A healthy, balanced dietary pattern, rather than one focused on individual nutrients or foods is key to maintaining heart health, according to a Scientific Statement issued by the American College of Cardiology and published in JACC, its flagship journal. Diets should include minimally processed plant-based foods and healthy fats and proteins, while limiting foods high in refined starches, added sugars, sodium or unhealthy fats, as well as highly processed foods of poor nutritional quality.
"Suboptimal diet is a key risk factor for cardiovascular disease (CVD), and diet and lifestyle modification is widely considered essential for both primary and secondary prevention," said Frank B. Hu, MD, PhD, Professor and Chair of Department of Nutrition at Harvard T.H. Chan School of Public Health and Chair of the Scientific Statement. "However, the concept of a 'heart-healthy' diet has evolved over time from nutrient-centric approaches to more holistic, food- and pattern-based strategies that better reflect advances in the understanding of the complex relationship between diet and cardiometabolic health."
Recently, guideline recommendations have shifted from individual nutrients to overall dietary patterns, with strong evidence supporting a variety of healthy dietary patterns, including the Mediterranean diet and dietary approaches to stop hypertension (DASH) diet. These patterns generally emphasize vegetables, fruits, whole grains, nuts, legumes, healthy protein sources, and unsaturated fats for lowering risk of CVD.
This Scientific Statement reviews current evidence on nutrition and cardiovascular health, including macronutrients, micronutrients, dietary patterns, ultra-processed foods and emerging nutrition-based interventions, and offers consensus recommendations on incorporating food and health into clinician/patient discussions on preventing and managing heart disease.
The consensus recommendations include:
- Diet and nutrition play a central role in preventing and managing cardiovascular kidney metabolic syndrome, which includes interconnected conditions such as CVD, diabetes, obesity and chronic kidney disease, with emphasis on plant-forward eating patterns, lower sodium intake and limiting highly processed foods of poor nutritional quality.
- Access to healthy foods, affordability and other social drivers of health significantly affect diet quality. Food security should be considered across four domains: availability, affordability, accessibility and utilization of nutritious foods.
- Cardiovascular risk is driven less by the percentage of carbohydrates, fats or protein consumed and more by overall nutrition quality, food sources and degree of processing.
- Current evidence supports replacing saturated fats with unsaturated fats, particularly from sources like liquid plant oils, nuts, seeds and fish, and prioritizing whole grains and other high-fiber food. Foods high in saturated fat, refined starches and added sugars should be limited.
- Make beverage choices that support cardiovascular health by prioritizing water and other unsweetened beverages and limiting sugar-sweetened beverages. Moderate consumption of coffee or tea can be part of a healthy dietary pattern. Alcohol consumption should generally be limited or avoided.
- GLP-1 receptor agonists can produce significant weight loss and cardiovascular benefits, but a nutrient-rich, high-quality diet remains important during treatment. Adequate intakes of protein, fiber, vitamins and minerals are essential for maintaining overall health and preventing nutritional deficiencies.
- "Food Is Medicine" programs that provide nutritious food as clinical interventions can improve diet quality, with growing evidence of benefits for clinical outcomes. Successful implementation will require integrating these programs into health care systems and developing sustainable approaches across diverse settings.
"Ultimately, heart-healthy eating is not about focusing on a single nutrient or food or following the latest dietary trend," Hu said. "What matters most is the overall quality of the diet—a consistent pattern of healthy food choices that supports cardiometabolic health and is sustainable over time."
