Project results: The impact of Mediterranean diet on coronary atherosclerosis

Coronary atherosclerosis is a leading cause of mortality and disability worldwide. Continuous efforts are needed to improve secondary prevention and understand the mechanism underlying disease progression. Based on primary prevention trials, a potential benefit of the Mediterranean diet after an Acute Coronary Syndrome (ACS) can be anticipated. However, the integrated microbiome-mediated/immunologic and metabolic pathways by which the Mediterranean diet modifies coronary atherosclerosis risk remain mostly unknown.

The project MEDIMACS over the past 4 years

Over the past 4 years (2018 – 2022) the project MEDIMACS (Impact of MEditerranean Diet, Inflammation and Microbiome on plaque vulnerability and microvascular dysfunction after an Acute Coronary Syndrome) studied the immunological, microbiotic and metabolomic mechanisms by which the Mediterranean diet impacts the progression of coronary atherothrombosis in patients after ACS. The consortium researchers collaborating in this project were from Spain, France, Israel and Sweden. The project was cofunded by the European Commission within the HDHL-INTIMIC cofunded call.


The two main aims of the MEDIMACS consortium during the runtime of the project were:

  • Evaluate the effects of a well-controlled Mediterranean diet intervention on atherosclerotic plaque vulnerability and coronary endothelial dysfunction after an episode of ACS.

  • Decipher the interplays among diet, microbiota, immunity and metabolism responsible for the observed effects.


In the MEDIMACS project, an in-depth analysis was conducted to examine the mechanisms and pathways through which the Mediterranean diet provides benefits to patients with symptomatic atherosclerosis. Diabetic patients after ACS were included in the MEDIMACS intervention trial, to study the impact of the Mediterranean diet on the progression of coronary atherosclerosis. The trial focussed on diabetic patients because these patients show a particularly high prevalence of atherosclerosis. The study found that following a well-controlled Mediterranean diet has a positive impact on anthropometric and biochemical parameters that are closely associated with cardiovascular health. Additionally, the Mediterranean diet was found to have a positive effect on the oral and gut microbiota, as well as on the immune adaptive response at the cellular and cytokine level, and on the metabolite profiles.

The results from the MEDIMACS study, that may explain, at least in part, the positive impact of Mediterranean diet on disease progression, could open novel clinical approaches for improving the treatment after ACS. New interventions based on diet and maintenance of the optimal microbiome status could shift in how patients are treated and lead to a possible reduction of the overall healthcare costs. 

In total, 11 projects were funded within the HDHL-INTIMIC cofunded call. The results of all 11 projects have been published on our website. See ‘more information’ below for already published project results.