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Table of Contents

Salem Health: Nutrition

Cardiovascular Disease

by Cherie Marcel, BS

Heart Disease and Diet

What We Know

The cardiovascular system includes the heart, blood vessels, and blood-forming organs (e.g., bone marrow). Cardiovascular disease (CVD) refers to conditions that interfere with the ability of the cardiovascular system to function properly. Most frequently, CVD involves the narrowing or blockage of blood vessels, which can lead to coronary artery disease (CAD) and heart failure or cerebrovascular accident (CVA; i.e., stroke). The two predominant conditions known to contribute to CVD are atherosclerosis and hypertension.

  • Atherosclerosis develops when fat deposits and other substances build up along the walls of the arteries to form plaque, which narrows the arteries and impedes blood flow.

  • Hypertension refers to high blood pressure (BP). Normal BP for adults in the United States is commonly considered to be < 120/80 mm HG. It is estimated that 1 billion persons worldwide, including 67 million Americans, meet the criteria for a diagnosis of hypertension, although many individuals are unaware of this because hypertension is frequently asymptomatic. When signs or symptoms are present, they can include headache, dizziness, flushed face, and/or fatigue. Severe hypertension can result in renal failure, neurologic abnormalities, and heart failure.

    • The majority of cases of hypertension are considered primary (i.e., occur with no known cause). Secondary hypertension can result from many conditions, including chronic renal disease, diabetes mellitus, and hyperthyroidism. Several medications can cause hypertension, including oral contraceptives, corticosteroids, and nonsteroidal anti-inflammatories (NSAIDs).

    • Blacks develop hypertension more frequently and at an earlier age than persons in other racial/ethnic groups. Risk factors that place Blacks at even higher risk for hypertension include female gender, family history of hypertension, smoking, high levels of stress and/or anxiety, alcoholism, and overweight.

Nutr-Cardiovascular_Disease_iStock_000042809764_Illustration.jpg

Risk Factors for CVD

  • Individuals with a family history of diabetes mellitus, hypertension, CVA, hypercholesterolemia, CAD, and/or a genetic tendency for obesity or who are themselves overweight or obese are at higher risk of developing CVD. Other risk factors are certain dietary and lifestyle habits; including high intake of fat, low intake of fiber, and low intake of fruits and vegetables; cigarette smoking; and/or low level of physical activity.

  • CAD

    • CAD is most commonly caused by atherosclerosis and/or hypertension and involves the narrowing of the blood vessels responsible for supplying oxygen and blood to the heart. As CAD becomes more severe, signs and symptoms such as chest pain or shortness of breath can develop, although persons with CAD can be asymptomatic until heart failure or sudden cardiac death occurs.

      • CAD is the leading cause of mortality in the U.S. and other developed countries

      • White men aged 35–44 years are 6.1 times more likely to die from CAD than White women in the same age category. Persons of non-White race/ethnicity do not have gender differences in CAD-related mortality. The reason for this is unknown. By the age of 75, the mortality rate for White women is equal to or exceeds that for men.

  • CVA

    • A CVA occurs when blood vessels in the brain are prevented from performing the normal process of supplying blood and oxygen to brain tissue. Signs and symptoms of CVA include dizziness, loss of balance or coordination, difficulty speaking or understanding words, numbness of the face or limbs, impaired vision, and/or sudden, severe headache. As in CAD, CVA is usually the result of atherosclerosis and/or hypertension.

      • CVAs are currently the third leading cause of mortality in the U.S.

      • Blacks are nearly twice as likely to have a CVA as Whites.

      • In genetically predisposed persons who are sensitive to sodium, high dietary intake of sodium is a risk factor for hypertension.

Medical Nutrition Therapy for CVD

  • American Heart Association (AHA) goals for CVD prevention are as follows:

    • Consume a healthy diet

    • Maintain a healthy body weight by balancing calorie intake with calorie expenditure

    • Maintain recommended levels of low-density lipoprotein (LDL) and high-density lipoprotein (HDL) cholesterol; LDL should be < 100 mg/dL and HDL ≥ 60 mg/dL

    • Maintain the recommended triglyceride level of < 150 mg/dL

    • Maintain normal blood pressure of < 120/80 mm/Hg for adults

    • Maintain normal blood glucose levels of < 100 mg/dL

    • Participate in regular physical activity

    • Avoid use of and exposure to tobacco products

  • AHA dietary and lifestyle recommendations

    • Balance calorie intake and physical activity to achieve or maintain a healthy body weight

      • Calculate the patient’s body mass (BMI) by dividing body weight (kilograms) by height (meters squared);or 703 multiplied by weight (pounds) and divided by height (inches squared)

    • Underweight: < 18.5; normal: 18.5–24.9; overweight: 25–29.9; obese: > 30

    • In patients over 65 years of age, evidence suggests that a slightly higher BMI (25–27) may help prevent bone deterioration and is associated with a lower risk of mortality.

