The Mediterranean diet is the best evidence-based model for cardiovascular prevention. It is supported by two major randomized secondary prevention trials (Lyon Heart and CORDIOPREV), one primary prevention trial (PREDIMED), and a large body of high-quality prospective epidemiological evidence. Key elements of the Mediterranean diet include high consumption of extra-virgin olive oil, plant-based foods (fruits, vegetables, nuts, legumes), and fish, along with reduced intake of processed meats, red meats, and ultra-processed products. Moderate wine consumption, preferably red wine, is an essential part of this diet. While removing wine has been linked to reduced preventive efficacy, recent concerns about the potential adverse effects of even low or moderate alcohol consumption have emerged. The UNATI trial, starting in June 2024, will randomize 10,000 individuals aged 50-75 to either abstinence or moderate consumption to address these concerns with the best possible evidence. The Mediterranean diet is characterized by a high intake of monounsaturated and polyunsaturated fats, primarily from olive oil and nuts, and a low intake of saturated fats. It has been associated with reduced cardiovascular risk factors, including high-density lipoprotein cholesterol, obesity, metabolic syndrome, diabetes, and hypertension. The Mediterranean diet, when supplemented with olive oil or nuts, reduces cardiovascular risk factors, inhibits inflammatory pathways related to atherosclerosis, and may have beneficial effects on endothelial function. The protective effects of the Mediterranean diet are likely due to synergistic interactions between its components rather than isolated effects of specific foods. Several scales are used to assess adherence to the Mediterranean diet, including the Mediterranean Diet Score (MDS) and the Mediterranean Diet Adherence Screener (MEDAS). The Mediterranean diet has been shown to reduce cardiovascular events, including myocardial infarction, stroke, and cardiovascular mortality, in both secondary and primary prevention trials. The PREDIMED trial, the largest study using the Mediterranean diet, demonstrated significant benefits in reducing cardiovascular events. However, some methodological limitations in the PREDIMED trial have been noted. Despite these limitations, the results of the PREDIMED trial remain the best available evidence on the Mediterranean diet's role in cardiovascular prevention. The Mediterranean diet is characterized by high consumption of vegetables, fruits, nuts, legumes, and whole grains, moderate consumption of fish and seafood, and a moderate amount of fermented dairy products. It requires low consumption of red meat, processed meats, and ultra-processed foods. A unique aspect of the Mediterranean diet is the regular consumption of moderate amounts of wine during meals. The primary source of fat is olive oil, and alcohol is primarily wine. Moderate consumption of red wine and olive oil has been shown to reduce the risk of cardiovascular diseases, including cardiovascular mortality, type 2 diabetes, metabolic syndrome, and obesity. The mechanisms underlying the protective effects of the Mediterranean diet include reduced inflammatory and oxidativeThe Mediterranean diet is the best evidence-based model for cardiovascular prevention. It is supported by two major randomized secondary prevention trials (Lyon Heart and CORDIOPREV), one primary prevention trial (PREDIMED), and a large body of high-quality prospective epidemiological evidence. Key elements of the Mediterranean diet include high consumption of extra-virgin olive oil, plant-based foods (fruits, vegetables, nuts, legumes), and fish, along with reduced intake of processed meats, red meats, and ultra-processed products. Moderate wine consumption, preferably red wine, is an essential part of this diet. While removing wine has been linked to reduced preventive efficacy, recent concerns about the potential adverse effects of even low or moderate alcohol consumption have emerged. The UNATI trial, starting in June 2024, will randomize 10,000 individuals aged 50-75 to either abstinence or moderate consumption to address these concerns with the best possible evidence. The Mediterranean diet is characterized by a high intake of monounsaturated and polyunsaturated fats, primarily from olive oil and nuts, and a low intake of saturated fats. It has been associated with reduced cardiovascular risk factors, including high-density lipoprotein cholesterol, obesity, metabolic syndrome, diabetes, and hypertension. The Mediterranean diet, when supplemented with olive oil or nuts, reduces cardiovascular risk factors, inhibits inflammatory pathways related to atherosclerosis, and may have beneficial effects on endothelial function. The protective effects of the Mediterranean diet are likely due to synergistic interactions between its components rather than isolated effects of specific foods. Several scales are used to assess adherence to the Mediterranean diet, including the Mediterranean Diet Score (MDS) and the Mediterranean Diet Adherence Screener (MEDAS). The Mediterranean diet has been shown to reduce cardiovascular events, including myocardial infarction, stroke, and cardiovascular mortality, in both secondary and primary prevention trials. The PREDIMED trial, the largest study using the Mediterranean diet, demonstrated significant benefits in reducing cardiovascular events. However, some methodological limitations in the PREDIMED trial have been noted. Despite these limitations, the results of the PREDIMED trial remain the best available evidence on the Mediterranean diet's role in cardiovascular prevention. The Mediterranean diet is characterized by high consumption of vegetables, fruits, nuts, legumes, and whole grains, moderate consumption of fish and seafood, and a moderate amount of fermented dairy products. It requires low consumption of red meat, processed meats, and ultra-processed foods. A unique aspect of the Mediterranean diet is the regular consumption of moderate amounts of wine during meals. The primary source of fat is olive oil, and alcohol is primarily wine. Moderate consumption of red wine and olive oil has been shown to reduce the risk of cardiovascular diseases, including cardiovascular mortality, type 2 diabetes, metabolic syndrome, and obesity. The mechanisms underlying the protective effects of the Mediterranean diet include reduced inflammatory and oxidative