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Intriguing questions about the MedDiet and the need to educate the public about lipid levels

Comment by Christi Deaton, Primary Care and Risk Factor Management Section

Risk Factors and Prevention

In this analysis (1), the investigators used a nationally representative survey to determine the prevalence of dyslipidaemia in the Greek population, and secondarily to assess awareness, treatment and control in a sub-sample and examine the association between dyslipidaemia and the Mediterranean diet (MedDiet). Hyperlipidaemia was determined by medical history by experienced clinicians in 97% of the sample along with sociodemographic and lifestyle information. Adherence to the MedDiet was measured using 2 non-consecutive 24-hour food recalls analysed by the MedDiet score. Overall approximately 21% of the sample had dyslipidaemia, with 59% receiving treatment and 47% having a normal lipid profile. Most people (64.5%) were unaware of their lipid status. Higher MedDiet adherence was associated overall with lower LDL and in males across all weight categories, but not in women.

In an accompanying editorial (2), the authors noted the lack of awareness of hyperlipidaemia found and compare to a similar analysis in Italy with 56% unaware of elevated cholesterol levels. The MedDiet was shown to have a positive effect on LDL levels in men, but not on HDL or triglycerides. The editorial goes on to speculate that the MedDiet may exert beneficial effects through lowered inflammatory or other pathways, even if there are modest effects on lipid levels.

This research and the editorial raise intriguing questions about the MedDiet and its effects, as well as highlighting the need to educate the public about lipid levels and to ensure that patients are aware of their own cholesterol results. This is a role that should be taken on by general practice as well as specialists. EAPC President, Martin Halle, has emphasised nutrition as a key focus for EAPC, and it is obvious that much needs to be learned about the effects of diet on health and its contribution to cardiovascular prevention.

Note: The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology


1. Magriplis E, Panagiotakos D, Mitsopoulou A-V, Karageorgou D, Bakogianni I, Dimakopoulos I, Micha R, Michas G, Chourdakis M, Chrousos GP, Roma E, Zampela A. Prevalence of hyperlipidaemia in adults
and its relation to the Mediterranean diet: the Hellenic National Nutrition andHealth Survey (HNNHS). European Journal of Preventive Cardiology. 2019; 26: 1957 – 1967. DOI: 10.1177/2047487319866023.

2. Bonaccio M, Gianfagna F, de Gaetano G, Iacoviello L. Too many individuals are unaware of their
blood lipid levels, but might still get health benefit from the Mediterranean diet through lipid-independent mechanisms. European Journal of Preventive Cardiology. 2019; 26: 1953 – 1956. DOI: 10.1177/2047487319867782