There is an alarming rise in the mortality rate from cardiovascular diseases (CVD) worldwide. According to the American Heart Association, cardiovascular diseases affect 121.5 million or nearly half (48%) of American adults.1 Several factors can trigger CVD and the lack of management results in a high rate of mortality along with physical deformities.2 The American Heart Association (AHA), in conjunction with the Centers for Disease Control and Prevention (CDC), the National Institutes of Health (NIH), and other governmental and intergovernmental agencies such as the World Health Organization (WHO) estimated a mortality rate of nearly 18 million CVD deaths, where 85% of deaths are due to heart disease. The WHO report shows the more devastating impacts of CVD, estimating that 31% of total global deaths are due to CVD.1,3
CVD is a group of diseases mainly associated with the heart and the vascular system, including coronary artery disease, high blood pressure, cardiac arrest, congestive heart failure, arrhythmia, peripheral artery disease, stroke, and congenital heart disease. Though there are several factors that can trigger CVD, atherosclerosis is believed to be a major cause that can lead to narrowing/blockage of arteries and blood vessels. CVD can cause heart attacks and strokes that result from impaired blood supply due to blood clots in the blood vessels.4
On average only one in five adults in the US have five or more metrics of ideal cardiovascular health:
The major risk factors associated with the onset of CVD are tobacco use, unhealthy diet resulting in obesity, lack of physical activity, stress, and excessive use of alcohol. Additionally, several diseases and physiological conditions such as hypertension, diabetes, and hyperlipidemia can trigger the onset of CVD. Researchers have reported that excessive smoking, use of tobacco and excessive consumption of alcohol has a devastating impact on health and constitute major risk factors for CVD. Both the risk factors act differently, excessive alcohol intake increases HDL-C level, TG level, and blood pressure while smoking reduces HDL-C level and increases TG and blood pressure.6 Other lifestyle factors such as physical inactivity and consumption of unhealthy foods can, over time, lead to obesity—another major risk factor for heart and vascular disorders.7
Disease prevention is grouped into two main strategies to minimize the risk of CVD, these are known as primary and secondary prevention. In primary prevention, major emphasis is placed on minimizing an individual’s risk of CVD by regular monitoring. Additionally, having an ideal diet along with recommended dietary supplements is key for primary prevention. Approximately 80% of CVDs can be prevented through improving lifestyle and diet habits such as not smoking, eating a healthy diet, increasing physical activity, maintaining a healthy weight, and controlling blood pressure and lipid levels.1
In secondary prevention, emphasis is given to those who have already had CVD and have a higher risk. In such profiling, monitoring risk factors at regular intervals is recommended. At this stage, reducing sodium intake, controlling cholesterol, maintaining optimal body weight, practicing routine physical exercise, quitting smoking and avoiding excessive consumption of alcohol are highly recommended.8 However, rigorous research efforts have demonstrated that diet is the most crucial risk factor, and a balanced diet may greatly reduce the risk of contracting CVD.9
It is well established that diet and CVD are interlinked. Several diet patterns were studied and validated to ensure effectiveness in cardiovascular disease prevention.10 The recommended diet plans to minimize the risk of CVD are:
Sodium is an essential element that affects blood pressure and CVD. Studies have shown that long-term, high-dose sodium consumption is a major risk factor for hypertension and CVD.11 WHO recommends a reduction to less than 2 g/day sodium (5 g/day salt) in adults as a preventive measure against cardiovascular disease. Reducing sodium intake to 2 g/day had no significant adverse effect on blood lipids, catecholamine levels, or renal function.12 The American Heart Association (AHA) recommends that dietary intake of sodium should not be more than 1.5 g/day.13 A low level of sodium intake helps to reduce blood pressure, left ventricular hypertrophy, and pro-inflammatory state.14
Low-fat diets are beneficial in reducing the risk of CVD. Studies have shown that fat consumption should not exceed 25%–35% of total calories. Recommended low-fat diets consist of saturated fat (SFA) 7%–10%, trans fat (TFA) <1%, monounsaturated fats (MUFA) and omega-3 polyunsaturated fat (n-3 PUFA).15 A low-fat diet reduces obesity and the risk of contracting CVD.
A low-carbohydrate diet helps to reduce and control body weight, which in turn lowers CVD risk. In low-carbohydrate diets (30–130 g of carbohydrates per day), it is recommended that carbohydrate intake should not exceed 30%–40% of total daily calories. This helps to reduce triglycerides (TG), increase HDL-cholesterol (HDL-C) levels, regulate blood pressure, and manage body weight.16 The study also demonstrated that a low-carbohydrate diet might lead to regaining the lost weight if it is discontinued.
