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. 2020 Apr 15;12(4):1088.
doi: 10.3390/nu12041088.

Dietary Factors and Risks of Cardiovascular Diseases: An Umbrella Review

Kridsada Chareonrungrueangchai  1 , Keerati Wongkawinwoot  1 , Thunyarat Anothaisintawee  1   2 , Sirimon Reutrakul  3
Affiliations

Dietary Factors and Risks of Cardiovascular Diseases: An Umbrella Review

Kridsada Chareonrungrueangchai et al. Nutrients. .

Abstract

Unhealthy diet is a significant risk factor for cardiovascular diseases (CVD). Therefore, this umbrella review aims to comprehensively review the effects of dietary factors, including dietary patterns, food groups, and nutrients on CVD risks. Medline and Scopus databases were searched through March 2020. Systematic reviews with meta-analyses (SRMA) of randomized controlled trials (RCTs) or observational studies measuring the effects of dietary factors on CVD risks were eligible. Fifty-four SRMAs, including 35 SRMAs of observational studies, 10 SRMAs of RCTs, and 9 SRMAs of combined RCT and observational studies, were included for review. Findings from the SRMAs of RCTs suggest the significant benefit of Mediterranean and high-quality diets for lowering CVD risk, with pooled risk ratios (RRs) ranging from 0.55 (95%CI: 0.39-0.76) to 0.64 (95%CI: 0.53-0.79) and 0.70 (95%CI: 0.57-0.87), respectively. For food nutrients, two SRMAs of RCTs found that high intake of n-3 polyunsaturated fatty acid (PUFA) significantly reduced CVD risks, with pooled RRs ranging from 0.89 (95%CI: 0.82, 0.98) to 0.90 (95%CI: 0.85-0.96), while evidence of efficacy of n-6 PUFA and combined n-3 and n-6 PUFA were inconsistent. Moreover, results from the SRMAs of RCTs did not find a significant benefit of a low-salt diet and low total fat intake for CVD prevention. For food groups, results from the SRMAs of cohort studies suggest that high intakes of legumes, nuts, and chocolate, as well as a vegetarian diet significantly reduced the risk of coronary heart disease, with pooled RRs of 0.90 (95%CI: 0.84-0.97), 0.68 (95%CI: 0.59-0.78), 0.90 (95%CI: 0.82-0.97), and 0.71 (95%CI: 0.57-0.87), respectively. Healthy dietary patterns had a significant benefit for CVD prevention. With the substitutional and synergistic interactions between different food groups and nutrients, dietary recommendations for CVD prevention should be focused more on healthy dietary patterns than single food groups or nutrients.

Keywords: cardiovascular disease; dietary factor; umbrella review.

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Conflict of interest statement

The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.

Figures

Figure 1
Figure 1
Flow chart of study selection.
Figure 2
Figure 2
Pooled risk ratios of dietary patterns and the risk of all-cause (A) and cardiovascular mortality (B), cardiovascular disease (C), and stroke (D). Results are from systematic reviews and meta-analyses of randomized controlled trials, except for that of the Dietary Approaches to Stop Hypertension (DASH) diet, which is from observational studies. (CVD, cardiovascular diseases)
Figure 3
Figure 3
Pooled risk ratios of food groups and risk of stroke (A), coronary heart disease (B), cardiovascular mortality (C), and all-cause mortality(D). Results are from systematic reviews and meta-analyses of observational studies. (CHD, coronary heart disease)
Figure 4
Figure 4
Pooled risk ratios of food nutrients and risk of all-cause and cardiovascular disease mortality. Results are from systematic reviews and meta-analyses of observational studies for (A) and (C), and systematic reviews and meta-analyses of randomized controlled trials (RCTs) for (B) and (D).
Figure 5
Figure 5
Pooled risk ratios for food nutrients and the risk of stroke and coronary heart disease. Results are from systematic reviews and meta-analyses of observational studies for (A) and (B), and systematic reviews and meta-analyses of RCTs for (C).
See this image and copyright information in PMC

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