Cardiovascular Nutrition: Current Controversies

Freeman AM, Morris PB, Aspry K, et al.
A Clinician’s Guide for Trending Cardiovascular Nutrition Controversies: Part II. J Am Coll Cardiol 2018;72:553-568.

The following are key points for clinicians to remember regarding trending cardiovascular (CV) nutrition controversies:

  1. Evidence supports the use of a diet high in fruits, vegetables, wholes grains, and legumes. Nuts in moderation have also been associated with lower risk of CV disease (CVD). Some healthy dietary patterns also include modest quantities of lean meats (including poultry and fish), low-fat dairy products, liquid vegetable oils, and alcoholic beverages. However, some foods remain controversial as to the CV health or harm related to such foods.
  2. Evidence for or against dairy products is limited by study design, potential biases of industry-sponsored trials, and heterogeneity of dairy products included in studies. That said, full-fat dairy products are a major source of saturated fat and sodium in the US diet, and thus, should be limited. Reduced fat dairy products include essential vitamins and minerals in addition to high-quality protein.
  3. Evidence demonstrates CV risk associated with added sugars including promotion of atherogenesis. Clinicians should recommend consumption of a whole foods diet with a low intake of processed foods, careful selection of foods with no or low amounts of added sugars in any form, and elimination of sugar-sweetened beverages.
  4. Limited evidence supports the avoidance of energy drinks due to current evidence of an increased risk for arrhythmias, coronary spasm, and potential death.
  5. Legumes are an important potential source of protein and fiber, which are affordable for most populations. Legumes are associated with reduced CVD events and improved blood glucose.
  6. Current data suggest coffee intake is correlated with a dose-dependent protective benefit including all-cause mortality and CVD mortality. Avoiding coffee drinks high in added sugars is recommended.
  7. Tea consumption is associated with arterial health and may reverse blood vessel dysfunction. As with coffee drinks, avoiding added sugars and high fat milk or cream is recommended. Alcohol consumption is observed to have vasodilator, antiplatelet, and anti-inflammatory effects. These potential benefits must be balanced with potential harm related to certain cancers, liver disease, and risk of falls.
  8. Consumption of mushrooms has been associated with improved CV outcomes, via anti-inflammatory and antioxidative effects. However high-quality data are lacking. High-quality data on fermented foods and seaweed are also lacking. That said, observational data suggest potential benefits for reducing risk of CVD outcomes and dyslipidemia.
  9. There are two distinct classes of omega-3 fatty acids (OM3): long-chain n-3 polyunsaturated fatty acids of marine origin; and alphalinolenic acid (ALA) of plant origin. Both have CV benefits, with evidence favoring the incorporation of plant or marine-based OM3 daily into a heart-healthy diet, as whole foods rather than supplement forms.
  10. Multiple large-scale studies do not support the supplemental use of vitamin B12 to prevent CVD. Only among those who are deficient in vitamin B12, supplemental use is recommended given this is an essential nutrient.

Editor’s Note: Part I of trending CV nutrition controversies was published last year (J Am Coll Cardiol 2017;69:1172-87).

Clinical Topics: Arrhythmias and Clinical EP, Diabetes and Cardiometabolic Disease, Dyslipidemia, Prevention, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Lipid Metabolism, Nonstatins, Statins, Diet

Keywords: Alcoholic Beverages, Antioxidants, Arrhythmias, Cardiac, Atherosclerosis, Blood Glucose, Coffee, Diet, Dyslipidemias, Energy Drinks, Fatty Acids, Omega-3, Fruit, Liver Diseases, Milk, Minerals, Neoplasms, Nuts, Plant Oils, Poultry, Primary Prevention, Seaweed, Sodium, Sweetening Agents, Tea, Vasodilator Agents, Vegetables, Vitamin B 12, Vitamins

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