Cover Story | Integrating Heart-Healthy Nutrition Into Everyday Cardiology Care
Dishing up healthy eating guidance for CV risk reduction across every age and stage
Hippocrates is often credited with saying, "Let food be thy medicine, and medicine be thy food." Now, modern day research is proving there is truth to this ancient wisdom.
While tremendous advances have been made in the management of cardiovascular disease, it remains the leading cause of death worldwide. We also know that cardiovascular disease is largely preventable through modifiable risk factors, including everyday dietary choices known to influence primary and secondary cardiovascular risk and outcomes. Alarmingly, 45% of cardiometabolic disease, including heart disease, stroke and type 2 diabetes (T2D), is now linked to poor diet. A leading culprit is the regular consumption of ultra-processed foods (UPFs), which are widely available and often affordable, yet typically low in nutritional value, and high in sodium, added sugars and unhealthy fats.
Today, the concept of "food as medicine" has gained renewed scientific momentum as mounting evidence demonstrates significant and measurable effects of heart-healthy dietary patterns on lipid profiles, blood pressure (BP), glycemic control and cardiovascular outcomes.
In response, contemporary cardiology guidelines including the recent ACC/AHA hypertension and dyslipidemia guidance increasingly recognize heart-healthy dietary patterns as a cornerstone of cardiovascular risk reduction.
"We have strong nutrition recommendations across cardiology guidelines. The challenge now is implementation – getting evidence-based nutrition guidance into cardiovascular care in practical ways that help patients make sustainable changes," says Kim Allan Williams Sr., MD, MACC, professor and chair, Department of Internal Medicine, University of Louisville School of Medicine and a past ACC president.
"Diet is upstream from nearly every major cardiovascular risk factor. Food should be viewed as a core component of preventive cardiovascular therapy, not just lifestyle counseling," he highlights.
Yet, despite the growing emphasis on nutrition in the guidelines, most cardiology training still offers limited practical preparation for translating nutrition science into patient-centered conversations.
"Most physicians feel inadequately trained in nutrition counseling, and any existing education tends to focus on nutrient biochemistry rather than practical dietary guidance," says Monica Aggarwal, MD, FACC, associate professor of medicine, University of Florida's Division of Cardiovascular Medicine. "We've focused so much on treatment that we've forgotten prevention. Patients want to know what they can do to their diet to support their health and heal their bodies. The goal is not perfection – the goal is to start the conversation."
Importantly, these conversations also occur amid the realities of patients' lives, including individual's access to healthy foods, cost, cultural food preferences, limited time for meal preparation, and hectic lifestyles that often favor convenient prepared or highly processed food options.
"Nutrition is fundamental to cardiovascular prevention and treatment, and it's something we should be prioritizing and normalizing," says Amit Khera, MD, MSc, FACC, director, Preventive Cardiology, UT Southwestern Medical Center. "At every visit, when we see a patient, we should be inquiring about dietary patterns and habits."
Khera and others say there is an urgent need to incorporate heart-healthy nutrition across cardiology care and not limit it solely to preventive visits. The good news is that even brief conversations about healthy eating patterns, simple food swaps (olive oil instead of butter, a handful of nuts instead of chips, water instead of soda), post-visit summary reminders, and leveraging educational tools can meaningfully shift patient dietary choices over time.
What We Know About Nutrition and CV Risk
Studies consistently show that the foods – and, in many, cases beverages – individuals consume directly affect nearly every cardiometabolic condition cardiologists help manage, including:
- Lipids and atherogenic cholesterol levels
- Blood pressure
- Glycemic control and insulin sensitivity
- Endothelial function
- Inflammation
- Body weight and adiposity
- Chronic kidney disease
- Risk of recurrent cardiovascular events
As such, experts say dietary intervention should ideally be incorporated alongside statins, antihypertensives, antiplatelet therapies and cardiac rehabilitation as an integral part of primary and secondary prevention.
