohort, or case-control) in which increased adherence to the MedD was accompanied by reduced cardiovascular risk. In addition, numerous small clinical trials have observed the effects of this diet or its main components on intermediate variables of cardiovascular risk such as blood pressure, blood lipids, insulin resistance, or endothelial function, adding plausibility to epidemiological studies by demonstrating possible mechanisms by which the MedD provides cardiovascular protection. However, in the era of evidence-based medicine, nutritional recommendations should be based on randomized interventional studies that analyze ‘‘hard’’ variables such as cardiovascular death, myocardial infarction, or stroke.