Abstract/Summary

Key messages ● Dietary factors can modify the underlying causes of car- diovascular disease: high blood pressure, impaired cardiac electrophysiology and factors driving atherogenesis, such as inflammation, oxidative stress, platelet activation, en- dothelial function and lipoprotein infiltration of the artery wall and resultant lipid accumulation. ● Atherosclerosis can affect arteries from an early age and is largely preventable by lifelong maintenance of a healthy body weight, a balanced diet and regular physical activity. ● Replacing saturated fat intake with unsaturated fat or wholegrains can decrease low-density lipoprotein (LDL) cholesterol concentrations; lowering LDL cholesterol re- duces cholesterol accumulation in atherosclerotic plaques and decreases risk of cardiovascular disease. ● The type of LDL particle is important: small, dense LDLs (and triacylglycerol-rich lipoprotein remnants) are particularly ath- erogenic. The atherogenic lipoprotein phenotype (more small dense LDL, reduced high-density lipoprotein cholesterol (HDL- C) and higher triacylglycerol) can be improved by weight loss and reducing intake of refined starches and sugars. ● Although dairy foods are rich in saturated fatty acids, evi- dence suggests that greater consumption of dairy foods is not associated with increased risk of cardiovascular disease, highlighting the importance of considering whole foods and dietary patterns in cardiovascular disease risk, rather than individual dietary components. ● Long-chain n-3 polyunsaturated fatty acids, derived from marine sources, can target many facets of atherosclerosis, including inflammation, thrombosis, blood pressure, vas- cular function, hypertriacylglycerolaemia and cardiac func- tion, but supplementation in populations at risk or with existing cardiovascular disease has not convincingly dem- onstrated reductions in mortality or events. ● Lowering sodium intake from dietary salt lowers blood pressure, even in the context of a healthy, balanced diet and in normotensive individuals, and may improve en- dothelial function. ● Reductions in animal protein intake and a shift to a pre- dominantly plant-based diet are recommended based on evidence that red and processed meat may be associated with increased risk of cardiovascular disease (possibly due to saturated fatty acid and sodium content) and the beneficial effects of higher intakes of fibre, potassium and other micronutrients, organic nitrate and phytochemicals in plant foods. Diets rich in fruits, vegetables, wholegrains, nuts and seeds may lower blood pressure and blood lipids, and improve endothelial function and glycaemic control.