As well, accumulating evidence most strongly supports whole food, plant-forward dietary patterns for reducing cardiovascular risk factors and improving long-term outcomes. Current cardiovascular prevention guidelines increasingly emphasize plant-based dietary patterns and long-term healthy eating focused on fruits, vegetables, whole grains, lean proteins, legumes and other fiber-rich foods rather than specific nutrients for lowering cardiovascular risk along with limiting consumption of saturated fat, sodium, added sugar and alcohol.
Several well-known, evidence-based eating patterns support the goal of eating whole, minimally processed foods, and have been linked to reduced cardiovascular risk (coronary heart disease, heart attack, stroke, death). These include:
- The Mediterranean diet
- DASH diet
- Whole food, plant-forward eating patterns
Plant-Forward, Other Healthy Protein, More Benefit the Heart
Protein has become a major focus of nutrition trends of late. From a cardiovascular perspective, experts say protein quality and source often matter over quantity alone. Current cardiology guidance supports shifting to plant-based protein sources – including beans, lentils, edamame, peas, soy, and nuts – and limiting animal protein sources high in saturated fat. Plant-based protein sources have been associated with more favorable cardiovascular outcomes, including improvements in lipids and cardiometabolic risk factors. Indeed, recent findings show those who consumed the highest vs. lowest proportion of plant vs. animal protein had a 19% lower risk of cardiovascular disease and 27% lower risk of coronary artery disease (CAD). Furthermore, a ratio of 1:2 or closer to 1:1 of plant to animal protein is best to prevent CAD.
Encourage patients to shift toward more proteins from plants and fish and choose low-fat, no sugar-added dairy products. When eating meat, opt for lean cuts and smaller portions (palm-sized portions) and limit processed meats, such as bacon and deli meat.
Swap saturated fats (butter, margarine, coconut oils that are solid at room temperature) for unsaturated fats.
Whole Grains
Whole grains retain fiber and nutrients that are largely lost during refining. Studies show that compared to infrequent intake, people who regularly eat whole grain foods are more likely to have improved lipid profiles, better BP and glycemic control, greater satiety, and an overall lower risk of cardiovascular disease, stroke and T2D.
Encourage patients to choose whole grains (oatmeal, brown rice, quinoa, whole wheat bread or pasta) in place of refined grains (white bread, white rice, pastries, and many packaged crackers and snack foods).
Daily sodium targets
Limiting daily sodium intake to <2,300 mg/day (about a teaspoon of salt) – and closer to 1,500 mg/day for many high-risk patients – is an evidence-based way to help lower BP, reduce vascular stiffness, prevent fluid retention and ease excess workload on the cardiovascular system. This is especially important for patients with hypertension, heart failure or elevated cardiovascular risk.
Most sodium comes from packaged, processed and prepared foods, so teaching patients to read nutrition labels and limit UPFs are important ways to lower sodium consumption.
Added Sugars
Diets high in added sugars have been linked to poor cardiovascular health and higher risks of cardiovascular disease.
Swap sugar-sweetened beverages for water or sparkling water and check the Nutrition Facts labels for added sugar (high-fructose corn syrup, cane sugar/syrup, fruit juice concentrates).
Focus on Fiber
Only 5% of American adults get the recommended amount of fiber. Low fiber can contribute to poor cardiometabolic health. Higher fiber intake has been shown to improve cholesterol, BP, satiety and metabolic outcomes.
It's easier than you think. "If patients are eating five servings of fruits and vegetables, whole grains and eating beans every day, they're going to get enough fiber," explains Aggarwal.
Reconsidering Alcohol
Mounting evidence suggests that even low to moderate alcohol intake may raise BP and contribute to adverse cardiovascular outcomes with no clear threshold for any cardioprotective benefit.
New guidelines emphasize limiting alcohol to reduce health risks.
"We are no longer recommending alcohol for cardiovascular benefits. The focus is on limiting intake and for those who don't drink, don't start for your heart [health]," says Khera.
