Skip to main content

Advertisement

SpringerLink
Log in

Effectiveness of Changes in Diet Composition on Reducing the Incidence of Cardiovascular Disease

  • Lipid Abnormalities and Cardiovascular Prevention (G De Backer, Section Editor)
  • Published:
Current Cardiology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

To highlight dietary changes shown to be associated with a lower risk of cardiovascular events in epidemiological studies and that have been proven to be effective in preventing cardiovascular diseases in clinical trials

Recent Findings

Since dietary changes always involve multiple variables, recent observational and intervention studies on dietary prevention of cardiovascular disease focus not only to the limitation of a single nutrient/food intake but also to the other dietary changes implemented to replace it.

Summary

The available evidence supports three major dietary strategies for cardiovascular disease prevention: (1) the replacement of saturated fat with unsaturated fat and/or fiber-rich carbohydrate foods; (2) the reduction of salt intake; (3) the implementation of dietary patterns resembling the traditional Mediterranean diet. This support derives not only from RCTs but also from the combination of large observational cohort studies and relatively short-term randomized trials on cardiovascular risk factors.

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

Similar content being viewed by others

References

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

  1. •• Forouhi NG, Krauss RM, Taubes G, Willet W. Dietary fat and cardiometabolic health: evidence, controversies and consensus for guidance. BMJ. 2018:361–k2139. https://doi.org/10.1136/bmj.k2139 This article takes a critical look at the evolution of scientific understanding about dietary fats and health, the difficulties of establishing public health dietary guidelines, and what the current advice should be for dietary fat consumption.

  2. •• Sacks, FM LAH, Wu JHY, 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–e23. https://doi.org/10.1161/CIR.0000000000000510 This American Heart Association presidential advisory on dietary fats and CVD reviews and discusses the scientific evidence, including the most recent studies, on the effects of dietary saturated fat intake and its replacement by other types of fats and carbohydrates on CVD.

    Article  PubMed  Google Scholar 

  3. Van Horn L, Carson JA, Appel LJ, Burke LE, Economos C, Karmally W, et al. Recommended dietary pattern to achieve adherence to the American Heart Association/ American College of Cardiology (AHA/ACC) guidelines: a scientific statement from the American Heart Association. Circulation. 2016(22):134, e505–e509. https://doi.org/10.1161/CIR.0000000000000462.

  4. Mozaffarian D, Katan MB, Ascherio A, Stampfer MJ, Willet WC. Trans fatty acids and cardiovascular disease. N Engl J Med. 2006;354(15):1601–13. https://doi.org/10.1056/NEJMra054035.

    Article  CAS  PubMed  Google Scholar 

  5. Lemaitre RN, King IB, Raghunathan TE, Pearce RM, Weinmann S, Knopp RH, et al. Cell membrane trans-fatty acids and the risk of primary cardiac arrest. Circulation. 2002;105(6):697–701.

    Article  CAS  Google Scholar 

  6. Siri Tarino PW, Sun Q, Hu FB, Krauss RM. Meta-analysis of prospective cohort studies evaluating the association of saturated fat with cardiovascular disease. Am J Clin Nutr. 2010;91(3):535–46. https://doi.org/10.3945/ajcn.2009.27725.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Chowdhury R, Warnakula S, Kunutsor S, Crowe F, Ward HA, Johnson L, et al. Association of dietary, circulating and supplement fatty acids with coronary risk. A systematic review and meta-analysis. Ann Intern Med. 2014;160(6):398–406. https://doi.org/10.7326/M13-1788.

    Article  PubMed  Google Scholar 

  8. Jakobsen MU, O’Reilly EJ, Heitmann BL, Pereira MA, Balter K, Fraser GE, et al. Major types of dietary fat and risk of coronary heart disease: a pooled analysis of 11 cohort studies. Am J Clin Nutr. 2009;89(5):1425–32. https://doi.org/10.3945/ajcn.2008.27124.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. 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. https://doi.org/10.1016/j.jacc.2015.07.055.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Hooper L, Martin N, Abdelhamid A, Davey Smith G. Reduction in saturated fat intake for cardiovascular disease (Review). Cochrane Database Syst Rev 2015, Issue 6. Art.No.:CD011737. Doi: https://doi.org/10.1002/14651858.CD011737.

