Effects of the Mediterranean Diet on Cardiovascular Outcomes—A Systematic Review and Meta-Analysis

Liyanage, Thaminda; Ninomiya, Toshiharu; Wang, Amanda; Neal, Bruce; Jun, Min; Wong, Muh Geot; Jardine, Meg; Hillis, Graham S.; Perkovic, Vlado

doi:10.1371/journal.pone.0159252

Cited by 162 publications

(111 citation statements)

References 31 publications

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Section: Dietary Patternsmentioning

confidence: 99%

“…For SRMAs of observational studies, dietary patterns were Mediterranean diet (eight SRMAs), DASH diet (three SRMAs), diets with high HEI and AHEI scores (two SRMAs), HEI/AHEI and cardiovascular health (CVH) scores (one SRMA), and Diet Inflammatory Index (DII) scores (one SRMA). For SRMAs of RCTs, the interventions were prescribing a Mediterranean diet (one SRMA) [18] and modifying diet quality by lowering the consumption of carbohydrates, fat, and calories, and increasing the consumption of fish, vegetables, complex carbohydrates, and fiber (two SRMA) [17,19]. Most of the SRMAs (16/18) considered the general population as the study's participants, while two included only high-risk populations (e.g., patients with obesity, hypertension, and DM).…”

Section: Dietary Patternsmentioning

confidence: 99%

See 1 more Smart Citation

Dietary Factors and Risks of Cardiovascular Diseases: An Umbrella Review

Chareonrungrueangchai

Wongkawinwoot

Anothaisintawee

et al. 2020

Nutrients

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Unhealthy diet is a significant risk factor for cardiovascular diseases (CVD). Therefore, this umbrella review aims to comprehensively review the effects of dietary factors, including dietary patterns, food groups, and nutrients on CVD risks. Medline and Scopus databases were searched through March 2020. Systematic reviews with meta-analyses (SRMA) of randomized controlled trials (RCTs) or observational studies measuring the effects of dietary factors on CVD risks were eligible. Fifty-four SRMAs, including 35 SRMAs of observational studies, 10 SRMAs of RCTs, and 9 SRMAs of combined RCT and observational studies, were included for review. Findings from the SRMAs of RCTs suggest the significant benefit of Mediterranean and high-quality diets for lowering CVD risk, with pooled risk ratios (RRs) ranging from 0.55 (95%CI: 0.39-0.76) to 0.64 (95%CI: 0.53-0.79) and 0.70 (95%CI: 0.57-0.87), respectively. For food nutrients, two SRMAs of RCTs found that high intake of n-3 polyunsaturated fatty acid (PUFA) significantly reduced CVD risks, with pooled RRs ranging from 0.89 (95%CI: 0.82, 0.98) to 0.90 (95%CI: 0.85-0.96), while evidence of efficacy of n-6 PUFA and combined n-3 and n-6 PUFA were inconsistent. Moreover, results from the SRMAs of RCTs did not find a significant benefit of a low-salt diet and low total fat intake for CVD prevention. For food groups, results from the SRMAs of cohort studies suggest that high intakes of legumes, nuts, and chocolate, as well as a vegetarian diet significantly reduced the risk of coronary heart disease, with pooled RRs of 0.90 (95%CI: 0.84-0.97), 0.68 (95%CI: 0.59-0.78), 0.90 (95%CI: 0.82-0.97), and 0.71 (95%CI: 0.57-0.87), respectively. Healthy dietary patterns had a significant benefit for CVD prevention. With the substitutional and synergistic interactions between different food groups and nutrients, dietary recommendations for CVD prevention should be focused more on healthy dietary patterns than single food groups or nutrients.Nutrients 2020, 12, 1088 2 of 18 (e.g., fruits, vegetables, nuts, whole grains, and legumes), and food nutrients (e.g., sodium, saturated fat, and monounsaturated fat). However, most evidence has focused on dietary fats, due to the established relationship between serum cholesterol level and CVD risks. Previous evidence on the association between dietary fat intake and CVD prevention is inconsistent and is still being debated. For instance, in 2017 the American Heart Association (AHA) recommended lowering saturated fat intake and replacing it with unsaturated fat, especially polyunsaturated fatty acids (PUFA), for CVD prevention [5]. However, some systematic reviews and meta-analyses (SRMA) of randomized controlled trials (RCT) did not show a significant benefit of PUFA for reducing CVD risks [6,7], and the findings from an 18-country cohort study also concluded that "total fat and types of fat were not associated with CVD" [8]. Similarly, findings from SRMAs [9-12] of the effects of other dietary factors, such as vegetables, fruits, and fibers on CVD risk...

