{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T16:36:09Z","timestamp":1790354169704,"version":"4.1.0"},"reference-count":96,"publisher":"MDPI AG","issue":"16","license":[{"start":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T00:00:00Z","timestamp":1786060800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Smart Health and Elderly Care Collaborative Project","award":["210000-H12311\/001"],"award-info":[{"award-number":["210000-H12311\/001"]}]},{"name":"Initial Research Funding for Early-Career Faculty at HZCU","award":["210000-581871"],"award-info":[{"award-number":["210000-581871"]}]},{"DOI":"10.13039\/501100008867","name":"Scientific Research Fund of Zhejiang Provincial Department of Education","doi-asserted-by":"publisher","award":["Y202557573"],"award-info":[{"award-number":["Y202557573"]}],"id":[{"id":"10.13039\/501100008867","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100008867","name":"Scientific Research Fund of Zhejiang Provincial Department of Education","doi-asserted-by":"publisher","award":["Y202557472"],"award-info":[{"award-number":["Y202557472"]}],"id":[{"id":"10.13039\/501100008867","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Introduction: Evidence linking Mediterranean dietary patterns and physical activity to mortality and major adverse cardiovascular events (MACEs) after coronary heart disease (CHD) diagnosis remains inconclusive. Methods: The search covered PubMed, MEDLINE, Scopus, Embase, and CENTRAL from January 2015 through 15 June 2026. Comparable hazard ratios (HRs) were pooled using random-effects models; non-equivalent estimands were reported separately. Risk of bias was evaluated with design-appropriate tools and certainty with GRADE. Results: The 40 reports represented 34 data sources and at least 260,354 unique patients, comprising six randomized trials, 30 observational reports, and four comparative nonrandomized studies. In one randomized comparison of Mediterranean and low-fat diets, the HR for MACE was 0.72 (95% CI 0.54 to 0.96; moderate certainty). Observational findings supported inverse associations of closer dietary adherence with all-cause mortality (HR 0.74, 95% CI 0.60 to 0.90; I2 = 44%) and MACE, whereas cardiovascular mortality remained uncertain. HRs for maintained or continued physical activity relative to persistent inactivity were 0.64 for all-cause mortality (95% CI 0.55 to 0.74; I2 = 29%) and 0.42 for cardiovascular mortality (95% CI 0.28 to 0.64; I2 = 72%). MACE findings for diet adherence and habitual physical activity generally favored lower risk. Randomized evidence on exercise or combined dietary and activity programs was sparse. Conclusions: Greater Mediterranean diet adherence and habitual physical activity were associated with more favorable CHD outcomes. Standardized, adequately powered trials are needed, especially for exercise and combined strategies.<\/jats:p>","DOI":"10.3390\/nu18162589","type":"journal-article","created":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T11:44:53Z","timestamp":1786103093000},"page":"2589","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Association of the Mediterranean Diet, Physical Activity and Related Lifestyle Factors on the Mortality and Major Adverse Cardiovascular Events in Patients with Coronary Heart Disease: A Systematic Review and Meta-Analysis"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-5398-5714","authenticated-orcid":false,"given":"Liusheng","family":"Mo","sequence":"first","affiliation":[{"name":"School of Medicine, Hangzhou City University, Hangzhou 310015, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-4865-1824","authenticated-orcid":false,"given":"Fengyu","family":"Qiu","sequence":"additional","affiliation":[{"name":"School of Medicine, Hangzhou City University, Hangzhou 310015, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-1935-6586","authenticated-orcid":false,"given":"Yueyao","family":"Liu","sequence":"additional","affiliation":[{"name":"School of Medicine, Hangzhou City University, Hangzhou 310015, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7717-6907","authenticated-orcid":false,"given":"Yuli","family":"Zang","sequence":"additional","affiliation":[{"name":"School of Medicine, Hangzhou City University, Hangzhou 310015, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1527-0014","authenticated-orcid":false,"given":"Cheng","family":"Chen","sequence":"additional","affiliation":[{"name":"School of Medicine, Hangzhou City University, Hangzhou 310015, China"},{"name":"Key Laboratory of Novel Targets and Drug Study for Neural Repair of Zhejiang Province, School of Medicine, Hangzhou City University, Hangzhou 310015, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,7]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1811","DOI":"10.1016\/S0140-6736(25)01917-8","article-title":"Global Burden of 292 Causes of Death in 204 Countries and Territories and 660 Subnational Locations, 1990\u20132023: A Systematic Analysis for the Global Burden of Disease Study 2023","volume":"406","author":"Naghavi","year":"2025","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1145","DOI":"10.1016\/S0140-6736(19)30427-1","article-title":"Mortality, Morbidity, and Risk Factors in China and Its Provinces, 1990\u20132017: A Systematic Analysis for the Global Burden of Disease Study 2017","volume":"394","author":"Zhou","year":"2019","journal-title":"Lancet"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"e000298","DOI":"10.1136\/bmjgh-2017-000298","article-title":"Sex Differences in Coronary Heart Disease and Stroke Mortality: A Global Assessment of the Effect of Ageing between 1980 and 2010","volume":"2","author":"Bots","year":"2017","journal-title":"BMJ Glob. 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