Cardiovascular disease remains the leading cause of death in the Western world. Heart attacks, strokes and heart failure are often the final outcome of a process spanning many years, during which genetic, environmental and behavioural factors interact. The good news is that many of these factors can be modified. Of all these, diet and lifestyle play a central role in prevention.
Over the past few decades, research has increasingly clarified which dietary patterns are associated with better cardiometabolic health. At the same time, new studies are highlighting how inflammation and imbalances in the gut microbiota play a role in regulating cardiovascular risk. In short, the heart lies at the centre of a complex metabolic network that involves the entire body.
Cardiovascular risk: when the metabolism sends warning signals
So-called cardiovascular risk represents the probability that a person will develop heart or blood vessel disease within a certain period of time, generally estimated over a ten-year horizon. This risk is calculated on the basis of various clinical parameters which, when combined, enable the identification of the most vulnerable individuals:
- high blood pressure
type 2 diabetes
abnormal blood lipid levels (cholesterol and triglycerides)
smoking
accumulation of visceral fat, particularly around the abdomen.
These factors do not act in isolation but influence one another, often within a broader context known as metabolic syndrome.
Metabolic syndrome is characterised by a cluster of abnormalities, specifically at least three of the following: being overweight, an increased waist-to-hip ratio, high blood sugar, high blood pressure and dyslipidaemia. These share a common denominator: a chronic, low-grade inflammatory state, which promotes the progression of atherosclerosis, the process leading to the formation of plaques in the arteries.
According to the most recent estimates, around 30% of the adult population meets the criteria for metabolic syndrome, making it one of the major public health challenges of our time.
The role of nutrition: not a diet, but a lifestyle (I know I’m repeating myself, but it’s not just me saying it…)
So you might ask: is there a perfect diet for the heart? If you’re expecting a list of specific foods, restrictions and fixed portion sizes, no. But…
The scientific literature suggests that it is not so much individual foods that make the difference, but rather the combination of daily choices that determines the protective effect. In fact, dietary patterns that have shown robust and reproducible results in reducing cardiovascular risk also include lifestyle factors. These are:
- the Mediterranean diet
- the DASH diet
The Mediterranean diet: the most widely studied dietary pattern
Of all dietary patterns, the Mediterranean diet is probably the most extensively studied and scientifically validated. It is a dietary pattern that emphasises:
- fresh fruit and vegetables
wholemeal grains
pulses
nuts and seeds
herbs and spices
extra virgin olive oil as the main source of fat.
Moderate consumption of fish and poultry, with red meat and sweets appearing less frequently.
The benefits of the Mediterranean diet stem from several factors. Extra virgin olive oil, rich in monounsaturated fatty acids and phenolic compounds, helps improve the lipid profile by reducing LDL cholesterol and promoting HDL cholesterol. The fibre found in whole grains, pulses and vegetables, on the other hand, helps regulate blood sugar levels and reduce fat absorption.
One of the most interesting findings comes from the large-scale PREDIMED study, which showed that a Mediterranean diet enriched with extra virgin olive oil can significantly reduce the incidence of type 2 diabetes and improve various metabolic parameters.
The DASH Diet: when blood pressure is the priority
The DASH diet (Dietary Approaches to Stop Hypertension) was developed with the specific aim of reducing blood pressure.
Here too, the diet is based on fresh, minimally processed foods: fruit and vegetables, whole grains, low-fat dairy products, fish, poultry and pulses, nuts and seeds.
The main feature of this diet is the reduction in sodium intake, i.e. table salt.
Numerous clinical studies have shown that the DASH diet is capable of reducing both systolic and diastolic blood pressure, with effects in some cases comparable to those of antihypertensive drugs in the early stages of high blood pressure.
Plant-based diets: it’s all about quality
In recent years, there has been a growing interest in plant-based diets. However, it is important to clarify that not all plant-based diets are automatically healthy.
In fact, a diet rich in refined grains, processed snacks, chips and sugary drinks may technically be ‘plant-based’, but it offers no metabolic benefits.
Conversely, the dietary patterns mentioned above, which favour whole, minimally processed plant foods, are associated with a lower incidence of metabolic syndrome and cardiovascular disease, thanks to their high fibre content (which also promotes a healthy gut microbiota), low energy density, reduced intake of saturated fats and higher presence of bioactive phytochemicals (e.g. polyphenols).
- Healthy fats and omega-3
Long-chain omega-3 fatty acids, found mainly in oily fish (such as sardines, mackerel and salmon), play an important role in regulating inflammation and lipid metabolism.
Numerous studies have linked regular consumption of omega-3 to a reduced risk of cardiovascular disease and improved plasma triglyceride levels.
