Contributed By Asst Prof Huang Zijuan, Senior Consultant, Cardiology

When it comes to eating for heart health, many with heart conditions are often overwhelmed by the sheer number of diets out there. Should you cut carbs? Go low-fat? Eat more protein?

Among all these options, the Mediterranean diet consistently shows impressive results in studies. Research has found that it can reduce strokes and heart attacks by up to 70%^1,2. It was first identified through Ancel Keys' research in the Seven Countries Study, which revealed its association with low heart disease death rates in Mediterranean countries³. Subsequent research then demonstrated the clear benefits of the Mediterranean diet across multiple health areas, particularly for heart health⁴.

Beyond the proven benefits, what makes this diet so appealing is its flexible and non-restrictive nature, offering a wide variety of flavours and ingredients, while remaining highly manageable for most people to follow.

Why It Works

The Mediterranean diet's effectiveness has been validated through landmark trials including PREDIMED¹, CORDIOPREV², and Lyon⁴, which have consistently demonstrated its cardiovascular benefits. When compared to the previously considered gold standard for heart health — the low-fat diet — the Mediterranean diet led to significant reductions in both fatal and non-fatal cardiovascular events. Most remarkably, studies have shown it can even reduce early plaque formation in blood vessels^1,5.

The Mediterranean Diet Guide^6,7

Healthy Fats: Use oils that are low in saturated fat such as canola or olive oil for your cooking and meal preparation.

Plenty of Plant Foods: Consume multiple servings of vegetables and fruits daily. Studies recommended around 400g of vegetables per day and three servings of fruit per day.

Enjoy in Moderation: Limit red meat, processed meat, butter, cream, sweetened drinks, and commercially made sweets.

Legumes, Fish/Seafood, and Nuts: Include legumes, fish or seafood, and nuts regularly in your meals. Studies recommend at least three times per week for legumes, three servings per week for fish or seafood, and three or more servings per week for nuts.

White Meat Preference: Choose white meat over red meat.

Sofrito: Include sofrito — a sauce made with tomato, onion, leek, or garlic, simmered with olive oil — into your meals twice a week or more. This flavourful addition is rich in beneficial phytochemicals (plant compounds). Research has shown that consuming a variety of antioxidant-rich colourful fruits and vegetables (like those found in sofrito) can help reduce early plaque formation in arteries.

Fit for the Asian Palate

The good news is that you do not have to give up your favourite Asian dishes for olives, feta or chickpeas to reap benefits. A recent literature review, published in Journal of the Asia-Pacific Society of Cardiology (JAPSC) in August 2025⁸, reveals promising findings for Asian populations. When Mediterranean diet principles were adapted with local cuisines across Japan, Korea, China, Singapore, and India, researchers observed associated reductions in cardiovascular events such as stroke and heart attack, alongside cardiometabolic conditions such as high blood pressure, blood sugar issues, and obesity.

Asian foods, beverages and spices have demonstrated cardiometabolic benefits in clinical trials, making them excellent culturally relevant alternatives to traditional Mediterranean ingredients. These foods include peanuts, cashew nuts, pistachios, soybean products, adzuki beans, green tea, cruciferous vegetables, mushrooms, kimchi, kelp, sesame seeds, turmeric, ginger, etc.

Together, these familiar foods form the heart-healthy Asian-Mediterranean diet, combining evidence-based Mediterranean diet principles with beneficial Asian ingredients to support cardiovascular health.

Try this checklist - the higher your score, the better for yourheart health! Daily goal: 10/10! (Download here)

REFERENCES

1. Murie-Fernandez M, Irimia P, Toledo E, et al. Carotid intima-media thickness changes with Mediterranean diet: a randomized trial (PREDIMED-Navarra). Atherosclerosis. 2011;219(1):158-162. doi:10.1016/J.ATHEROSCLEROSIS.2011.06.050
2. Delgado-Lista J, Alcala-Diaz JF, Torres-Pena JD, et al. Long-term secondary prevention of cardiovascular disease with a Mediterranean diet and a low-fat diet (CORDIOPREV): a randomised controlled trial. The Lancet. 2022;399(10338):1876-1885. doi:10.1016/S0140-6736(22)00122-2
3. Mediterranean dietary patterns in the 1960s - Seven Countries Study | The first study to relate diet with cardiovascular disease. Accessed July 7, 2024. https://www.sevencountriesstudy.com/mediterranean-dietary-patterns/
4. Kris-Etherton P, Eckel RH, Howard B V., St. Jeor S, Bazzarre TL. Lyon Diet Heart Study. Circulation. 2001;103(13):1823-1825. doi:10.1161/01.CIR.103.13.1823
5. Jimenez-Torres J, Alcala-Diaz JF, Torres-Pena JD, et al. Mediterranean Diet Reduces Atherosclerosis Progression in Coronary Heart Disease: An Analysis of the CORDIOPREV Randomized Controlled Trial. Stroke. 2021;52(11):3440-3449. doi:10.1161/STROKEAHA.120.033214
6. Estruch R, Ros E, Salas-Salvado J, et al. Primary Prevention of Cardiovascular Disease with a Mediterranean Diet Supplemented with Extra-Virgin Olive Oil or Nuts. New England Journal of Medicine. 2018;378(25). doi:10.1056/NEJMOA1800389/SUPPL_FILE/NEJMOA1800389_DISCLOSURES.PDF
7. Rivas-Garcia L, Quintana-Navarro GM, Torres-Pena JD, et al. Dietary antioxidant intake reduces carotid intima-media thickness in coronary heart disease patients: From the CORDIOPREV study. Free Radic Biol Med. 2024;210:221-229. doi:10.1016/J.FREERADBIOMED.2023.11.026
8. Zijuan Huang, Natalie Koh SY, Yun Yun Go, Chiwyeh Lim. The Heart Healthy Asian Mediterranean Diet: A Literature Review. Journal of Asian Pacific Society of Cardiology. 2025