"It's not one thing – fat, sugar, salt – it's a healthy pattern. If people are eating more fruits, vegetables, whole grains, fewer ultra-processed foods, less sugar and sodium [they are] going to be a lot healthier." Amit Khera, MD, MSc, FACC
A Word on Ultra-Processed Foods
Alarmingly, UPFs make up over half of all calories in the average U.S. diet and they are growing in popularity. Higher consumption of these foods is increasingly linked to greater risk of obesity, hypertension, T2D, cardiovascular disease and all-cause death. A recent study found that people who consumed over nine servings of UPFs a day on average were 67% more likely to suffer a major cardiac event than people consuming about one serving of such foods a day.
But experts say it's important to distinguish between normal food processing and ultra-processing. Minimally processed foods – for example, steel-cut or rolled oats, whole grains, frozen vegetables, canned no-salt beans, tofu and low-fat yogurt – can be part of a healthy diet. Many UPFs, however, are high in sodium, added sugars and saturated fats, all of which have been tied to hypertension, dyslipidemia, obesity and cardiovascular disease.
"The processing and prepping of food isn't a bad thing. The concern is with UPFs that have been heavily altered, stripped of fiber and nutrients, and loaded with additives and preservatives," explains Aggarwal, adding that many are engineered to be highly palatable, contributing to overeating and excess caloric intake.
Still Evolving Research
Questions remain about the cardiovascular effects of certain foods. Research is looking into the role of full-fat vs. low-fat dairy products, if there is an ideal amount of protein, as well as the long-term effects of highly processed foods.
Newer research is also testing whether food-as-medicine interventions, such as tailored meal programs, are cardioprotective and may reduce barriers to heart-healthy eating patterns and support long-term cardiovascular risk reduction.
Translating Nutrition Science Into Practice
It's not easy to change dietary behaviors and clinicians have limited time for nutrition counseling. But there are some strategies to help make dietary guidance stick.
Simple Messages Matter
Keep the message simple and actionable, say the experts.
"Patients can quickly feel overwhelmed by broad recommendations, such as "eat better" without any specific guidance. Yet, overly detailed instructions about nutrient targets, daily percentages, grams of specific nutrients, can be hard to follow," says Viet Le, DMSc, MPAS, PA-C, FACC, editor of CardioSmart, ACC's patient engagement program.
"Patients don't need complicated nutrition science," says Aggarwal. "Keep the focus on the person's overall eating patterns and practical changes that fit their life."
Avoid Leading With Restrictions
"Patients do better when they are not just told 'avoid this,' but helped to build a repeatable pattern," says Williams.
He advises patients to add healthy foods – for example, a rainbow of colorful fruits and vegetables, beans, intact whole grains (such as oats and barley), nuts, seeds, and unsaturated plant oils – and gradually replace foods high in saturated fat such as butter, processed meats and fried foods.
Meet Patients Where They Are
This is important in terms of their readiness, lived experience and motivation to make dietary changes. Tailor recommendations to personal and cultural preferences and daily life – making dietary changes feel practical and sustainable within their daily routines.
Copyright © 2011, Harvard University. For more information about The Healthy Eating Plate, please see The Nutrition Source, Department of Nutrition, Harvard T.H. Chan School of Public Health, www.thenutritionsource.org, and Harvard Health Publications, www.health.harvard.edu.
Simple Visuals, Tools Support Conversations
"Conversations about nutrition don't have to start when the clinician enters the room," says Le. "Simple visuals in the waiting and exam rooms help patients start making sense of what they're seeing in their own lives. This creates a more natural, shared starting point for a conversation about heart-healthy eating."
CardioSmart's patient-facing Healthy Living resources and other reputable tools, including the My Healthy Plate visual, can help busy practices deliver nutrition and lifestyle counseling, and help translate evidence into something patients can see, understand and act on at home.
Le adds these materials can help reinforce the message that nutrition is an integral part of cardiovascular care.
Make It a Habit
Making time to talk about heart-healthy eating reaps dividends for patients. "If the cardiologist mentions healthy eating, patients will then recognize it's important," says Khera.
Engaging the entire team – physicians, nurses, PAs, nutritionists and behavioral health specialists – helps reinforce the cardioprotective benefits of healthy eating and support contemporary guidance about and attention to the role of nutrition.