Plant-based sources of omega-3 also include flaxseeds, chia seeds and walnuts.
- Fibre (whole grains, vegetables, pulses)
Dietary fibre helps to improve various metabolic parameters:
it reduces cholesterol absorption
it modulates the glycaemic response
it promotes a feeling of fullness.
Epidemiological evidence shows that regular consumption of whole grains is associated with a reduction in cardiovascular disease and the risk of type 2 diabetes (which, let’s not forget, is often a risk factor for cardiometabolic health).
Conversely, high consumption of refined grains appears to be linked to an increased risk of metabolic syndrome.
Does this mean we should stop going to the pizzeria or eating a plate of pasta? Obviously not, but shifting the balance towards more ‘whole’ foods certainly helps.
- Fruit, vegetables and polyphenols
Fruit and vegetables are a valuable source of vitamins, minerals and polyphenols, bioactive compounds with antioxidant and anti-inflammatory properties.
Foods particularly rich in these compounds include: berries, citrus fruits, as well as tea and coffee (the anti-inflammatory and antioxidant properties of chlorogenic acid and epigallocatechins more than offset the potential risk of caffeine causing high blood pressure. But be careful: 2–3 espressos or cups of green tea a day is one thing; clinging to the coffee machine 20 times a day is quite another).
To the delight of many, cocoa is also a source of polyphenols, but here too, watch out for excesses and ensure good quality.
Meanwhile, extra virgin olive oil, the only fatty condiment permitted in the Mediterranean diet, must obviously be of good quality to maximise the benefits. And you certainly shouldn’t bathe in it.
Polyphenols help protect the endothelium, the thin layer of cells lining the inside of blood vessels, by promoting the production of nitric oxide, a molecule essential for vasodilation and regulating blood flow.
- Seeds, nuts and pulses
Oilseeds and nuts provide an ideal combination of unsaturated fats, plant-based protein and fibre.
Walnuts, for example, are particularly rich in omega-3 polyunsaturated fatty acids, as are flaxseeds, which contain lignans with antioxidant effects.
Pulses also play an important role in cardiometabolic prevention: they provide plant-based protein, complex carbohydrates and numerous phytochemicals with protective properties.
Microbiota and metabolism: a new frontier
Those who have been following me for a while are aware of my ‘obsession’ with the gut microbiota, and not without reason: it is, in fact, one of the most promising areas of research and also concerns the regulation of energy metabolism and heart health.
Recent studies suggest that the composition of the microbiota may influence susceptibility to metabolic syndrome and cardiovascular disease. Diets rich in fibre, polyphenols and plant-based foods promote the growth of beneficial gut bacteria that produce protective metabolites, such as short-chain fatty acids. So, eating well is good for you both directly and indirectly, through the action of the little friends you host in your tummy.
It’s not just about diet: lifestyle matters
Is that all? Well, you wish 😊
Even the most balanced diet cannot fully offset other lifestyle-related risk factors.
If you smoke daily, drink alcohol and lead a sedentary lifestyle, well, let’s just say that sorting out your diet only gets you halfway there.
Giving up smoking is probably the most effective measure for cardiovascular prevention: smoking damages the endothelium, increases inflammation and promotes the formation of atherosclerotic plaques. The scientific literature indicates that after just 1–2 years, the risk is halved compared to smokers. Within 5 years, the risk drops by 60%, and after 10–15 years, the risk of heart disease approaches that of someone who has never smoked. Shall we start quitting?
Limiting alcohol consumption is another important point. The most recent evidence suggests that the supposed benefits of moderate drinking have probably been overestimated. A glass of good-quality wine, occasionally, is good for the soul, but daily consumption is certainly associated with a higher risk. So, it’s up to you…
What, on the other hand, can often only be increased is physical activity, which is all too often irregular, yet is one of the cornerstones of cardiometabolic prevention. Exercise improves insulin sensitivity, lowers blood pressure, aids weight management and helps reduce inflammation.
The guidelines recommend at least 150 minutes of moderate aerobic activity per week (30 minutes a day on weekdays), combined with muscle-strengthening exercises 1–2 times a week.
Protecting your heart every day
In conclusion, cardiovascular prevention does not depend on a single action or a ‘miracle’ food. Nor does it depend solely on a list of restrictions. Rather, it is the result of a series of daily choices which, over time, build up or weaken our bodies.
In fact, the heart is nourished not only by the blood flowing through the arteries, but by the care we give it every day.
A heartfelt greeting from your
Nutritionist
Tatiana Gaudimonte
info@loveyourbody.ch