    • In some cases, body composition testing (e.g., dual-energyx-ray absorptiometry scan, skin calipers) may be necessary.

      • Education is recommended to increase awareness and understanding of food labels, calorie content of popular food items, and portion control.

      • Physical activity for 30–60 minutes on most days of the week is recommended.

    • Consume a diet rich in vegetables and fruits.

      • Eat a variety of deeply-colored fruits and vegetables (e.g., spinach, carrots, berries).

      • Fruit juice is not recommended because it does not provide the fiber of whole fruit and has a higher calorie content per serving.

    • Choose whole-grain, high-fiber foods.

      • Research has shown that high dietary fiber intake is associated with a lower risk for CVD and all-cause mortality, although the inverse relationship with all-cause mortality decreases with age.

      • At least half of the grains consumed should be whole grains.

    • Consume fish, especially oily fish, at least twice a week.

      • Fish is a great source of the unsaturated fat omega-3, which has many health benefits, including reduced risk for CVD.

      • Certain sources of fish and seafood (e.g., shark, swordfish, king mackerel, tilefish) contain high levels of mercury, which can be harmful to fetal development, infants, young children, and women of childbearing age, although evidence suggests that there is no apparent risk for prenatal mercury exposure from ocean fish consumption alone.

    • Limit intake of saturated fat, trans fat, and cholesterol.

      • It is currently recommended that dietary fat and cholesterol intake should be limited as follows:

        • Total dietary fat ≤ 35% of total caloric intake but not less than 20%

        • Saturated fat ≤ 7% of total caloric intake

        • Trans fat ≤ 1% of total caloric intake

        • Cholesterol < 300 mg/day

      • Choose lean meats and lean vegetarian alternatives.

      • Choose dairy products that are fat-free, 1% fat, and low-fat.

      • Limit consumption of partially hydrogenated fats.

    • Minimize intake of beverages and foods with added sugar.

    • Choose and prepare foods with little or no salt.

      • Sodium intake should not exceed 2,300 mg/day.

    • For those who consume alcohol, consume in moderation.

      • It is recommended that men limit alcohol intake to 2 drinks/day and women limit intake to 1 drink/day, preferably consumed with meals.

        • - 1 drink = 12 ounces of beer, 4 ounces of wine, or 1 ½ ounces of 80 proof liquor

    • Continue to follow the AHA dietary and lifestyle recommendations when eating food prepared outside of the home (e.g., in restaurants, schools, and grocery stores).

  • Dietary Approaches to Stop Hypertension (DASH) diet.

    • Although the DASH diet moderately restricts alcohol and caffeine, it is noted more for its inclusion of foods than its limitations. The diet focuses on food choices that are high in fiber, moderate in fat and protein, and low in saturated fat, cholesterol, and sodium. Eating fruits and vegetables is encouraged, along with whole grains, legumes, nuts, seeds, low-fat dairy products, and lean meats.

    • Based on a 2,000 calorie/day diet, the daily components of the DASH diet include the following:

      • 7–8 servings of grains

      • 4–5 servings of fruits

      • 4–5 servings of vegetables

      • 2–3 servings of low-fat dairy products

      • 2 servings of lean meat

    • Eating nuts, seeds, and dry beans is recommended 4–5 times weekly.

    • Caffeine is restricted to no more than 3 caffeine-containing beverages/day.

    • Alcohol is limited to no more than 2 standard alcoholic beverages/day.

  • Mediterranean diet

    • The Mediterranean diet replaces saturated fats with unsaturated fats, predominantly olive oil, and encourages intake of fresh fruits, fresh vegetables, beans, nuts, and seeds. Dairy products, eggs, and red meat are limited and processed foods are avoided as much as possible. Emphasis is placed on using seasonally fresh and locally grown foods. The basic recommendations include the following:

      • Eat a well-rounded diet that includes a variety of fresh fruits and vegetables, beans, nuts, seeds, fish and olive oil.

