The Mediterranean diet (MD), rich in minimally processed plant foods and monounsaturated fats but low in saturated fats, meat, and dairy, is one of the most studied diets for cardiovascular health. Observational and randomized controlled trials show that MD reduces body weight, improves cardiovascular disease surrogates, and prevents cardiovascular disease, diabetes, and obesity. However, the mechanisms by which MD benefits cardiovascular health are not fully understood. MD is associated with characteristic changes in the intestinal microbiota, including increased growth of species producing short-chain fatty acids (SCFAs) and Bifidobacteria, Bacteroides, and Faecalibacterium prausnitzii, and reduced growth of Firmicutes and Blautia species. These changes are favorable for inflammation, oxidative status, and metabolic health. The MD promotes heart health through its effects on gut microbiota, which are mediated by its components such as extra-virgin olive oil, legumes, cereals, nuts, fruits, vegetables, dairy products, and fish. These components have anti-inflammatory, antioxidant, and cardioprotective properties. The MD is also associated with a lower risk of cardiovascular disease, with studies showing that adherence to the MD is linked to lower cardiovascular disease incidence and mortality. The MD's beneficial effects on cardiovascular health are mediated by its impact on the gut microbiota, which produces SCFAs and other metabolites that improve host metabolism and reduce inflammation. The MD is associated with a more diverse gut microbiota, with increased abundance of Bacteroidetes and decreased abundance of Firmicutes. The MD is also associated with lower levels of inflammatory markers and higher levels of beneficial metabolites. The MD's effects on the gut microbiota are influenced by its components, such as fiber, polyphenols, and other nutrients. The MD is associated with a lower risk of cardiovascular disease, with studies showing that adherence to the MD is linked to lower cardiovascular disease incidence and mortality. The MD's beneficial effects on cardiovascular health are mediated by its impact on the gut microbiota, which produces SCFAs and other metabolites that improve host metabolism and reduce inflammation. The MD is associated with a more diverse gut microbiota, with increased abundance of Bacteroidetes and decreased abundance of Firmicutes. The MD is also associated with lower levels of inflammatory markers and higher levels of beneficial metabolites. The MD's effects on the gut microbiota are influenced by its components, such as fiber, polyphenols, and other nutrients. The MD is associated with a lower risk of cardiovascular disease, with studies showing that adherence to the MD is linked to lower cardiovascular disease incidence and mortality.The Mediterranean diet (MD), rich in minimally processed plant foods and monounsaturated fats but low in saturated fats, meat, and dairy, is one of the most studied diets for cardiovascular health. Observational and randomized controlled trials show that MD reduces body weight, improves cardiovascular disease surrogates, and prevents cardiovascular disease, diabetes, and obesity. However, the mechanisms by which MD benefits cardiovascular health are not fully understood. MD is associated with characteristic changes in the intestinal microbiota, including increased growth of species producing short-chain fatty acids (SCFAs) and Bifidobacteria, Bacteroides, and Faecalibacterium prausnitzii, and reduced growth of Firmicutes and Blautia species. These changes are favorable for inflammation, oxidative status, and metabolic health. The MD promotes heart health through its effects on gut microbiota, which are mediated by its components such as extra-virgin olive oil, legumes, cereals, nuts, fruits, vegetables, dairy products, and fish. These components have anti-inflammatory, antioxidant, and cardioprotective properties. The MD is also associated with a lower risk of cardiovascular disease, with studies showing that adherence to the MD is linked to lower cardiovascular disease incidence and mortality. The MD's beneficial effects on cardiovascular health are mediated by its impact on the gut microbiota, which produces SCFAs and other metabolites that improve host metabolism and reduce inflammation. The MD is associated with a more diverse gut microbiota, with increased abundance of Bacteroidetes and decreased abundance of Firmicutes. The MD is also associated with lower levels of inflammatory markers and higher levels of beneficial metabolites. The MD's effects on the gut microbiota are influenced by its components, such as fiber, polyphenols, and other nutrients. The MD is associated with a lower risk of cardiovascular disease, with studies showing that adherence to the MD is linked to lower cardiovascular disease incidence and mortality. The MD's beneficial effects on cardiovascular health are mediated by its impact on the gut microbiota, which produces SCFAs and other metabolites that improve host metabolism and reduce inflammation. The MD is associated with a more diverse gut microbiota, with increased abundance of Bacteroidetes and decreased abundance of Firmicutes. The MD is also associated with lower levels of inflammatory markers and higher levels of beneficial metabolites. The MD's effects on the gut microbiota are influenced by its components, such as fiber, polyphenols, and other nutrients. The MD is associated with a lower risk of cardiovascular disease, with studies showing that adherence to the MD is linked to lower cardiovascular disease incidence and mortality.