The Mediterranean Diet and Cardiovascular Disease

  • 1st Revision: Lucy Walker
  • 2nd Revision: Noor Al- Tameemi
  • 3rd Revision: Ha Nguyen

Dietary behaviours are a key factor underlying cardiovascular health. While there is no universally agreed idea of the best diet to achieve optimal heart health and reduce disease risk, the majority of experts often converge on one specific diet – the Mediterranean diet.

One of the most heavily studied diets out there, the Mediterranean diet is inspired by the dietary practises in Greece, Italy, and other countries bordering the Mediterranean Sea. Unlike many popular fad diets which include calorie-restricted rubrics and endless ‘good and bad’ food lists, the Mediterranean diet simply advocates eating natural foods and dodging the processed, meat-heavy ones. In truth, it is less a diet than it is an eating pattern – a pattern that is practical and feasible, and one that can be sustained over one’s lifetime.

The Mediterranean diet is rich in fruit, vegetables, oily fish, wholegrain cereals, with modest amounts of meat and low-fat skimmed dairy. It substitutes saturated fats, such as dairy products and butter, with monounsaturated fats, most commonly consumed as the famous Greek olive oil. 

Beyond a general improvement to your overall health, eating a Mediterranean diet can reduce your risk of heart disease, stroke – particularly in women – and cardiovascular death by up to 30%1. While the most significant effects can be seen with the adjustment of your entire diet, making small improvements every day can slowly contribute to better cardiovascular health.

Fruit and vegetables

The essence of the Mediterranean diet is plant-based (plant-centric), specifically whole, natural foods. To get started, it is suggested to fill half your plate with approximately 3 different types of vegetables that range in diverse colours.

Though far from an exhaustive list, you might want to include vegetables such as spinach, tomatoes, peppers, cucumbers, sweet potatoes, and onions. Fruit also comprises similar benefits for cardiovascular health. Experts suggest consuming 2-3 portions of fruit per day. These could include pears, apples, melons, oranges – in fact, any fruit that is in season!

Fact! These plant-based foods contain essential compounds that are both anti-inflammatory and antioxidant which are key compounds paramount for reducing cholesterol and high blood pressure. For instance, broccoli is high in vitamin C, which prevents atherosclerosis by reducing the buildup of cholesterol.

Tip! Consuming whole, natural foods is more beneficial than canned ones. For instance, eating whole, ripe tomatoes offers more benefits than canned tomato soup from concentrate. Similarly, eating the peels of fruit provides 10 times more fibre than when consumed in its peeled or juiced form. 


Legumes tend to be overlooked by many under their definition of ‘healthy eating behaviours’ . However, they are the cornerstone of the Mediterranean diet. Legumes is a broad term for foods such as lentils, beans, peas and peanuts, amongst others.

They possess many benefits for your cardiovascular health, attributable to their unique blend of nutrients: fibre, protein and phytochemicals. Studies have indicated their meaningful improvements in glycemic control, blood pressure and body weight, which are all factors contributing to the decreased incidence of cardiovascular disease2.

Healthy fats

There is a common misconception about the negative impact of fats on our health. However, there is a clear distinction between unhealthy and healthy fats. Unhealthy fats are comprised of saturated and trans fats, such as those found in butter and potato chips.

These foods can increase low-density lipoprotein (LDL) cholesterol (the “bad” cholesterol which collects on your blood vessel walls) to harmful levels, and thus increase the risk of heart disease.

On the contrary, the Mediterranean diet includes the healthy ones: monounsaturated and polyunsaturated fats. Olive oil, which constitutes the majority of fat consumption, is packed with anti-inflammatory and anti-hypertensive qualities helping to maintain normal blood pressure and optimal cardiovascular health3.

Though the Mediterranean diet promotes plant-based foods, fresh fish is also encouraged around twice a week. Fish contains high levels of omega-3 fatty acids; these are polyunsaturated fats that help fight inflammation, decrease triglycerides and reduce the incidence of stroke and heart failure.

Salmon, sardines, shrimp and scallops are the most recommended given their high fatty acid content4.

Wholegrain cereals

Whole wheat, such as buckwheat, rye, brown rice, and whole oats are the keys contributing to a healthy heart. Unlike refined grains, such as white bread, pasta and muffins, these whole grains contain a higher concentration of substances and nutrients which influence risk factors for heart disease. Their fibre, vitamins, phytochemicals and antioxidants contribute to lowering total and LDL cholesterol, blood pressure and heart disease risk. 

