Diet is just as essential for cardiac health as it is for cardiac recovery. Unfortunately, the nutritional deficiencies that lead to cardiovascular disease seldom resolve after a cardiac health event without sound nutritional guidance from a medical professional.

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After a cardiac event, patients may need to reduce cholesterol intake or lose weight, among other dietary goals. The following is a snapshot of current research on supplements and whole foods that are beneficial for cardiac recovery. 

Iron

Iron deficiency can cause anaemia, which can limit muscle function when oxygen levels drop. Low iron levels may also lead to activity intolerance and shortness of breath in patients. Unfortunately, this deficiency is perhaps more common than you would think. 

Among the 211 study participants, 39% were iron deficient. Among those in cardiac rehab following surgery, 61% were iron deficient, followed by 46% of patients with heart failure, and 31% of patients with coronary artery disease.

Methods of administration

Evidence supports iron supplementation during cardiac recovery but the form of administration may be critical. Intravenous therapy may be more effective than oral supplementation.

According to a 2021 review published in ESC Heart Failure, oral iron therapy has not been studied extensively. Of the two studies that met inclusion criteria for the review, one study only had seven patients. That study concluded that oral iron supplementation did not lead to a higher peak oxygen consumption. In the other study, oral iron therapy showed no significant improvements.

By comparison, another study included in the review demonstrated that intravenous iron therapy was associated with self-reported quality of life improvements from patients, improved 6-minute walking distances, and “early reductions in calculated plasma volume status in weight.”

Myocardial infarction recovery

According to a 2019 review published in Pharmaceuticals, there is evidence that myocardial infarction (MI) patients healed faster after starting iron supplementation 4 days after onset. Iron deficiency is also common in patients with pulmonary hypertension. When iron levels improved, these patients could walk for longer periods. Patients looking to source iron from whole foods can turn to beans, lentils, spinach, tofu, prune juice, dried fruits, nuts, and broccoli.

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Vitamin D

Vitamin D deficiency has been linked to cardiovascular disease. This hormone balances calcium and phosphate levels, improving cardiac function and strengthening cardiac tissue.

Food sources

• Rich sources of vitamin D include:
• Trout
• Salmon
• White mushrooms
• Sardines
• Fortified nut beverages like almond and oat milk

If relying on supplements, patients should take vitamin D with food to enhance absorption. Research indicates that foods with some fat work best. Recommended vitamin D levels vary by age, as well as the amount of natural sun exposure a person receives. This may be contingent on a patient’s geographic location. 

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Coenzyme Q10

Coenzyme Q10 (CoQ10) is a mitochondrial molecule that facilitates energy production in human cells. Research has shown that many patients with cardiac conditions, such as cardiomyopathy, have low levels of CoQ10. A 2022 review published in the Asian Journal of Cardiology Research highlights some of the benefits of CoQ10 supplementation for cardiac patients. Examples include:

1. 300 mg daily increased antioxidant activity and lowered inflammation levels in patients with CAD who were using statins.
2. CAD patients significantly decreased total cholesterol and raised HDL-C levels in a meta-analysis involving eight trials. 
3. CoQ10 lowered ventricular arrhythmias, boosted left ventricular function, and reduced total cardiac death in patients with post-myocardial reperfusion.
4. When administered within the first 3 days of MI, patients who received 120 mg of CoQ10 daily benefitted from its “rapid protective effects.”

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Fish oil

Fish oil is rich in the omega-3 polyunsaturated fatty acids EPA and DHA. According to the Asian Journal of Cardiology Research review, fish oils have demonstrated efficacy in reducing angina, fatal and non-fatal MI, and sudden cardiac death.

One study included in the review estimated that fish oil led to a 14% to 15% risk reduction for populations at high risk of coronary heart disease. Doses of 2 to 4 g daily of EPA and DHA have also been shown to reduce triglyceride levels and slow atherosclerosis, plaque formation, and coronary artery calcification.

MI recovery

Study participants received the supplement for 6 months following MI. Fish oil led to a “reduction in adverse left ventricular remodelling, non-infarct myocardial fibrosis and serum biomarkers of systemic inflammation beyond the current guideline-based standard of care.”

The review also highlights an Italian study in which 7,000 heart failure patients received 1 g of omega-3 fatty acids daily. Researchers found that ejection fractions lowered in 91% of participants over 3.9 years. In addition to fish oil and krill oil supplements, omega-3 fatty acids can be sourced from nuts and seeds, plant oils, and some fortified foods.

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Mediterranean diet

No diet is perfect, but the Mediterranean diet checks many boxes for recovering cardiac patients, or those concerned about their cardiovascular health. 

According to Circulation Research review:

“There is a large, strong, plausible, and consistent body of available prospective evidence to support the benefits of the MedDiet on cardiovascular health.”

After combing through existing studies, researchers selected 45 for inclusion in their meta-analysis. They called the evidence substantiating the Mediterranean diet’s cardiac benefits “large, strong, and consistent,” noting that it leads to reduced rates of coronary heart disease, ischaemic stroke, and total CVD.

Combating CVD

A 2017 review published in the Journal of Cardiovascular Medicine reached similar conclusions, calling the diet “a reliable weapon against CVD progression.”

Specifically, the diet improves endothelial function, arterial stiffness, and cardiac remodelling, reducing peripheral artery disease, coronary artery disease, and heart failure. The antioxidant-rich diet can also lead to improvements in patients with atrial fibrillation, one highlighted study concluded. The diet relies on the following staples:

• Whole grains
• Vegetables
• Legumes
• Fruits
• Nuts
• Seeds
• Herbs and spices
• Olive oil
• Fatty fish (mackerel, herring, sardines, albacore tuna, and salmon)
• Wine (in moderation)

Patients interested in the Mediterranean diet can begin by basing meals around whole grains, beans, and vegetables, eating fish twice weekly, swapping out butter with olive oil, and eating fresh fruit for dessert.

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This story is contributed by Ashley Perez and is a part of our Global Content Initiative, where we feature selected stories from our Global network which we believe would be most useful and informative to our doctor members.