The Mediterranean diet is the best evidence-based model for cardiovascular prevention. It is characterized by a high consumption of extra-virgin olive oil, natural plant-based foods (fruits, vegetables, nuts, and legumes), and fish, along with a reduction in processed meats, red meats, and ultraprocessed products. Moderate consumption of wine, preferably red wine, during meals is also an essential element of this traditional pattern. Despite the association between removing wine from the Mediterranean diet and reduced preventive efficacy, recent doubts have emerged about the possible adverse effects of even low or moderate intake of any alcoholic beverages. A new large Spanish trial, UNATI, which will begin in June 2024, aims to address these doubts with the best available evidence. The trial will randomize 10,000 drinkers aged 50 to 75 years to abstinence or moderate consumption. The results of these trials and various prospective epidemiological studies support the beneficial effects of the Mediterranean diet in preventing cardiovascular events, both in primary and secondary prevention. However, the role of alcohol consumption in the Mediterranean diet remains controversial, and more robust evidence is needed to provide clear recommendations based on solid scientific certainty.The Mediterranean diet is the best evidence-based model for cardiovascular prevention. It is characterized by a high consumption of extra-virgin olive oil, natural plant-based foods (fruits, vegetables, nuts, and legumes), and fish, along with a reduction in processed meats, red meats, and ultraprocessed products. Moderate consumption of wine, preferably red wine, during meals is also an essential element of this traditional pattern. Despite the association between removing wine from the Mediterranean diet and reduced preventive efficacy, recent doubts have emerged about the possible adverse effects of even low or moderate intake of any alcoholic beverages. A new large Spanish trial, UNATI, which will begin in June 2024, aims to address these doubts with the best available evidence. The trial will randomize 10,000 drinkers aged 50 to 75 years to abstinence or moderate consumption. The results of these trials and various prospective epidemiological studies support the beneficial effects of the Mediterranean diet in preventing cardiovascular events, both in primary and secondary prevention. However, the role of alcohol consumption in the Mediterranean diet remains controversial, and more robust evidence is needed to provide clear recommendations based on solid scientific certainty.