Skip to main content

Advertisement

SpringerLink
Log in

An Update on Nutrition Guidance for Cardiovascular Health

  • Published:
Current Atherosclerosis Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

The goal of this article is to summarize recent guidance on diet and cardiovascular health.

Recent Findings

Cardiovascular diseases are the leading cause of death in the USA, and diet significantly impacts cardiovascular disease risk. The focus of contemporary dietary recommendations has shifted from single nutrient replacements to dietary patterns such as the Mediterranean, healthy USA, Dietary Approaches to Stop Hypertension, and healthy plant-based patterns.

Summary

Recommended dietary patterns emphasize whole grains, fruits, vegetables, nuts, seeds, legumes/pulses, seafood, lean meats, and fish/seafood. They also limit intakes of ultra-processed foods, processed meats, and alcohol, as well as foods high in salt and added sugars, particularly sugar-sweetened beverages.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. World Health Organization: Cardiovascular Diseases. https://www.who.int/health-topics/cardiovascular-diseases#tab=tab_1 Accessed 03/08/2023 2023.

  2. Centers for Disease Control and Prevention: Heart Disease Facts. 2022. https://www.cdc.gov/heartdisease/facts.htm. Accessed 03/08/2023 2023.

  3. Schwingshackl L, Bogensberger B, Hoffmann G. Diet quality as assessed by the healthy eating index, alternate healthy eating index, dietary approaches to stop hypertension score, and health outcomes: an updated systematic review and meta-analysis of cohort studies. J Acad Nutr Dietetics. 2018;118(1):74-100. e11.

    Article  Google Scholar 

  4. Petersen KS, Kris-Etherton PM. Diet quality assessment and the relationship between diet quality and cardiovascular disease risk. Nutrients. 2021;13(12):4305.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Estruch R, Ros E, Salas-Salvadó J, Covas M-I, Corella D, Arós F, et al. Primary prevention of cardiovascular disease with a Mediterranean diet supplemented with extra-virgin olive oil or nuts. NEJM. 2018;378(25): e34.

    Article  CAS  PubMed  Google Scholar 

  6. Delgado-Lista J, Alcala-Diaz JF, Torres-Peña JD, Quintana-Navarro GM, Fuentes F, Garcia-Rios A, et al. Long-term secondary prevention of cardiovascular disease with a Mediterranean diet and a low-fat diet (CORDIOPREV): a randomised controlled trial. Lancet. 2022;399(10338):1876–85.

    Article  CAS  PubMed  Google Scholar 

  7. Estruch R, Martínez-González MA, Corella D, Salas-Salvadó J, Ruiz-Gutiérrez V, Covas MI, et al. Effects of a Mediterranean-style diet on cardiovascular risk factors: a randomized trial. Ann Intern Med. 2006;145(1):1–11. https://doi.org/10.7326/0003-4819-145-1-200607040-00004.

    Article  PubMed  Google Scholar 

  8. Das D, Adhikary S, Das RK, Banerjee A, Radhakrishnan AK, Paul S, et al. Bioactive food components and their inhibitory actions in multiple platelet pathways. J Food Biochem. 2022;46(12):e14476. https://doi.org/10.1111/jfbc.14476.

    Article  CAS  PubMed  Google Scholar 

  9. Ferguson JF, Allayee H, Gerszten RE, Ideraabdullah F, Kris-Etherton PM, Ordovás JM, et al. Nutrigenomics, the microbiome, and gene-environment interactions: new directions in cardiovascular disease research, prevention, and treatment: a scientific statement from the American Heart Association. Circulation: Cardiovasc Genet. 2016;9(3):291–313.

    CAS  Google Scholar 

  10. Dietary Guidelines Advisory Committee. Scientific Report of the 2020 Dietary Guidelines Advirosry Committee: Advisory Report to the Secretary of Agriculture and the Secretary of Health and Human Services. U.S. Department of Agriculture, Agricultural Research Service, Washington, DC; 2020.