      • Limit red meat, dairy products, eggs, caffeine, and alcohol; moderate intake of red wine is acceptable.

    • Following the Mediterranean diet has been associated with > 50% lower risk of obesity, which is notable considering that it does not recommend limiting fat intake.

  • Sodium restriction

    • Sodium occurs naturally in most foods and is added to most processed foods. Table salt, which is made of sodium and chloride, is the largest source of dietary sodium.

    • It is recommended that healthy adults limit sodium intake to 3,000 mg/day; however, the typical American dietary intake of sodium is 4,000–6,000 mg/day. Although high sodium intake is not thought to cause hypertension in most individuals, a sodium-controlled diet appears to be beneficial to many persons with hypertension.

    • The no-added-salt (NAS) diet eliminates all added salt in the diet, which typically reduces the average daily sodium intake to approximately 3,000 mg/day.

    • A sodium-controlled diet of < 2,000 mg/day eliminates added salt and most processed foods. This diet is usually recommended for management of hypertension, although it can be a difficult diet to adhere to with the wide use and availability of high-sodium foods and medications that contain sodium.

      • Medications with the potential to increase blood sodium levels include anabolic steroids, birth control pills, certain antibiotics, clonidine, corticosteroids, laxatives, lithium, and nonsteroidal anti-inflammatory drugs (NSAIDs).

    • Restriction of < 1,000 mg/day of sodium intake is occasionally prescribed. This degree of restriction is extremely difficult for most people to adhere to and is typically reserved for hospitalized patients.

Research Findings

  • High dietary intake of red meat and other sources of saturated fatty acids has been correlated with increased risk for CVD; a diet high in white meat, fish, and unsaturated fatty acids (particularly monounsaturated fatty acids) has shown potential for reducing CVD risk by lowering LDL cholesterol levels.

  • In general, persons who consume a diet high in fiber have the tendency to practice healthier overall lifestyle habits. They are frequently more physically active, consume a diet that is lower in fat and higher in fruits and vegetables, abstain from smoking, and consume less alcohol and caffeine.

  • Although it is important to limit intake of saturated fat and cholesterol, it is also important to avoid replacing saturated fat and cholesterol with a diet that is high in simple carbohydrates. Diets that are high in simple carbohydrates are associated with dyslipidemia and diabetes mellitus. Diet modification for the prevention of CVD should include unsaturated fats, lean proteins, complex carbohydrates, fruits, and vegetables.

  • Necessary weight loss increases insulin activity, improving insulin resistance and reducing the need for the use of medication for the control of diabetes mellitus. Similarly, weight loss by overweight and obese persons improves hypertension and frequently alleviates the need for taking antihypertensive medications.

Summary

Individuals should become knowledgeable about the role of diet in CVD. Health and diet history, in relation to AHA recommendations, may contribute to risk factors for obesity, hypertension, CAD, and CVA. It is recommended to eat a balanced diet that includes appropriate dietary fat options balanced with healthy choices for lean protein, complex carbohydrates, and a wide variety of fresh fruits and vegetables. Patients with CVD and their family members should follow the prescribed treatment regimen and continue medical surveillance to monitor health status. Research suggests a diet high in white meat, fish, and unsaturated fatty acids may reduce the risk for CVD.

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Reviewers

Darlene Strayer, RN, MBA, Cinahl Information Systems, Glendale, CA

Nursing Executive Practice Council, Glendale Adventist Medical Center, Glendale, CA

Citation Types

Type
Format
MLA 9th
Marcel, Cherie. "Cardiovascular Disease." Salem Health: Nutrition, edited by Sharon Richman, Salem Press, 2016. Salem Online, online.salempress.com/articleDetails.do?articleName=Nutr_0188.
APA 7th
Marcel, C. (2016). Cardiovascular Disease. In S. Richman (Ed.), Salem Health: Nutrition. Salem Press. online.salempress.com.
CMOS 17th
Marcel, Cherie. "Cardiovascular Disease." Edited by Sharon Richman. Salem Health: Nutrition. Hackensack: Salem Press, 2016. Accessed December 14, 2025. online.salempress.com.