We all would agree that diet plays a key role in primary prevention of cardiovascular disease (CVD) yet this conclusion is based on clinical studies that mostly included men or did not include sex-specific analyses so that whether this holds true for women, as well as men, is not well established. In this issue of Heart, Pant and colleagues1 report a meta-analysis of 16 prospective cohort studies, including over 7 million women, comparing CVD risk with low vs high adherence to a Mediterranean diet. High adherence to a Mediterranean diet in women was associated with a lower incidence of CVD (HR 0.76, 95% CI 0.72 to 0.81; I2=39%, p test for heterogeneity=0.07), total mortality, and coronary heart disease (figure 1). Similar benefits of high dietary adherence were seen in men. We agree with the author’s recommendation that “ Future research should adopt more sex aggregated research designs to develop tailored dietary guidelines for CVD prevention.”

Forest plot of pooled hazard ratios (HRs) in female participants for incident cardiovascular disease (CVD) according to highest vs lowest category of Mediterranean diet adherence using the random effects model. Higher adherence to a Mediterranean diet had a favourable effect on incident CVD (HR 0.76, 95% CI 0.72 to 0.81; I2=38.6%, p test for heterogeneity=0.07). RE, random effects. See Pant et al 1 for full citations of the studies listed in this figure.

Early diagnosis of …