Mediterranean lifestyle and risk of adverse cardiovascular events, all-cause and cardiovascular mortality among individuals with type 2 diabetes.

Authors

María Del Carmen Aznar de la Riera, Jesús Díaz-Gutiérrez, Stefanos N Kales, Miguel Ruiz-Canela, Almudena Castro Conde, Beth Frates, Fernando Rodríguez-Artalejo, Mercedes Sotos-Prieto

Published in

EClinicalMedicine. Volume 98. Pages 104134. Epub Aug 07, 2026.

Abstract

Individuals with type 2 diabetes experience a significantly increased risk of major adverse cardiovascular events (MACE), highlighting the need for effective management tools. Although the Mediterranean Lifestyle has been associated with a lower risk of cardiovascular disease (CVD) in the general population, evidence among adults with type 2 diabetes remains limited. The aim of this study was to evaluate the association between adherence to the Mediterranean Lifestyle Index (MEDLIFE) and risk of MACE, all-cause and CVD mortality in British adults with type 2 diabetes.
We analyzed data from 3612 individuals aged 40-70 from the UK Biobank cohort, who had type 2 diabetes at baseline (2009-2012) and were followed up until 2024. The MEDLIFE consisted of 25 items, organized into three blocks: (i) Mediterranean food consumption, (ii) Mediterranean dietary habits, and (iii) Physical activity, rest, social habits and conviviality (range 0-25, highest adherence). Incident MACE data were obtained through hospital records, while mortality data were ascertained from the National Death Index. Cox regression models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for the outcomes studied, adjusting for potential confounders.
After a median follow-up of 10.5-12.1 years, 737 (20.4%) MACE, 171 (4.73%) CVD deaths, and 645 (17.9%) all-cause deaths were identified. Higher adherence to the MEDLIFE was associated with stepwise decreases in MACE risk, all-cause and CVD mortality. Compared to participants in the lowest MEDLIFE quartile, the HR (95% CI) for those in the highest quartile was 0.73 (0.59-0.91) for MACE, 0.74 (0.58-0.93) for all-cause mortality, and 0.49 (0.30-0.81) for CVD mortality (all p-trend <0.01). Each MEDLIFE block contributed to the observed associations. Analyses remained robust throughout sensitivity analyses.
Higher adherence to the MEDLIFE was associated with significantly lower risks of MACE, all-cause and CVD mortality among British individuals with type 2 diabetes. Our findings support the MEDLIFE as a promising and accessible tool for type 2 diabetes management.
This work was supported by the Carlos III Health Institute, the Secretary of R+D+I; the European Regional Development Fund/European Social Fund (FIS grants 22/1111; 23/00079); National Agency of Research (CNS2022-135623); Ministerio de Educación, Formación Profesional y Deportes (FPU contract to MDCAR).

PMID:
42602660
Bibliographic data and abstract were imported from PubMed on 15 Aug 2026.

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