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The Mediterranean Diet: A Key to Longevity and Health for Women

The Mediterranean diet has long been celebrated for its remarkable health benefits and its potential to enhance longevity. Rooted in the traditional eating habits of countries bordering the Mediterranean Sea, this diet emphasizes a rich variety of plant-based foods, healthy fats, and lean proteins. A recent study published in JAMA Network Open offers new insights into how adherence to the Mediterranean diet is associated with reduced all-cause mortality among US women. By examining the underlying biological mechanisms, the study sheds light on the powerful impact this dietary pattern can have on women’s health and longevity. Let’s delve into the findings and understand why the Mediterranean diet continues to be hailed as one of the healthiest dietary patterns.

 

What is the Mediterranean Diet?

The Mediterranean diet is characterized by a high intake of fruits, vegetables, whole grains, legumes, nuts, and olive oil. It includes moderate consumption of fish and poultry, low consumption of dairy products and red meat, and an emphasis on plant-based foods. Wine is consumed in moderation, typically with meals. This diet is rich in monounsaturated fats, particularly from olive oil, and includes a balance of omega-3 and omega-6 fatty acids.

The Mediterranean diet is inspired by the traditional dietary patterns of countries bordering the Mediterranean Sea, such as Greece, Italy, and Spain. It emphasizes plant-based foods, healthy fats, and lean protein sources, and is associated with numerous health benefits, including reduced risk of chronic diseases and improved longevity.

The Mediterranean diet emphasizes eating:

  • Fruits and Vegetables: High intake of a variety of fresh produce.
  • Whole Grains: Foods like barley, oats, and brown rice.
  • Legumes and Nuts: Beans, lentils, and nuts for protein and fiber.
  • Olive Oil: The main source of fat, replacing butter and other fats.
  • Fish and Seafood: Regular consumption, particularly of fatty fish like salmon.
  • Poultry and Eggs: Moderate amounts for lean protein.
  • Dairy: Limited intake, mainly cheese and yogurt.
  • Red Meat: Minimal consumption.
  • Wine: Keeping alcohol consumption in moderation, typically with meals.
  • Herbs and Spices: Used instead of salt for flavoring.

 

Principles of the Mediterranean Diet

  1. Variety and Balance: Eat a wide range of foods for a diverse nutrient intake.
  2. Plant-Based Focus: Make fruits, vegetables, legumes, and nuts the foundation of your diet.
  3. Healthy Fats: Use olive oil, including nuts and fish, avoiding unhealthy fats.
  4. Lean Proteins: Opt for fish, poultry, and legumes over red meat.
  5. Whole Foods: Choose minimally processed foods to retain nutrients.
  6. Moderation: Practice portion control and moderate alcohol intake.
  7. Social Eating: Enjoy meals with family and friends to enhance the experience.

 

The Mediterranean Diet: A Key to Longevity and Health for Women Heart Matters

This pyramid visually summarizes the Mediterranean diet’s principles, emphasizing a foundation of physical activity and social interaction, a high intake of plant-based foods, moderate consumption of protein sources and dairy, and a limited intake of red meat and sweets.

 

Study Overview

The study followed 25,315 healthy women from the Women’s Health Study over an average of 24.7 years. It aimed to see how closely following the Mediterranean diet affected their risk of death from any cause.

 

Key Findings

The study found that women who followed the Mediterranean diet closely had a lower risk of dying from any cause:

  • 8% Lower Risk: For those with moderate adherence.
  • 23% Lower Risk: For those with high adherence.

Higher Mediterranean diet adherence was also linked to reduced risks of cardiovascular disease (CVD) and cancer mortality. Compared to those with low adherence scores, women with high adherence scores showed a 17% reduction in CVD mortality and a 20% reduction in cancer mortality.

 

Scoring Adherence

The Mediterranean diet adherence score ranges from 0 to 9, based on the consumption of nine components:

  1. Vegetables (excluding potatoes): 1 point if intake is above median.
  2. Fruits: 1 point if intake is above median.
  3. Nuts: 1 point if intake is above median.
  4. Whole Grains: 1 point if intake is above median.
  5. Legumes: 1 point if intake is above median.
  6. Fish: 1 point if intake is above median.
  7. Monounsaturated to Saturated Fat Ratio: 1 point if above median.
  8. Red and Processed Meats: 1 point if intake is below median.
  9. Alcohol: 1 point if intake is between 5 and 15 grams per day (equivalent to one drink).

 

Biological Mechanisms

To unravel the biological mechanisms underlying the reduced mortality risk, the study examined 33 blood biomarkers related to lipid, lipoprotein, apolipoprotein, inflammation, insulin resistance, and metabolism measurements. ​ The analysis revealed that small molecule metabolites and inflammatory biomarkers contributed the most to the lower mortality risk, explaining 14.8% and 13.0% of the association, respectively. ​ Triglyceride-rich lipoproteins, body mass index, and insulin resistance played significant roles, explaining 10.2%, 10.2%, and 7.4% of the association, respectively. ​

Interestingly, standard cholesterol or glycemic measures had minimal contributions to the lower mortality risk associated with adherence to the Mediterranean diet. ​ This suggests that the Mediterranean diet’s benefits extend beyond traditional markers of cardiovascular health, emphasizing the importance of considering a holistic approach to dietary patterns.

The study also looked at how the diet affects various health markers:

  • Inflammation and Metabolism: Reduced inflammation and better metabolic health significantly contributed to the lower risk of death.
  • Insulin Sensitivity and Weight Management: Better blood sugar control and weight maintenance.