  11. Kirkpatrick CF, Maki KC. Dietary influences on atherosclerotic cardiovascular disease risk. Curr Atheroscler Rep. 2021;23:1–9.

    Article  Google Scholar 

  12. U.S. Department of Agriculture and U.S. Department of Health and Human Services. Dietary Guidelines for Americans, 2020–2025, 9th edn. 2020. Available at DietaryGuidelines.gov.

  13. Gardner CD, Vadiveloo MK, Petersen KS, Anderson CAM, Springfield S, Van Horn L, et al. Popular dietary patterns: alignment with American Heart Association 2021 dietary guidance: a scientific statement from the American Heart Association. Circulation. 2023;147(22):1715–30. https://doi.org/10.1161/CIR.0000000000001146.

    Article  PubMed  Google Scholar 

  14. •• Cara KC, Goldman DM, Kollman BK, Amato SS, Tull MD, Karlsen MC. Commonalities among dietary recommendations from 2010 to 2021 clinical practice guidelines: a meta-epidemiological study from the American College of Lifestyle Medicine. Adv Nutr. 2023. https://doi.org/10.1016/j.advnut.2023.03.007. This systematic review identified commanalities between nutrition recommendations from governments, professional societies, and large health stakeholder associations.

  15. Visseren FL, Mach F, Smulders YM, Carballo D, Koskinas KC, Bäck M, et al. 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice: developed by the Task Force for cardiovascular disease prevention in clinical practice with representatives of the European Society of Cardiology and 12 medical societies with the special contribution of the European Association of Preventive Cardiology (EAPC). Eur Heart J. 2021;42(34):3227–337.

    Article  PubMed  Google Scholar 

  16. • Lichtenstein AH, Appel LJ, Vadiveloo M, Hu FB, Kris-Etherton PM, Rebholz CM, et al. 2021 dietary guidance to improve cardiovascular health: a scientific statement from the American Heart Association. Circulation. 2021;144(23):e472–87. This is the 2021 guidelines on improving cardiovascular health frm the American Heart Association.

    Article  PubMed  Google Scholar 

  17. Maki KC, Dicklin MR. Is there an optimal diet for primordial prevention of atherosclerosis? Eur Heart J. 2022;43(34):3189–91.

    Article  PubMed  Google Scholar 

  18. •• Kirkpatrick CF, Sikand G, Petersen KS, Anderson CAM, Aspry KE, Bolick JP, et al. Nutrition interventions for adults with dyslipidemia: a clinical perspective from the National Lipid Association. J Clin Lipidol. 2023. https://doi.org/10.1016/j.jacl.2023.05.099. This recent clinical perspective from the National Lipid Association provides an update on the recommendations for lifestyle therapies to manage dyslipidemias in adults.

    Article  PubMed  Google Scholar 

  19. Hemler EC, Hu FB. Plant-based diets for cardiovascular disease prevention: all plant foods are not created equal. Curr Atheroscler Rep. 2019;21:1–8.

    Article  Google Scholar 

  20. Melina V, Craig W, Levin S. Position of the Academy of Nutrition and Dietetics: vegetarian diets. J Acad Nutr Diet. 2016;116(12):1970–80.

    Article  PubMed  Google Scholar 

  21. Gan ZH, Cheong HC, Tu Y-K, Kuo P-H. Association between plant-based dietary patterns and risk of cardiovascular disease: a systematic review and meta-analysis of prospective cohort studies. Nutrients. 2021;13(11):3952.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Kim H, Caulfield LE, Garcia-Larsen V, Steffen LM, Coresh J, Rebholz CM. Plant-based diets are associated with a lower risk of incident cardiovascular disease, cardiovascular disease mortality, and all-cause mortality in a general population of middle-aged adults. J Am Heart Assoc. 2019;8(16): e012865.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Glenn AJ, Lo K, Jenkins DJ, Boucher BA, Hanley AJ, Kendall CW, et al. Relationship between a plant-based dietary portfolio and risk of cardiovascular disease: findings from the Women’s Health Initiative prospective cohort study. J Am Heart Assoc. 2021;10(16): e021515.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Gibbs J, Gaskin E, Ji C, Miller MA, Cappuccio FP. The effect of plant-based dietary patterns on blood pressure: a systematic review and meta-analysis of controlled intervention trials. J Hypertens. 2021;39(1):23–37. https://doi.org/10.1097/hjh.0000000000002604.

