RT Journal Article SR Electronic T1 Primary prevention of cardiovascular disease in women with a Mediterranean diet: systematic review and meta-analysis JF Heart JO Heart FD BMJ Publishing Group Ltd and British Cardiovascular Society SP 1208 OP 1215 DO 10.1136/heartjnl-2022-321930 VO 109 IS 16 A1 Pant, Anushriya A1 Gribbin, Sarah A1 McIntyre, Daniel A1 Trivedi, Ritu A1 Marschner, Simone A1 Laranjo, Liliana A1 Mamas, Mamas A A1 Flood, Victoria A1 Chow, Clara K A1 Zaman, Sarah YR 2023 UL http://heart.bmj.com/content/109/16/1208.abstract AB 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.All data relevant to the study are included in the article or uploaded as supplementary information.