N° 37 | November 2018

A healthy diet for better cardiovascular health

In recent years, the scientific evidence on the links between diet and cardiovascular disease has generally strengthened.

The European Heart Network (EHN) presented the science in its 2017 paper Transforming European food and drink policies for cardiovascular health, where it proposes population goals(*) on foods and nutrients. These goals include recommendation for fruit and vegetables (F&V), where the evidence that higher intakes are protective against premature death, and more specifically against cardiovascular deaths and stroke risk, has also strengthened.

The EHN proposed intermediate and long-term population goals for F&V (Table 1):
Table 1: Revised population goals for F&V (EHN)

Intermediate goal Long term goal
+ 400 g/day +600 g/day

A cardiovascular health promoting diet means a shift from an animal-based diet to a more plant-based diet. This includes vegetables, fruit and berries in abundance. Whole grain products, nuts and seeds, fish, pulses and low fat dairy products are also important, as are non-tropical vegetable oils in modest amounts. This everyday dietary pattern also limits consumption of red meat, processed meat products and foods or drinks with low content of vitamins, minerals and dietary fibre and/or a high content of free sugars, saturated/trans fats or salt.

Three dietary patterns associated with cardiovascular health have been subject of scientific investigation:

  • Mediterranean diet: characterised by a high intake of fruit, vegetables, pulses, wholegrain products, monounsaturated fatty acids (such as olive oil), and fish. Studies have shown that this diet can lower overall death rates, cardiovascular death and cardiovascular risk1.
  • Dietary Approach to Stop Hypertension (DASH): plant-based diet, rich in fruit, vegetables, whole grains and nuts, with low-fat dairy products, lean meats, fish and poultry. This dietary pattern is associated with an improvement in blood pressure and lipid profile, thus lowering cardiovascular diseases (CVD) risk2.
  • Healthy Nordic Diet: including natural fibre-rich foods such as vegetables, pulses, fruit (especially berries), nuts, seeds and whole grains as well as rapeseed oil and fat-free or low-fat dairy products. Studies have shown that this diet has cardiovascular benefits3.

Dietary components that increase CVD risk
To reduce the risk of CVD, some of EHN’s recommendations for sugar, fat, and salt are set out in Table 2.

Taken together, the population goals proposed above should translate to a cardiovascular health promoting diet that has a low energy density, which is important for weight maintenance and for the prevention of overweight and obesity. EHN proposes an intermediate goal for adults to have an average Body Mass Index of less than 23, and a long-term goal of 21. A diverse and balanced diet covers the need for nutrients and food supplements are rarely needed.

Table 2: EHN recommendations on fat, sugar and salt

Dietary
components
Explanatory comments Recommendations
Fat • Replace saturated fats by unsaturated fats and complex carbohydrates to reduce total LDL-cholesterol in blood and thus the risk of heart disease.
• Minimize trans-fat intakes4
• Saturated fat
Intermediate goal: <10% of calories from saturated fats for the general population and <7% of calories for a population at a high risk for CVD; <1/3 of total fat
Long-term goal: 7% of calories, and < 1/3 of total fat;
Replaced with unsaturated fats (++ polyunsaturated) and fibre-rich complex carbohydrates
• Trans-fat: <0.5% of calories, of which 0% from industrially-produced trans-fat
• Total fat: ~25% of calories
Sugars Decrease sugar-sweetened drinks as much as possible and limit the amount of fruit juice consumed (sugary drinks including fruit juices and dairy products with added sugars, sweets, candies and cakes) may have a beneficial effect (although small) on cardiovascular health. Intermediate goal: <10% of calories
Long-term goal: <5% of calories
Salt Clear relationship between salt intake and cardiovascular death as well as overall death rates <5 g of salt (2 g of sodium) per day


* Population goals aren’t guidelines for individuals; they represent an average intake for the whole population so policymakers can identify the gaps between

actual and recommended diets and help them translate these goals into dietary guidelines.

Based on: Transforming European food and drink policies for cardiovascular health – Chapter 2: Food, drink and cardiovascular disease: the science. EHN Paper
2017. http://www.ehnheart.org/publications-and-papers/publications/1093:transforming-european-food-and-drinks-policies-for-cardiovascular-health.html

  1. Estruch, R.et al..N. Engl. J. Med. 368, 1279–90 (2013).
  2. Appel, L.J.et al. l.JAMA 294, 2455–2464 (2005).
  3. Nordic Council of Ministers.Nordic Nutrition Recommendations 2012. Integrating nutrition and physical activity.Nordic Nutrition Recommendations 2012 (2012).
  4. Piepoli, M.F.et al. J 37 SRC-G, 2315–2381 (2016). Intermediate goal
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