A five-year analysis of 240 coronary heart disease patients revealed that Mediterranean diet consumption significantly increased expression of miR-1 and miR-145 in younger participants (under 56), while older patients (over 66) showed no such response. These microRNAs target inflammation-related genes including CCL2 and SMAD3, suggesting enhanced cardiovascular protection through reduced inflammatory pathways. The age-dependent response represents a critical finding that challenges the assumption of universal dietary benefits. This differential response likely reflects age-related changes in cellular plasticity and gene regulation machinery. For clinical practice, the results suggest personalized nutrition approaches may be necessary, with Mediterranean dietary patterns potentially offering greater cardiovascular protection for middle-aged adults with existing heart disease. However, the study's limitation to patients with established coronary disease raises questions about applicability to healthy populations. The five-year timeframe provides meaningful insight into sustained dietary effects, though longer follow-up would strengthen conclusions about cardiovascular outcomes. This work advances precision nutrition by identifying age as a key modifier of diet-gene interactions in cardiovascular health.