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The objective of this manuscript was to review the evidence on the association between adherence to a Mediterranean diet (MeDiet) and the risk of cardiovascular disease (CVD). We also updated the results of the last available meta-analysis.In 2013, a landmark study in the field, the PREvención con DIeta MEDiterránea randomized trial, with 7447 high-risk participants, published its final results. They provided a strong support to the beneficial role of a traditional MeDiet for primary cardiovascular prevention. When these results were combined with those of the Lyon Diet Heart Study (a secondary prevention trial), we found that an intervention with a MeDiet was associated with a 38% relative reduction in the risk of CVD clinical events (pooled random-effects risk ratio: 0.62; 95% confidence interval, CI: 0.45–0.85). Regarding observational studies assessing clinical end-points as outcome, we identified seven new cohort studies published after the last meta-analysis. After removing studies that only assessed fatal outcomes, a two-point increase in adherence to the MeDiet (0–9 score) was associated with a significant reduction in cardiovascular events (pooled risk ratio: 0.87; 95% CI: 0.85–0.90) with no evidence of heterogeneity.Consistent evidence suggests that the promotion of the Mediterranean dietary pattern is an effective and feasible tool for the prevention of CVD.