What dietary recommendations are suggested for a patient with coronary artery disease (CAD)?

Dietary Recommendations for Coronary Artery Disease

Patients with coronary artery disease should follow a Mediterranean-style dietary pattern emphasizing vegetables, fruits, whole grains, legumes, nuts, fish, and olive oil while restricting saturated fat to less than 6% of total calories, limiting sodium to under 2,300 mg daily, and eliminating trans fats and sugar-sweetened beverages. 1

Core Dietary Pattern

The Mediterranean diet has demonstrated up to a 65% reduction in cardiac death and nonfatal myocardial infarction in patients with established coronary disease. 1 This dietary approach provides superior outcomes compared to isolated nutrient modifications and should serve as the foundation of nutritional therapy. 1

Primary Food Choices

Choose these foods daily:

• Vegetables and fruits: 4-5 servings per day, emphasizing deeply colored varieties with higher micronutrient content 1, 2
• Whole grains: 30-90g daily to reduce cardiovascular events and type 2 diabetes risk 2
• Legumes, nuts, and seeds: 4-5 servings per week for protein, fiber, and beneficial nutrients 2
• Fish, especially oily fish: At least twice weekly for omega-3 fatty acids (EPA and DHA) 1
• Lean protein sources: Choose lean cuts of meat, remove poultry skin before eating 2

Fat Modification Strategy

Reduce saturated fat to less than 6% of total caloric intake (or <7% as a minimum threshold), which lowers LDL cholesterol and reduces cardiovascular morbidity and mortality. 1 A Cochrane review demonstrated a 17% reduction in cardiovascular events when saturated fat was reduced over 4 years, with a number needed to treat of 53. 1

Specific Fat Recommendations

• Replace saturated fats with monounsaturated fats (olive oil, <20% of daily calories) and polyunsaturated fats (≤10% of daily calories from sources like salmon) 1
• Use liquid vegetable oils instead of solid fats for cooking and food preparation 1
• Eliminate trans fats completely (<1% of total energy) by avoiding partially hydrogenated fats 1
• Limit dietary cholesterol to <200-300 mg per day 1

Critical pitfall: When saturated fats are replaced with refined carbohydrates or added sugars rather than healthy unsaturated fats, cardiovascular risk may actually increase due to adverse effects on HDL cholesterol, triglycerides, and small dense LDL particles. 1

Carbohydrate Quality Matters

Minimize refined carbohydrates and added sugars while emphasizing complex carbohydrates from whole food sources. 1

Carbohydrate Guidelines

• Avoid refined grains containing <25% whole grain by weight (white bread, white rice, refined breakfast cereals) 1, 2
• Eliminate sugar-sweetened beverages including soft drinks, energy drinks, fruit drinks with added sugars, and sweetened coffee/tea beverages 1, 2
• Limit added sugars in all forms: sucrose, glucose, fructose, maltose, dextrose, corn syrups, concentrated fruit juice, and honey 1
• Cut back on pastries and high-calorie bakery products (muffins, doughnuts) 1, 2

Higher dietary fiber intake improves blood pressure, insulin sensitivity, and supports weight loss goals while reducing cardiovascular events and all-cause mortality. 1

Sodium Restriction

Limit sodium intake to <2,300 mg daily, with an optimal target of 1,500 mg daily to lower blood pressure and reduce future cardiovascular events. 1 Sodium reduction improves biomarkers of cardiac injury, inflammation, and cardiac strain even in patients with established coronary disease. 1

Practical Sodium Reduction

• Limit processed meats (smoked, cured, salted meats with chemical preservatives), which are major contributors to dietary sodium 1, 2
• Compare sodium content on nutrition labels and choose lower-sodium options 2
• Prepare foods with little or no added salt 1
• Reduce high-sodium condiments 2

Dairy and Protein Sources

• Select fat-free or low-fat dairy products (skim milk, 1%-fat milk, low-fat yogurt) 1, 2
• Limit processed meats due to sodium content and cardiovascular risk 1, 2
• Include plant-based protein sources like legumes and nuts as alternatives to red meat 1, 2

Food Preparation Methods

Grill, bake, or broil fish, meat, and poultry instead of frying to avoid adding saturated and trans fats. 2 When preparing fish, avoid cream sauces or frying in hydrogenated fats. 2

Alcohol Consumption

If alcohol is consumed, limit to no more than 1 drink per day for women and 2 drinks per day for men. 1, 2

Weight Management Integration

Balance calorie intake with physical activity to achieve or maintain a healthy body weight (BMI 18.5-24.9 kg/m²). 1 Obesity independently increases cardiovascular risk and adversely affects LDL cholesterol, blood pressure, and glucose metabolism. 1

Weight Management Strategies

• Track weight, physical activity, and calorie intake regularly 1
• Prepare and eat smaller portions 1
• Replace high-calorie foods with fruits and vegetables 1, 2
• Use nutrition facts panels when choosing foods to buy 1, 2
• Accumulate at least 30 minutes of physical activity most days of the week 1

What NOT to Use

Nonprescription dietary supplements (including omega-3 supplements, vitamins C, D, E, beta-carotene, and calcium) are not beneficial for reducing acute cardiovascular events in patients with coronary disease. 1, 2, 3 Some supplements like calcium and beta-carotene have shown potential adverse cardiovascular effects. 2, 3 Patients should not substitute supplements for proven therapies like statins, antiplatelet agents, or the dietary modifications outlined above. 3

Implementation Algorithm

1. Establish baseline dietary pattern using nutrition facts panels and food tracking 1, 2
2. Transition to Mediterranean-style eating emphasizing the core food groups listed above 1
3. Systematically reduce saturated fat to <6% of calories by substituting with monounsaturated and polyunsaturated fats 1
4. Eliminate trans fats and minimize refined carbohydrates and added sugars 1
5. Reduce sodium to <2,300 mg daily by limiting processed foods and added salt 1
6. Ensure fish consumption at least twice weekly for omega-3 fatty acids 1
7. Monitor weight and adjust portions to achieve energy balance 1

These dietary modifications work synergistically with guideline-directed medical therapy and should be initiated immediately upon diagnosis, ideally before hospital discharge. 1