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

Published in Mayo Clinic Proceedings: Innovations, Quality & Outcomes
· DOI :10.1016/j.mayocpiqo.2019.05.001
Vincent A. Pallazola1
Estimated H-index: 1
(Johns Hopkins University),
Dorothy M. Davis (Johns Hopkins University)+ -3 AuthorsFrancine K. Welty35
Estimated H-index: 35
(BIDMC: Beth Israel Deaconess Medical Center)
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.
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Published on Nov 10, 2018in Journal of the American College of Cardiology18.64
Scott M. Grundy167
Estimated H-index: 167
Neil J. Stone40
Estimated H-index: 40
+ 21 AuthorsDaniel E. Forman44
Estimated H-index: 44
Glenn N. Levine, MD, FACC, FAHA, Chair Patrick T. O’Gara, MD, MACC, FAHA, Chair-Elect Jonathan L. Halperin, MD, FACC, FAHA, Immediate Past Chair [‡‡‡][1] Sana M. Al-Khatib, MD, MHS, FACC, FAHA Joshua A. Beckman, MD, MS, FAHA Kim K. Birtcher, PharmD, MS, AACC Biykem Bozkurt, MD, PhD,
Published on Mar 17, 2019in Journal of the American College of Cardiology18.64
Donna K. Arnett79
Estimated H-index: 79
Roger S. Blumenthal72
Estimated H-index: 72
+ 15 AuthorsDonald M. Lloyd-Jones83
Estimated H-index: 83
Author(s): Arnett, Donna K; Blumenthal, Roger S; Albert, Michelle A; Buroker, Andrew B; Goldberger, Zachary D; Hahn, Ellen J; Himmelfarb, Cheryl D; Khera, Amit; Lloyd-Jones, Donald; McEvoy, J William; Michos, Erin D; Miedema, Michael D; Munoz, Daniel; Smith, Sidney C; Virani, Salim S; Williams, Kim A; Yeboah, Joseph; Ziaeian, Boback
Published on Feb 1, 2019in The Lancet59.10
Andrew N. Reynolds4
Estimated H-index: 4
(University of Otago),
Jim Mann65
Estimated H-index: 65
+ 3 AuthorsLisa Te Morenga9
Estimated H-index: 9
(University of Otago)
Summary Background Previous systematic reviews and meta-analyses explaining the relationship between carbohydrate quality and health have usually examined a single marker and a limited number of clinical outcomes. We aimed to more precisely quantify the predictive potential of several markers, to determine which markers are most useful, and to establish an evidence base for quantitative recommendations for intakes of dietary fibre. Methods We did a series of systematic reviews and meta-analyses ...
Published on Jan 1, 2019in Heart5.08
Yongcheng Ren9
Estimated H-index: 9
(SZU: Shenzhen University),
Yu Liu5
Estimated H-index: 5
(SZU: Shenzhen University)
+ 14 AuthorsHaohang Sun2
Estimated H-index: 2
(Zhengzhou University)
Objective Studies investigating the impact of chocolate consumption on cardiovascular disease (CVD) have reached inconsistent conclusions. As such, a quantitative assessment of the dose–response association between chocolate consumption and incident CVD has not been reported. We performed a systematic review and meta-analysis of studies assessing the risk of CVD with chocolate consumption. Methods PubMed and EMBASE databases were searched for articles published up to 6 June 2018. Restricted cubi...
Published on Nov 14, 2018in BMJ27.60
Cara B. Ebbeling35
Estimated H-index: 35
(Harvard University),
Henry A. Feldman74
Estimated H-index: 74
(Harvard University)
+ 7 AuthorsDavid S. Ludwig66
Estimated H-index: 66
(Harvard University)
Abstract Objective To determine the effects of diets varying in carbohydrate to fat ratio on total energy expenditure. Design Randomized trial. Setting Multicenter collaboration at US two sites, August 2014 to May 2017. Participants 164 adults aged 18-65 years with a body mass index of 25 or more. Interventions After 12% (within 2%) weight loss on a run-in diet, participants were randomly assigned to one of three test diets according to carbohydrate content (high, 60%, n=54; moderate, 40%, n=53;...
Published on Nov 1, 2018in The Lancet59.10
Mahshid Dehghan22
Estimated H-index: 22
(Population Health Research Institute),
Andrew Mente30
Estimated H-index: 30
(McMaster University)
+ 36 AuthorsAlvaro Avezum70
Estimated H-index: 70
Summary Background Dietary guidelines recommend minimising consumption of whole-fat dairy products, as they are a source of saturated fats and presumed to adversely affect blood lipids and increase cardiovascular disease and mortality. Evidence for this contention is sparse and few data for the effects of dairy consumption on health are available from low-income and middle-income countries. Therefore, we aimed to assess the associations between total dairy and specific types of dairy products wi...
Published on Sep 1, 2018in The Lancet59.10
Max Griswold11
Estimated H-index: 11
(UW: University of Washington),
Nancy Fullman31
Estimated H-index: 31
(UW: University of Washington)
+ 509 AuthorsJoseph Salama20
Estimated H-index: 20
(UW: University of Washington)
Summary Background Alcohol use is a leading risk factor for death and disability, but its overall association with health remains complex given the possible protective effects of moderate alcohol consumption on some conditions. With our comprehensive approach to health accounting within the Global Burden of Diseases, Injuries, and Risk Factors Study 2016, we generated improved estimates of alcohol use and alcohol-attributable deaths and disability-adjusted life-years (DALYs) for 195 locations fr...
Published on Aug 28, 2018in Circulation23.05
Rachel K. Johnson31
Estimated H-index: 31
Alice H. Lichtenstein79
Estimated H-index: 79
+ 7 AuthorsJudith Wylie-Rosett52
Estimated H-index: 52
In the United States, 32% of beverages consumed by adults and 19% of beverages consumed by children in 2007 to 2010 contained low-calorie sweeteners (LCSs). Among all foods and beverages containing...
Published on Jul 1, 2018in European Journal of Clinical Nutrition3.11
L. M. Hengeveld1
Estimated H-index: 1
(PHRI: Public Health Research Institute),
Jaike Praagman3
Estimated H-index: 3
(UU: Utrecht University)
+ 3 AuthorsIvonne Sluijs28
Estimated H-index: 28
(UU: Utrecht University)
Fish consumption of at least 1 portion/week is related to lower cardiovascular disease (CVD) risk. It is uncertain whether a less frequent intake is also beneficial and whether the type of fish matters. We investigated associations of very low intakes of total, fatty, and lean fish, compared with no fish intake, with 18-year incidences of stroke, coronary heart disease (CHD), and CVD mortality. Data were used from 34,033 participants, aged 20–70 years, of the EPIC-Netherlands cohort. Baseline (1...
Published on Jun 21, 2018in The New England Journal of Medicine70.67
Ramón Estruch73
Estimated H-index: 73
Emilio Ros72
Estimated H-index: 72
+ 18 AuthorsJosé Lapetra36
Estimated H-index: 36
Abstract Background Observational cohort studies and a secondary prevention trial have shown inverse associations between adherence to the Mediterranean diet and cardiovascular risk. Methods In a multicenter trial in Spain, we assigned 7447 participants (55 to 80 years of age, 57% women) who were at high cardiovascular risk, but with no cardiovascular disease at enrollment, to one of three diets: a Mediterranean diet supplemented with extra-virgin olive oil, a Mediterranean diet supplemented wit...
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