Contemporary issues regarding nutrition in cardiovascular rehabilitation.

In this article, we discuss certain contemporary and controversial topics in cardiovascular (CV) nutrition including recent data regarding the health benefits of the Mediterranean diet, the role of saturated fatty acids, red meat and the microbiome in CV disease and the current role of personalized CV nutrition. Findings from the PREDIMED study now demonstrate the health benefits of the Mediterranean diet even in the absence of heart disease. The study highlighted that even small, sustained and easily implementable changes to diet can provide significant health benefits even in Mediterranean regions. Likewise, observational data in secondary prevention show that increased adherence to the Mediterranean diet is associated with good long-term clinical outcomes among subjects with stable coronary heart disease. The role of saturated fats in the development of CV disease remains controversial, although data suggest that these fats are associated with modestly increased risk of CV events. In contrast, the obesity epidemic currently driving the CV risk worldwide is in large part due to excess consumption of refined carbohydrates. Furthermore, a growing body of evidence suggests that the intestinal microbiome is highly sensitive to lifestyle choices and may play a pivotal role in modulating CV disease development. For example, recent evidence linking processed and unprocessed meats to increased CV risk pointed to the gut microbial metabolite trimethylamine N-oxide as a potential culprit. Finally, given the high interindividual variability in response to interventions including diet, personalized nutrition has potential to play a major role in tailoring diets based on genetic make-up to maximize health benefits. This approach is still in its infancy but is highly promising.