    Article  CAS  PubMed  Google Scholar 

  25. Liang S, Mijatovic J, Li A, Koemel N, Nasir R, Toniutti C, et al. Dietary patterns and non-communicable disease biomarkers: a network meta-analysis and nutritional geometry approach. Nutrients. 2022;15(1). https://doi.org/10.3390/nu15010076.

  26. Schwingshackl L, Chaimani A, Hoffmann G, Schwedhelm C, Boeing H. A network meta-analysis on the comparative efficacy of different dietary approaches on glycaemic control in patients with type 2 diabetes mellitus. Eur J Epidemiol. 2018;33(2):157–70. https://doi.org/10.1007/s10654-017-0352-x.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Partula V, Deschasaux M, Druesne-Pecollo N, Latino-Martel P, Desmetz E, Chazelas E, et al. Associations between consumption of dietary fibers and the risk of cardiovascular diseases, cancers, type 2 diabetes, and mortality in the prospective NutriNet-Santé cohort. AJCN. 2020;112(1):195–207.

    Google Scholar 

  28. Reynolds A, Mann J, Cummings J, Winter N, Mete E, Te Morenga L. Carbohydrate quality and human health: a series of systematic reviews and meta-analyses. Lancet (London, England). 2019;393(10170):434–45. https://doi.org/10.1016/s0140-6736(18)31809-9.

    Article  CAS  PubMed  Google Scholar 

  29. Sacks FM, Lichtenstein AH, Wu JH, Appel LJ, Creager MA, Kris-Etherton PM, et al. Dietary fats and cardiovascular disease: a presidential advisory from the American Heart Association. Circulation. 2017;136(3):e1–23.

    Article  PubMed  Google Scholar 

  30. Casas R, Castro-Barquero S, Estruch R, Sacanella E. Nutrition and cardiovascular health. Int J Mol Sci. 2018;19(12):3988.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Jayedi A, Shab-Bidar S. Fish consumption and the risk of chronic disease: an umbrella review of meta-analyses of prospective cohort studies. Adv Nutr (Bethesda, Md). 2020;11(5):1123–33. https://doi.org/10.1093/advances/nmaa029.

    Article  Google Scholar 

  32. Zhang B, Xiong K, Cai J, Ma A. Fish consumption and coronary heart disease: a meta-analysis. Nutrients. 2020;12(8). https://doi.org/10.3390/nu12082278.

  33. Jiang L, Wang J, Xiong K, Xu L, Zhang B, Ma A. Intake of fish and marine n-3 polyunsaturated fatty acids and risk of cardiovascular disease mortality: a meta-analysis of prospective cohort studies. Nutrients. 2021;13(7). https://doi.org/10.3390/nu13072342.

  34. Becerra-Tomás N, Paz-Graniel I, Kendall CWC, Kahleova H, Rahelić D, Sievenpiper JL, et al. Nut consumption and incidence of cardiovascular diseases and cardiovascular disease mortality: a meta-analysis of prospective cohort studies. Nutr Rev. 2019;77(10):691–709. https://doi.org/10.1093/nutrit/nuz042.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Maki KC, Dicklin MR, Kirkpatrick CF. Saturated fats and cardiovascular health: current evidence and controversies. J Clin Lipidol. 2021;15(6):765–72.

    Article  PubMed  Google Scholar 

  36. Kris-Etherton PM, Krauss RM. Public health guidelines should recommend reducing saturated fat consumption as much as possible: YES. Am J Clin Nutr. 2020;112(1):13–8.

