How to Eat Well for Cardiovascular Disease
Cardiovascular disease (or CVD) is a general term for several conditions that affect the heart and blood vessels. They usually, but not always, involve something called atherosclerosis, which is a build-up of fatty deposits (called plaque) inside the arteries. The plaque obstructs or stops blood flow, which can cause serious damage to the heart or another body part, or even death.
In fact, cardiovascular disease is the leading cause of death in the United States. Learning more about CVD can help you prevent it, and help you live longer if you already have it. The main types of CVD include:
Abnormal heart rhythms: A heartbeat that is often unsteady, too slow or too fast
Aorta disease and Marfan syndrome: The widening and tearing of the aorta artery
Cardiomyopathies: Diseases of the heart muscle, or enlarged heart
Congenital heart disease: Problems with one or more parts of the heart, which occurs before birth; may involve genes or the fetus' exposure to infections, alcohol or drugs
Coronary artery disease: Narrowing and hardening of the arteries from plaque
Deep vein thrombosis and pulmonary embolism: Blood clots in deep veins, which can break loose and travel through your bloodstream to your lungs
Heart attack: When a blocked vein or leaking blood vessel slows blood and oxygen flowing back to the heart
Heart failure: A poorly pumping heart, causing your body to hold in salt and water, which results in shortness of breath and swelling
Heart valve disease: Problems with one or more of the valves that sit at the exit of the four chambers of the heart
Pericardial disease: Inflammation of the lining of the heart, often caused by infection
Rheumatic heart disease: Occurs when rheumatic fever, an inflammatory disease most common in children, damages the heart valves
Stroke: When a blocked artery or leaking blood vessel slows blood and oxygen flowing to the brain
Vascular disease: A circulatory system issue that blocks or slows blood flow to a body part (such as the legs) or the brain
The Centers for Disease Control and Prevention (CDC) say about half of all Americans - 47%, to be exact - have at least one of three key risk factors for heart disease: high blood pressure, high cholesterol and smoking. Other risk factors include family history of one or more of the conditions listed above, excess alcohol use, low physical activity, being overweight and/or having type 2 diabetes.
As for sex and age, cardiovascular disease is the number one killer of both men and women of almost every ethnicity. And though anyone can have CVD, the risk increases as you age.
If you're diagnosed with CVD, one of the treatments your healthcare team will discuss with you is lifestyle changes, including what you eat, fitness, alcohol and tobacco use. While diet isn't the only reason people get CVD, it does play a major role in your heart health. Here's an overview of the best and worst foods for people who have or are at high risk of CVD.
What to eat to prevent and treat cardiovascular disease
Plant-based diet
A diet that emphasizes mostly plant-based foods and limits animal-based foods has been scientifically proven to be good for your heart health. Eating more vegetables, fruits, beans and legumes, whole grains, nuts, seeds, and healthy plant-based oils (avocado oil, coconut oil, and olive oil), will provide an abundance of heart-healthy fiber, vitamins, minerals, antioxidants and beneficial fats. A plant-based diet can either include or exclude occasional portions of animal-based meats and dairy.
Pescatarian or Mediterranean
Following a mostly plant-based diet that incorporates fish and seafood plus healthy fats (such as the Pescatarian Diet or Mediterranean Diet) has been associated with a reduced rate of developing a first acute coronary event (a rupture caused by plaque build-up in arteries). Combining a diet rich in plant-based foods with nuts, olives, olive oil, and fatty fish that is rich in omega-3s, such as salmon, tuna, trout, sardines, herring, oysters and mackerel, can reduce the risk of both CVD and type 2 diabetes.
Healthy fats
Though a low-fat diet was (and still is) often prescribed for someone with heart issues, that advice can be counterintuitive, especially if removing fat means you eat more refined carbohydrates (which is the usual pattern). Eating fat is helpful and necessary for cell and brain function in all people, including people with or at risk for CVD.
While the fat topic can be controversial, all experts agree on two things. First, your best fat choices are foods high in monounsaturated fats, such as avocados, olive oil, nuts and seeds, and fatty fish like salmon, anchovies and bluefin tuna that contain omega 3s. Second, you should aim to eliminate trans fats and limit other inflammatory oils that are high in omega 6s, such as corn oil and soybean oil (ingredients common in many ultra-processed foods).
What about saturated fat? Controversy exists on the topic, especially when it comes to heart health. While literature points to diets high in saturated and trans fats being associated with high cholesterol, saturated fat has been found to have a neutral impact that's neither particularly good nor bad when it comes to other heart issues. And health benefits have even been connected to some high saturated fat choices, such as eggs, coconut oil, full-fat dairy, ghee and butter, and grass-fed beef.
For someone with high cholesterol, reducing overall fat intake (and especially reducing trans and saturated fats) within a whole-food, low-processed diet makes sense. For people where high cholesterol is not a concern, saturated fats can be fine choices along with other monounsaturated and some polyunsaturated fats (walnuts, sunflower seeds, and flaxseeds).
Foods to avoid for cardiovascular disease
Inflammatory foods
A recent study published in the Journal of the American College of Cardiology, found that people who eat the most inflammatory foods have almost 50 percent higher risk of developing heart disease. Another study showed that ultra-processed foods (from which the average American gets almost 58% of their daily calories) are highly inflammatory due to high quantities of sugar, trans fat, salt, refined flour, additives and preservatives.
People at risk of CVD would be wise to limit foods in the ultra-processed category, including fast foods, processed meats, baked goods, deep-fried foods, sweet and savory snack foods, and candy.
