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Effect of the Mediterranean diet on incidence of heart failure in European countries: a systematic review and meta-analysis of cohort studies

European Journal of Clinical Nutrition volume 79, pages 195–199 (2025)Cite this article

Subjects

Abstract

Introduction

Heart failure (HF) is one of the most common cardiovascular disorders, and its prevalence is increased due to age, genetics, and lifestyle factors. Emerging evidence suggests that the Mediterranean Diet (Med Diet) is linked to lower all-cause mortality in patients with increased cardiovascular disease risk, such as those with HF.

Objective

To conduct a systematic review and meta-analysis of observational studies into the relationship between the Med Diet on HF risk.

Design

Several databases (PubMed, Scopus, Web of Science and Cochrane Library) until the 01st of May 2023 were searched. Our research was conducted based on the updated 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Data were reported as risk ratios (RRs) with their 95% confidence intervals (CIs) as results of multivariate or univariate analyses.

Results

From the original 1206 studies collected, six observational prospective studies were included, with a total of 216,385 European participants without evidence of HF at baseline. Over a mean period of 11 years of follow-up, a 1-point increase in the Med Diet score was associated with a significantly lower risk of HF (RR = 0.940; 95% CI: 0.912–0.969, p < 0.0001; I2 = 42.9%). Categorised by sex, a higher adherence to Med Diet was associated with a significantly lower incidence of HF in women (RR = 0.942; 95% CI: 0.912-0.973, p = 0.001; I2 = 41.8%), but not in men. The overall quality of included studies was good.

Conclusions

Higher adherence to Med Diet across European countries is associated with lower risk of HF, particularly in women.

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Author information

Authors and Affiliations

  1. Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties, “G. D’Alessandro”-PROMISE-University of Palermo, Palermo, Italy

    Nicola Veronese, Francesco Saverio Ragusa, Ligia J. Dominguez & Mario Barbagallo

  2. Consiglio Nazionale delle Ricerche, Neuroscience Institute, Padova, Italy

    Stefania Maggi

  3. Faculty of Life Sciences and Medicine, Centre for Human and Applied Physiological Sciences, King’s College London, London, UK

    Oliver C. Witard

  4. Centre for Health Performance and Wellbeing, Anglia Ruskin University, Cambridge, UK

    Lee Smith

  5. Faculty of Medicine and Surgery, University of Enna “Kore”, 94100, Enna, Italy

    Ligia J. Dominguez

  6. Department of Musculoskeletal and Ageing Science, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK

    Masoud Isanejad & Konstantinos Prokopidis

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  1. Nicola Veronese
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  2. Francesco Saverio Ragusa
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Contributions

Veronese, Ragusa, Witard: wrote the first draft of the manuscript; Veronese, Prokopidis: data analysis, methodology; Maggi, Barbagallo, Dominguez, Smith: critical revision of the work; Isanjead, Ragusa: data collection.

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Correspondence to Nicola Veronese.

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Veronese, N., Ragusa, F.S., Maggi, S. et al. Effect of the Mediterranean diet on incidence of heart failure in European countries: a systematic review and meta-analysis of cohort studies. Eur J Clin Nutr 79, 195–199 (2025). https://doi.org/10.1038/s41430-024-01519-4

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