  11. Willett W. Nutritional epidemiology, vol. 2013. 3rd ed. New York, NY: Oxford University Press. p. 1, 317–16, 319.

  12. US Department of Agriculture, Agricultural Research Service, National Nutrient Database for Standard Reference, release 28, 2016. https://ndb.nal.usda.gov/ndb/search/list

  13. • Wang DD, Li Y, Chiuve SE, Stampfer MJ, Manson JE, Rimm EB, et al. Association of specific dietary fats with total and cause – specific mortality. JAMA Intern Med. 2016;176(8):1134–45. https://doi.org/10.1001/jamainternmed.2016 The paper highlights the results of the follow-up on two large cohorts showing that different types of dietary fats have divergent associations with total and cause-specific mortality.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Farvid MS, Ding M, Pan A, Sun Q, Chiuve SE, Steffen LM, et al. Dietary linoleic acid and risk of coronary heart disease: a systematic review and meta – analysis of prospective cohort studies. Circulation. 2014;130(18):1568–78. https://doi.org/10.1161/CIRCULATIONAHA.114.010236.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Berger S, Raman G, Vishwanathan R, Jacques PF, Johnson EJ. Dietary cholesterol and cardiovascular disease: a systematic review and meta-analysis. Am J Clin Nutr. 2015;102:276–94. https://doi.org/10.3945/ajcn.114.100305.

    Article  CAS  PubMed  Google Scholar 

  16. • Betchold A, Boeing H, Schwedhelm C, Hoffmann G, Knuppel S, Iqbal K, et al. Food groups and risk of coronary heart disease, stroke and heart failure: a systematic review and dose-response meta- analysis of prospective studies. Crit Rev Food Sci Nutr. 2019;59(7):1071–90. https://doi.org/10.1080/10408398.2017.1392288 A meta-analysis synthesizing the knowledge about the relation between intake of 12 major food groups and the risk of coronary heart disease, stroke, and heart failure.

    Article  CAS  Google Scholar 

  17. Zhong VW, Van Horn L, Cornelis MC, Wilkins JT, Ning H, Carnethon MR, et al. Associations of dietary cholesterol or egg consumption with incident cardiovascular disease and mortality. JAMA. 2019;321(11):1081–95. https://doi.org/10.1001/jama.2019.1572.

    Article  CAS  PubMed  Google Scholar 

  18. Dehghan M, Mente A, Zhang X, Swaminathan S, Li W, Mohan V, et al. Associations of fats and carbohydrate intake with cardiovascular disease and mortality in 18 countries from five continents (PURE): a prospective cohort study. Lancet. 2017;390(10107):2050–62. https://doi.org/10.1016/S0140-6736(17)32252-3.

    Article  CAS  PubMed  Google Scholar 

  19. Noto H, Goto A, Tsujimoto T, Noda M. Low-carbohydrate diets and all-cause mortality: a systematic review and meta-analysis of observational studies. PLoS One. 2013;8(1):e55030. https://doi.org/10.1371/journal.pone.0055030.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Seidelmann SB, Claggett B, Cheng S, Henglin M, Shah A, Steffen LM, et al. Dietary carbohydrate intake and mortality: a prospective cohort study and meta-analysis. Lancet Public Health. 2018;3(9):e419–28. https://doi.org/10.1016/S2468-2667(18)30135-X.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Threapleton DE, Greenwood DC, Evans CE, Cleghorn CL, Nykjaer C, Woodhead C, et al. Dietary fiber intake and risk of cardiovascular disease: systematic review and meta-analysis. BMJ. 2013;347:f6879. https://doi.org/10.1136/bmj.f6879.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Kim Y, Je Y. Dietary fiber intake and total mortality: a meta-analysis of prospective cohort studies. Am J Epidemiol. 2014;180(6):565–73. https://doi.org/10.1093/aje/kwu174.

    Article  PubMed  Google Scholar 

  23. Kim Y, Je Y. Dietary fiber intake and mortality from cardiovascular disease and all cancers: a meta-analysis of prospective cohort studies. Arch Cardiovas Dis. 2016;109(1):39–54. https://doi.org/10.1016/j.acvd.2015.09.005.

    Article  Google Scholar 

  24. •• Reynolds A, Mann J, Cumming J, Winter N, Mete E, Te Morenga L. Carbohydrate quality and human health: a series of systematic reviews and meta – analyses. Lancet. 2019;393(10170):434–45. https://doi.org/10.1016/S0140-6736(18)31809-9 This paper examines key indicators of carbohydrate quality in relation to a range of non-communicable disease outcomes from cohort studies and randomized trials.