The good news is that it does not take major alterations in your diet to reap these benefits; studies have shown that a small change from white to whole grain bread results in a 20% lower risk of a heart attack5.

Tip! These cereals are best consumed within a dietary pattern that also contains fibre from fruit, vegetables, legumes and nuts.

Meat, dairy products and eggs

The general guidelines for these foods are that they should be consumed in moderation. Dairy products, eggs and poultry are recommended 2-3 times per week.

Milk and other dairy products are the top sources of artery-clogging saturated fat and cholesterol, contributing to an increase in heart disease risk. However, moderate consumption has been shown to improve blood pressure and heart rate.6

Tip! If dairy is a large part of your daily dietary regime, try substituting it with non-dairy products such as vegan cheese, or unsweetened nut milk. If you are a cheese fanatic, opt for less processed products such as Parmesan and mozzarella instead of plastic-like American slices.

Red meat should be eaten very sparingly, perhaps once or twice a month. Many studies have found an association between red meat, high blood pressure, high cholesterol and obesity.7


A moderate intake of wine, specifically red wine, is associated with a significantly reduced risk of developing cardiovascular disease. However, while small amounts are seen as heart-healthy, overconsumption is a serious risk factor for disease and stroke. So, don’t start drinking for your health!

Here are the key takeaways on following the Mediterranean diet:

  • Eat plant-centric, with an emphasis on fruits, vegetables, legumes, whole grains, nuts and seeds
  • Maintain a higher ratio of unsaturated fats to saturated fats 
  • Consume seafood, dairy, poultry and wine in moderation
  • Red meat can be consumed sparingly
  • Avoid processed foods
  • Less of a diet, more of a lifestyle


  1. Arós, F. and Estruch, R. Mediterarranean Dirt and Cardiovascular Prevention. Revista Española de Cardiología. 2013;66(10):771-774.
  2. Widmer RJ, Flammer AJ, Lerman LO, Lerman A. The Mediterranean diet, its components, and cardiovascular disease. The American journal of medicine. 2015;128(3):229-38.
  3. Nocella C, Cammisotto V, Fianchini L, D'Amico A, Novo M, Castellani V, Stefanini L, Violi F, Carnevale R. Extra virgin olive oil and cardiovascular diseases: Benefits for human health. Endocrine, Metabolic & Immune Disorders-Drug Targets (Formerly Current Drug Targets-Immune, Endocrine & Metabolic Disorders. 2018 Jan;18(1):4-13.
  4. Gorton, D. (2018). “Whole Grains and the Heart”. Heart Foundation.
  5. Vitaglione P, Mennella I, Ferracane R, Rivellese AA, Giacco R, Ercolini D, Gibbons SM, La Storia A, Gilbert JA, Jonnalagadda S, Thielecke F. Whole-grain wheat consumption reduces inflammation in a randomized controlled trial on overweight and obese subjects with unhealthy dietary and lifestyle behaviors: role of polyphenols bound to cereal dietary fiber. The American journal of clinical nutrition. 2015;101(2):251-61.
  6. Bhupathi, V., Mazariegos, M., Cruz Rodriguez, J.B., Deoker, A. Dairy Intake and Risk of Cardiovascular Disease. Curr Cardiol Rep. 2020; 22(3): pp. 11.
  7. Kontogianni MD, Panagiotakos DB, Pitsavos C, Chrysohoou C, Stefanadis C. Relationship between meat intake and the development of acute coronary syndromes: The CARDIO2000 case–control study. European Journal of Clinical Nutrition. 2008;62(2):1717.
This content is purely informational and isn’t medical guidance. It shouldn’t replace professional medical counsel. Always consult your physician regarding treatment risks and benefits. See our editorial standards for more details.

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Vicky Stogiannidou

University of Bath, BSc Biology
Vicky Stogiannidou has graduated from the University of Bath with a BSc Biology where she studied topics related to neuroscience, biochemistry and immunity. Vicky has developed a strong interest in health-related fields, one of these being nutrition. Vicky deeply believes that diet is instrumental for optimal health and is the culprit underlying many chronic diseases today. Beyond the keto diet, she has been researching heavy metals, which are found in many food sources and act as toxic catalysts for numerous diseases.

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