Primary prevention of cardiovascular disease and Mediterranean Diet

Mediterranean diet and primary prevention of cardiovascular disease

Primary prevention: Walnuts and extra-virgin olive oil: healthy fats

A Spanish research team conducted a multicenter randomized trial of Mediterranean Diet pattern for the primary prevention of cardiovascular events.
The participants (7447; age range 55 to 80 years; 57% women) were with no cardiovascular disease but at high cardiovascular risk at enrollment (they had either type 2 diabetes mellitus or at least three of the following major risk factors: hypertension, smoking, overweight or obesity, elevated low-density lipoprotein cholesterol levels, low high-density lipoprotein cholesterol levels or a family history of premature coronary heart disease).
They were randomly assigned to one of three diets:

  • a Mediterranean Diet supplemented with mixed nuts (30 g of mixed nuts: 7.5 g of almonds, 7.5 g of hazelnuts and 15 g of walnuts);
  • a Mediterranean Diet supplemented with extra-virgin olive oil (≥4 tbsp/day);
  • a control diet (advice to reduce dietary fat).

It should be noted that extravirgin olive oil is the cornerstone of Mediterranean Diet.

Moreover, in comparison with those in the control group, participants in the two Mediterranean-Diet groups significantly increased weekly servings of legumes and fish. These were the only between-group differences.
No physical activity was promoted, nor total calorie restriction advised.
Participants were followed for a median of 4.8 years.
The primary end point was the rate of myocardial infarction, stroke, or death from cardiovascular causes that is the rate of major cardiovascular events.

This study have shown that among persons at high cardiovascular risk, a Mediterranean Diet supplemented with nuts or extra-virgin olive oil has proved to be effective in the primary prevention of cardiovascular disease, reducing the incidence of major cardiovascular events.


Estruch R., Ros E., Salas-Salvadó J., et al. Primary prevention of cardiovascular disease with a Mediterranean Diet. N Engl J Med 2013. doi:10.1056/NEJMoa1800389