 

The Mediterranean Diet: A Key to Longevity and Health for Women Heart Matters

 

Practical Tips for Adopting the Mediterranean Diet

  1. Focus on Plant-Based Foods: Fill your plate with vegetables, fruits, legumes, and whole grains.
  2. Choose Healthy Fats: Use olive oil and include nuts and seeds.
  3. Opt for Fish and Poultry: Prefer these over red meat.
  4. Avoid Processed Foods: Stick to whole, unprocessed foods.
  5. Enjoy Meals Socially: Eat with family and friends.
  6. Moderate Alcohol: If you drink, do so in moderation, preferably wine with meals.

 

Conclusion

The Mediterranean diet offers a holistic approach to health and well-being, emphasizing balanced nutrition and a sustainable lifestyle. The Women’s Health Study findings underscore the diet’s potential to reduce mortality and improve overall health for women. By embracing the Mediterranean diet, women can savor various delicious foods while significantly enhancing their longevity and quality of life. This evidence-based dietary pattern supports long-term health and promotes a vibrant and fulfilling lifestyle, making it an invaluable choice for those seeking to optimize their well-being.

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other anti-anginals

When first-line therapies for angina, such as beta blockers, calcium channel blockers, and nitrates, prove inadequate or are not well-tolerated, second-line therapies may be considered.
Perhexiline is a unique medication that enhances the heart's ability to utilize fatty acids for energy, reducing its reliance on oxygen and lowering oxygen demand. This action helps improve blood flow and alleviates chest pain in some patients with refractory angina.
Nicorandil is another second-line option with a dual mechanism of action. It opens potassium channels in smooth muscle cells, causing vasodilation and enhancing coronary blood flow. Additionally, nicorandil also stimulates nitric oxide release, further dilating blood vessels and reducing heart workload.
Trimetazidine is an anti-ischemic agent that improves cardiac efficiency by enhancing glucose metabolism and shifting the heart's energy production to a more oxygen-efficient process. As second-line therapies, these medications offer alternative approaches for managing angina in individuals who do not respond adequately to first-line treatments or those experiencing side effects from other medications.

lipid lowering therapies

Lipid-lowering therapies play a critical role in managing coronary artery disease (CAD), a condition characterized by the narrowing of blood vessels that supply the heart. Among the most commonly discussed and debated classes of medications are statins, which effectively reduce cholesterol levels and are widely prescribed to lower the risk of cardiovascular events. Alongside statins, other medications like ezetimibe, fibrates, and niacin are also utilized to target specific aspects of lipid metabolism, such as cholesterol absorption, triglyceride levels, and raising high-density lipoprotein (HDL) cholesterol. Additionally, the introduction of medications that inhibit PCSK9, an enzyme involved in cholesterol metabolism, has provided a promising new approach to further lower LDL cholesterol levels. These PCSK9 inhibitors, such as Repatha (evolocumab), have shown significant efficacy in reducing LDL cholesterol levels in patients with CAD, especially for those who may not respond well to traditional therapies.

Nitrates

Nitrates are widely used to treat angina and provide quick relief for chest pain. Commonly available in the form of sublingual sprays or tablets, patches, and long-acting tablets, nitrates work by dilating blood vessels, allowing for increased blood flow and reduced resistance. This dilation eases the heart's workload, leading to a decreased demand for oxygen and prompt alleviation of angina symptoms. Sublingual nitrates act rapidly and are often used to provide immediate relief during angina attacks, while patches and long-acting tablets are employed for preventive purposes. However, nitrates may cause side effects such as headaches, dizziness, and flushing, which usually subside over time.

calcium channel blockers

Calcium channel blockers, including amlodipine, felodipine, cardizem (diltiazem), and verapamil, are commonly prescribed for the treatment of angina. These medications work by inhibiting the influx of calcium into the muscle cells of the heart and blood vessels, leading to their relaxation. As a result, blood vessels widen, promoting improved blood flow and reduced blood pressure. In the context of angina, this relaxation decreases the heart's workload, lowering the demand for oxygen and alleviating chest pain. Calcium channel blockers offer a valuable treatment option for individuals with angina, but it is essential to be aware of potential side effects, which may include headaches, dizziness, flushing, and ankle swelling.

Beta blockers

Beta blockers, such as metoprolol, propranolol, atenolol, carvedilol, and bisoprolol, play a crucial role in treating angina. By blocking certain receptors in the heart, they effectively reduce heart rate and the force of contraction, thereby easing the heart's workload. This mechanism of action leads to a decreased demand for oxygen, making beta blockers highly effective in relieving chest pain associated with angina. As with any medication, it's important to consider potential side effects, including tiredness, worsened asthma, erectile dysfunction in some males, and more vivid dreams during sleep. Consult your healthcare provider to determine the suitability of beta blockers for managing your angina and overall heart health.

Anti-platelet Medications

Anti-platelet medications play a crucial role in preventing blood clot formation, reducing the risk of serious cardiovascular events such as heart attacks and strokes. Among the widely used anti-platelet drugs are aspirin, clopidogrel, and ticagrelor.

Aspirin: This well-known medication inhibits platelet activation, making it less likely for platelets to stick together and form clots. Aspirin is commonly used for primary and secondary prevention of heart attacks and strokes.

Clopidogrel: As a potent anti-platelet agent, clopidogrel works by blocking specific receptors on platelets, preventing them from aggregating. It is often prescribed to patients with acute coronary syndrome, those undergoing stent procedures, and for some cases of peripheral arterial disease.

Ticagrelor: Ticagrelor is another effective anti-platelet drug that works by inhibiting platelet activation. It is used in acute coronary syndrome, often given alongside aspirin to reduce the risk of heart-related events.