Exploring the therapeutic potential of bioactive compounds from selected plant extracts of Mediterranean diet constituents for cardiovascular diseases: A review of mechanisms of action, clinical evidence, and adverse effects

Cardiovascular diseases are the leading cause of global mortality, accounting for 32% of deaths in 2019. Plant-based extracts, rich in bioactive compounds, have significantly contributed to modern medicine, offering therapeutic potential for various diseases. However, their use is limited by possible side effects, drug interactions, and a lack of comprehensive preclinical and clinical studies. This review aims to provide an overview of the mechanisms of action, clinical evidence, and adverse effects of key bioactive compounds derived from select Mediterranean plants, integral to the Mediterranean diet: Allium sativum (diallyl trisulfide, allicin, and S-allyl [cysteine]), Crataegus monogyna (quercetin, apigenin, and chlorogenic acid), Crocus sativus (crocin and safranal), Olea europaea (oleic acid, oleuropein, hydroxytyrosol, oleocanthal, and oleacein), Salvia rosmarinus (rosmarinic acid, carnosol and carnosic acid), and Vitis vinifera (resveratrol). The review will focus on mechanisms such as antioxidant, anti-inflammatory, and vasodilatory effects, as well as the regulation of lipid metabolism, which may be relevant to conditions like atherosclerosis and hypertension. In addition to summarizing current scientific evidence, this study aims to guide future research by identifying knowledge gaps and offering recommendations for designing preclinical and clinical studies. Key areas for future exploration include the long-term safety of these compounds, the evaluation of their synergistic effects when consumed as part of the Mediterranean diet, and the need for standardized protocols in clinical settings. By expanding the scientific foundation for these traditional remedies, this review may help pave the way for their use in the development of future phytomedicines.