Mediterranean diet and cardiovascular disease: a step closer to mechanisms using a precision animal model?

Abstract

Coronary heart disease (CHD), the leading cause of mortality in the U.S. and other western countries, is a multifactorial disease. As a result of extensive investigations spanning several decades, many contributing factors, such as age, sex, smoking, hypertension, obesity and a high cholesterol level have been identified, and these factors are now known as well-established or traditional risk factors for CHD. Novel factors, including biomarkers of vascular endothelial dysfunction, inflammation, genetics, and dyslipidemia [e.g. small dense low-density lipoprotein and lipoprotein(a)], have emerged recently and their association with CHD, as well as their potential for predicting future risk have been tested in many studies with some showing considerable promise. The diet-heart theory described more than six decades ago by Dr. Ancel Keys, the founder of “The Seven Countries Study” (SCS), has remained central in shaping the efforts to reduce global risk of CHD based on lifestyle modification. The SCS was the first epidemiological longitudinal study systematically investigating the relationship between lifestyle, diet, CHD and stroke risks in multiple populations representing different regions of the world with contrasting dietary patterns [1]. Dr. Keys and his colleagues demonstrated a direct and independent association between the serum total cholesterol level and the risk and rates of heart attack and stroke both at the population and at the individual level across diverse cultures. Through studies like these, the importance of the Mediterranean diet in modulating CHD risk, the impact of changes in lifestyle and diets of populations in the Mediterranean region on the rates of heart disease, and associations between food composition (e.g., saturated fatty acids, mono- and polyunsaturated fatty acids, etc.) and coronary death rate have been explored [2-4].