The common perception that fat and cholesterol are uniformly bad for the cardiovascular system is being questioned by a host of current studies. Elevated cholesterol levels are associated with heart disease in the United States, Finland, the Netherlands, Italy, Greece, Croatia and Serbia (formerly part of Yugoslavia), and Japan. However, in certain countries, they may pose more of a threat than others. For example some studies show that while cholesterol levels of 210 mg/dL correspond to a 5 percent increase in the death rate from heart disease in Japan and Mediterranean Europe (Greece and Italy) it translates to a 10 percent increase in the death rate in central Europe, 12 percent in the United States, and 15 percent in Northern Europe. Men with a cholesterol level generally considered safe (190 mg/dL) are twice as likely to die of heart disease in Northern Europe than in the Mediterranean.

It has become apparent that other aspects of the diet, besides cholesterol, are important for protection from cardiovascular disease. Compared with the Northern European and US diets, the Mediterranean diet contains less meat but more fish, fresh fruits, and fresh vegetables. The fatty acids consumed in Northern Europe and the United States are pre-dominantly saturated but in the Mediterranean predominantly monounsaturated. Intake of the antioxidant vitamins beta-carotene and alpha-tocopherol [vitamin E] is highest in the Mediterranean. Flavonoid intake is twice as high in the Mediterranean as in Northern Europe and the United States, and is highest in Japan. Intake of flavonoids, polyphenolic substances with antioxidant properties, has been shown to protect against CHD.