Dietary Patterns and Coronary Heart Disease

Abstract

Globally coronary heart disease (CHD) is the leading cause of death and morbidity in adults. The type of dietary pattern consumed plays an important role in the risk of developing CHD. Healthy dietary patterns (or higher nutrient quality diets) which are associated with decreased risk of CHD include higher Healthy Eating Indices scores, Mediterranean diet (MedDiet), Dietary Approaches to Stop Hypertension (DASH) and vegetarian diets and are characterized by higher consumption of vegetables, fruits, whole-grains, low-fat dairy, and seafood, limited (or no) intake of red and processed meat, and lower intakes of refined grains, sugar-sweetened foods and beverages compared to an increased CHD risk associated with higher adherence to Western dietary patterns. Healthy dietary patterns have CHD protective effects because they are lower in energy density and higher in fiber, healthier fatty acid profiles, essential nutrients, antioxidants, and electrolytes, and are anti-inflammatory compared with Western diets. Meta-analyses estimate that healthy dietary patterns are associated with a significantly decreased CHD risk by 20–33%, while Western-type patterns are associated with an increased CHD risk by up to 45%, especially in US studies and in individuals over 50 years of age. A number of randomized controlled trials (RCTs) support the role for healthy dietary patterns in reducing CHD risk biomarkers including blood lipids and lipoproteins, systemic inflammatory or oxidative stress factors such as hs-CRP and oxidized LDL-C, and carotid atherosclerosis and improving endothelial health and blood pressure. Replacing 5% of energy intake from saturated fats with equivalent energy intake from polyunsaturated and monounsaturated fats, or carbohydrates from whole grains was associated with a significant 25%, 15%, and 9% lower risk of CHD, respectively. However, replacing saturated fat with carbohydrates from refined starches and/or added sugars was not significantly associated with lower CHD risk.