Let's start to orient ourselves in this way, made of many myths and false promises. For many years we have known that diet plays a fundamental role in the prevention of cardiovascular disease. In particular, the observation of populations living in the Mediterranean area has revealed lower rates of heart attack and stroke compared to other regions of the world. This phenomenon has been attributed to the Mediterranean lifestyle, characterized by a diet rich in fruit, vegetables, legumes, whole grains, fish and extra virgin olive oil. Numerous observational studies have confirmed that following a Mediterranean diet is associated with a reduction in the risk of cardiovascular events. However, there was a lack of direct evidence from controlled clinical trials that demonstrated with certainty the causal benefit of this type of diet. Furthermore, although we know that extra virgin olive oil is a key component of the Mediterranean diet, it was important to better understand its specific role in protecting the heart.

The PREDIMED study, recently published in the NEJM, represented a fundamental stage. For the first time, it has rigorously and controlledly evaluated whether following a Mediterranean diet, enriched with extra virgin olive oil or dried fruit, could reduce the incidence of serious cardiovascular events in people at high risk. Unlike previous observational studies, PREDIMED used a randomized design, which allows for more reliable and robust results. Over 7400 people between the ages of 55 and 80, all at high cardiovascular risk but without known heart disease, were divided into three groups: one followed a Mediterranean diet with plenty of extra virgin olive oil, a second a Mediterranean diet with a handful of dried fruit per day (walnuts, almonds and hazelnuts) and the third group received only general advice to reduce fat in the diet. All participants received ongoing support through educational meetings and, depending on the group, free supplies of oil or dried fruit.

After about five years, it was seen that those who followed the enriched Mediterranean diet (with oil or dried fruit) had a 30% lower risk of suffering a heart attack, stroke or cardiovascular death, compared to those who were only trying to reduce fat. But let's take a closer look at what the Mediterranean diet followed in the study includes:

• Abundant use of extra virgin olive oil (at least 4 tablespoons a day)
• Eat lots of fruits and vegetables
• Regular consumption of fish, legumes and whole grains
• Moderate portions of wine with meals (only for those who already drank it)
• Sharply reduce consumption of red meat, processed baked goods and sugary drinks

How do we explain these results? This study confirms that the Mediterranean diet, if followed correctly, is a powerful tool to protect our heart. But in particular we learn that extra virgin olive oil is considered a “superfood” in the Mediterranean diet. Several scientific studies show that extra virgin olive oil is rich in polyphenols, natural compounds that act as powerful antioxidants. Antioxidants help fight inflammation, protect cells from damage and improve the health of the arteries, making them more elastic. In addition, extra virgin olive oil contains good fats (especially oleic acid, a type of monounsaturated fat) that help reduce bad cholesterol (LDL) and increase good cholesterol (HDL). This balance between LDL and HDL is crucial: high levels of LDL promote the formation of plaque (“fat accumulations”) in the arteries, increasing the risk of heart attack and stroke, while a good level of HDL helps to “clean” the arteries from these deposits. The mechanisms by which olive oil protects the heart are multiple, such as the reduction of inflammation through polyphenols, also present in red wine. In addition, olive oil protects the endothelium, or the thin internal lining of blood vessels, improving endothelial function and promoting better blood flow in small vessels and finally has an antioxidant effect, neutralizing free radicals, molecules that damage the cells of various organs. These benefits have been confirmed not only by the PREDIMED study, but also by numerous other international research. For example, epidemiological studies in southern Europe show that populations that consume more extra virgin olive oil have less heart disease and live longer.

It's not about counting calories or making drastic sacrifices. The important thing is to choose the right foods every day, making room for quality extra virgin olive oil, a handful of natural dried fruit, fish, vegetables and legumes. Prefer raw extra virgin olive oil to dress salads, vegetables, legumes and even on a simple slice of wholemeal bread. We will certainly clarify many other tips, perplexities and doubts with Dr. Farnetti. Please, we are waiting for you! Live Mediterranean, live better!