Mediterranean Dietary Pattern Adherence, High-Sensitivity C-Reactive Protein, and Incident Cardiovascular Events: A 7-Year Prospective Cohort Study

This study investigates longitudinal association between Mediterranean dietary pattern adherence score, high-sensitivity C-reactive protein trajectory, and incident major adverse cardiovascular events over 7 years within the context of nutritional epidemiology and preventive cardiology, an area of growing scientific importance given its implications for dietary counseling protocols in cardiovascular primary prevention and anti-inflammatory dietary recommendation development. Using validated 137-item food frequency questionnaire with Mediterranean Diet Score computation, annual hs-CRP measurement, and incident MACE adjudication by blinded cardiologist committee, we examine Mediterranean diet anti-inflammatory olive oil polyphenols, omega-3 fatty acids, and dietary fiber reducing systemic inflammation measured by hs-CRP and downstream atherosclerotic plaque formation in 6,842 adults (mean age 58.4 years, 52% female) from 8 U.S. health systems followed 2015-2022 with annual visits drawn from 8 U.S. academic medical center outpatient primary care and cardiology clinics. Results indicate that highest MDS tertile (score >=12) is associated with 34% lower MACE hazard (HR 0.66, 95% CI 0.54-0.80) versus lowest tertile, with hs-CRP reduction mediating 42% of the protective effect (p < 0.001), with 34% lower MACE hazard, 42% mediated through hs-CRP reduction as the primary quantitative benchmark. Concordance between primary and confirmatory measurement approaches exceeded 93%, validating the analytical framework. These findings contribute empirically to nutritional epidemiology and preventive cardiology and carry actionable implications for the design of programs and policies targeting dietary counseling protocols in cardiovascular primary prevention and anti-inflammatory dietary recommendation development.