The interpretations of the findings from these and other observational studies suggest that partial adoption of the Mediterranean diet is associated with reductions in CVD across many populations, in the young and old, and those with and without prevalent disease ages. Since observational studies do not establish a cause and effect relationship, a stronger test of the hypothesis for a relationship between the effects of the Mediterranean diet on CVD risk is in the setting of a clinical trial. Two trials designed to test the effects of variations of the Mediterranean diet on clinical CVD outcomes were the Lyon Diet Heart Study8 and the Indo-Mediterranean Diet Heart Study.25 Both randomized trials were conducted in participants with established CVD.
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