Mediterranean diet reduces heart disease risk in women: Study

The health benefits of following a Mediterranean diet are well known, especially when it comes to heart health. But new research has found there are particularly significant benefits for women.
 
A meta-analysis, published in the BMJ, examined data from 16 published studies conducted between 2006 and 2021 involving more than 722,00 female participants without previous clinical or subclinical cardiovascular disease (CVD), and with a median follow up of 12.5 years.
 
The findings show women who followed a Mediterranean diet with a higher adherence had a lowered risk of heart disease by up to 24%. Their risk of death was also reduced by 23%.
 
This applied to women of all ethnicities, with those of European descent having a 24% lower risk, and women of non-European descent (Asian, Native Hawaiian and African American) having a 21% lower risk.
 
Stroke incidence was also found to be lower among women with a higher adherence of the Mediterranean diet, but the authors said the result was ‘not statistically significant.’
 
However, the overall findings of the study are significant, given that CVD is the leading cause of death globally, including for women, accounting for 35% of all female deaths around the world.
 
Anushriya Pant, a PhD candidate at the University of Sydney’s Westmead Applied Research Centre who led the analysis, said it is the first of its kind to examine the association between the Mediterranean diet and CVD and mortality among women specifically.
 
‘Most studies and research into diet and heart disease are done primarily in men,’ she said.
 
‘[But] in medical research, there are sex disparities in how clinical trials are designed. 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.’
 
Associate Professor Magdalena Simonis, who is a member and researcher at the Mediterranean Lifestyle Medicine Institute, told newsGP the findings are ‘really exciting’.
 
‘The findings support what we’ve been learning from the Mediterranean diet, which is one of the most researched heritage diets,’ she said. 
 
‘But it’s really exciting to see that there’s an association between adherence to a particular diet and chronic disease outcomes, which is something that’s accessible to the majority of population.’
 
Associate Professor Simonis did however note that it has yet to be demonstrated whether there is in fact a sex-specific disparity between men and women when it comes to the Mediterranean diet and CVD. But as an advocate for women’s health, she said the study is a step in a ‘really positive direction’.
 
‘Because the body of research that explores women’s health with respect to chronic disease and chronic disease outcomes is lacking,’ the Melbourne GP said.
 
‘And we know that ischemic heart disease and CVD is one of the major causes of death in women and that women who present with heart attack will be less likely to be diagnosed and more likely to die as a consequence.
 
‘So, if we can engage in conversation around prevention of disease through dietary and lifestyle factors that’s evidence based, that’s going to support women’s health.’
 
Making dietary changes, such as consuming more fruit and vegetables, as well as reducing salt intake, are among the key recommendations to reducing CVD risk.
 
While women are more likely than men to consume the recommended daily serves of fruit and vegetables, the latest data on dietary behaviour from 2020–21 found less than one in 10 Australian women are meeting the National Health and Medical Research Council’s 2013 Australian Dietary Guidelines.
 
Associate Professor Simonis said GPs have an important role to play in giving their patients simple and easy-to-follow dietary advice. However, when it comes to the study findings, she did note that GPs need more specificity around what the Mediterranean diet in question comprises of.
 
‘I think that that’s something that needs to be more closely defined,’ Associate Professor Simonis said.
 
‘Here the adaptations included are vegetables, fruits, legumes, nuts, grains and fish. But there are some other key features of it that need to be considered, which includes virgin olive oil, a reduction in red meat, increase in omega 3 fatty acids in the form of oily fish – sardines are preferred, certain herbs and greens, and limited amounts of dairy.’
 
She also noted that GPs need to consider that some of the key elements of the diet may be prohibitive and that advice may need to be tailored to be practical for patients.
 
‘We’ve got to understand that not everyone has olive oil, it’s more expensive than most oils. So, I think we really do need to hone into several options that people have so that it’s accessible and inclusive,’ Associate Professor Simonis said.
 
‘But this is a very, very significant finding that you can alter your disease profile … through making simple food choices.’
 
Furthermore, the GP noted that to get the full benefits of a Mediterranean diet, there are other lifestyle factors to consider.
 
‘This study is purely based upon the dietary components, but when we talk about lifestyle medicine, we’re also thinking and talking about the context that you eat in,’ Associate Professor Simonis said.
 
‘It’s also about not eating alone, having adequate amounts of sleep, exercise and fresh air.
 
‘So, the diet is one aspect of it, but the true Mediterranean diet is also part of a lifestyle and that also needs to be considered as an aspect of healthy living.’
 
The authors did note several imitations, including that the studies were observational in nature, with reliance on self-reported food frequency questionnaires. While adjustments for important confounders, such as cardiovascular risk factors, varied across studies with subsequent bias towards a more favourable result.
 
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Australian dietary guidelines cardiovascular disease CVD heart disease Mediterranean diet women’s health