Article Text

Systematic review
Primary prevention of cardiovascular disease in women with a Mediterranean diet: systematic review and meta-analysis
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  1. Anushriya Pant1,
  2. Sarah Gribbin2,
  3. Daniel McIntyre1,
  4. Ritu Trivedi1,
  5. Simone Marschner1,
  6. Liliana Laranjo1,
  7. Mamas A Mamas3,
  8. Victoria Flood4,
  9. Clara K Chow1,5,
  10. Sarah Zaman1,5
  1. 1 Westmead Applied Research Centre and Faculty of Medicine and Health, The University of Sydney, Westmead, New South Wales, Australia
  2. 2 Department of General Health, Alfred Hospital, Melbourne, Victoria, Australia
  3. 3 Keele Cardiovascular Research Group, Institute of Primary Care and Health Sciences, Keele, UK
  4. 4 Sydney School of Health Sciences and Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
  5. 5 Department of Cardiology, Westmead Hospital, Westmead, New South Wales, Australia
  1. Correspondence to A/Prof Sarah Zaman, Westmead Applied Research Centre and Faculty of Medicine and Health, The University of Sydney, Westmead, New South Wales, 2145, Australia; sarah.zaman{at}sydney.edu.au

Abstract

Background Dietary modification is a cornerstone of cardiovascular disease (CVD) prevention. A Mediterranean diet has been associated with a lower risk of CVD but no systematic reviews have evaluated this relationship specifically in women.

Objective To determine the association between higher versus lower adherence to a Mediterranean diet and incident CVD and total mortality in women.

Methods A systematic search of Medline, Embase, CINAHL, Scopus, and Web of Science (2003–21) was performed. Randomised controlled trials and prospective cohort studies with participants without previous CVD were included. Studies were eligible if they reported a Mediterranean diet score and comprised either all female participants or stratified outcomes by sex. The primary outcome was CVD and/or total mortality. A random effects meta-analysis was conducted to calculate pooled hazard ratios (HRs) and confidence intervals (CIs).

Results Sixteen prospective cohort studies were included in the meta-analysis (n=7 22 495 female participants). In women, higher adherence to a Mediterranean diet was associated with a lower CVD incidence (HR 0.76, 95% CI 0.72 to 0.81; I2=39%, p test for heterogeneity=0.07), total mortality (HR 0.77, 95% CI 0.74 to 0.80; I2=21%, p test for heterogeneity=0.28), and coronary heart disease (HR 0.75, 95% CI 0.65 to 0.87; I2=21%, p test for heterogeneity=0.28). Stroke incidence was lower in women with higher Mediterranean diet adherence (HR 0.87, 95% CI 0.76 to 1.01; I2=0%, p test for heterogeneity=0.89), but this result was not statistically significant.

Conclusion This study supports a beneficial effect of the Mediterranean diet on primary prevention of CVD and death in women, and is an important step in enabling sex specific guidelines.

  • Risk Factors
  • Coronary Artery Disease
  • Education, Medical
  • Systematic Reviews as Topic
  • Epidemiology

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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Footnotes

  • Twitter @simoneMarschne1, @MMamas1973, @clara_chow, @DrSarahjZaman

  • Contributors AP was responsible for conducting the systematic review and meta-analysis, and writing the manuscript. SG, DM and RT assisted in the screening stage of the systematic review. SG assisted in data extraction and risk assessment. SM helped perform the statistical analysis. All authors critically reviewed the manuscript. SZ is responsible for the study design, conception of the study, and critically reviewing the manuscript. SZ is responsible for the overall content as the guarantor. SZ accepts full responsibility for the work and the conduct of the study, had access to the data, and controlled the decision to publish.

  • Funding No funding was received for this study. SZ was supported by a Heart Foundation Future Leader Fellowship (ID 102627) for their work.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.