Practical, Evidence-Based Approaches to Nutritional Modifications to Reduce Atherosclerotic Cardiovascular Disease: An American Society For Preventive Cardiology Clinical Practice Statement

Danielle Belardo; Erin D Michos; Ron Blankstein; Roger S Blumenthal; Keith C Ferdinand; Kevin Hall; Kevin Klatt; Pradeep Natajaran; Robert J Ostfeld; Koushik Reddy; Renee Rodriguez; Urshila Sriram; Deirdre K Tobias; Martha Gulati

doi:10.1016/j.ajpc.2022.100323

Practical, Evidence-Based Approaches to Nutritional Modifications to Reduce Atherosclerotic Cardiovascular Disease: An American Society For Preventive Cardiology Clinical Practice Statement

Am J Prev Cardiol. 2022 Mar 2:10:100323. doi: 10.1016/j.ajpc.2022.100323. eCollection 2022 Jun.

Authors

Affiliations

¹ IOPBM, Newport Beach, CA, USA.
² Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, MD, USA.
³ Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
⁴ Department of Medicine, Tulane University School of Medicine, New Orleans, LA, USA.
⁵ National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, USA.
⁶ Baylor College of Medicine, Houston, TX, USA.
⁷ Division of Cardiology, Montefiore Health System, Bronx, NY, USA.
⁸ Department of Medicine, James A. Haley VA Medical Center - University of South Florida, Tampa, FL, USA.
⁹ Palo Alto Medical Foundation - Sutter Health, USA.
¹⁰ Department of Nutrition, College of Natural, Behavioral, and Health Sciences, Simmons University, Boston, MA, USA.
¹¹ Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
¹² Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston MA, USA.
¹³ University of Arizona, Phoenix AZ, USA.

Abstract

Despite numerous advances in all areas of cardiovascular care, cardiovascular disease (CVD) is the leading cause of death in the United States (US). There is compelling evidence that interventions to improve diet are effective in cardiovascular disease prevention. This clinical practice statement emphasizes the importance of evidence-based dietary patterns in the prevention of atherosclerotic cardiovascular disease (ASCVD), and ASCVD risk factors, including hyperlipidemia, hypertension, diabetes, and obesity. A diet consisting predominantly of fruits, vegetables, legumes, nuts, seeds, plant protein and fatty fish is optimal for the prevention of ASCVD. Consuming more of these foods, while reducing consumption of foods with saturated fat, dietary cholesterol, salt, refined grain, and ultra-processed food intake are the common components of a healthful dietary pattern. Dietary recommendations for special populations including pediatrics, older persons, and nutrition and social determinants of health for ASCVD prevention are discussed.

Keywords: ACC, American college of cardiology; AHA, American heart association; ASCVD, atherosclerotic cardiovascular disease; CER, continuous energy restriction; CHD, coronary heart disease; CVD, cardiovascular disease; Cardiovascular disease; Cardiovascular disease prevention; Clinical trials; DASH, dietary approaches to stop hypertension; DHA, docosahexaenoic acid; EPA, eicosapentanoic acid; EVOO, extra virgin olive oil; HDL-C, high density lipoprotein cholesterol; HR, hazards ratio; IER, intermittent energy restriction; LD, low density lipoprotein cholesterol; MUFA, monounsaturated fatty acids; NHANES, national health and nutrition examination survey; Nutrition; OMT, optimal medical therapy; PUFA, polyunsaturated fatty acids; PURE, prospective urban rural epidemiology; RCT, randomized controlled trial; SFA, saturated fatty acids; Social determinants of health; T2D, type 2 diabetes; TER, timed energy restriction; US, United States; VD, vegetarian diet.