Making six key foods a regular part of your diet may lower your risk of cardiovascular disease, new research shows.

For the study, published in the European Heart Journal, researchers analyzed data from six international studies that included 245,000 participants—with and without prior cardiovascular disease—from 80 countries. They used a diet score from the Prospective Urban and Rural Epidemiological (PURE) study, ongoing research run by the Population Research Health Institute.12

The researchers found that having a diet filled with whole fruits, vegetables, legumes, nuts, fish, and whole-fat dairy products helped lower a person’s risk of cardiovascular disease, including heart attacks and strokes.2

“The biggest gains in avoiding premature cardiovascular disease and deaths globally is expected to occur by increasing the intake of healthy foods to a moderate degree, especially in poorer world regions,” Andrew Mente, MSc, PhD, lead researcher for the study and associate professor at McMaster University, told Health.

Mente highlighted that the study was global in scope instead of centered on high-income or Western countries, the focus of many previous diet studies. He said those studies may not apply to people who live in lower to middle-income countries, where inadequate intake—rather than excess consumption—of certain foods may cause health issues.

Cardiovascular diseases are the leading cause of death globally, resulting in an estimated 17.9 million deaths each year, according to the World Health Organization. A third of those deaths occur prematurely in people younger than 70.3 An unhealthy diet lacking protective foods such as vegetables and whole grains is considered a main cardiovascular disease risk factor.4

“This study emphasizes the power of nutrition, and that low intakes of heart healthy foods are associated with poor outcomes,” Martha Gulati, MD, director of preventive cardiology and associate director of the Preventive and Rehabilitative Cardiac Center in the Smidt Heart Institute at Cedars-Sinai, told Health.

The Six Key Foods for Heart Health

Based on their findings, the researchers recommend eating two to three daily servings of both fruit and vegetables, two daily servings of dairy, and one daily serving of nuts.2

“The score also includes three to four weekly servings of legumes and two to three weekly servings of fish,” Mente said. “Possible substitutes included whole grains at one serving daily, and unprocessed red meat or poultry at one serving daily.”

This study differs from other papers because researchers focused on a broad range of natural foods eaten in moderation rather than a diet limited to a small number of foods, Sheri Berger, RDN, CDCES, registered dietitian nutritionist at El Camino Hospital Cardiac & Pulmonary Wellness Center, told Health.

“[Their findings] suggest it is better to consume key quality foods such as fruits, vegetables, nuts, legumes, fish, and dairy rather than focus on limiting foods high in saturated fat such as whole fat dairy and meat,” she said.

Including certain foods while not limiting others may make the PURE diet easier to stick to than other diets, ultimately resulting in better cardiovascular outcomes, said Gulati.

She noted that “the most interesting aspect of this study” is the finding that dairy—about two daily servings of whole-fat milk, yogurt, or cheese—can be included with other beneficial foods as part of a nutritious diet.

“We advise, currently, that the consumption of saturated fat—which often comes from animal products—increases the risk for cardiovascular disease and this study does not support that,” she said. “We may need to re-evaluate how we advise about whole-fat [dairy] products but I still think that it is more [that] the diet was overall better.”

The study also provided more evidence that increasing consumption of foods known to be cardio-protective—fish, nuts, vegetables, and legumes—does indeed protect heart health, said Gulati.

How To Eat To Prevent Cardiovascular Disease

An inclusive plant-based diet is a great choice for heart disease prevention, said Berger. This type of diet focuses on whole plant foods like fruits, vegetables, legumes, and nuts. However, dairy and quality protein from animals can be included too.

“For example, meals could feature a large portion of colorful fruits and vegetables, quality protein from fish, meat, nuts, and/or legumes, fiber rich whole grains such farro, brown rice, or quinoa, and a source of dairy a couple times per day,” Berger said. “Generally, there is no one magic food or property of one food that by itself protects the heart. It is what we eat regularly that will affect heart health and overall health.”

There’s no need to worry if you can’t eat nuts, fish, or any of the other recommended foods identified in the study, experts told Health. Not having them in your diet doesn’t necessarily mean you’re at greater risk for cardiovascular disease.

Mente said researchers observed the biggest health gains with a diet score of four out of a maximum of six, with modest additional health benefits with scores above four. “So improving intake in even three or four of these foods would produce a marked protection,” he said.

Nuts can also be replaced with pumpkin seeds, chia seeds, or ground flaxseed, said Gulati. Additionally, algal oil supplementation can fill in nutrient gaps for omega-3s.5

Gulati noted that a heart-healthy diet doesn’t include large amounts of foods high in saturated fats and should include no trans fats, such as fried foods and packaged baked goods. She said that many processed foods tend to be a mainstay of diets worldwide because they are relatively cheap and easy to access. These foods don’t make as much room for heart-healthy foods in a person’s diet.

“We all need variety in our diet, and joy with the meals we eat, which is partially the food, [but also] the access to healthy food choices,” Gulati said. “The important element is overall diet quality from nourishing foods.”

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