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The available evidence shows that the traditional Mediterranean diet represents a sustainable, healthy, and highly palatable pattern with a wide array of associated health benefits. In particular, its protective effects on cardiovascular disease have been supported by several consistent large RCTs, namely, the Lyon Diet-Heart Study, PREDIMED, PREDIMED-Plus and CORDIOPREV. The traditional Mediterranean diet is not a vegetarian diet, but it emphasizes the preferential consumption of minimally processed plant-based foods: fruits, vegetables, whole-grain cereals, legumes, and tree nuts. Its unique components\u2014different from other healthy, plant-based, food patterns\u2014are extra-virgin olive oil as the main source of fat (keeping a high monounsaturated-to-saturated fat ratio), a high consumption of tree nuts, and low-to-moderate consumption of red wine with meals. However, the inclusion of an alcoholic beverage in a healthy diet is becoming increasingly controversial. An ongoing RCT, the University of Navarra Alumni Trialist Initiative (UNATI), aims to answer this question in 10 000 drinkers. In addition to conventional epidemiologic studies, metabolomics techniques have been applied to assess the role of adherence to the Mediterranean diet and to better understand the mechanisms involved in the protection afforded by this interesting dietary pattern. In this review, we update the available scientific evidence.<\/jats:p>","DOI":"10.1093\/cvr\/cvaf218","type":"journal-article","created":{"date-parts":[[2025,11,6]],"date-time":"2025-11-06T13:08:52Z","timestamp":1762434532000},"page":"2465-2475","source":"Crossref","is-referenced-by-count":15,"title":["The Mediterranean diet and cardiovascular disease"],"prefix":"10.1093","volume":"121","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5617-4729","authenticated-orcid":false,"given":"Mar\u00eda","family":"Barber\u00eda-Latasa","sequence":"first","affiliation":[{"name":"Instituto de Investigaci\u00f3n Sanitaria de Navarra (IdiSNA), Navarra Institute for Health Research, 31008 Pamplona ,","place":["Spain"]},{"name":"Department of Preventive Medicine and Public Health, University of Navarra , Irunlarrea 1, Pamplona 31008 ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3917-9808","authenticated-orcid":false,"given":"Miguel A","family":"Mart\u00ednez-Gonz\u00e1lez","sequence":"additional","affiliation":[{"name":"Instituto de Investigaci\u00f3n Sanitaria de Navarra (IdiSNA), Navarra Institute for Health Research, 31008 Pamplona ,","place":["Spain"]},{"name":"Department of Preventive Medicine and Public Health, University of Navarra , Irunlarrea 1, Pamplona 31008 ,","place":["Spain"]},{"name":"Biomedical Research Network Center for Pathophysiology of Obesity and Nutrition (CIBEROBN), Carlos III Health Institute, 28029 Madrid, Spain"},{"name":"Department of Nutrition, Harvard TH Chan School of Public Health, Boston"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,11,10]]},"reference":[{"key":"2025121812271403300_cvaf218-B1","doi-asserted-by":"crossref","first-page":"2982","DOI":"10.1016\/j.jacc.2020.11.010","article-title":"Global burden of cardiovascular diseases and risk factors, 1990\u20132019: update from the GBD 2019 study","volume":"76","author":"Roth","year":"2020","journal-title":"J Am Coll Cardiol"},{"key":"2025121812271403300_cvaf218-B2","doi-asserted-by":"crossref","first-page":"2350","DOI":"10.1016\/j.jacc.2023.11.007","article-title":"Global burden of cardiovascular diseases and risks, 1990\u20132022","volume":"82","author":"Mensah","year":"2023","journal-title":"J Am Coll Cardiol"},{"key":"2025121812271403300_cvaf218-B3","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1093\/cvr\/cvad176","article-title":"Global prevalence of cardiovascular risk factors based on the life\u2019s essential 8 score: an overview of systematic reviews and meta-analysis","volume":"120","author":"L\u00f3pez-Bueno","year":"2024","journal-title":"Cardiovasc Res"},{"key":"2025121812271403300_cvaf218-B4","first-page":"414","article-title":"Primary prevention of cardiovascular disease with a Mediterranean diet supplemented with extra-virgin olive oil or nuts","volume":"378","author":"Estruch","journal-title":"N Engl J Med"},{"key":"2025121812271403300_cvaf218-B5","doi-asserted-by":"crossref","first-page":"1876","DOI":"10.1016\/S0140-6736(22)00122-2","article-title":"Long-term secondary prevention of cardiovascular disease with a Mediterranean diet and a low-fat diet (CORDIOPREV): a randomised controlled trial","volume":"399","author":"Delgado-Lista","year":"2022","journal-title":"Lancet"},{"key":"2025121812271403300_cvaf218-B6","doi-asserted-by":"crossref","first-page":"1591","DOI":"10.1016\/j.jand.2018.05.021","article-title":"Update of the healthy eating index: HEI-2015","volume":"118","author":"Krebs-Smith","year":"2018","journal-title":"J Acad Nutr Diet"},{"key":"2025121812271403300_cvaf218-B7","doi-asserted-by":"crossref","first-page":"1117","DOI":"10.1056\/NEJM199704173361601","article-title":"A clinical trial of the effects of dietary patterns on blood pressure. 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