Dietary Patterns and Cardiovascular Disease: A systematic review of 29 prospective studies with 1,249,644 participants, published in the last 20 years

Abstract

Aim: The fact that the role of various dietary patterns on cardiovascular disease (CVD) incidence has not yet been well established, reveals the need to estimate the association of dietary patterns and CVD risk. Material and Methods: A review of English language articles, archived in PubMed (2000-2021) was performed. Additional studies were identified by searching the bibliographies of the eligible articles at the start of the review. Search items included: coronary heart/cardiovascular disease, dietary patterns, diet, Mediterranean, DASH, prudent, western, vegan, plant-based. Only prospective cohort studies with adult participants that had no underlying disease at baseline were included. Independent extraction of articles by 2 authors using predefined data fields, including study quality indicators. Guidelines of the Prisma statement were kept. Results: 1,249,644 participants and 31,709 CVD fatal or non-fatal events were observed out of 29 studies that were included. The Mediterranean, the DASH-style, the Prudent, and the Plant-based dietary patterns were consistently associated with reduced risk of a CVD event, while the western dietary pattern was associated with an increase or did not show any significant relationship with CVD outcomes. Conclusions: Based on the present findings and the fact that the role of diet has been underestimated in CVD prevention guidelines, a dietary pattern rich in fruits and vegetables, whole grains, nuts, fish, and vegetable oils, with alcohol in moderation, if at all, and avoids red and processed meats, refined carbohydrates, foods and beverages with added sugar, sodium, and trans, should be further promoted.