The good news is that simple strategies – asking one open-ended question, using a brief questionnaire, providing a food prescription, or sharing nutrition-related educational materials and visuals at the point of care – can help start the conversation and, more importantly, help patients connect everyday choices to their long-term health, function and quality of life.
Here are eight practical ways to integrate and prioritize heart-healthy nutrition as part of routine cardiovascular care.
- Consider using a brief, validated dietary questionnaire, such as the eight-question Start the Conversation, ahead of time or while patients are waiting to quickly assess eating patterns and identify opportunities for change.
- Start each visit with an open-ended lifestyle question before discussing medications or symptoms. This helps engage patients and gives insight into what matters most to them (staying active, having more energy and time with family, avoiding another stent) to connect dietary recommendations to personal goals. "Walk me through what dinner looked like yesterday." "What are your go-to meals most weeks?"
- Write a "food prescription" as with a medication order. "Aim for 5+ servings of fruits and vegetables a day, beans regularly and whole grains."
- Display and share printable education tools from CardioSmart.org and other reputable sources to spark discussion and reinforce heart-healthy eating patterns.
- Use a patient's health measures – elevated BP, dyslipidemia, elevated glucose or weight trends – as teachable moments to connect dietary habits with cardiovascular risk.
- Carefully use AI with appropriate prompts to help generate heart-healthy recipe ideas for patients tailored to their individual food preferences, culture and budget.
- Use follow-up visits to check in, celebrate successes and reinforce achievable heart-healthy habits.
- Automate registered dietitian referrals, when appropriate.
Practical Pearls For Talking With Patients About Heart-Healthy Eating
- Frame nutrition advice around shifting toward a heart-healthy eating pattern rather than restriction, labeling foods as strictly "good" or "bad," or focusing too heavily on nutrient calculations alone.
- Anchor the conversation in what matters most to the patient. Link dietary habits to how patients feel in terms of energy, sleep, symptoms and daily function.
- Focus on progress, not perfection. Encourage patients to start with one or two achievable dietary goals at a time, such as adding one more serving of vegetables each day or choosing water instead of sugary drinks.
- Use conversational, nonjudgmental language. Ask, "What change do you feel ready to make this week?" instead of saying, "You need to eat better" or "That food is bad."
- Remind patients that slip-ups can happen. Work stress, travel, family dynamics, social events and many other factors can affect eating habits. Emphasize that the goal is an overall healthy eating pattern, not perfection.
- Reflect what you hear back to the patient. For example: "It sounds like time and convenience are the biggest barriers for you." This shows understanding and helps tailor realistic solutions.
- Reassure patients that healthy eating can be affordable. Suggest lower-cost options such as:
- Frozen fruits and vegetables, which retain high nutritional value
- No-salt-added canned beans
- Lower-cost fish options, such as canned tuna
- Highlight other health benefits. These may include improved energy, better gut health and overall well-being.
Short on time? Here are simple nutrition messages patients can act on:
- Aim for 5+ fruits and vegetables a day. A serving is about one baseball-sized piece of fruit or 1 cup of vegetables. Filling half your plate with plant foods at meals is a simple way to get there.
- Swap sugary drinks for water.
- Add more beans. They're low cost and packed with fiber, potassium and protein.
- Choose whole, minimally processed foods. Limit processed meats and ultra-processed foods high in sodium, added sugars and unhealthy fats.
- Opt for whole grains. Choose oats, brown rice, quinoa and whole-grain breads instead of white bread, white rice or packaged snack foods.
- Cook more meals at home. Flavor foods with herbs and spices instead of salt, and bake, steam or grill foods rather than frying them.
- Choose unsaturated fats. Use olive oil, nuts, seeds and avocado instead of butter and other saturated fats.
Clinical Topics: Cardiovascular Care Team, Diabetes and Cardiometabolic Disease, Prevention, Diet
Keywords: Cardiology Magazine, ACC Publications, CM-Jul-Aug-2026, Diet, Food, and Nutrition, Risk Factors, Diet, Diet, Healthy, Nutrition Assessment
