Abstract：
OBJECTIVE: This study aimed to review meta-analyses of randomised controlled trials that evaluated the effectiveness of the Mediterranean Diet for the primary and secondary prevention of cardiovascular disease.
METHODS: Five databases (Medline, Embase, Cochrane, CINAHL and ProQuest) were searched from inception to November 2022. Inclusion criteria were: (i) systematic review of randomised controlled studies with metanalysis; (ii) adults ≥18 years from the general population with (secondary prevention) and without (primary prevention) established cardiovascular disease; (iii) Mediterranean Diet compared with another dietary intervention or usual care. Review selection and quality assessment using AMSTAR-2 were completed in duplicate. GRADE was extracted from each review, and results were synthesised narratively.
RESULTS: Eighteen meta-analyses of 238 randomised controlled trials were included, with an 8% overlap of primary studies. Compared to usual care, the Mediterranean Diet was associated with reduced cardiovascular disease mortality (n = 4 reviews, GRADE low certainty; risk ratio range: 0.35 [95% confidence interval: 0.15-0.82] to 0.90 [95% confidence interval: 0.72-1.11]). Non-fatal myocardial infarctions were reduced (n = 4 reviews, risk ratio range: 0.47 [95% confidence interval: 0.28-0.79] to 0.60 [95% confidence interval: 0.44-0.82]) when compared with another active intervention. The methodological quality of most reviews (n = 16/18; 84%) was low or critically low and strength of evidence was generally weak.
CONCLUSIONS: This review showed that the Mediterranean Diet can reduce fatal cardiovascular disease outcome risk by 10%-67% and non-fatal cardiovascular disease outcome risk by 21%-70%. This preventive effect was more significant in studies that included populations with established cardiovascular disease. Better quality reviews are needed.
METHODS: Five databases (Medline, Embase, Cochrane, CINAHL and ProQuest) were searched from inception to November 2022. Inclusion criteria were: (i) systematic review of randomised controlled studies with metanalysis; (ii) adults ≥18 years from the general population with (secondary prevention) and without (primary prevention) established cardiovascular disease; (iii) Mediterranean Diet compared with another dietary intervention or usual care. Review selection and quality assessment using AMSTAR-2 were completed in duplicate. GRADE was extracted from each review, and results were synthesised narratively.
RESULTS: Eighteen meta-analyses of 238 randomised controlled trials were included, with an 8% overlap of primary studies. Compared to usual care, the Mediterranean Diet was associated with reduced cardiovascular disease mortality (n = 4 reviews, GRADE low certainty; risk ratio range: 0.35 [95% confidence interval: 0.15-0.82] to 0.90 [95% confidence interval: 0.72-1.11]). Non-fatal myocardial infarctions were reduced (n = 4 reviews, risk ratio range: 0.47 [95% confidence interval: 0.28-0.79] to 0.60 [95% confidence interval: 0.44-0.82]) when compared with another active intervention. The methodological quality of most reviews (n = 16/18; 84%) was low or critically low and strength of evidence was generally weak.
CONCLUSIONS: This review showed that the Mediterranean Diet can reduce fatal cardiovascular disease outcome risk by 10%-67% and non-fatal cardiovascular disease outcome risk by 21%-70%. This preventive effect was more significant in studies that included populations with established cardiovascular disease. Better quality reviews are needed.
摘要：
目的：本研究旨在回顾评价地中海饮食对心血管疾病一级和二级预防有效性的随机对照试验的荟萃分析。
方法：五个数据库(Medline，Embase,科克伦,CINAHL和ProQuest)从开始到2022年11月进行了搜索。纳入标准是：（i）采用Meta分析的随机对照研究的系统评价；（ii）一般人群中≥18岁的成年人（二级预防）和未（一级预防）已建立心血管疾病；（iii）地中海饮食与其他饮食干预或常规护理相比。使用AMSTAR-2的审查选择和质量评估一式两份。从每个评论中提取等级，并对结果进行了叙述合成。
结果：共纳入238项随机对照试验的18项meta分析，与主要研究有8%的重叠。与常规护理相比，地中海饮食与降低心血管疾病死亡率相关(n=4综述，等级低确定性；风险比范围：0.35[95%置信区间：0.15-0.82]至0.90[95%置信区间：0.72-1.11]）。非致命性心肌梗死减少（n=4，风险比范围：0.47[95％置信区间：0.28-0.79]至0.60[95％置信区间：0.44-0.82]）与另一项积极干预措施相比。大多数综述（n=16/18；84％）的方法学质量较低或极低，证据强度普遍较弱。
结论：本综述显示，地中海饮食可降低10%-67%的致死性心血管疾病结局风险和21%-70%的非致死性心血管疾病结局风险。这种预防作用在包括患有心血管疾病的人群的研究中更为显著。需要更好的质量审查。
方法：五个数据库(Medline，Embase,科克伦,CINAHL和ProQuest)从开始到2022年11月进行了搜索。纳入标准是：（i）采用Meta分析的随机对照研究的系统评价；（ii）一般人群中≥18岁的成年人（二级预防）和未（一级预防）已建立心血管疾病；（iii）地中海饮食与其他饮食干预或常规护理相比。使用AMSTAR-2的审查选择和质量评估一式两份。从每个评论中提取等级，并对结果进行了叙述合成。
结果：共纳入238项随机对照试验的18项meta分析，与主要研究有8%的重叠。与常规护理相比，地中海饮食与降低心血管疾病死亡率相关(n=4综述，等级低确定性；风险比范围：0.35[95%置信区间：0.15-0.82]至0.90[95%置信区间：0.72-1.11]）。非致命性心肌梗死减少（n=4，风险比范围：0.47[95％置信区间：0.28-0.79]至0.60[95％置信区间：0.44-0.82]）与另一项积极干预措施相比。大多数综述（n=16/18；84％）的方法学质量较低或极低，证据强度普遍较弱。
结论：本综述显示，地中海饮食可降低10%-67%的致死性心血管疾病结局风险和21%-70%的非致死性心血管疾病结局风险。这种预防作用在包括患有心血管疾病的人群的研究中更为显著。需要更好的质量审查。
