Atherosclerosis is the underlying cause of cardiovascular diseases (CVD) and is interrelated to stroke, heart attack, and heart failure. The Mediterranean Diet (MedDiet) has been closely associated with reduced CVD morbidity and mortality, but research is not well explored for this relationship in individuals with diabetes (who experience greater CVD morbidity and mortality than individuals without diabetes). The aim of this review was to explore the literature related to the MedDiet and atherosclerosis and associated risk factors in individuals with and without diabetes. In total, 570 articles were identified, and 36 articles were included. The articles were published between 2011 and 2021. Platforms used for the search were PubMed, Scopus, Cochrane Library, and ProQuest. Our literature search included clinical and observational studies. Clinical studies revealed the MedDiet was associated with improved biomarkers, plaque, and anthropometric measurements that are associated with atherosclerosis and CVD. Observational studies identified associations between the MedDiet and lower presence of atherosclerosis, improved vascular aging, and increased endothelial progenitor cells. However, most of the studies took place in Mediterranean countries. Further research is needed to better understand the long-term effects the MedDiet on atherosclerosis and its associated risk factors in diverse populations to include individuals with and without diabetes.
Several studies have identified improvements in the risks of cardiovascular disease in adults following a Mediterranean dietary pattern. However, data are scarce on its association with coronary artery calcification (CAC) and pericardial adiposity (PAT) in US adults with and without diabetes. To address this gap, we conducted a case-control study using baseline data from the Coronary Artery Calcification in Type 1 Diabetes (CACTI) study [n = 1255; Type 1 Diabetes (T1D): n = 563; non-Diabetes Mellitus (non-DM): n = 692]. Participants completed a validated food frequency questionnaire, fasting (12 h overnight fast) biochemical analyses, and a physical examination including anthropometric measures. CAC and PAT were measured using electron beam-computed tomography. Logistic regression models were used to examine the associations of the Mediterranean-Style Dietary Pattern Score (MSDPS) with CAC (presence or absence), and linear regression models were applied to PAT analyses. In all of the adjusted models, no significant associations with CAC were found. For PAT, an increasing MSDPS was consistently associated with its lower volume in models adjusted for age, sex, diabetes status, total calories, and body mass index (all p < 0.05). The association between MSDPS and PAT was attenuated after adjusting for serum lipids and physical activity. In conclusion, the baseline data from the CACTI study show that a greater adherence to MSDPS is associated with a lower PAT volume and provide evidence that the Mediterranean dietary pattern is associated with lower cardiovascular risk markers.
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