This chapter discusses the state of knowledge for several food groups, nutrients, and dietary patterns, and their relation with cardiovascular health. The chapter also discusses factors influencing food choices, the public health impact of diet on cardiovascular disease (CVD), and recommendations for achieving better cardiovascular health (see Fuster and Hurst’s Central Illustration). Cardiovascular health can be improved through lifestyle changes such as not smoking, increasing physical activity, and adhering to a healthy diet. Current evidence gathered from decades of nutritional research emphasizes avoidance of excess caloric intake, greater consumption of vegetables, fruits, nuts and legumes, whole grains, and fish; moderate consumption of low-fat dairy products, and coffee; and lower intake of processed meats and unprocessed red meats, refined grains, sodium, and sugar-sweetened beverages (SSBs). Alcohol, if consumed, should be consumed in low-to-moderate amounts. Preventive efforts by healthcare providers, dietitians, and governments should be focused on promoting better overall eating habits and diet quality. The strategies to improve the diet of the population should include addressing nutrition literacy of the general population, the availability of healthy affordable foods, the food environment including restaurants and school cafeterias, social and cultural norms regarding eating habits, and limiting marketing of unhealthy products.
Importance of Nutrition and Diet for Health
Cardiovascular diseases (CVD), specifically coronary heart disease (CHD) and stroke, are the leading causes of death and disability-adjusted life-years worldwide.1 However, CVD and its related risk factors are largely preventable by primary prevention. Hence, effective approaches for the prevention of CVD, including changes in lifestyle and diet, are key to reduce disease burden and improve overall population health.
Among the many established risk factors for CVD, diet is one of the primary modifiable risk factors.2 In the last several decades, numerous studies have enhanced our understanding of the relationship between diet and cardiovascular health. Understanding the relationship between individual dietary factors and patterns with cardiometabolic disease is crucial to identify priorities, guide public health policies, and inform strategies to improve dietary habits and health. Indeed, suboptimal diet was responsible for an estimated 1 in 5 premature deaths globally from 1990 to 2016.2 In the United States, suboptimal diets were associated with more deaths than any other risk factors. In 2016, they were responsible for an estimated 529,300 deaths, of which 84% were due to CVD.3 Among individual dietary components, the largest estimated mortality was associated with suboptimal sodium intake (9.5%), followed by nuts and seeds, seafood omega-3 fatty acids, vegetables, fruits, sugar-sweetened beverages (SSBs), and whole grains (each between 5.9% and 8.5%) and, finally, polyunsaturated fats (2.3%) and unprocessed red meats (0.4%).4
A growing body of evidence highlights the importance of diet in reducing the risk of CVD and death and, consequently, the burden that this causes in health systems ...