Purpose: Cardiovascular diseases (CVD) are the leading cause of death globally. The current model of care for high-income countries involves preventive medication and highly trained healthcare professionals, which is expensive and not transposable to low-income countries. An innovative, effective approach adapted to limited human, technical, and financial resources is required. Measures to reduce CVD risk factors, including diet, are proven to be effective. The survey "Scaling-up Packages of Interventions for Cardiovascular disease prevention in selected sites in Europe and Sub-Saharan Africa" aims to develop non-pharmacological cardiovascular prevention and control programs in primary care and community settings in high, middle, and low-income countries. This review aims to identify the existing, validated dietary interventions for primary CVD prevention from national and international clinical guidelines that can be implemented in primary care and communities.
Methods: A systematic review of CVD prevention guidelines was conducted between September 2017 and March 2023 using the Turning Research Into Practice medical database, the Guidelines International Network, and a purposive search. The ADAPTE procedure was followed. Two researchers independently conducted the searches and appraisals. Guidelines published after 01/01/2012 addressing non-pharmacological, dietary interventions for primary CVD prevention or CVD risk factor management, in the adult general population in primary care or in community settings were included and appraised using the Appraisal of Guidelines Research and Evaluation II score. Individual dietary recommendations and the studies supporting them were extracted. Then supporting data about each specific dietary intervention were extracted into a matrix.
Results: In total, 1375 guidelines were identified, of which 39 were included. From these, 383 recommendations, covering 10 CVD prevention themes were identified. From these recommendations, 165 studies for effective dietary interventions for CVD prevention were found. Among these, the DASH diet was the most effective on multiple CVD risk factors. Combining diet with other interventions such as exercise and smoking cessation increased efficacy. No guidelines provided detailed implementation strategies.
Conclusion: The DASH diet combined with other interventions was the most effective on an individual basis. However, expansion in the wider population seems difficult, without government support to implement regulations such as reducing salt content in processed food.
Trial registration: Clinical Trials NCT03886064.
Keywords: Diet; Heart diseases; Population health management; Primary health care; Primary prevention.
Heart disease is the leading cause of death around the world. Strategies to prevent heart disease in high-income countries rely on medications and the skills of highly trained healthcare professionals. However, this is expensive and unsuitable for low-income countries. Consequently, an innovative, effective approach, which can be adapted to countries with limited human, technical and financial resources is needed. A program called SPICES was developed to identify strategies other than medication to prevent and control heart disease. This program reviewed the evidence for smoking cessation, physical activity, and dietary strategies, which may be useful to prevent heart disease in communities with limited resources.In this review, the investigators searched online databases to find clinical guidelines that recommended dietary strategies to manage heart disease worldwide. The information found from this search revealed that the DASH diet, inspired by the Mediterranean diet, helps with weight loss, and improves blood pressure and cholesterol levels making it the most effective diet for preventing heart disease. It is even more effective if it is combined with other strategies such as exercise, stopping smoking or reducing the amount of alcohol consumed. However, this works well for individuals but is difficult to expand to the wider population. Therefore, government support is needed to implement regulations such as reducing salt content in processed food.
© 2023. The Author(s).