The evolution of the heart-healthy diet for vascular health: A walk through time

Vasc Med. 2020 Apr;25(2):184-193. doi: 10.1177/1358863X19901287. Epub 2020 Mar 3.

Abstract

The rate of cardiovascular disease (CVD) mortality reduction in the United States has plateaued recently, despite the development of novel preventive pharmacotherapies, increased access to care, and healthcare spending. This is largely due to American's poor dietary patterns and practices causing increasing trends in the prevalence of obesity and type 2 diabetes mellitus. For decades, dietary guidelines on 'healthy diets' to reduce CVD risk, grounded in epidemiological research, have been nationally distributed to Americans. In this review, we highlight landmark events in modern nutrition science and how these have framed past and current understandings of diet and health. We also follow the evolution of dietary recommendations for Americans throughout the years, with an emphasis on recommendations aimed to reduce risk for CVD and mortality. Secondly, we examine how the low-fat ideology came to dominate America in the last decades of the 20th century and subsequently contributed to an excess intake of refined carbohydrates which, in the context of an increasingly sedentary lifestyle, may have fueled the obesity epidemic. We then examine the current major evidence-based dietary patterns and specific dietary approaches to reduce CVD risk, reviewing the literature surrounding nutritional components of the heart-healthy diet and discussing the dietary patterns proven most effective for CVD prevention: the Dietary Approaches to Stop Hypertension (DASH) diet, the Mediterranean diet, and the healthy vegetarian diet. Finally, we discuss emerging dietary trends, considerations for nutrition counseling, and future directions within the important field of nutrition, with the ultimate goal of improving vascular health.

Keywords: cardiovascular disease; diet; nutrition.

Publication types

  • Historical Article
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Cardiovascular Diseases / epidemiology
  • Cardiovascular Diseases / history
  • Cardiovascular Diseases / physiopathology
  • Cardiovascular Diseases / prevention & control*
  • Diet, Healthy* / adverse effects
  • Diet, Healthy* / history
  • Diet, Healthy* / trends
  • Diffusion of Innovation
  • Feeding Behavior
  • Forecasting
  • Health Status
  • Heart / physiopathology*
  • History, 20th Century
  • History, 21st Century
  • Humans
  • Nutritional Status
  • Nutritive Value
  • Protective Factors
  • Recommended Dietary Allowances
  • Risk Assessment
  • Risk Factors
  • Risk Reduction Behavior*