Healthy Hearts in Mediterranean Lands? Maybe Not

Study in a Spanish City Shows Heart Risks That Are Similar to U.S. and U.K.

Medically Reviewed by Laura J. Martin, MD on January 13, 2011
From the WebMD Archives

Jan. 13, 2011 -- For years, the Mediterranean diet, well-known for its heart-healthy effects, has evoked images of dining tables laden with fruits, vegetables, whole grains, red wine, and a splash of olive oil -- with those who follow the diet protected against heart attacks and other cardiovascular ailments.

However, a new study that looked at more than 2,000 urban Spanish adults challenges the thinking that people in Mediterranean countries all enjoy healthy diets and lifestyles.

Cardiovascular diseases are the main cause of death in Spain, accounting for 33% of all deaths. In the new study, researchers looked at residents of Malaga City on the southern coast, finding they had a prevalence of cardiovascular risk factors similar to those found in the U.S. and the U.K.

The problem is not the diet itself, but that some residents can't afford the foods that make it up, says researcher Rosa Bernal Lopez, PhD, of the Virgen de la Victoria Hospital in Malaga. ''The paradox is that traditional foods of the Mediterranean diet (olive oil, fruits, vegetables, legumes, fish) are more expensive than junk or fast food, so the social classes with lower purchasing power have more difficulty following the traditional Mediterranean diet."

''This study is showing us the prevalence of risk factors [for heart disease] is very similar to other countries," says Martha Daviglus, MD, PhD, professor of preventive medicine and medicine at the Northwestern University Feinberg School of Medicine and an American Heart Association spokeswoman.

She reviewed the study findings for WebMD.

The findings are no reason to abandon the Mediterranean diet, Daviglus says, if it's followed correctly. "A modified Mediterranean diet is a great idea to follow," she says.

The study appears in The International Journal of Clinical Practice.

In an editorial accompanying the research, Anthony Wierzbicki, MD, PhD, a consultant in metabolic medicine and chemical pathology at Guy's & St. Thomas' Hospitals in London, points out that the original research on the Mediterranean diet was done 40 years ago on rural populations and that lifestyles have changed dramatically since then, with more fast-food consumption and less manual work.

Risk Factors Are High for Heart Disease

Bernal-Lopez and colleagues evaluated a random sample of the population of Malaga City. Participants ages 18 to 80 took part in a clinical interview that included a physical exam and gathering of social and demographic information. Also a blood sample was drawn.

The researchers found that cardiovascular disease risk factors were high. For example:

  • More than 60% were overweight or obese
  • 76.7% had a sedentary lifestyle
  • 27.7% smoked
  • 33.1% had high blood pressure
  • 7.1% had diabetes
  • 65.4% had high cholesterol

Overall, nearly 30% had three or more modifiable risk factors for cardiovascular disease, such as high blood pressure, diabetes, abdominal obesity, smoking, sedentary lifestyle, or a cholesterol problem.

When the researchers focused just on those participants above age 50, they found nearly 83% had unhealthy levels of belly fat and more than 84% were either overweight or obese.

When the researchers looked at the younger participants ages 18 to 29, they found that 35.5% were overweight or obese, which they termed ''worrying."

Some of the dismal findings, the researchers write, have to do with the city they studied. Residents there are less active than residents in other areas of the country, and their lower educational level was linked with higher rates of smoking, obesity, and cholesterol problems.

Spain vs. U.K., U.S.

In the editorial, Wierzbicki points out that the data seem to dispel the healthy Mediterranean image. The data from Spain, he writes, ''are worse than those in a UK self-selected cohort that underwent CVD risk screening in 2008 and in the UK National Health Survey for England."

The new data, he writes, ''shows parallels with the USA where the highest burdens of cardiometabolic risk are found in the sunniest southern states."

So why does the myth of people from Mediterranean countries all being healthy persist? Wierzbicki points to the original data on the Mediterranean diet, conducted decades ago when lifestyles were different and people were more likely to be engaged in manual work.

Show Sources


Anthony Wierzbicki, MD, PhD, consultant, metabolic medicine/chemical pathology, Guy's & St. Thomas' Hospitals, London.

Martha Daviglus, MD, PhD, professor of preventive medicine and medicine, Northwestern University Feinberg School of Medicine, Chicago; spokeswoman, American Heart Association.

Rosa Bernal-Lopez, PhD, researcher, Hospital Virgen de la Victoria, Malaga, Spain.

Wierzbicki, A. The International Journal of Clinical Practice, January 2011; vol 65: pp 3-5.

Gomez-Huelgas, R. The International Journal of Clinical Practice, January 2011; vol 65: pp 35-40.

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