The evolution of the heart-healthy diet for vascular health: A walk through time

Abstract

The rate of cardiovascular disease (CVD) mortality reduction in the United States has plateaued recently, despite the development of novel preventive pharmacotherapies, increased access to care, and healthcare spending. This is largely due to American’s poor dietary patterns and practices causing increasing trends in the prevalence of obesity and type 2 diabetes mellitus. For decades, dietary guidelines on ‘healthy diets’ to reduce CVD risk, grounded in epidemiological research, have been nationally distributed to Americans. In this review, we highlight landmark events in modern nutrition science and how these have framed past and current understandings of diet and health. We also follow the evolution of dietary recommendations for Americans throughout the years, with an emphasis on recommendations aimed to reduce risk for CVD and mortality. Secondly, we examine how the low-fat ideology came to dominate America in the last decades of the 20th century and subsequently contributed to an excess intake of refined carbohydrates which, in the context of an increasingly sedentary lifestyle, may have fueled the obesity epidemic. We then examine the current major evidence-based dietary patterns and specific dietary approaches to reduce CVD risk, reviewing the literature surrounding nutritional components of the heart-healthy diet and discussing the dietary patterns proven most effective for CVD prevention: the Dietary Approaches to Stop Hypertension (DASH) diet, the Mediterranean diet, and the healthy vegetarian diet. Finally, we discuss emerging dietary trends, considerations for nutrition counseling, and future directions within the important field of nutrition, with the ultimate goal of improving vascular health.

A Mediterranean lifestyle reduces the risk of cardiovascular disease in the “Seguimiento Universidad de Navarra” (SUN) cohort

“…The Mediterranean diet has proven effective in preventing cardiovascular risk in both the Mediterranean and non-Mediterranean populations [27] and is a current recommendation for the American population [34,35]. In this regard, and taking into account the results of the present study, we believe that other populations should encourage the incorporation of other Mediterranean lifestyle factors in combination with diet to improve CVD incidence [27,36].…”

“…When the different components of MEDLIFE were analyzed individually, we observed whole-grain food consumption was inversely associated with the risk of CVD [23,30,31]. Evidence suggests whole-grain foods might attenuate the postprandial blood glucose response and may moderate glycemic profiles [32,33,34]. Taking a short nap, less than 30 min, most days of the week was also associated with a lower CVD risk possibly due to the stress-relieving effect of short naps [35], whereas no association was found for avoiding snacks between meals or limiting snacks to less than once a week.…”

A Heart-Healthy Diet for Cardiovascular Disease Prevention: Where Are We Now?

“…By its very nature, the Mediterranean diet limits or eliminates many of the culprits in the standard American diet that drive CVD – saturated fat, highly processed refined grains and sugars, and red meat. 2 , 10 , 21 The Mediterranean diet differs from other dietary patterns as there is a greater emphasis on EVOO, nuts, reduced dairy consumption, and eating with family. 22 The Mediterranean diet has been found to be favorable as a food pattern, rather than single nutrient supplementation, as it inherently provides anti-oxidants, reduces inflammation of the vascular wall, modulates pro-atherogenic genes, alters gut microbiome, and improves lipid panels by decreasing low density lipoprotein cholesterol (LDL-C) and raising high density lipoprotein cholesterol (HDL-C).…”

“… 1 Over time, various diets have been studied for their effectiveness in CVD prevention. 2 One of the earliest epidemiological studies investigating the link between diet and CVD was the Seven Countries Study led by Ancel Keys between 1958 and 1964, which demonstrated that the myocardial infarction (MI) rate was lower in countries where fruits, vegetables, grains, beans, and fish formed the major part of the diet. 3 , 4 The INTERHEART Study then showed that 90% of MIs were due to preventable factors, with daily consumption of fruits and vegetables, along with regular physical activity, being associated with a 40% reduction in MI [Odds Ratio (OR)=0.60 (95% CI=0.51–0.71)].…”

Nutrition Intervention in Cardiac Rehabilitation

“…[5][6][7][8] Cardiac rehabilitation (CR), prescribed to patients with a history of a recent myocardial infarction, chronic stable angina, heart failure with reduced ejection fraction, cardiovascular surgery, and other CVD, is a comprehensive multidisciplinary approach composed of supervised exercise and counseling, with nutrition counseling and education serving as a core component. 1,4,9 Although there is consensus that the quality of nutrition mitigates CVD [10][11][12][13][14] and CR reduces CVD mortality and improves quality of life, 15 best practice methodologies for nutrition intervention in CR are lacking and the barriers to implementation of successful nutrition interventions in CR and sustained healthy dietary behaviors are complex.The aim of this review is to briefly summarize the evidence-based cardioprotective diets and explore the fundamental role of registered dietary nutritionists (RDN) in CR, the current evidence behind nutrition interventions in CR, and behavior change techniques (BCT) integral to nutrition intervention in CR. We provide recommendations for best practices in CR nutrition intervention and propose future innovative strategies of nutrition research and its potential role in supporting long-term change in CR.…”