The Mediterranean diet (MD) is a dietary pattern rich in minimally processed plant foods and monounsaturated fats, while being low in saturated fats, meat, and dairy products. It has been extensively studied for its cardiovascular health benefits, showing reductions in body weight, improved cardiovascular disease surrogates, and prevention of fatal and nonfatal cardiovascular diseases, diabetes, and obesity. The MD is also associated with characteristic changes in the gut microbiota, including increased growth of species producing short-chain fatty acids and beneficial bacteria like *Clostridium leptum*, *Eubacterium rectale*, Bifidobacteria, and *Faecalibacterium prausnitzii*. These changes are linked to reduced inflammation, oxidative stress, and improved metabolic health. The review highlights the MD's impact on cardiovascular health through its effects on gut microbiota. It discusses the MD's components, such as extra-virgin olive oil, legumes, cereals, nuts, fruits, vegetables, dairy products, fish, and wine, and their specific health benefits. The MD's beneficial effects on cardiovascular outcomes are supported by epidemiological studies and intervention trials, though the mechanisms are not fully understood. The review also explores the gut microbiome's role in cardiovascular health, noting that the MD promotes a diverse and healthy gut microbiota, which can influence cardiovascular risk factors through various pathways, including the production of beneficial metabolites like short-chain fatty acids and the modulation of immune responses. The MD's ability to modulate the gut microbiota may be a key factor in its cardiovascular benefits, and future research is needed to fully understand these mechanisms.The Mediterranean diet (MD) is a dietary pattern rich in minimally processed plant foods and monounsaturated fats, while being low in saturated fats, meat, and dairy products. It has been extensively studied for its cardiovascular health benefits, showing reductions in body weight, improved cardiovascular disease surrogates, and prevention of fatal and nonfatal cardiovascular diseases, diabetes, and obesity. The MD is also associated with characteristic changes in the gut microbiota, including increased growth of species producing short-chain fatty acids and beneficial bacteria like *Clostridium leptum*, *Eubacterium rectale*, Bifidobacteria, and *Faecalibacterium prausnitzii*. These changes are linked to reduced inflammation, oxidative stress, and improved metabolic health. The review highlights the MD's impact on cardiovascular health through its effects on gut microbiota. It discusses the MD's components, such as extra-virgin olive oil, legumes, cereals, nuts, fruits, vegetables, dairy products, fish, and wine, and their specific health benefits. The MD's beneficial effects on cardiovascular outcomes are supported by epidemiological studies and intervention trials, though the mechanisms are not fully understood. The review also explores the gut microbiome's role in cardiovascular health, noting that the MD promotes a diverse and healthy gut microbiota, which can influence cardiovascular risk factors through various pathways, including the production of beneficial metabolites like short-chain fatty acids and the modulation of immune responses. The MD's ability to modulate the gut microbiota may be a key factor in its cardiovascular benefits, and future research is needed to fully understand these mechanisms.