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

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
• guidelines
• nutrition
• disparities
• gut microbiome

Abbreviations

ACC, American College of Cardiology; AHA, American Heart Association; ADP, Alternate Day Fasting; BMI, Body Mass Index; CVD, Cardiovascular Disease; DASH, Dietary Approaches to Stop Hypertension; HDL-C, High Density Lipoprotein Cholesterol; IF, Intermittent Fasting; LDL-C, Low Density Lipoprotein Cholesterol; MI, Myocardial Infarction; RCT, Randomized Controlled Trial; T2D, Type 2 Diabetes; TRE, Time Restricted Eating; TMAO, Trimethylamine-N-oxide; US, United States; VLC, Very Low Carbohydrate.

Disclosure

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.

Additional information

Funding

Dr. Michos is funded by the Amato Fund for Women’s Cardiovascular Health at Johns Hopkins University and by an American Heart Association Award, Number: 946222. Dr. Gulati is funded by the Anita Dann Friedman Chair in Women’s Cardiovascular Medicine and Research, and by the Department of Defense (Award Number: W81XWH-17-2-0030).