What is the best diet to lower cardiovascular risk?

Mediterranean Diet is the Best Diet to Lower Cardiovascular Risk

The Mediterranean diet is the most effective dietary pattern for reducing cardiovascular disease risk, with evidence showing up to a 30% reduction in total cardiovascular disease events compared to other dietary approaches. 1

Evidence for Different Dietary Approaches

Mediterranean Diet (Best Option)

• The Mediterranean diet is characterized by high intake of plant-based foods (vegetables, fruits, legumes, nuts, whole grains), olive oil as the main fat source, moderate fish consumption, limited red meat, and moderate wine consumption 1
• The PREDIMED trial demonstrated a 30% reduction in total cardiovascular disease among individuals randomized to a Mediterranean diet plus extra-virgin olive oil or mixed nuts 1
• The Mediterranean diet has been associated with lower rates of myocardial infarction, heart failure, and ischemic stroke in long-term observational studies 2
• This dietary pattern improves multiple cardiovascular risk factors including blood pressure, lipid profiles, and inflammation markers 3
• The Mediterranean diet is sustainable and has strong cultural roots that facilitate dietary compliance 1

DASH Diet (Good Alternative)

• The Dietary Approaches to Stop Hypertension (DASH) diet is the only diet proven effective for improving all three main CVD risk factors: blood pressure, lipid profiles, and weight loss 1
• DASH emphasizes fruits, vegetables, whole grains, low-fat dairy, lean proteins, and limited sodium intake 1
• The DASH diet recommends 4-5 servings of vegetables and fruits daily, along with whole grains and limited salt intake 1

Ketogenic Diet (Not Recommended for CVD Prevention)

• Current cardiovascular guidelines do not recommend ketogenic diets for cardiovascular disease prevention 1
• High-fat, low-carbohydrate diets may increase LDL cholesterol in some individuals 3
• There is insufficient evidence from long-term trials showing cardiovascular benefits of ketogenic diets 1

Salt Restriction Alone (Insufficient)

• While sodium reduction to <2,300 mg/day (optimally 1,500 mg/day) is recommended, salt restriction alone is insufficient as a complete dietary strategy for cardiovascular risk reduction 3
• Salt reduction should be part of a comprehensive dietary approach rather than the sole focus 1

Medication-Only Approach (Insufficient)

• Relying solely on medication without dietary modification is not supported by current cardiovascular prevention guidelines 1
• Dietary interventions have been shown to reduce cardiovascular risk independently of medication effects 1

Key Components of Heart-Healthy Diets

Plant-Based Foods

• Consume 4-5 servings of vegetables and fruits daily, emphasizing deeply colored varieties with higher micronutrient content 1, 3
• Include legumes up to 400g/week as they are associated with CVD risk reduction 1
• Consume 30g/day of unsalted nuts, which provide healthy fats and nutrients 1, 3

Healthy Fats

• Replace saturated fats with monounsaturated fats (olive oil) and polyunsaturated fats 3
• Limit saturated fat to less than 6% of total caloric intake 3
• Completely avoid trans fats as they increase cardiovascular morbidity and mortality 3

Whole Grains and Carbohydrates

• Choose whole grains over refined grains and limit high glycemic index foods 1
• Consume 2 servings/day of whole grains and limit refined low glycemic index cereal foods to 1 serving/day 1
• Minimize sugar-sweetened beverages which are associated with increased CHD risk 1

Protein Sources

• Consume fish 1-2 times/week, preferably oily fish rich in omega-3 fatty acids 1
• Limit red meat consumption and avoid processed meats high in saturated fat and sodium 1, 3
• Include plant-based protein sources like legumes and nuts 3

Practical Implementation

• Replace high-calorie foods with fruits and vegetables 1
• Use liquid vegetable oils instead of solid fats 1
• Select low-fat or fat-free dairy products 1
• Compare sodium content of similar products and choose those with less salt 1
• Grill, bake, or broil fish, meat, and poultry instead of frying 1
• Limit processed foods high in sodium, sugar, and unhealthy fats 3

Common Pitfalls to Avoid

• Focusing on single nutrients rather than overall dietary pattern 1
• Relying on supplements instead of whole foods (non-prescription dietary supplements are not beneficial for reducing acute CVD events) 3
• Replacing saturated fats with refined carbohydrates rather than healthy fats or whole grains 3
• Consuming fruit juices instead of whole fruits (juices lack fiber content and satiety value) 1
• Preparing fish with cream sauces or frying in unhealthy oils 3

The Mediterranean diet represents the optimal dietary pattern for cardiovascular disease prevention based on the strongest and most recent evidence. This diet not only reduces cardiovascular risk but is also sustainable and adaptable to different cultural contexts.