    Article  CAS  PubMed  Google Scholar 

  25. Poggio R, Gutierrez L, Matta MG, Elorriaga N, Irazola V, Rubinstein A. Daily sodium consumption and CVD mortality in the general population: systematic review and meta-analysis of prospective studies. Public Health Nutr. 2015;18(4):695–704. https://doi.org/10.1017/S1368980014000949.

    Article  PubMed  Google Scholar 

  26. Aburto NJ, Ziolkovska A, Hooper L, Elliott P, Cappuccio FP, Meerpohl JJ. Effect of lower sodium intake on health: systematic review and meta-analyses. BMJ. 2013;346:f1326. https://doi.org/10.1136/bmj.f1326.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Abete I, Romaguera D, Vieira AR, Lopez de Munain A, Norat T. Association between total, processed, red and white meat consumption and all-cause, CVD, and IHD mortality: a meta-analysis of cohort studies. Br J Nutr. 2014;112(5):762–75. https://doi.org/10.1017/S000711451400124X.

    Article  CAS  PubMed  Google Scholar 

  28. Chen GC, Lv DB, Png Z, Liu QF. Red and processed meat consumption and risk of stroke: a meta-analysis of prospective cohort studies. Eur J Clin Nutr. 2013;67(1):91–5. https://doi.org/10.1038/ejcn.2012.180.

    Article  PubMed  Google Scholar 

  29. • Mozaffarian D. Dietary and policy priorities for cardiovascular disease, diabetes and obesity. A comprehensive review. Circulation. 2016;133(2):187–225. https://doi.org/10.1161/CIRCULATIONAHA.115.018585 This review considers the history, new evidence, controversies, and corresponding lessons for modern dietary and policy priorities for cardiovascular diseases, obesity, and diabetes mellitus.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. O’ Sullivan TA, Hafekost K, Mitrou F, Lawrence D. Food sources of saturated fat and the association with mortality: a meta-analysis. Am J Public Health. 2013;103(9):e31–42. https://doi.org/10.2105/AJPH.2013.301492.

    Article  Google Scholar 

  31. Qin LQ, Xu JY, Han SF, Zhang ZL, Zhao YY, Szeto IM. Dairy consumption and risk of cardiovascular disease: an update meta-analysis of prospective cohort studies. Asia Pac J Clin Nutr. 2015;24(1):90–100. https://doi.org/10.6133/apjcn.2015.24.1.09.

    Article  PubMed  Google Scholar 

  32. Alexander DD, Bylsma LC, Vargas AJ, Cohen SS, Doucette A, Mohamed M, et al. Dairy consumption and CVD: a systematic review and meta-analysis. Br J Nutr. 2016;115(4):737–50. https://doi.org/10.1017/S0007114515005000.

    Article  CAS  PubMed  Google Scholar 

  33. Chartier D–, JP BD, Tessier-Grenier M, Cotè JA, Labonté MÈ, Desroches S, et al. Systematic review of the association between dairy product consumption and risk of cardiovascular - related clinical outcomes. Adv Nutr. 2016;7(6):1026–40. https://doi.org/10.3945/an.115.011403.

    Article  Google Scholar 

  34. Aune D, Keum N, Giovannucci E, Fadnes LT, Boffetta P, Greenwood DC, et al. Whole grain consumption and risk of cardiovascular disease, cancer and all-cause and cause specific mortality: systematic review and dose – response meta-analysis of prospective studies. BMJ. 2016;353:i2716. https://doi.org/10.1136/bmj.i2716.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Zong G, Gao A, Hu FB, Sun Q. Whole grain intake and mortality from all-causes, cardiovascular disease, and cancer: a meta-analysis of prospective cohort studies. Circulation. 2016;133(24):2370–80. https://doi.org/10.1161/CIRCULATIONAHA.115.021101.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. Kim Y, Keogh J, Clifton PM. Nuts and cardio-metabolic disease: a review of meta-analyses. Nutrients. 2018;10(12):E1935. https://doi.org/10.3390/nu10121935.

    Article  CAS  PubMed  Google Scholar 

  37. Te Morenga L, Mallard S, Mann J. Dietary sugars and body weight: systematic review and meta-analyses of randomized controlled trials and cohort studies. BMJ. 2012;346:e7492. https://doi.org/10.1136/bmj.e7492.

    Article  Google Scholar 

  38. Xi B, Huang Y, Reilly KH, Li S, Zheng R, Barrio – Lopez MT, et al. Sugar – sweetened beverages and risk of hypertension and CVD: a dose- response meta-analysis. Br J Nutr. 2015;113(5):709–17. https://doi.org/10.1017/S0007114514004383.

