[How strong is the evidence that a Mediterranean diet will prevent cardiovascular disease?]

A recent Cochrane review stated that 'There is a paucity of evidence for secondary prevention' of cardiovascular disease (CVD) by a Mediterranean-style diet. The CORDIOPREV trial attempted to fill this gap. Subjects in the Mediterranean-diet group increased their intake of olive oil by 24 g per day and also ate a bit more fruit, vegetables and nuts than a high-carbohydrate control group. Incidence of CVD fell by 25% in 7 y. Known causes of CVD such as blood pressure, LDL cholesterol and overweight were not affected. Thus one has to assume that small amounts of fruits, vegetables, nuts and olive oil cause a major reduction in CVD through hitherto unknown pathways. This requires a leap of faith that the current author is reluctant to take.