A Clinician's Guide to Healthy Eating for Cardiovascular Disease Prevention

Abstract

Despite continued advances in health care, the cardiovascular disease (CVD) mortality rate has plateaued in recent years and appears to be trending upward. Poor diet is a leading cause of obesity and type 2 diabetes mellitus, which are leading contributors to CVD morbidity and mortality. Although dietary modification is a cornerstone of CVD prevention, implementation in clinical practice is limited by inadequate formal training in nutrition science. In this report, we review the individual components of a heart-healthy diet, evidence-based dietary recommendations, and the impact of diet on CVD risk factor prevention and management. Furthermore, we examine the unique difficulties of dietary counseling in low-socioeconomic-status environments and provide an evidence-based approach to better serve these populations. We utilized PubMed searches in adults with no date restriction with the following search terms: "carbohydrate," "fat," protein," "DASH," "Mediterranean," "plant-based," "vegetarian," "cardiovascular disease," "obesity," "weight loss," "diabetes," "socioeconomic status," and "race." In this review, we demonstrate that patients should focus on implementing a general diet plan that is high in fruits, whole grains, legumes, and nonstarchy vegetables while low in trans-fats, saturated fats, sodium, red meat, refined carbohydrates, and sugar-sweetened beverages. The Dietary Approaches to Stop Hypertension, Mediterranean, and vegetarian diets have the most evidence for CVD prevention. Clinicians should understand the barriers that patients may face in terms of access to healthy dietary choices. Further research is needed to determine the dietary changes that are most economically, socioculturally, and logistically feasible to reduce these barriers. Improvement in diet is a public health priority that can lead to a significant population-level reduction in CVD morbidity and mortality. It is imperative that clinicians understand current dietary practice guidelines and implement evidence-based dietary counseling in those at high risk for CVD.

Keywords: ACC, American College of Cardiology; AHA, American Heart Association; CHD, coronary heart disease; CVD, cardiovascular disease; DASH, Dietary Approaches to Stop Hypertension; HDL-C, high-density lipoprotein cholesterol; LCHF, low-carbohydrate high-protein/fat; LDL-C, low-density lipoprotein cholesterol; MI, myocardial infarction; PURE, Prospective Urban Rural Epidemiology; RCT, randomized control trial; SBP, systolic blood pressure; SES, socioeconomic status; SSB, sugar-sweetened beverage; USDA, US Department of Agriculture.

Figure 1

Impact of dietary intervention on cardiovascular health classified by evidence to support benefit or harm. ^aSafe alcohol consumption depends on quantity consumed, timing (such as with driving or sleep), sex, medical history, and the effect of alcohol on the person's overall health and life. CVD, cardiovascular disease; DASH, Dietary Approaches to Stop Hypertension.

Figure 2

The “US Department of Agriculture (USDA) MyPlate” visual guide to a healthy diet.