Mediterranean Diet Linked to Lower Risk of Heart Disease and Stroke Interview with:

Professor Ralph Stewart MBChB (Otago), FRACP, FCSANZ, MD Auckland City Hospital University of Auckland, New Zealand

Prof. Ralph Stewart

Professor Ralph Stewart MBChB (Otago), FRACP, FCSANZ, MD
Auckland City Hospital
University of Auckland, New Zealand What is the background for this study? What are the main findings?

Dr. Stewart: A number of studies have suggested a favorable effect of a Mediterranean dietary pattern on the risk of heart disease, but few large studies have evaluated this dietary pattern in a global population of patients with known coronary heart disease.  We assessed a Mediterranean diet score based on frequency of consumption of common foods using a very simple questionnaire.  Globally this included a very broad range of diets – showing the benefits of this dietary pattern  can be achieved with many different foods.

We founds that greater adherence to this diet was associated with a lower risk of recurrent heart attacks, strokes and deaths from any cause.  In contrast a western diet score, which measured more consumption of foods thought to be unhealthy, including processed carbohydrates, sweetened foods and drinks and deep fried foods were not associated with the risk of cardiovascular events. What should clinicians and patients take away from your report?

Dr. Stewart: The findings suggest it may be better to focus on eating more healthy foods rather than avoiding unhealthy foods.

The success of the traditional approach to dietary advice, which often focusing on avoiding foods which are enjoyed, has been variable.  A clear message to increase healthy foods – eat 3 or more servings of fruit and vegetables each day –could be more successful , but additional research is needed to confirm this. What recommendations do you have for future research as a result of this study?

Dr. Stewart: The major limitation of the study is that it was an observational study.  Because of this we could identify an association but cannot be sure it is causal.  This is a limitation of most diet – health studies.

A major problem with nutrition research is the lack of reliable evidence from randomized trials.  Studies are needed which compare outcomes with different approaches to dietary advice.  However these types of studies are very hard to undertake. Is there anything else you would like to add?

Dr. Stewart: One strength of the study is we were able to show that a few simple questions could identify a dietary pattern associated with a lower risk.  These questions can be applied to a very broad range of diets internationally and could possibly be used to focus simple dietary advice. Thank you for your contribution to the community.


Ralph A. H. Stewart, Lars Wallentin, Jocelyne Benatar, Nicolas Danchin, Emil Hagström, Claes Held, Steen Husted, Eva Lonn, Amanda Stebbins, Karen Chiswell, Ola Vedin, David Watson, Harvey D. White. Dietary patterns and the risk of major adverse cardiovascular events in a global study of high-risk patients with stable coronary heart disease.
European Heart Journal, 2016; ehw125 DOI: 10.1093/eurheartj/ehw125

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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Last Updated on April 26, 2016 by Marie Benz MD FAAD