Yearly attained adherence to Mediterranean diet, estimated trajectories of lipid profile from 55 to 80 years, and onset of clinical dyslipidemias in adults and older adults

Abstract Background The Mediterranean diet (MedDiet) is linked to cardioprotection and short-term improvements in triglycerides, high-density lipoprotein cholesterol (HDL-C), and the ratio low-density lipoprotein cholesterol (LDL-C)/HDL-C. However, whether these benefits persist over long periods (particularly in older adults, whose lipid profiles naturally worsen with age) remains uncertain. It is also unclear whether sustained adherence to the MedDiet can help prevent clinically relevant dyslipidemias that may trigger pharmacological treatment. Because dietary adherence fluctuates over time, studying repeated measures of MedDiet adherence offers a more realistic understanding of its long-term associations with lipid metabolism. Purpose We investigated the association between yearly attained adherence to a MedDiet and trajectories of triglycerides, HDL-C, and the LDL-C/HDL-C ratio, as well as the risk of clinically relevant dyslipidemias, in adults aged 55-80 at high cardiovascular risk. Methods In 6,690 participants (67.0 ± 6.2 years, 58% women) from the Prevención con Dieta Mediterránea trial, we compared trajectories of triglycerides, HDL-C, and LDL-C/HDL-C between participants with high or low cumulative adherence to the MedDiet (≥10 vs. 10 points) over time using mixed-effects regression with multivariate smoothed cubic splines. We examined the association between high MedDiet adherence and the risk of five dyslipidemias (triglycerides ≥150 or ≥200 mg/dL; low HDL-C; LDL-C ≥130 or ≥160 mg/dL) using multivariable Cox regressions. Results Compared to low adherence to the MedDiet, high adherence was associated with lower triglycerides (differences in the range: -10 to -13 mg/dL), particularly among individuals with high (≥150 mg/dL) baseline triglycerides (-10 to -19 mg/dL) or among those using triglyceride-lowering medications (-21 to -31 mg/dL). MedDiet was also associated with higher HDL-C (+1 to +2 mg/dL) and lower LDL-C/HDL-C ratio. High adherence to the MedDiet was associated with a lower risk of all dyslipidemias (range: -23% to -48%). One-point adherence increases were associated with a 50-85% lower dyslipidemia risk among individuals with particularly low adherence (8 points). Conclusion In adults aged 55-80 at high cardiovascular risk, greater long-term adherence to a MedDiet was associated with a better lipid profile and a lower risk of clinically relevant dyslipidemias.