March 17, 2023 – Women may have their own reasons now to adapt the ever-popular Mediterranean diet: It appears to lower the risks of heart disease and death in women.
Those who closely followed a Mediterranean diet had a 24% lower risk of heart disease and 23% lower risk of death over time compared with those following other kinds of diets. The diet places an emphasis on vegetables, fruits, whole grains, legumes, seafood, lean protein, and healthy fats such as olive oil and nuts.
"The Mediterranean diet is known for its health benefits, especially for heart health, but most studies and research into diet and heart disease are done primarily in men," said lead author Anushriya Pant, a PhD candidate at the University of Australia's Westmead Applied Research Centre.
"In medical research, there are sex disparities in how clinical trials are designed," she said. "This creates large gaps in clinical data, which can potentially impact the development of health advice. Our work is a step towards addressing this gap."
In the new report, published in the journal Heart, Pant and colleagues analyzed 16 studies published between 2006 and 2021 that included information on how closely people followed the Mediterranean diet and enrolled either all women or separated the outcomes by sex. The researchers excluded studies that referred to only certain components of the Mediterranean diet or combined it with other lifestyle-related factors.
The studies, which were mostly focused in the U.S. and Europe, included 722,495 adult women who didn’t have previous reports of heart disease and were monitored for an average of 12.5 years for their heart health.
Overall, those who more closely followed a Mediterranean diet were less likely to have cardiovascular disease — including heart failure, heart attacks, and other major adverse cardiovascular events — as well as death. Although the risk of stroke was also lower, it wasn't considered statistically significant.
Further analyses showed similar reductions in risk for women of different ethnicities who followed the Mediterranean diet. Women of European descent had a 24% lower risk of heart disease, and women of non-European descent (Asian, Native Hawaiian, and African American) had a 21% lower risk.
The researchers call for more sex-specific research around heart disease, including specific risk factors linked to menopause, pregnancy-related concerns such as pre-eclampsia and gestational diabetes, and autoimmune diseases that are more prominent among women, such as systemic lupus.
Future studies should also explore the reasons why the Mediterranean diet is linked with lower heart disease and death, they said. The diet may reduce inflammation, boost antioxidants, and benefit the gut microbiome. It’s also rich in beneficial nutrients such as polyphenols (organic compounds found in some vegetables and fruit), nitrates, and omega-3 fatty acids, and it’s high in fiber and low in glycemic load.
"What we eat today has important health implications for our cardiometabolic health for years to come," said Samia Mora, MD, a professor of medicine at Harvard Medical School and director of the Center for Lipid Metabolomics at Brigham and Women's Hospital.
Mora, who wasn't involved with this study, has researched the links between the Mediterranean diet and heart health. She and colleagues have found that women who follow the diet are more likely to have lower inflammation, insulin resistance, body mass index, and blood pressure.
"Women are often the primary meal preparers, and their dietary habits influence other family members — in particular children," she said. "It was striking to see the results, with about one-quarter reduction in fatal and nonfatal cardiovascular events. This is very similar to the benefit that we see with statin therapy, a commonly used medication to lower cholesterol."