The Mediterranean diet appears to help prevent chronic diseases and improve overall health. The components of the Mediterranean diet include plant foods, olive oil as the primary source of fat, daily intake of vegetables, fruits, whole grains and healthy fats, limited consumption of dairy products and moderate intake of fish, poultry, and wine.17 The Mediterranean diet seems to be effective in minimizing the risk of CVD. It is characterized by high fat intake (40%–50% of total daily calories), which includes saturated fatty acids of less than 8% and monounsaturated fatty acids in the range of 15%–25% of total calories. The high omega-3 fatty acid intake from fish and plant sources and a low omega-6:omega-3 ratio of 2:1–1:1 is recommended. The Mediterranean diet helps to reduce TG levels, increase HDL-C blood levels, and improve insulin sensitivity.18,19
The Dietary Approach to Stop Hypertension (DASH) diet is a nutritional program designed to control hypertension, a major risk factor for CVD. The DASH diet is a combination of several food products: vegetables and fruits, low-fat dairy products, whole grains, fish, nuts, and low-fat meats such as poultry. The recommended DASH diet consists of total fat (27% of total caloric intake), saturated fatty acid (6% of total caloric intake), carbohydrates (55% of total caloric intake), proteins (18% of total caloric intake), cholesterol (150 mg) and fiber (31 g). Additionally, three vital elements—potassium (4,700 mg), magnesium (500 mg), and calcium (1,240 mg)—are recommended with the DASH diet.19
In addition to the recommended diet plans, seasonal, local, fresh vegetables and fruits, whole bread and grains, legumes, nuts, and olive oil are beneficial.20 It is recommended to have a moderate intake of dairy products (low-fat), as well as eggs, fish, and chicken. In general, a diet rich in dietary fibers, whole grains, vegetables, and fruits, along with dairy products is useful in reducing CVD risk.21
The American Heart Association recommended potassium intake for adults is 4,700 mg/day. According to meta-analysis, the AHA found an inverse association between potassium intake and risk of stroke. Potassium intake of 3,500 mg/day was associated with the lowest risk of stroke.22 Potassium-rich foods include bananas, spinach, broccoli, oranges, cantaloupe, honeydew, apricots, grapefruit, sweet potatoes, mushrooms, cucumbers, zucchini, and peas.
Along with the recommended diet plans, dietary supplements can be very helpful in preventing the risk of CVD, as well as managing associated symptoms. The dietary supplements should include age-appropriate multivitamins, probiotics, coenzyme Q10, and minerals. Studies have demonstrated that the use of multivitamins reduces CVD risk.23 Coenzyme Q10 and vitamin D were studied and considered effective in reducing the risk of CVD. Similarly, probiotics were reported to be effective in CVD prevention by improving lipid metabolism and blood pressure profiles. Probiotics are also helpful in maintaining useful gut microbiota and controlling metabolic inflammation indirectly associated with CVD.24
Multivitamins and mineral supplements inhibit oxidative damage by scavenging free radicals.25 Folic acid (vitamin B9) and or combination of folic acid, vitamin B6 and B12 significantly reduces homocysteine levels and improves homocysteine mediated endothelial dysfunction.26 Further, consuming omega-3 fatty acids such as alpha-linolenic acid (ALA), eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA) protect against CVD.27 Researchers have investigated that dietary intake of EPA and DHA significantly reduces triglyceride levels.28
A balanced lifestyle is also key for maintaining good health and preventing CVD. Clinical studies have demonstrated that, when combined, excessive alcohol intake, lack of physical activity, and smoking increase CVD risk. Smoking and the use of tobacco in any form increases blood pressure which can trigger CVD. Further, the chemicals present in tobacco affect blood vessel lumen and can trigger atherosclerosis.29 Similarly, carbon monoxide from smoking replaces oxygen from hemoglobin and increases blood pressure. Quitting smoking and limiting alcohol intake are strongly recommended to avoid the risk of CVD.30
Researchers have reported that regular exercise has favorable effects on human health and reduces CVD risk by reducing body weight, controlling blood pressure, reducing bad (LDL and total) cholesterol, increasing good (HDL) cholesterol and increasing insulin sensitivity.31,32
According to the American College of Cardiology (ACC) and the American Heart Association (AHA), adults need at least 150 minutes/week of moderate exercise or 75 minutes/week of vigorous/intensive physical activity.33 Both aerobic and anaerobic exercises are beneficial to minimize the risk of CVD. As per American College of Sports Medicine, aerobic exercise (30 minutes, rise of mean blood pressure 20-40mm Hg) such as cycling, dancing, hiking, jogging/long-distance running, swimming and walking use large muscles which is beneficial for cardiac remodeling and myocardial contractility. On the contrary, anaerobic exercises (5-10 minutes, rise in mean blood pressure >100mm Hg) represent intense physical activities such as fast-stretching muscles and include sprinting, high-intensity interval training (HIIT), and power-lifting utilizing energy sources within the muscle irrespective of oxygen supply.34,35
A balanced diet together with dietary supplements, including vitamin D, folate, vitamin B6, vitamin B12, and minerals such as potassium and magnesium, are the key to controlling the risk of CVD. Additionally, taking CoQ10, omega-3 fatty acids, and plant phytosterols could be beneficial.