2021 AHA Dietary Guidance for Cardiovascular Health

Lichtenstein AH, Appel LJ, Vadiveloo M, et al., on behalf of the American Heart Association Council on Lifestyle and Cardiometabolic Health; Council on Arteriosclerosis, Thrombosis and Vascular Biology; Council on Cardiovascular Radiology and Intervention; Council on Clinical Cardiology; and Stroke Council.
2021 Dietary Guidance to Improve Cardiovascular Health: A Scientific Statement From the American Heart Association. Circulation 2021;Nov 2:[Epub ahead of print].

The following are key points to remember from the 2021 American Heart Association (AHA) scientific statement on dietary guidance to improve cardiovascular health:

  1. Adjust energy intake and expenditure to achieve and maintain a healthy body weight. Energy balance may be achieved by combining a healthy dietary pattern with ≥150 minutes of moderate physical activity per week. Metabolic needs decrease by about 70-100 calories per day with each decade of adult life.
  2. Eat plenty of fruits and vegetables; choose a wide variety. A diet rich in fruits and vegetables—except for white potatoes—is associated with a reduced risk of cardiovascular disease (CVD). Eating a wide variety of these provides adequate essential nutrients and phytochemicals. Fresh, frozen, canned, and/or dried fruits and vegetables are all acceptable.
  3. Choose foods made mostly with whole grains rather than refined grains. Randomized controlled trials have shown that eating whole grains instead of refined grains improves cardiovascular risk factors.
  4. Choose healthy sources of protein.
    • Mostly protein from plants (legumes and nuts): Higher intake of legumes (beans and peas) was associated with lower CVD risk in a recent systematic review. Higher nut intake was associated with lower risk of CVD, coronary heart disease (CHD), and stroke.
    • Fish and seafood: Current evidence supports dietary patterns that include ≥2 fish meals per week. However, preparation of fish by frying is not associated with benefits.
    • Low-fat or fat-free dairy products instead of full-fat dairy products: Dietary patterns that include low-fat dairy are associated with a lower risk of obesity, CVD, and mortality.
    • If meat or poultry are desired, choose lean cuts and avoid processed forms: There is a direct association between red meat intake and CVD incidence and mortality, and an even stronger association for processed meat such as bacon or hot dogs.
  5. Use liquid plant oils rather than tropical oils (coconut, palm, and palm kernel), animal fats (e.g., butter and lard), and partially hydrogenated fats. Liquid plant oils are rich in unsaturated fats, which reduce low-density lipoprotein (LDL) cholesterol and CVD risk, as are peanuts, most tree nuts, and flax seeds.
  6. Choose minimally processed foods instead of ultra-processed foods.* High intake of ultra-processed foods is associated with obesity, type 2 diabetes, CVD, and all-cause mortality.
  7. Minimize intake of beverages and foods with added sugars. Added sugars have consistently been associated with elevated risk of type 2 diabetes, CHD, and excess body weight. Alternative sweeteners have shown mixed effects on metabolism.
  8. Choose and prepare foods with little or no salt. There is a direct, positive relationship between salt intake and blood pressure. In the United States, leading sources of salt are packaged/processed foods and foods prepared outside the home.
  9. If you do not drink alcohol, do not start; if you choose to drink alcohol, limit intake. Risk of atrial fibrillation and of hemorrhagic stroke increases with increased alcohol intake. Ischemic stroke and CHD are lowest in those who drink 1-2 alcoholic beverages daily. The AHA does not recommend commencing alcohol use to improve CVD health.
  10. Adhere to this guidance regardless of where food is prepared or consumed.

*There is no commonly accepted definition for ultra-processed foods, and some healthy foods may exist within the ultra-processed food category.

Clinical Topics: Arrhythmias and Clinical EP, Cardiovascular Care Team, Diabetes and Cardiometabolic Disease, Dyslipidemia, Prevention, Atrial Fibrillation/Supraventricular Arrhythmias, Lipid Metabolism, Nonstatins, Diet, Exercise

Keywords: Alcohol Drinking, Atrial Fibrillation, Blood Pressure, Brain Ischemia, Cardiovascular Diseases, Cholesterol, LDL, Coronary Disease, Diabetes Mellitus, Type 2, Diet, Dyslipidemias, Exercise, Fats, Unsaturated, Fruit, Hemorrhagic Stroke, Ischemic Stroke, Nutrients, Nuts, Obesity, Plant Oils, Pork Meat, Poultry, Primary Prevention, Risk Factors, Seafood, Sodium, Sugars, Sweetening Agents, Vascular Diseases, Vegetables, Whole Grains

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