A Clinician's Guide to Healthy Eating for Cardiovascular Disease Prevention

Abstract

Despite continued advances in health care, the cardiovascular disease (CVD) mortality rate has plateaued in recent years and appears to be trending upward. Poor diet is a leading cause of obesity and type 2 diabetes mellitus, which are leading contributors to CVD morbidity and mortality. Although dietary modification is a cornerstone of CVD prevention, implementation in clinical practice is limited by inadequate formal training in nutrition science. In this report, we review the individual components of a heart-healthy diet, evidence-based dietary recommendations, and the impact of diet on CVD risk factor prevention and management. Furthermore, we examine the unique difficulties of dietary counseling in low-socioeconomic-status environments and provide an evidence-based approach to better serve these populations. We utilized PubMed searches in adults with no date restriction with the following search terms: "carbohydrate," "fat," protein," "DASH," "Mediterranean," "plant-based," "vegetarian," "cardiovascular disease," "obesity," "weight loss," "diabetes," "socioeconomic status," and "race." In this review, we demonstrate that patients should focus on implementing a general diet plan that is high in fruits, whole grains, legumes, and nonstarchy vegetables while low in trans-fats, saturated fats, sodium, red meat, refined carbohydrates, and sugar-sweetened beverages. The Dietary Approaches to Stop Hypertension, Mediterranean, and vegetarian diets have the most evidence for CVD prevention. Clinicians should understand the barriers that patients may face in terms of access to healthy dietary choices. Further research is needed to determine the dietary changes that are most economically, socioculturally, and logistically feasible to reduce these barriers. Improvement in diet is a public health priority that can lead to a significant population-level reduction in CVD morbidity and mortality. It is imperative that clinicians understand current dietary practice guidelines and implement evidence-based dietary counseling in those at high risk for CVD.

Sodium and Potassium Intakes and Cardiovascular Risk Profiles in Childhood Cancer Survivors: The SCCSS-Nutrition Study

“…There is strong evidence that reducing Na intake lowers blood pressure and hypertension risk [11]. Blood pressure response to Na intake is greater in children, adolescents, and adults with hypertension than in those without [15,53], so reducing Na intake in all CCSs, especially those who suffer from hypertension, could lower blood pressure and eventually reduce cardiovascular events and mortality.…”

“…Thirteen percent of CCSs exposed to cardiotoxic treatments suffered a life-threatening cardiovascular event in the 30 years after cancer treatment [8]. In the general population, hypertension, obesity, diabetes mellitus, smoking, and dyslipidemia are primary contributors to CVD [9][10][11]. These risk factors are also relevant for CCSs, and represent important modifiable factors in the development and severity of CVD [12][13][14].…”

Effectiveness of Individual Nutrition Education Compared to Group Education, in Improving Anthropometric and Biochemical Indices among Hypertensive Adults with Excessive Body Weight: A Randomized Controlled Trial

“…It also can minimize the side effects of these chronic diseases if they have already been diagnosed [8]. For patients with hypertension, various nonpharmacological interventions are recommended, including weight loss, healthy diet plan, sodium reduction, potassium supplementation, smoking cessation, moderation in alcohol consumption, and increased physical activity [2,[8][9][10][11].…”

“…Dietary intervention is considered as a good therapeutic step for overweight people with high blood pressure [2,8,11]. Several dietary plans have been recognized as effective dietary strategies to prevent and manage elevated blood pressure, including Dietary Approaches to Stop Hypertension (DASH) diet [12], Optimal Macro-Nutrient Intake to Prevent Heart Disease (OmniHeart) diet [13], Portfolio diet [14], Mediterranean diet [15], and vegetarian diet [16].…”

“…Most patients can, however, prevent hypertension-related health problems with well-chosen lifestyle changes alone. Scientists agree that this strategy, despite being cost-effective and safe for patients, can also bring considerable therapeutic benefits [11,17]. Interestingly, even if such changes do not bring about direct effects in terms of decreasing blood pressure, they can do it in an indirect way, by improving the patient's physical and emotional state.…”