Mediterranean diet adherence and chronotropic response in patients undergoing exercise testing

Abstract

Introduction: Adherence to the Mediterranean diet has been associated with favorable cardiovascular and metabolic outcomes. However, its relationship with chronotropic response during exercise testing remains insufficiently explored. This study aimed to evaluate the association between Mediterranean Diet Adherence Score (MEDAS) and exercise test parameters, particularly chronotropic response, in patients undergoing exercise testing. Methods: This single-center, prospective observational study included patients referred for exercise testing in a cardiology outpatient clinic. Adherence to the Mediterranean diet was assessed using the MEDAS questionnaire. Exercise test parameters, including exercise duration, peak heart rate, heart rate reserve, chronotropic index, and double product, were recorded using the standard Bruce protocol. Laboratory parameters were obtained from fasting blood samples. Patients were categorized into low and high MEDAS groups based on the median score. Multivariable linear regression analysis was performed to identify determinants of chronotropic index. Results: A total of 312 patients were included. Patients with higher MEDAS scores demonstrated higher chronotropic index and heart rate reserve values compared with those with lower adherence. Fasting glucose, triglyceride levels, and triglyceride–glucose index tended to be lower in the high MEDAS group. MEDAS score showed a weak but significant negative correlation with body mass index. In multivariable analysis, beta-blocker and calcium channel blocker use were the strongest determinants of chronotropic index, while MEDAS score was not independently associated after adjustment. Conclusion: Higher adherence to the Mediterranean diet is associated with favorable trends in chronotropic response and cardiometabolic parameters in patients undergoing exercise testing. MEDAS may serve as a practical complementary tool for lifestyle-based cardiovascular risk assessment.