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Heart-healthy diet

Recommendations for heart-healthy eating and the science behind them 

Focus on foods, not nutrients in isolation

Historically, nutrition science has focused on researching the effect of individual nutrients in foods on the risk of diseases. However, this poses challenges:

  • It's difficult to evaluate the impact of a single dietary factor independently of any other changes in the diet.
  • Food is made up of a mixture of nutrients and other components. It would be inappropriate to ascribe the health effects of a food only to one component.
  • If energy intake is kept constant, eating less of one macronutrient implies eating more of others. The quality of this replacement is important, as it could have an impact on the observed effect.

As such, caution is required in solely using the results of randomised controlled studies (RCT), or even meta-analyses of RCTs, when examining the effect of a single dietary change on cardiovascular disease (CVD) risk.

In recent years, to overcome some of these problems, nutrition research has also focused on examining foods and dietary patterns - rather than specific nutrients in isolation - and the risk of cardiovascular disease. Consistent evidence from epidemiological studies indicates that higher intakes of fruit, non-starchy vegetables, nuts, legumes, fish, vegetable oils and whole grains, along with lower amounts of red and processed meats, foods higher in added sugar and salt, are associated with a lower incidence of CV events.

The recent Global Burden of Disease report has attributed approximately two thirds of deaths from coronary heart disease in the UK to poor diet. This includes not eating enough whole grains, legumes, fruits, vegetables, nuts and seeds, and excess salt and sugar.

Heart-healthy eating to manage cholesterol includes:

  • Plenty of fruits, vegetables and plant based foods.
  • A variety of healthy sources of protein such as legumes (for example, beans and lentils), fish, nuts, seeds and poultry. If red meat is eaten, make sure it's lean, and watch the quantity.
  • High-fibre starchy foods, such as brown rice, wholegrain pasta, and potatoes with their skin on, to increase wholegrain and fibre intake.
  • Some low fat dairy foods.
  • Some healthy fats (for example, vegetable oils and spreads, nuts, seeds, olives and avocados) instead of saturated fats.
  • Fewer foods and drinks high in sugar, such as biscuits, cakes, chocolates, fizzy drinks and cordials.
  • The right amount of foods to maintain a healthy weight. 
These foods are low in saturated fats and added sugars, and contain good amounts of unsaturated fats, fibre, whole grains and other plant compounds. Based on the totality of evidence, this optimal combination helps to improve heart health by reducing cardiovascular risk factors – including lowering blood lipids.

The impact of specific lifestyle changes on lipids have been thoroughly evaluated in the 2019 ESC/ EAS guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk

Read the recommendations

Evidence behind the dietary recommendations