Esposito et al. (100) explored possible mechanisms underlying a dietary intervention and randomized 180 patients (99 men, 81 women) with the metabolic syndrome to a Mediterranean-style diet (instructions about increasing daily consumption of whole grains, vegetables, fruits, nuts, and olive oil) versus a cardiac-prudent diet with fat intake less than 30%. After 2 years, body weight decreased more in the intervention group than in the control group, but even after controlling for weight loss, inflammatory markers, such as IL-6, IL-7, IL-18, and CRP, and insulin resistance declined more in the intervention than in the control group, and endothelial function improved. Only 40 patients in the intervention group still had metabolic syndrome after 2 years compared with 78 patients on the control diet; thus, the prevalence of the metabolic syndrome was reduced approximately by one-half (Figure 3). Because a similar decrease in the prevalence of the metabolic syndrome has been obtained with rimonabant, a cannabinoid receptor blocker, in a group of obese patients after 1 year of treatment, with a 30% rate of discontinuation for side effects (101- 102), the whole diet approach seems particularly intriguing and promising to reduce the cardiovascular burden associated with the metabolic syndrome.