    Article  CAS  PubMed  Google Scholar 

  39. Sofi f MC, Abbate R, Gensini GF, Casini A. Mediterranean diet and health status: an updated meta- analysis and a proposal for a literature – based adherence score. Public Health Nutr. 2014;17(12):2769–82. https://doi.org/10.1017/S1368980013003169.

    Article  PubMed  Google Scholar 

  40. Mozaffarian D, Micha R, Wallace S. Effects on coronary heart disease of increasing polyunsaturated fat in place of saturated fat: a systematic review and meta- analysis of randomized controlled trials. PLoS Med. 2010;7(3):e1000252. https://doi.org/10.1371/journal.pmed.1000252.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  41. Taylor RS, Ashton KE, Moxham T, Hooper L, Ebrahim S. Reduced dietary salt for the prevention of cardiovascular disease: a meta – analysis of randomized controlled trials (Cochrane review). Am J Hypertens. 2011;24(8):843–53. https://doi.org/10.1038/ajh.2011.115.

    Article  CAS  PubMed  Google Scholar 

  42. He FJ, MacGregor GA. Salt reduction lowers cardiovascular risk: meta-analysis of outcome trials. Lancet. 2011;378(9789):380–2. https://doi.org/10.1016/S0140-6736(11)61174-4.

    Article  PubMed  Google Scholar 

  43. Adler AJ, Taylor F, Martin N, Gottlieb S, Taylor RS, Ebrahim S. Reduced dietary salt for the prevention of cardiovascular disease (review). Cochrane Database Syst Rev. 2014;12:CD009217. https://doi.org/10.1002/14651858.CD009217.

    Article  Google Scholar 

  44. • Dinu M, Pagliai G, Casini A, Sofi F. Mediterranean diet and multiple health outcomes: an umbrella review of meta-analyses of observational studies and randomised trials. Eur J Clin Nutr. 2018;72(1):30–43. https://doi.org/10.1038/ejcn.2017.58 This is an umbrella review of the evidence across meta-analyses of observational studies and randomized clinical trials on the evidence and the validity of the association between the adherence to the Mediterranean diet and multiple health outcomes.

    Article  CAS  PubMed  Google Scholar 

  45. Grosso G, Maraventano S, Yang J, Micek A, Pajak A, Scalfi L. A comprensive meta- analysis on evidence of Mediterranean diet and cardiovascular disease: are individual components equal? Crit Rev Food Sci Nutr. 2017;57(15):3218–32. https://doi.org/10.1080/10408398.2015.1107021.

    Article  PubMed  Google Scholar 

  46. Estruch R, Ros E, Salas- Salvadó J, Covas MI, Corella D, Arós F, et al. Primary prevention of cardiovascular disease with a Mediterranean diet. N Engl J Med. 2018;378(25):e34. https://doi.org/10.1056/NEJMoa1800389.

    Article  CAS  PubMed  Google Scholar 

  47. de Lorgeril M, Salen P, Martin JL, Monjaud I, Delaye J, Mamelle N. Mediterranean diet, traditional risk factors, and the rate of cardiovascular complications after myocardial infarction: final report of the Lyon Heart Study. Circulation. 1999;99(6):779–85.

    Article  Google Scholar 

Download references

Acknowledgments

The expert linguistic revision of R. Scala is gratefully acknowledged.

Author information

Authors and Affiliations

  1. Department of Clinical Medicine and Surgery, Federico II University, Via S. Pansini 5, 80131, Naples, Italy

    Ilaria Calabrese & Gabriele Riccardi

Authors
  1. Ilaria Calabrese
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Gabriele Riccardi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Gabriele Riccardi.

Ethics declarations

Conflict of Interest

Ilaria Calabrese and Gabriele Riccardi declare that they have no conflicts of interests in relation to the content of this article.

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.

This article is part of the Topical Collection on Lipid Abnormalities and Cardiovascular Prevention

Electronic supplementary material

ESM 1

(DOCX 54 kb)

ESM 2

(DOCX 42 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Calabrese, I., Riccardi, G. Effectiveness of Changes in Diet Composition on Reducing the Incidence of Cardiovascular Disease. Curr Cardiol Rep 21, 88 (2019). https://doi.org/10.1007/s11886-019-1176-y

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11886-019-1176-y

Keywords

Search

Navigation