In general, the traditional Mediterranean diet consists of a high intake of monounsaturated fatty acids, primarily from olives and olive oil, and PUFAs, particu- larly -linoleic acid from nuts, as well as increased con- sumption of fruits, vegetables, whole grains, legumes, and fish, along with moderation in alcohol intake and lim- ited red meats (Table 12). Kastorini et al305 performed a meta-analysis demonstrating that the Mediterranean diet exerts favorable effects on the components of the meta- bolic syndrome, namely reducing waist circumference, triglycerides, SBP, diastolic BP, glucose, and insulin re- sistance measured by homeostatic model assessment, and increases high-density lipoprotein levels. Lifestyle Modifications and HF Multifactorial Lifestyle Modification Interventions Does Multifactorial Lifestyle Modification Prevent HF? A healthful lifestyle appears to reduce the risk of devel- oping HF. The Physicians Health Study (1982 2008) demonstrated that participants with the healthiest life- styles had the lowest lifetime risk of developing HF.306 Six healthy lifestyle factors were assessed: BMI <25 kg/ , not smoking, regular exercise 5 times/wk, moder- ate drinking (5 14 times/wk), consumption of breakfast cereal, and consumption of fruits and vegetables ( 4 servings/d). During 22.4 years of follow-up in 20900 men, 1200 (5.7%) developed HF. A higher number of healthy lifestyle characteristics was associated with a lower risk of developing HF. The lifetime risk for HF in those without any of the above healthy lifestyle factors was 21.2% compared with only 10.1% in those with 4 lifestyle factors. There are limited data to determine whether the imple- mentation of lifestyle modification in at-risk patients can translate into a reduced risk of HF. 