As we navigate February, recognized for Valentine’s Day and heart health awareness, NEM Health acknowledges the significance of this initiative. Going beyond awareness, we are here to offer practical advice and guidance on lifestyle changes that promote heart well-being. We are publishing a series of articles aiming to provide valuable evidence-basedinsights to support your journey toward a heart-healthy lifestyle.
If you missed our introduction to heart health, that can be found here
Different components play a role in achieving and maintaining a healthy heart. The “Life’s Essential 8” refers to the comprehensive components of cardiovascular health, as detailed by the American Heart Association (1). The eight components, which should be the minimum in our opinion, consist of various factors crucial for assessing and optimizing cardiovascular health (Figure 1).
Figure 1: Life’s Essential 8: healthy diet, participation in physical activity, healthy levels of blood lipids, glucose and blood pressure, healthy weight, avoidance of nicotine, and healthy sleep. Adopted from (1).
In this article, we focus on the relationship between what we eat and our heart health.
The evolution of the heart-healthy diet has been a dynamic process shaped by landmark events in modern nutrition science (2). Starting with the development of the diet-heart hypothesis in the 1940s and the subsequent focus on potential dietary causes of cardiovascular disease (CVD), the 1980s saw the emergence of nutritional guidelines aimed at reducing fat intake. This low-fat ideology and the introduction of the food pyramid emphasized the limitation of fat intake and the consumption of low-fat products. However, this led to the unintended consequence of increased intake of refined carbohydrates, contributing to the obesity epidemic.
One significant shift in the 21st century was the recognition of the limitations of a low-fat diet and the appreciation of balanced diets with an intake of healthier unsaturated fats. This new approach was supported by studies assessing the impact of specific macronutrients, foods, and diets on heart health. Presently, the focus is on increased consumption of vegetables, fruits, whole grains, and lean protein, with a reduction in saturated fats, sodium, refined carbohydrates, and sugar-sweetened beverages. The strongest evidence supports the Dietary Approaches to Stop Hypertension (DASH), Mediterranean, and healthy vegetarian diets for reducing CVD risk. Today’s dietary recommendations prioritize balanced intake and the consumption of non-processed foods, reflecting an evolution towards a more informed and holistic understanding of the heart-healthy diet.
The current nationally endorsed heart-healthy dietary patterns are the DASH diet, the Mediterranean diet, and the healthy vegetarian diet (2).
The DASH diet
The DASH diet includes high consumption of vegetables, fruits, low-fat dairy products, whole grains, lean meats, fish, poultry, beans, and nuts while limiting sodium intake. It has been shown to lower blood pressure and LDL cholesterol levels and reduce cardiovascular risk.
The Mediterranean diet
The Mediterranean diet emphasizes high consumption of leafy green vegetables, fruits, nuts, legumes, whole grains, and extra-virgin olive oil, moderate consumption of lean meat, fish, poultry, and low-fat dairy, and limited consumption of red meat and sweets. It has been associated with both primary and secondary CVD prevention, reduced risk of CVD mortality, stroke, and all-cause mortality.
The healthy vegetarian diet
The healthy vegetarian diet substitutes meat, seafood, and poultry with whole grains, nuts, and legumes. It is associated with a lower risk of CVD, reduced LDL cholesterol levels, and improved systolic blood pressure. However, the health benefits of the vegetarian diet may vary depending on the foods chosen to replace traditional protein sources.
These dietary patterns have been endorsed due to their proven benefits for CVD prevention, weight loss, and protection against coronary heart disease and all-cause mortality.
In addition to the described above diets, intermittent fasting is emerging as a promising strategy for maintaining cardiovascular health. While it is not part of the current recommendations, and no extensive randomized control trials are investigating the link between intermittent fasting and cardiovascular outcomes, existing human studies indicate that this dietary approach may lower the risk of cardiovascular disease by positively influencing weight management, hypertension, dyslipidemia, and diabetes (3).
One study aimed to compare the effects of a high-protein, intermittent fasting, low-calorie diet with a heart-healthy diet on weight loss, blood lipids, and vascular compliance in obese adults (4). The experiment involved 40 participants in two phases: a 12-week weight loss phase and a 1-year weight maintenance phase. Both diets led to reduced body weight and BMI and improved blood lipids during weight loss. In the maintenance phase, the high-protein, intermittent fasting group showed less regain in BMI, LDL cholesterol, and better arterial compliance compared to the heart-healthy group after one year. Although more studies are needed, the findings suggest the advantages of the high-protein, intermittent fasting diet in long-term weight maintenance and cardiovascular health.
To learn more about nutrition and health, explore our articles on sugar and aging as well as our series on intermittent fasting.
In conclusion, key moments in nutrition science have influenced the evolution of heart-healthy dietary recommendations. Initially centered around low-fat diets in the mid-20th century, our understanding has progressed to emphasize balanced nutrition in the 21st century. The current focus on whole, unprocessed foods and specific diets like DASH and Mediterranean underscore the importance of a holistic approach. In the future, ongoing research, along with increased public awareness and personalized guidance, will continue to influence collective efforts to reduce the burden of CVD.
- Lloyd-Jones DM, Allen NB, Anderson CAM, Black T, Brewer LC, Foraker RE, et al. Life’s Essential 8: Updating and Enhancing the American Heart Association’s Construct of Cardiovascular Health: A Presidential Advisory From the American Heart Association. Circulation. 2022 Aug 2;146(5):e18–43.
- The evolution of the heart-healthy diet for vascular health: A walk through time – Nicole Mercado Fischer, Vincent A Pallazola, Helen Xun, Miguel Cainzos-Achirica, Erin D Michos, 2020 [Internet]. [cited 2024 Jan 8]. Available from: https://journals.sagepub.com/doi/full/10.1177/1358863X19901287
- Dong TA, Sandesara PB, Dhindsa DS, Mehta A, Arneson LC, Dollar AL, et al. Intermittent Fasting: A Heart Healthy Dietary Pattern? Am J Med. 2020 Aug 1;133(8):901–7.
- Zuo L, He F, Tinsley GM, Pannell BK, Ward E, Arciero PJ. Comparison of High-Protein, Intermittent Fasting Low-Calorie Diet and Heart Healthy Diet for Vascular Health of the Obese. Front Physiol [Internet]. 2016 [cited 2024 Jan 30];7. Available from: https://www.frontiersin.org/articles/10.3389/fphys.2016.00350
