Diet and cardiovascular disease: What works?

The Bottom Line

  • Globally, cardiovascular disease results in almost 18 million deaths every year.
  • Diet is a modifiable behaviour that can impact one’s health and lifespan.   
  • A variety of dietary patterns and programs exist; these include the Mediterranean, low fat, low sodium, very low fat, modified fat, combined low fat and low sodium, Ornish, and Pritikin diets.
  • In people living with or at higher risk of cardiovascular disease, Mediterranean and low fat diets can help reduce the risk of death and non-fatal heart attacks.  

Talk of different dietary programs is aplenty! Mediterranean, low fat, and low sodium diets may be some familiar ones. But additional popular examples include very low fat, modified fat, a combination of low fat and low sodium, Ornish, and Pritikin. Each of these diets is structured differently and provides its own set of guidelines to follow (1):

  • Mediterranean: recommends increased consumption of vegetables, fruit, fish, and monounsaturated fats like olive oil.  
  • Low fat: recommends total fat consumption to account for 20% to 30% of your total calories, and saturated fat, specifically, to account for less than 10% of your calories.
  • Low fat plus low sodium: same as low fat plus the added recommendation of consuming less than 2.4 grams of sodium per day.
  • Very low fat: recommends total fat consumption to account for 10% to 20% of your total calories.
  • Modified fat: recommends consumption of more polyunsaturated fat vs. saturated fat without reducing total fat consumption.
  • Ornish: a mostly plant-based diet recommending total fat consumption to account for less than 10% of your total calories.
  • Pritikin: recommends consumption of 40 to 45 g/1000 kilocalories of fibre and that carbohydrate consumption account for 70% to 75% of your total calories, while protein accounts for 15% to 20%.

With a variety of diverse options to choose from in this seemingly ever-growing list, it can be overwhelming to wade through the evidence and pinpoint what works and for who. Yet, it’s still an important conversation to have, especially because diet is recognized as a modifiable behaviour that can increase or decrease our risk of developing and managing chronic diseases, as well as dying prematurely (2).


In fact, globally, chronic diseases are responsible for 41 million deaths annually, with cardiovascular diseases contributing to almost 18 million of these deaths (3). So, what popular dietary programs can reduce the risk of death in people living with cardiovascular disease or at a higher risk of developing it? A recent systematic review comparing the seven dietary programs listed above with other strategies that aim to lower cardiovascular risk (e.g., medication, exercise) or minimal strategies in the form of little to no dietary advice and support, breaks down the evidence (1).


What the research tells us

The review found two standout dietary programs compared to minimal intervention: Mediterranean and low fat! These programs can decrease the risk of death in those living with or at higher risk of cardiovascular disease. The benefits are seen at up to 17 years. Unfortunately, these positive results don’t extend to the very low fat, modified fat, combined low fat and low sodium, Ornish, and Pritikin diets.  


The good news continues! It appears Mediterranean and low fat dietary programs can also reduce the risk of non-fatal heart attacks, while the Mediterranean dietary program can reduce the risk of stroke as well (1).


Making changes to dietary behaviours is one way to impact aspects of your health and well-being. But these modifications should never be taken lightly and should be made in consultation with your healthcare team. This will ensure that that your needs, preferences, and safety are taken into consideration.     

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References

  1. Karam G, Agarwal A, Sadeghirad B, et al.  Comparison of seven popular structured dietary programmes and risk of mortality and major cardiovascular events in patients at increased cardiovascular risk: systematic review and network meta-analysis. BMJ. 2023; 380:e072003.
  2. World Health Organization. Cardiovascular diseases (CVDs). [Internet] 2021. [cited October 2024]. Available from: https://www.who.int/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds)  
  3. World Health Organization. Noncommunicable diastases [Internet] 2023. [cited October 2024]. Available from: https://www.who.int/news-room/fact-sheets/detail/noncommunicable-diseases

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