Cardiovascular Disease Prevention by Diet Modification: JACC Health Promotion Series

Abstract

Reduction in excess calories and improvement in dietary composition may prevent many primary and secondary cardiovascular events. Current guidelines recommend diets high in fruits, vegetables, whole grains, nuts, and legumes; moderate in low-fat dairy and seafood; and low in processed meats, sugar-sweetened beverages, refined grains, and sodium. Supplementation can be useful for some people but cannot replace a good diet. Factors that influence individuals to consume a low-quality diet are myriad and include lack of knowledge, lack of availability, high cost, time scarcity, social and cultural norms, marketing of poor-quality foods, and palatability. Governments should focus on cardiovascular disease as a global threat and enact policies that will reach all levels of society and create a food environment wherein healthy foods are accessible, affordable, and desirable. Health professionals should be proficient in basic nutritional knowledge to promote a sustainable pattern of healthful eating for cardiovascular disease prevention for both healthy individuals and those at higher risk.

Keywords: diet; epidemiology; health promotion; prevention; risk factors.

Central Illustration:. Flow diagram of the development of cardiovascular disease and possible prevention by a healthy diet.

Avoiding excess calories is an integral part of halting the development of cardiovascular disease risk factors (i.e. primordial prevention). Unfavorable eating patterns are driven by a variety of biological, social, economic, and psychological factors , and a robust intervention from all levels of society may steer populations toward a healthier diet and prevent disease progression. Diet and other lifestyle changes remain crucial steps in primary and secondary prevention of cardiovascular disease, although the relative importance of medication and clinical procedures increases over time with disease progression. Abbreviations: AHEI, Alternative Healthy Food Index; CHD, coronary heart disease; CI, confidence interval; CVD, cardiovascular disease; DASH, Dietary Approaches to Stop Hypertension; MedDiet, Mediterranean Diet; RR, risk ratio; SSB, sugar sweetened beverage.

Figure 1:. Summary of various meta-analyses for the associations of key foods and food groups, and dietary patterns with incident cardiovascular disease.

High amounts of processed meat, SSB, and refined grain consumption are associated with greater CVD incidence; moderate coffee and alcohol intake, and high fruit/vegetable, dairy (low-fat), whole grain, fish, and nut intake are associated with lower incidence. High adherence to Mediterranean, DASH, AHEI, and Prudent dietary patterns are significantly predictive of lower CVD incidence. Abbreviations: AHEI, Alternative Healthy Food Index; CHD, coronary heart disease; CI, confidence interval; CVD, cardiovascular disease; DASH, Dietary Approaches to Stop Hypertension; MedDiet, Mediterranean Diet; RR, risk ratio; SSB, sugar sweetened beverage.