    Article  PubMed  Google Scholar 

  37. Mensink RP. Effects of saturated fatty acids on serum lipids and lipoproteins: a systematic review and regression analysis. Geneva: World Health Organization; 2016.

  38. Baigent C, Blackwell L, Emberson J, Holland LE, Reith C, Bhala N, et al. Efficacy and safety of more intensive lowering of LDL cholesterol: a meta-analysis of data from 170,000 participants in 26 randomised trials. Lancet (London, England). 2010;376(9753):1670–81. https://doi.org/10.1016/s0140-6736(10)61350-5.

    Article  CAS  PubMed  Google Scholar 

  39. Ference BA, Ginsberg HN, Graham I, Ray KK, Packard CJ, Bruckert E, et al. Low-density lipoproteins cause atherosclerotic cardiovascular disease. 1. Evidence from genetic, epidemiologic, and clinical studies. A consensus statement from the European Atherosclerosis Society Consensus Panel. Eur Heart J. 2017;38(32):2459–72.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. Li Y, Hruby A, Bernstein AM, Ley SH, Wang DD, Chiuve SE, et al. Saturated fats compared with unsaturated fats and sources of carbohydrates in relation to risk of coronary heart disease: a prospective cohort study. J Am Coll Cardiol. 2015;66(14):1538–48.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  41. Grillo A, Salvi L, Coruzzi P, Salvi P, Parati G. Sodium intake and hypertension. Nutrients. 2019. https://doi.org/10.3390/nu11091970.

    Article  PubMed  PubMed Central  Google Scholar 

  42. He FJ, Tan M, Ma Y, MacGregor GA. Salt reduction to prevent hypertension and cardiovascular disease: JACC state-of-the-art review. J Am Coll Cardiol. 2020;75(6):632–47.

    Article  CAS  PubMed  Google Scholar 

  43. Filippini T, Malavolti M, Whelton PK, Naska A, Orsini N, Vinceti M. Blood pressure effects of sodium reduction: dose–response meta-analysis of experimental studies. Circulation. 2021;143(16):1542–67.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  44. Sacks FM, Svetkey LP, Vollmer WM, Appel LJ, Bray GA, Harsha D, et al. Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet. DASH-Sodium Collaborative Research Group. N Engl J Med. 2001;344(1):3–10. https://doi.org/10.1056/nejm200101043440101.

    Article  CAS  PubMed  Google Scholar 

  45. Food and Drug Administration: Sodium Reduction. 2023. https://www.fda.gov/food/food-additives-petitions/sodium-reduction. Accessed 06/19/2023.

  46. Zhong VW, Van Horn L, Greenland P, Carnethon MR, Ning H, Wilkins JT, et al. Associations of processed meat, unprocessed red meat, poultry, or fish intake with incident cardiovascular disease and all-cause mortality. JAMA Intern Med. 2020;180(4):503–12.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  47. Iqbal R, Dehghan M, Mente A, Rangarajan S, Wielgosz A, Avezum A, et al. Associations of unprocessed and processed meat intake with mortality and cardiovascular disease in 21 countries [Prospective Urban Rural Epidemiology (PURE) Study]: a prospective cohort study. Am J Clin Nutr. 2021;114(3):1049–58. https://doi.org/10.1093/ajcn/nqaa448.

    Article  PubMed  Google Scholar 

  48. Monteiro CA, Cannon G, Moubarac JC, Levy RB, Louzada MLC, Jaime PC. The UN Decade of Nutrition, the NOVA food classification and the trouble with ultra-processing. Public Health Nutr. 2018;21(1):5–17. https://doi.org/10.1017/s1368980017000234.

    Article  PubMed  Google Scholar 

  49. Juul F, Parekh N, Martinez-Steele E, Monteiro CA, Chang VW. Ultra-processed food consumption among US adults from 2001 to 2018. Am J Clin Nutr. 2022;115(1):211–21. https://doi.org/10.1093/ajcn/nqab305.

