Plaque stability and the southern European paradox

Rev Esp Cardiol (Engl Ed). 2013 Jan;66(1):56-62. doi: 10.1016/j.recesp.2012.07.014. Epub 2012 Oct 15.
[Article in English, Spanish]


Differences between European countries in coronary heart disease mortality were initially described in the 20th century, and albeit less dramatic than first reported, these differences remain substantial. Three main hypotheses have been proposed to explain the so-called "Mediterranean paradox": a) underestimation of coronary heart disease mortality due to methodological flaws; b) the "lag time" hypothesis, and c) the traditional Mediterranean diet and lifestyle. In this manuscript we present and discuss another possible explanation for the Mediterranean paradox related to the higher prevalence and and incidence of stable atheromatous plaques in this area.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Coronary Disease / mortality*
  • Coronary Disease / pathology
  • Diet, Mediterranean
  • Europe / epidemiology
  • Female
  • Humans
  • Life Style
  • Lipid Metabolism
  • Male
  • Mediterranean Region / epidemiology
  • Middle Aged
  • Plaque, Atherosclerotic / metabolism
  • Plaque, Atherosclerotic / mortality*
  • Plaque, Atherosclerotic / pathology