Added-sugar foods and drinks
Diets high in added sugar have been linked to increased risk of CVD. While added sugars are found in many ultra processed foods, you can also find them in soda and energy drinks, sugar-sweetened coffee and tea, homemade and purchased desserts and breakfast cereals.
Alcohol
Habitual light to moderate alcohol intake (up to 1 drink per day for women and 1 or 2 drinks per day for men) is associated with decreased risks for total mortality, coronary artery disease, diabetes mellitus, congestive heart failure, and stroke. However, higher levels of alcohol consumption are associated with increased cardiovascular risk.
This is an important distinction and not one to be taken lightly. Even if you abstain from alcohol on most days, but have an episode of high alcohol intake on one or more days per week (weekends, for example), you're putting yourself at higher risk of CVD than someone who abstains from alcohol or meets the threshold of light to moderate intake, as defined above. Also, remember that alcohol is a source of empty calories, meaning you get little to no health benefit from it. And if you are overweight or obese, empty calories do nothing to help you lose weight.
Supplements that can help with cardiovascular disease
Additional support from certain supplements could help prevent or treat CVD. Always consult your doctor before starting a new supplement.
Fiber
If you're not meeting the recommended daily fiber amount (25 grams for women and 38 grams for men), it may be a good idea to use a fiber supplement to boost your intake. Research shows that blond psyllium husk can help lower LDL cholesterol while raising HDL cholesterol. Start by taking a small amount, drinking plenty of fluids, and then increasing the amount slowly so as to avoid cramping and excess gas.
Coenzyme Q10 (CoQ10)
This enzyme supplement has been connected to lowering blood pressure and reducing symptoms in people with congestive heart failure. It's sometimes prescribed alongside a cholesterol-lowering statin drug, since statins can reduce the amount of CoQ10 your body makes on its own.
Omega-3 Fatty Acids
Studies (especially those on people who have high triglycerides and are taking a statin drug) have shown that taking a daily omega-3 supplement can reduce the risk of heart attack and other CVDs. These studies all used a combination EPA and DHA omega-3 supplement.
Red Rice Yeast
This over-the-counter supplement contains a substance called monacolin K, which has the same chemical structure as the prescription statin lovastatin. When used daily, studies show red rice yeast can reduce total cholesterol and LDL cholesterol.
Have cardiovascular disease? Do this first.
If you smoke or chew tobacco or drink excess alcohol, the first thing you should do is work with a professional counselor to help you quit. The chemicals in tobacco raise blood pressure, reduce HDL cholesterol and damage your blood vessels - and not just for you, but the people around you, too.
For excess alcohol drinkers, the empty calories are counterproductive to heart health and can increase blood pressure, sensitize your heart to abnormal rhythms, and even cause heart muscle damage and weakness.
If you aren't a tobacco or alcohol user, the next best thing you can do is reduce belly fat. Researchers have discovered that belly fat is a large predictor of heart disease risk. In fact, one recent study suggested that for every two inches you add to your waistline, your risk of heart disease increases nearly 20 percent. While you can't target weight loss in one area of your body, the best way to lose belly fat is to eat a wholesome diet and to increase physical activity.
What else to know about cardiovascular disease
For people with or at risk of CVD, there are other factors that can help extend life. Consider the above recommended dietary approaches with the following in mind:
Medication
Depending on your risk for CVD or the type of cardiovascular disease you have, your doctor will likely prescribe medication along with lifestyle changes. Common medications for heart issues include:
ACE inhibitors, which expand blood vessels
Beta blockers, which decrease heart rate and lower blood pressure
Statins to lower LDL cholesterol
Vasodilators, which reduce the workload of the heart
Many of these medications are prescribed for life, which may or may not be a good thing for you, and it can even be harmful to stop taking them once you start.
Physical activity
Regular physical activity reduces the risk of dying prematurely from CVD. It also helps prevent the development of diabetes, helps maintain weight loss, and reduces hypertension, which are all independent risk factors for CVD. If you're new to physical activity, start by creating a 30-minute daily walking habit and increase to daily walking plus light weight lifting to build muscle.
Stress management
Chronic stress is when stress is constant and your body is in high gear off and on for days or weeks at a time. Though it's easier said than done, building some healthy boundaries around stress-inducing events and schedules can not only improve your mental health, but also reduce your risk of high blood pressure, heart attack and stroke.
Anger management
Like stress, anger can have an immediate effect on your heart, too. You're almost five times more likely to have a heart attack and three times more likely to have a stroke in the 2 hours after an angry outburst.
Prioritize sleep
Not only are you better able to manage diet, stress and anger when you sleep well, but a recent study also showed that those who get less than 6 hours of sleep per night are at increased risk of atherosclerosis.
Testing
As with any health condition, "knowing your numbers" is important, and maybe most important for heart health. Knowing your blood pressure, taking a heart stress test, and getting labs that show your blood lipid (cholesterol and triglycerides) and A1c (a measure of sugar in the blood) are meaningful tools to help you and your doctor know where you stand in terms of heart health risk. Cholesterol testing also has become more sophisticated in recent years, so you can ask for advanced lipoprotein testing and other nonstandard lipid tests to better define your specific risk and best care plan. Also, genetic testing is available that can help you make informed decisions about diet, such as saturated fat consumption.
Try our 3-day meal plan for cardiovascular health
Now that you’ve learned how to eat well - and clean - for improved heart health, we’re making it easy. Our exclusive 3-day meal plan will give you a taste of what it’s like to put all of these principles into practice. Follow our meal plan here.
