What Should You Eat to Protect Your Heart?
Focus on whole, minimally processed foods: abundant fruits and vegetables (at least 5 servings daily), whole grains, legumes, nuts, fatty fish at least twice weekly, and healthy fats from olive oil and avocados. Limit red and processed meat, refined carbohydrates, added sugars, sodium, and saturated fat to less than 7% of total calories.
The American Heart Association's 2021 Dietary Guidance to Improve Cardiovascular Health provides an updated evidence-based framework. The guidance emphasizes dietary patterns over individual nutrients, recognizing that the overall eating pattern matters more than any single food or supplement. Key recommendations include adjusting caloric intake to achieve healthy weight, eating plenty and a variety of fruits and vegetables, choosing whole grains over refined grains, using liquid plant oils rather than tropical oils and animal fats, and minimizing added sugars, processed meats, and ultra-processed foods.
The strongest evidence supports the Mediterranean dietary pattern and the DASH diet. Both share core principles: plant-predominant eating with abundant fruits, vegetables, legumes, nuts, and whole grains; fish as a primary protein source; olive oil as the main cooking fat; and minimal processed foods. The Lyon Diet Heart Study demonstrated a 72% reduction in cardiac death and nonfatal MI with a Mediterranean-style diet, and the PREDIMED trial showed a 30% reduction in major cardiovascular events with the Mediterranean diet supplemented with extra-virgin olive oil or nuts.
The PREDIMED trial showed a 30% reduction in major cardiovascular events with the Mediterranean diet
What Is the Mediterranean Diet?
The Mediterranean diet is a plant-rich eating pattern inspired by traditional cuisines of Greece, Italy, and Spain. It emphasizes olive oil, fish, whole grains, legumes, fruits, vegetables, nuts, and moderate red wine, while limiting red meat, processed foods, and added sugars. It is the most evidence-supported dietary pattern for cardiovascular disease prevention.
The landmark PREDIMED trial randomized 7,447 adults at high cardiovascular risk to a Mediterranean diet supplemented with extra-virgin olive oil (1 liter per week), a Mediterranean diet supplemented with mixed nuts (30g daily), or a control low-fat diet. After a median follow-up of 4.8 years, both Mediterranean diet groups showed a 30% reduction in the primary composite endpoint of myocardial infarction, stroke, and cardiovascular death compared to the control diet. The olive oil group had a 31% reduction and the nuts group a 28% reduction.
Beyond cardiovascular events, the Mediterranean diet has demonstrated benefits for type 2 diabetes prevention, cognitive function, cancer risk reduction, and all-cause mortality. A meta-analysis of 29 observational studies found adherence to the Mediterranean diet was associated with a 10% reduction in cardiovascular incidence or mortality, 6% reduction in cancer incidence or mortality, and 13% reduction in neurodegenerative diseases. The diet's benefits are attributed to its anti-inflammatory, antioxidant, and lipid-modifying properties.
The PREDIMED trial randomized 7,447 adults and showed 30% reduction in cardiovascular events
What Foods Should You Avoid for Heart Health?
Limit saturated fat to less than 7% of total calories, eliminate trans fats entirely, reduce sodium to less than 2,300 mg daily, minimize added sugars to less than 25 grams daily for women and 36 grams for men, and limit processed and red meat to no more than 1-2 servings per week.
Trans fats are the most harmful dietary fat for cardiovascular health, raising LDL cholesterol while lowering HDL cholesterol. While artificial trans fats from partially hydrogenated oils have been largely eliminated from the food supply following the 2018 FDA ban, small amounts remain in some processed foods. Saturated fat from red meat, butter, cheese, and tropical oils (coconut, palm) raises LDL cholesterol. The Harvard Nurses' Health Study and Health Professionals Follow-up Study found that replacing 5% of calories from saturated fat with polyunsaturated fat reduced coronary heart disease risk by 25%.
Ultra-processed foods (UPFs) — including packaged snacks, sugary beverages, fast food, processed meats, and ready-to-eat meals — have emerged as a major cardiovascular concern. A meta-analysis in the BMJ found that each 10% increase in UPF consumption was associated with a 12% higher risk of cardiovascular disease. These foods are typically high in sodium, added sugars, unhealthy fats, and additives while being low in fiber, vitamins, and minerals. The NutriNet-Santé study confirmed that higher UPF intake is independently associated with increased cardiovascular and all-cause mortality.
