## 3 The Modern Mediterranean Diet and Its Health Benefits
### Heart Diseases  
The first strong evidence of the beneficial health effects of MD was associated with the lower mortality rates from cardiovascular diseases observed in Greece [6]. Plant-based diets such as MD may contribute to better control of dyslipidemia management in addition to the prevention of cardiovascular diseases (CVD) [4; 107]. The effects of MD on risk factors for heart diseases are outlined in several research reports, which conclude that this particular style of diet may decrease the death rates from heart diseases that constitute the main cause of death in developed countries, accounting for about 17 million deaths per year [161]. [PERSON] et al. [162], who conducted a cross-section animal model study, suggested that high-sugar and high-fat diets such as the modern Western diet resulted in cardiac systolic and diastolic dysfunction, which was reversed when subjects were fed with a standard diet. Despite issues with the methodological approaches followed in intervention trials, and meta-analyses reports that raised concerns regarding the postulated beneficial effects of MD against CVD, a recent critical review report by [PERSON] et al. [163] concluded that these potential controversies are not sufficient to compromise the positive impact of MD on the functions of the cardiovascular system. They also suggested that the existing evidence is strong and consistent, and justifies that the adherence to the MD improves cardiovascular health outcomes through the reductions in rates of coronary heart disease, ischemic strokes, and total cardiovascular diseases. The first evidence of the beneficial effects of the MD was reported in 1950s. Subsequently, numerous clinical trials and epidemiological studies have confirmed the association of this diet with the low incidence of CVD through the improvement of the blood lipid profile [6; 164]. A recent clinical study suggested that the consumption of olive oil, which is a key ingredient of the MD, may improve several risk factors of CVD via the diet's antithrombotic and anti-inflammatory activities [27]. Moreover, [PERSON] et al. [165] compared the short-term impact of two MD ingredients (olive-oil or nuts groups) with a low-fat diet on 772 asymptomatic individuals with high risk of cardiovascular diseases and concluded that, although no clinical outcomes were evaluated, both MDs had beneficial effects against cardiovascular diseases. The short-term effects were associated with the improvement in systolic blood pressure, plasma glucose levels, and the cholesterol-high-density lipoprotein cholesterol ratio [165]. Similar findings were observed by [PERSON] et al. [166], who carried out a controlled crossover study and suggested that following an MD for a 10-day period may improve mood and functions of the cardiovascular system, such as blood systolic pressure. [PERSON] et al. [167] also attributed the beneficial effects of the MD to better blood pressure control and reduction of metabolic syndrome. Long-term cohort studies have also been undertaken, such as that conducted by [PERSON] et al. [168], who carried out a cohort study with 609 participants who experienced a fatal or nonfatal confirmed acute myocardial infarction or unstable angina requiring revascularization. The authors suggested that high adherence to the MD reduces the risk factors of CVD, particularly the incidents of fatal or nonfatal coronary heart disease events, and the diet should play a significant role in the prevention of coronary heart disease in healthy populations. In the same context, [PERSON] et al. [169] mentioned the high risk of elevated blood pressure for acute coronary syndromes and the positive effects of the MD in controlling hypertension. [PERSON] et al. [170] suggested that MD may significantly reduce the development of these syndromes, particularly in the elder population, via the reduction in blood pressure levels and in markers of vascular inflammation.