The Mediterranean diet decreases prothrombotic microvesicle release in asymptomatic individuals at high cardiovascular risk

Clin Nutr. 2020 Nov;39(11):3377-3384. doi: 10.1016/j.clnu.2020.02.027. Epub 2020 Feb 27.


Background & aims: Circulating microvesicles (cMV) are small phospholipid-rich vesicles that contribute to the atherothrombotic process, and are biomarkers of cardiovascular disease (CVD) burden and progression. Diet is a cornerstone for CVD prevention, but dietary effects on cMV shedding are poorly characterized. We aimed at assessing the long term effects of a Mediterranean diet compared to a low-fat diet (LFD) on MV shedding by cells of the blood and vascular compartments in patients at high cardiovascular risk treated as per guidelines.

Methods: A total of 155 participants from the PREDIMED trial free of cardiovascular events after a mean follow-up of 5 years (n = 53 from the Mediterranean diet supplemented with extra-virgin olive oil -EVOO-; n = 49 from the Mediterranean diet supplemented with mixed nuts -Nuts-; and n = 53 from the LFD) were included in the study. At baseline and after one-year intervention, cMV were quantified and characterized by flow cytometry to identify their activated parental cell origin and prothrombotic potential by Annexin V (AV) binding.

Results: After one year of dietary intervention, platelet-derived PAC-1+/AV+ and CD62P+/AV+ cMV concentrations were lower in the Nuts group compared with the LFD and EVOO interventions (P = 0.036 and 0.003, respectively). In addition, prothrombotic cMV carrying tissue factor (CD142+/AV+) and CD11a+/AV+ cMV derived from activated cells, were significantly lower in both Mediterranean diet (EVOO and Nuts) interventions compared to one year of LFD (P < 0.0001 and 0.028, respectively). SMAα+/AV- cMV were lower in the LFD compared to the Nuts group after one year of intervention (P = 0.038).

Conclusions: cMV are markers of cell activation and vascular injury that appear to be sensitive to dietary changes. Following a Mediterranean diet rich in EVOO or nuts is associated with lower cell activation towards a pro-atherothrombotic phenotype, suggesting a delay in the development of CV complications.

Keywords: Cardiovascular disease; Cell activation; Circulating microvesicles; Leukocytes; Mediterranean diet; Platelets.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Asymptomatic Diseases
  • Atherosclerosis / blood
  • Atherosclerosis / complications
  • Atherosclerosis / diet therapy*
  • Biomarkers / blood
  • Blood Platelets / metabolism
  • Cardiovascular Diseases / etiology
  • Cardiovascular Diseases / prevention & control*
  • Cell-Derived Microparticles*
  • Diet, Fat-Restricted / methods
  • Diet, Mediterranean*
  • Dietary Supplements
  • Female
  • Heart Disease Risk Factors
  • Humans
  • Inflammation Mediators / blood
  • Male
  • Middle Aged
  • Nuts
  • Olive Oil / administration & dosage
  • Thrombosis / blood
  • Thrombosis / complications
  • Thrombosis / diet therapy*


  • Biomarkers
  • Inflammation Mediators
  • Olive Oil