This Diet Can Lower Your Threat of Heart Attack and Stroke (Even If You're High Risk)
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A meta-analysis of 40 clinical trials links the Mediterranean diet to a lowered risk of heart attack and stroke.
The diet was the most effective at lowering risk of any eating plans studied.
Experts say a Mediterranean-style diet is worth pursuing, along with other heart-healthy measures.
The Mediterranean diet has repeatedly been recommended by health organizations and experts as an eating plan to help improve your overall health. But new research shows it can actually reduce your risk of heart attack and stroke even if you’re at high risk for both or either — and even if you don’t increase exercise.
That’s the main takeaway from a new meta-analysis published in the BMJ. For the study, researchers analyzed data from 40 trials on seven popular dietary programs that are designed to lower your risk of death and major heart events, including low-fat diets, the Mediterranean diet, very low-fat diets, a modified-fat diet, and combined low-fat and low-sodium diet. Overall, more than 35,500 people were followed for an average of three years on these diets.
The researchers found that the Mediterranean diet prevented 17 fewer deaths from any cause, 17 fewer heart attacks, and seven fewer strokes per 1,000 people over five years in people who were at a higher risk of heart disease when compared to those who received minimal intervention — even if they didn't increase their exercise. Low-fat diets also helped, leading to nine fewer deaths and seven fewer heart attacks per 1,000 people over five years. (The other diets had little to no detectable benefit compared to minimal intervention.)
Overall, researchers concluded that Mediterranean diets could reduce the odds of dying from any cause, along with heart attack. “Mediterranean programs are also likely to reduce stroke risk,” they added.
Given that heart disease is the leading cause of death in the U.S., it’s understandable to have questions. Here’s what you need to know.
Why might the Mediterranean diet help reduce your risk of heart disease and stroke?
It’s important to point out that this isn’t the only study to show that following a Mediterranean diet may help your cardiovascular health. In fact, the American Heart Association (AHA) recommends the Mediterranean diet as a way to help achieve its dietary recommendations for healthy eating patterns that emphasize eating plenty of vegetables, fruits, whole grains, beans, and legumes, along with low-fat or fat-free dairy products, fish, poultry, non-tropical vegetable oils, and nuts.
“If you’re consuming a large amount of varied carbohydrates, including fruits, vegetables, and grain products that are found in the Mediterranean diet, you’ll have a much better chance for a healthier life,” says Yu-Ming Ni, M.D., a non-invasive cardiologist at MemorialCare Heart and Vascular Institute at Orange Coast Medical Center in Fountain Valley, Calif.
Experts say there are a few reasons why the Mediterranean diet alone may help improve your heart health. “It’s low in saturated fat and high in fiber, which specifically helps manage levels of LDL (bad) cholesterol,” says Jessica Cording, R.D., author of The Little Book of Game-Changers. “Olive oil is also thought to be a main bioactive food in this style of eating, as it's rich in heart-healthy monounsaturated fatty acids and phenolic compounds that have been associated with numerous health benefits, including positive effects on heart health.” (The AHA specifically points out that there is some evidence that a Mediterranean diet rich in virgin olive oil “may help the body remove excess cholesterol from arteries and keep blood vessels open.”)
A traditional Mediterranean diet also includes a lot of vegetables and “researchers also believe that the fiber and antioxidants in these foods help protect against disease,” Cording says. Many fruits and vegetables are also good sources of potassium, a mineral that helps manage blood pressure, she points out.
The nutrients found in the Mediterranean diet are important, too, says Keri Gans, R.D., author of The Small Change Diet. “The Mediterranean diet is packed with nutrients that have anti-inflammatory benefits, such as vitamin C, vitamin E, and omega-3 fatty acids,” she says. Fish is another staple food in the Mediterranean diet, and it provides anti-inflammatory omega-3 fatty acids that can support heart health, Cording says.
There are indirect heart-healthy benefits of following the Mediterranean diet, too, including having a lower body weight when compared to people who eat a standard American diet, says Katherine Lebarre, R.D., a dietitian with Spectrum Health. “You’re having whole foods, less processed foods, getting more fibers, eating more consistently…it will help to prevent over-hunger and maintain satiety levels throughout the day,” she says. “Your blood sugar is more stable. Healthy foods make you feel more full because of the fiber content.” All of those factors together can help you maintain a lower weight, which can support good heart health, she says.
Common heart disease risk factors
There are a few factors that raise your risk of developing heart disease and stroke. While some, like your genetics, can’t be helped, there are certain risk factors you can do something about. These are the most common risk factors for heart disease and stroke, according to the Centers for Disease Control and Prevention (CDC):
High blood pressure
High LDL cholesterol
Diabetes
Smoking and exposure to secondhand smoke
Obesity
Following an unhealthy diet
Physical inactivity
What to do if you’re at high risk for developing heart disease
If you’re at high risk for developing heart disease, it’s important to have a conversation with your doctor, Dr. Ni says. “You have to make sure you’re on the right medications and have gotten the right testing to address any current problems,” he says. “At the same time, you should be talking about what you can do with your lifestyle that can impact your future risk for heart attack and stroke.”
Among other things, your doctor will likely encourage you to get the recommended 150 minutes of moderate-intensity exercise a week, along with trying to follow a healthy eating plan.
If you’re interested in pursuing a Mediterranean-style diet, there are a few elements to focus on, according to Gina Keatley, C.D.N., co-owner of Keatley Medical Nutrition Therapy:
Load up on fruits and vegetables. “Aim for at least double your starch portion or protein portion in fruit and/or vegetables,” she says. Meaning, if you’re having 4 oz. of fish, you’ll want to have 8 oz. of vegetables with your meal. “They provide essential vitamins, minerals, and antioxidants that promote heart health,” Keatley says.
Make smart whole-grain choices. “Choose whole grains like brown rice, quinoa, whole wheat pasta, and whole grain bread to get more fiber in your diet, which is beneficial for lowering LDL,” Keatley says.
Add legumes to your diet. “Legumes: Incorporate beans, lentils, and chickpeas into your meals as a good source of plant-based protein, fiber, and other nutrients,” Keatley says.
Put fish and poultry in regular rotation. “Consume moderate amounts of fish and shellfish—especially fish like cod, mackerel, and sardines and shellfish like oysters, crab, and mussels—and poultry, as they provide high-quality protein and essential nutrients,” Keatley says. “Fish also contains omega-3 fatty acids, which have been shown to reduce inflammation and lower the risk of heart disease.”
And, if you feel overwhelmed by changing up your eating plan, consider consulting a nutritionist. “Meeting with a dietitian familiar with the diet is very beneficial,” Lebarre says. “They can help implement the diet in a way that works for the patient.”
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