    Article  PubMed  Google Scholar 

  50. Srour B, Fezeu LK, Kesse-Guyot E, Allès B, Méjean C, Andrianasolo RM, et al. Ultra-processed food intake and risk of cardiovascular disease: prospective cohort study (NutriNet-Santé). BMJ (Clinical research ed). 2019;365:l1451. https://doi.org/10.1136/bmj.l1451.

    Article  PubMed  PubMed Central  Google Scholar 

  51. Hall KD, Ayuketah A, Brychta R, Cai H, Cassimatis T, Chen KY, et al. Ultra-processed diets cause excess calorie intake and weight gain: an inpatient randomized controlled trial of ad libitum food intake. Cell Metab. 2019;30(1):67-77.e3. https://doi.org/10.1016/j.cmet.2019.05.008.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  52. Crimarco A, Landry MJ, Gardner CD. Ultra-processed foods, weight gain, and co-morbidity risk. Curr Obes Rep. 2022;11(3):80–92. https://doi.org/10.1007/s13679-021-00460-y.

    Article  PubMed  Google Scholar 

  53. Monteiro CA, Astrup A, Ludwig DS. Does the concept of “ultra-processed foods” help inform dietary guidelines, beyond conventional classification systems? YES. Am J Clin Nutr. 2022;116(6):1476–81. https://doi.org/10.1093/ajcn/nqac122.

    Article  PubMed  Google Scholar 

  54. Yang B, Glenn AJ, Liu Q, Madsen T, Allison MA, Shikany JM, et al. Added sugar, sugar-sweetened beverages, and artificially sweetened beverages and risk of cardiovascular disease: findings from the Women's Health Initiative and a network meta-analysis of prospective studies. Nutrients. 2022;14(20). https://doi.org/10.3390/nu14204226.

  55. Roerecke M. Alcohol's impact on the cardiovascular system. Nutrients. 2021;13(10). https://doi.org/10.3390/nu13103419.

  56. World Health Organization. Global status report on alcohol and health 2018. Geneva: World Health Organization; 2018.

  57. Lloyd-Jones DM, Allen NB, Anderson CAM, Black T, Brewer LC, Foraker RE, et al. Life’s Essential 8: updating and enhancing the American Heart Association’s construct of cardiovascular health: a presidential advisory from the American Heart Association. Circulation. 2022;146(5):e18–43. https://doi.org/10.1161/cir.0000000000001078.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Midwest Biomedical Research, 211 East Lake Street, Suite 3, Addison, IL, 60101, USA

    Liana L. Guarneiri & Kevin C. Maki

  2. Department of Applied Health Science, Indiana University School of Public Health-Bloomington, Bloomington, IN, 47408, USA

    Kevin C. Maki

Authors
  1. Liana L. Guarneiri
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kevin C. Maki
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kevin C. Maki.

Ethics declarations

Conflict of Interest

Liana L. Guarneiri is an employee of Midwest Biomedical Research.

Kevin C. Maki reports research grants from: 89Bio, Beren Therapeutics, Cargill, General Mills, Greenyn, Hass Avocado Board, Indiana University Foundation, Matinas Biopharma, National Cattlemen’s Beef Association/Beef Checkoff, National Dairy Council, Naturmega, NeuroEnergy Ventures, Pepsico, Pharmavite. They also report consulting fees from: 89Bio, Acasti Pharma, Beren Therapeutics, Bragg Live Products, Campbell’s, Eli Lilly and Co., General Mills, Medifast, New Amsterdam Pharmaceuticals, and Seed. He also reports payments or honoraria from the National Lipid Association for a Masters of Lipidology lecture and conference presentations. In addition, he serves on the Advisory Board for 89Bio, Matinas Biopharma, and North Sea Therapeutics, as well as serving on the National Research Science Advisory Committee-Advisory Board for the National Dairy Council.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Guarneiri, L.L., Maki, K.C. An Update on Nutrition Guidance for Cardiovascular Health. Curr Atheroscler Rep 25, 597–603 (2023). https://doi.org/10.1007/s11883-023-01128-9

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11883-023-01128-9

Keywords

Search

Navigation