Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2023 Apr 21:19:237-253.
doi: 10.2147/VHRM.S379874. eCollection 2023.

A Heart-Healthy Diet for Cardiovascular Disease Prevention: Where Are We Now?

Alaa Diab  1   2 , L Nedda Dastmalchi  3 , Martha Gulati  4 , Erin D Michos  1   5
Affiliations
Review

A Heart-Healthy Diet for Cardiovascular Disease Prevention: Where Are We Now?

Alaa Diab et al. Vasc Health Risk Manag. .

Abstract

Purpose of review: The relationship between cardiovascular health and diet is evolving. Lifestyle modifications including diet changes are the primary approach in managing cardiometabolic risk factors. Thus, understanding different diets and their impact on cardiovascular health is important in guiding primary and secondary prevention of cardiovascular disease (CVD). Yet, there are many barriers and limitations to adopting a heart healthy diet.

Recent findings: Diets rich in fruits, vegetables, legumes, whole grains, and lean protein sources, with minimization/avoidance of processed foods, trans-fats, and sugar sweetened beverages, are recommended by prevention guidelines. The Mediterranean, DASH, and plant-based diets have all proven cardioprotective in varying degrees and are endorsed by professional healthcare societies, while other emerging diets such as the ketogenic diet and intermittent fasting require more long-term study. The effects of diet on the gut microbiome and on cardiovascular health have opened a new path for precision medicine to improve cardiometabolic risk factors. The effects of certain dietary metabolites, such as trimethylamine N-oxide, on cardiometabolic risk factors, along with the changes in the gut microbiome diversity and gene pathways in relation to CVD management, are being explored.

Summary: In this review, we provide a comprehensive up-to-date overview on established and emerging diets in cardiovascular health. We discuss the effectiveness of various diets and most importantly the approaches to nutritional counseling where traditional and non-traditional approaches are being practiced, helping patients adopt heart healthy diets. We address the limitations to adopting a heart healthy diet regarding food insecurity, poor access, and socioeconomic burden. Lastly, we discuss the need for a multidisciplinary team-based approach, including the role of a nutrition specialist, in implementing culturally-tailored dietary recommendations. Understanding the limitations and finding ways to overcome the barriers in implementing heart-healthy diets will take us miles in the path to CVD prevention and management.

Keywords: cardiovascular disease; diet; disparities; guidelines; gut microbiome; nutrition.

PubMed Disclaimer

Conflict of interest statement

Unrelated to this work, Dr. Michos has served on advisory boards for Amgen, Amarin, AstraZeneca, Bayer, Boehringer Ingelheim, Esperion, Novartis, Novo Nordisk, and Pfizer. Dr. Gulati has served on advisory boards for Novartis and Bayer. The authors report no other conflicts of interest in this work.

Figures

Figure 1
Figure 1
The Heart Healthy Dietary Patterns: Mediterranean Diet, DASH Diet, and Healthy Plant-Based Diet.
Figure 2
Figure 2
The Heart–Gut axis (the role of the Gut Microbiome in Cardiovascular Health).
Figure 3
Figure 3
Challenges and Opportunities for Implementing a Heart Healthy Diet.
See this image and copyright information in PMC

References

    1. Tsao CW, Aday AW, Almarzooq ZI, et al. Heart disease and stroke statistics-2022 update: a report from the American heart association. Circulation. 2022;145(8):e153–e639. - PubMed
    1. Fischer NM, Pallazola VA, Xun H, Cainzos-Achirica M, Michos ED. The evolution of the heart-healthy diet for vascular health: a walk through time. Vasc Med. 2020;25(2):184–193. - PubMed
    1. Menotti A, Puddu PE. How the Seven Countries Study contributed to the definition and development of the Mediterranean diet concept: a 50-year journey. Nutr Metab Cardiovasc Dis. 2015;25(3):245–252. - PubMed
    1. Delarue J. Mediterranean Diet and cardiovascular health: an historical perspective. Br J Nutr. 2021;1–14. - PubMed
    1. Yusuf S, Hawken S, Ounpuu S, et al. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet. 2004;364(9438):937–952. - PubMed