Nutrition for Coronary Artery Disease (Arteriosclerosis)

First, regular butter was the enemy, and then chocolate and wine joined the opposition. Later reports indicated that these food items were not as bad as researchers originally thought (when consumed in moderation, of course). With so much conflicting nutrition information and a host of dietary guidelines to follow, it’s no wonder there is confusion about how to use nutrition to reduce the risk of coronary artery disease and arteriosclerosis. The information below will help you make sense of the latest nutrition guidelines for coronary artery disease (CAD).

How Can Nutrition Help Against Coronary Artery Disease (CAD)?

A heart-healthy diet is a key factor in preventing coronary artery disease (also called ischemic heart disease) and reducing the progression of arteriosclerosis (also called atherosclerosis). Arteriosclerosis is a process in which fat, cholesterol, and other deposits build up on the inside of the coronary arteries, thereby reducing blood flow to the heart and increasing the risk of a heart attack or stroke. Four risk factors for coronary artery disease are directly related to nutrition: high blood pressure, high blood cholesterol, diabetes, and obesity.

In general, a heart-healthy diet is one that provides enough of each essential nutrient as well as adequate energy to maintain a healthy weight.

A heart-healthy diet is:

• Low in saturated animal fats and hydrogenated vegetable fats (trans fats)
• High in fiber and whole grains and low in simple carbohydrates
• Rich in fruits and vegetables
• Low in sugar, salt, and alcohol

Most importantly, a heart-healthy diet is balanced, contains a variety of foods from all of the basic food groups, and does not eliminate any one food group.

Low-Fat Diet Guidelines to Reduce Coronary Artery Disease (CAD) Risk

Following a low-fat diet can help you manage high blood cholesterol, diabetes and obesity – three of the four risk factors for coronary artery disease. According to the dietary guidelines published by the U.S. Department of Health and Human Services, Americans should limit saturated fats to less than seven percent of total daily calories (16 grams for a 2,000 calorie diet), and less than 300 mg/dL of cholesterol. Trans fatty acid consumption should be kept as low as possible, as there is no safe level of this type of fat, which comes from fried foods as well as foods that list “partially hydrogenated” or “hydrogenated” on the ingredient list. Total fat should not exceed 35 percent of total daily calories (ranging from 20 to 35 percent), and most fats should come from polyunsaturated and monounsaturated fats, such as fish, nuts, and vegetable oils. Protein sources—including meat, poultry, dry beans, and dairy products—should be lean, low-fat, or fat-free. Fats and oils high in saturated and/or transfatty acids should be limited.

As part of a diet low in saturated fat and cholesterol, soy protein (25 grams a day as a substitute for animal protein) has also been shown to reduce the risk of coronary artery disease (CAD).

Nuts are a great source of monounsaturated fat as well as dietary fiber, and researchers have linked regular nut intake to a lower incidence of coronary artery disease. Eating fresh or dry roasted nuts in moderation (1 ounce or less daily) provides many protective nutrients. To get the most heart-healthy benefits from nuts, stay away from nuts that are salted, coated in sugar, or roasted in oil.

Omega-3 Fatty Acid Guidelines to Reduce Coronary Artery Disease (CAD) Risk

Omega-3 fatty acids are healthy fats that moderately reduce blood triglycerides (fats) and elevate levels of HDL (the “good” type) cholesterol, thereby reducing the progression of atherosclerosis. Omega-3 fatty acids can be found in cold-water fish and flax seeds, as well as some other foods. The American Heart Association recommends eating omega-3-rich fish at least twice a week (total of 6 ounces per week). Fish oil and flax oil supplements are also good sources of omega-3 fatty acids, but fish intake is preferred when possible. Patients taking more than 3 grams of omega-3 fatty acids in the form of supplements should consult their doctor, as high intake can cause bleeding in some people. When buying fish oil supplements, look for the highest levels of docosahexaenoic acid (DHA) and eicosapentenoic acid (EPA), which should make up more than 50 percent of the total milligrams of the dosage.

High-Fiber Guidelines to Reduce Coronary Artery Disease (CAD) Risk

Dietary fiber helps to reduce elevated cholesterol, one of the risk factors for coronary artery disease. Fiber, the part of plants the body cannot digest, also helps to control blood sugar and manage weight, while also reducing the risk of gastrointestinal disease by increasing bowel regularity. The recommended intake for total fiber for adults up to age 50 is 25 grams per day for women and 38 grams for men. For those over age 50, the recommended intake is 21 grams for women and 30 grams for men. To consume enough fiber, eat whole grain products, fruits and vegetables, and legumes (such as dry beans, lentils, and peas).

Fruit and Vegetable Guidelines to Reduce Coronary Artery Disease (CAD) Risk

According to the national guidelines, you should eat at least 2 cups of fruit and 2 ½ cups of vegetables per day (for a reference 2,000-calorie intake diet), with higher or lower amounts depending on your recommended calorie level. Select a variety of fruits and vegetables each day and choose from all five vegetable subgroups (dark green, orange, legumes, starchy vegetables, and other vegetables) several times a week. A major 2002 study proved that consuming at least three or more servings of fruits and vegetables was associated with a reduced risk of coronary artery disease and stroke and all-cause mortality in the general U.S. population.

Other Dietary Guidelines to Reduce Coronary Artery Disease (CAD) Risk

As part of a low-fat, low-cholesterol diet, the consumption of plant sterols and stanols in certain food products and/or dietary supplements (in softgel form), has been shown to lower LDL and total cholesterol, thereby reducing coronary artery disease risk.

When taken as a dietary supplement, garlic has several heart protective properties and has been shown to slightly lower blood cholesterol levels and reduce overall coronary artery disease risk. Some studies suggest that garlic can also help lower high blood pressure, although the evidence is not conclusive. Patients taking garlic supplements should consult their doctor, as it can cause bleeding in some people.

It is a good idea for everyone to limit salt, but it is especially important for patients managing high blood pressure. Whether or not consuming salt actually causes high blood pressure has been a matter of debate, and recent studies indicate that high blood pressure may be more closely linked to a diet lacking in essential minerals. However, limiting salt intake is still important. It is recommended that a person should consume no more than 1,500 mg of sodium per day, and meet the potassium recommendation (4,700 mg/day) with food.

Tips for Success in Avoiding Coronary Artery Disease (CAD)

• Seek guidance from your doctor and a registered dietitian.

• Keep a diet log to track your daily intake of foods.

• Learn how to measure portions so you can identify a serving size and practice portion control, particularly for weight loss or maintenance.

• Distribute meals and snacks throughout the day.

• Read food and supplement labels carefully.

• Discuss nutrition supplements with your cardiologist before you start taking them to evaluate potential interactions with other medical conditions and/or prescription medications.

Additional Resources

Bazzano LA, He J, Ogden LG, et al. Fruit and vegetable intake and risk of cardiovascular disease in US adults: the first National Health and Nutrition Examination Survey Epidemiologic Follow-up Study. Am J Clin Nutr. 2002;76(1):93-99.

The American Heart Association offers a wealth of information on diet and nutrition as well as a variety of ways to prevent or manage coronary artery disease.

“Dietary Guidelines for Americans” and additional nutrition information is available from the National Agricultural Library, Food and Nutrition Information Center and from the American Dietetic Association.