One of the most common questions asked by patients to clinicians is what should they eat to lower cardiovascular risk. This article summarises updated dietary evidence from the European Society of Cardiology (ESC) that can be recommended to patients to lower cardiovascular disease (CVD) risk.

The study

Consuming more plant-based meals (but avoiding refined cereals and starchy foods), and consuming less salt and animal-derived foods is related to a decreased risk of cardiovascular disease. These are the conclusions of a study published in the journal Cardiovascular Research, a publication of the European Society of Cardiology (ESC). To summarise the conclusions of the thorough assessment of studies on food and heart disease, plant-based foods should account for the majority of calories in heart-healthy diets. The report includes current data on the amount and frequency with which each food may be ingested safely.

There is no evidence that any diet is harmful to the cardiovascular system. It is a question of amount and frequency of intake," research author Professor Gabriele Riccardi of Naples Federico II University in Italy explained. "In the past, we made the error of viewing one nutritional component as the adversary and the only thing that needed to be changed. Rather than that, we now need to look at diets holistically, and if we eliminate one thing, it is critical to replace it with a healthy alternative."

What does the data indicate?

1. The new data distinguishes processed and red meat, both of which are linked with an elevated risk of cardiovascular disease – from chicken, which displays no association at moderate intakes (up to three 100 gram meals per week). Red meat (beef, swine, and lamb) should be limited to two 100-gram portions per week, while processed meat (bacon, sausages, and salami) should be used sparingly.
2. Legumes (up to four 180 grams meals per week) are advised as a protein substitute for red meat. Moderate spinach intake (two to four servings of 150 g per week) is also supported by the most recent data for heart disease prevention, however, there may be issues about sustainability.
3. Poultry may be an acceptable protein substitute for red meat when consumed in moderation.
4. Given the substantial link between fruits and vegetables and a reduced risk of atherosclerosis, daily consumption should be raised to as much as 400 g for each. A handful (about 30 g) of nuts each day is suggested.
5. Poultry, when consumed in moderation, maybe a good protein substitute for red meat.
6. Recent data do not support a necessity for healthy individuals to consume low-fat dairy products rather than full-fat dairy products in order to prevent heart disease. Rather, both full-fat and low-fat dairy products are not connected with an elevated risk when consumed in moderation and as part of a balanced diet.
7. "Small amounts of cheese (three 50-gram portions per week) and regular yoghurt intake (200-gram servings per day) are also associated with a protective effect owing to their fermentation," Professor Riccardi explained. "We now know that gut bacteria play a significant role in mitigating cardiovascular risk. Fermented dairy products include beneficial microorganisms that aid in overall wellness."
8. With regards to cereals, a piece of unique advice is offered based on the glycaemic index (GI), with meals with a high GI causing blood sugar to rise more quickly than those with a low GI. As foods with a high glycemic index (i.e. white bread, white rice) are related to an increased risk of atherosclerosis, intake should be limited to two servings per week and otherwise substituted with whole-grain meals (i.e. bread, rice, oat, barley) and low glycemic index foods (i.e. pasta, parboiled rice, corn tortilla).
9. In terms of drinks, coffee and tea (up to three cups daily) have been linked to a decreased risk of cardiovascular disease. Soft drinks, even those with fewer calories, are associated with an increased risk and should be substituted with water save on rare instances. Moderate alcohol intake (up to two glasses of wine per day for men and one glass per day for women; or one can of beer) is related to a reduced risk of heart disease when compared to excessive consumption or abstention. Professor Riccardi, however, stated that "in light of the overall effect of alcohol on health, this research should be taken as the maximum permissible consumption rather than a suggested quantity."
10. In terms of chocolate, the current data support a daily intake of up to 10 grams of dark chocolate. According to the authors, "At this level of intake, the beneficial effects outweigh the risk of weight gain and its associated adverse effects on cardiovascular health."

Conclusion

Professor Riccardi stated that eating should be pleasurable in order to encourage healthy individuals to adopt long-term lifestyle changes. "We need to rediscover culinary traditions like the Mediterranean diet, which features delectable meals that incorporate beans, healthy grains, nuts, fruits, and vegetables," he added.

The authors concluded:

"A strategy based solely on guidelines and nutritional education will not be sufficient to change the population's lifestyle. Policy options should therefore include measures to enable the development, marketing, availability, and affordability of foods that are not only healthy but also aesthetically pleasing."

Suggested food consumption according to available evidence on the association between food choices and risk of atherosclerosis

Disclaimer- The views and opinions expressed in this article are those of the author's and do not necessarily reflect the official policy or position of M3 India.

The author is a practising super specialist from New Delhi.