Although these data are provocative, the Mediterranean diet has not been widely implemented or incorporated into the metabolic syndrome guidelines and needs to be further studied in the HF population. Diet in Patients With Established HF Among Women s Health Initiative participants, higher DASH diet scores were associated with modestly lower mortality rates in women with HF.325 Similarly, there was a trend toward an inverse association between Mediter- ranean diet scores and lower mortality rates among women with HF.325 In a cross-sectional study of 372 con- secutive patients with HF, the Mediterranean diet was as- sociated with beneficial effects on biventricular systolic and diastolic function.326 These data provide support for the concept that di- etary recommendations developed for other cardiovas- cular conditions or general populations may also be ap- propriate in patients with HF. Similarly, in patients with HFpEF with treated hyperten- sion, the sodium-restricted DASH diet has been shown to reduce systemic BP, arterial stiffness, and oxidative and to improve diastolic function, arterial elas- tance, and ventricular-arterial coupling.328 Data on the role of the Mediterranean diet in patients with HF are very limited. Among postmenopausal women enrolled in the Women s Health Initiative trial, there was a nonsignificant trend toward an inverse association be- tween Mediterranean diet scores and mortality in women It should be noted that the major and distinc- tive components of the Mediterranean diet may not have been captured by the food frequency questionnaire used in this study and may have contributed to these nonsig- It is also interesting to note that the DASH-type diet is similar to the Mediterranean diet in its components. 