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Section: Dietary Patternsmentioning

confidence: 99%

Section: Dietary Patternsmentioning

confidence: 99%

Dietary Factors and Risks of Cardiovascular Diseases: An Umbrella Review

Chareonrungrueangchai

Wongkawinwoot

Anothaisintawee

et al. 2020

Nutrients

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“…The Mediterranean diet, high in fruits, vegetables, nuts, cereals, fish, and olive oil with moderate red wine consumption and minimal amounts of red meat and dairy products has been linked to beneficial effects on vascular disease, blood pressure, glycemic control, and lipids (76, 77). However, evidence is limited and variable regarding cardio-protection from diet in the general population (78), and almost nonexistent in patients receiving trastuzumab specifically. Aggressive glycemic control is also recommended in guidelines despite a paucity of evidence that this will decrease heart failure risk.…”

Section: Preventing Trastuzumab-induced Cardiotoxicitymentioning

confidence: 99%

Incidence, Diagnosis, and Treatment of Cardiac Toxicity From Trastuzumab in Patients With Breast Cancer

Nowsheen

Viscuse

O’Sullivan

et al. 2017

Curr Breast Cancer Rep

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Purpose of review Treatment with trastuzumab is a cornerstone of human epidermal growth factor receptor 2 (HER2)-overexpressing breast cancer treatment, but carries an unfortunate risk of toxicity to the cardiovascular system. Here we review recent findings on trastuzumab-associated cardiotoxicity, focusing on its incidence, diagnosis, and treatment. Recent findings Screening with multigated acquisition scan (MUGA) or echocardiogram (ECHO) is recommended to assess cardiac function prior to and during trastuzumab therapy. Because trastuzumab-induced cardiotoxicity is typically reversible, cessation of trastuzumab and/or administration of first line heart failure agents effectively restores cardiac function in most cases. Severe trastuzumab-induced cardiotoxicity is rare enough that the risk-benefit ratio still weighs in favor of its use in the vast majority of patients with HER2+ breast cancer. Summary An improved understanding of the pathophysiology underlying trastuzumab-induced cardiotoxicity and the identification of patients at highest risk will allow us to continue to safely administer trastuzumab in patients with breast cancer.

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“…Much of the recent data on the effects of plant-based diets on CVD risk come from studies of vegetarian or semi-vegetarian diets (which allow the inclusion of fish and/or up to two servings of chicken per week) (Appleby & Key 2015;Wang et al 2015;Dinu et al 2016) or MedDs (Bloomfield et al 2016;Garcia et al 2016;Godos et al 2016;Liyanage et al 2016;Nissensohn et al 2016).…”

Section: Cardiovascular Disease and Plant-based Dietsmentioning

confidence: 99%

“…Details of the main studies that have evaluated the association between plant-based dietary regimes (both vegetarian and MedD) and cardiovascular heath are detailed in Table 1 (Key et al 1999;Appleby et al 2016 ;Crowe et al 2011;Buckland et al 2009;Key et al 2003;Key et al 2009;Lopez-Garcia et al 2014;Mart ınez-Gonz alez et al 2014). In a recent review of RCTs comparing MedDs to control diets, individual studies were pooled to create summary estimates for the RR of the diets on major vascular events and vascular deaths (Liyanage et al 2016). Five studies (n = 9950) were identified which when pooled showed a protective effect of a MedD against major vascular events (RR 0.69, 95% CI: 0.55, 0.86) and stroke (RR 0.66; 95% CI: 0.48, 0.92) but not cardiovascular mortality (RR 0.90: 95% CI: 0.72, 1.11).…”

Section: Cardiovascular Disease and Plant-based Dietsmentioning

confidence: 99%

An update of the evidence relating to plant‐based diets and cardiovascular disease, type 2 diabetes and overweight

Harland¹,

Garton

2016

Nutrition Bulletin

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Recent findings from meta-analyses, European cohorts and randomised controlled trials (RCTs) evaluating the relationship between plant-based dietary regimes (i.e. those with an emphasis on plant foods, such as vegetarian, vegan, Mediterranean or combination diets), and the incidence of, or risk factors for, cardiovascular disease (CVD), type 2 diabetes (T2D) and obesity are considered in this review. Evidence from meta-analyses of epidemiological studies indicates that those following plant-based dietary regimes have around 20-25% lower risk of developing CVD and a similar reduced risk of developing T2D. Evidence from RCTs indicates that those following plant-based dietary regimes have lower total cholesterol, low-density lipoprotein-cholesterol and blood pressure, and modest reductions in inflammatory and endothelial markers. Higher intake of plant foods has been associated with lower incidence of obesity, lower BMI and smaller waist circumference. For weight loss, it seems that following a plantbased dietary regime results in weight loss comparable to that achieved on conventional reduced calorie diets, but with better overall weight management. The totality of evidence indicates there are benefits for cardiovascular health, risk of developing T2D and weight management from following a plant-based dietary regime. From a nutritional perspective, plant-based diets tend to be lower in saturated fatty acids, higher in unsaturated fatty acids and fibre, and lower in energy density than typical 'Western' diets. These qualities may be at the core of the health benefits reported and/or it may be simply a greater proportion of plant foods in the diet that is beneficial in its own right.

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Effects of the Mediterranean Diet on Cardiovascular Outcomes—A Systematic Review and Meta-Analysis

Cited by 162 publications

References 31 publications

Dietary Factors and Risks of Cardiovascular Diseases: An Umbrella Review

Dietary Factors and Risks of Cardiovascular Diseases: An Umbrella Review

Incidence, Diagnosis, and Treatment of Cardiac Toxicity From Trastuzumab in Patients With Breast Cancer

An update of the evidence relating to plant‐based diets and cardiovascular disease, type 2 diabetes and overweight

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