Coronary Heart Disease & Diet
How to prevent and treat CHD with nutrition

Key points
  • Diet and diet-related conditions, such as obesity, type 2 diabetes, and hypertension are globally the most significant risk factors for the development of coronary heart disease (CHD).

  • All international guidelines recommend dietary modifications, which reduce the risk for incident CHD and recurring cardiovascular disease (CVD) events.

  • An optimal CHD-preventing diet is rich in whole plant foods such as whole grains, fruits, vegetables, legumes, and nuts, and low in sodium, processed, and animal foods.

CHD is the leading cause of death globally1)

Pathomechanisms That Are Influenced by Diet:

Endothelial dysfunction and atherosclerosis


  • increased LDL cholesterol is the key driver for atherosclerosis
  • saturated fats, trans fats, and cholesterol in the diet increase concentrations of blood lipids and cause dyslipidemia, including increased LDL
  • HDL cholesterol has various endothelial-protective effects2)

Fatty acids

  • omega-3-mono- and polyunsaturated fatty acids (MUFA and PUFA) improve endothelial function, augment endothelial relaxation, prevent inflammation, and lower cardiovascular risk
  • omega-6-MUFA and -PUFA, saturated and trans fatty acids impair endothelial function3)


Exogenous antioxidants

  • contained in many vegetables, fruits and other plant-based foods; help reduce oxidative stress
  • protect LDL molecules against oxidation, preserve endothelial-dependent vasorelaxation, and limit atherosclerosis4)


  • complex carbohydrates such as soluble fiber from fruits and vegetables are associated with reduced atherosclerotic progression and lower CVD risk5)6)
  • simple carbohydrates are associated with a higher risk for CVD7)

Trimethylamine N-oxide (TMAO)

  • gut microbe-dependent metabolic by-product from carnitine and choline
  • TMAO activates immune and inflammatory responses, alters cholesterol metabolism, and promotes atherosclerotic thrombosis8)9)

The Scientific Evidence

Epidemiological Evidence

  • 28% risk reduction for CHD incidence in prospective studies comparing highest diet adherence to a Mediterranean diet with the lowest category10)
  • 25% risk reduction for CHD incidence in prospective studies comparing highest diet adherence to a healthy plant food diet with the lowest category11) (healthy plant food diet: rich in whole grains, fruits/vegetables, nuts/legumes, oils, tea/coffee and low in juices/sweetened beverages, refined grains, potatoes/fries, sweets, and animal foods)
  • 32% lower risk of CHD development in vegetarians compared to nonvegetarians (EPIC-Oxford study)12)
  • 33% risk reduction for myocardial infarction in prospective studies comparing highest diet adherence to a Mediterranean diet with the lowest category13)

Evidence from RCTs and Corresponding Meta-Analyses

  • 28-31% risk reduction for major cardiovascular events when following a Mediterranean diet supplemented with nuts or extra virgin olive-oil compared to a fat-reduced diet14)
  • 72% risk reduction for cardiac death and myocardial infarction when following a Mediterranean diet compared to a Western diet15)
  • -19 mg/dL LDL cholesterol in vegans vs. omnivores16)
  • significant risk reduction of CVD through higher intake of flavonoids17)
  • significant positive dose-dependent association between plasma TMAO levels, cardiovascular events, and mortality18)

General Recommendations

Eat predominantly or entirely from a wide variety of whole plant foods:

  • Maximize the intake of high-quality plant foods such as vegetables, whole grains, legumes, fruits, nuts, seeds, herbs, and spices; your health will benefit from every step towards more whole plant foods.
  • Eliminate or limit all processed foods, refined carbohydrates, and sugar-sweetened foods and beverages.
  • Eliminate or limit red and processed meat products (such as burgers, sausages, bacon, ham, salami, dried meat, canned meat, and pastrami).
  • Eliminate or limit other animal products such as poultry, fish, eggs, cheese, and dairy.
  • Make sure to cover potentially critical nutrients with a wide variety of plant foods, enriched foods/drinks, or supplements (especially vitamin B12 and vitamin D); find more information in our Nutrition Library.

Disease-Specific Recommendations

  • Limit sodium intake – avoid processed foods (which are always high in salt), and experiment with different spices and herbs to give flavor to your food while reducing the amount of salt.
  • Choose healthy, whole food fat sources such as nuts, seeds, or avocados. When oil is needed, choose omega-3-rich oils (such as flaxseed, hemp, canola, and nut oils) over omega-6-rich oils (such as sunflower, safflower, and corn oil); avoid saturated fats (such as animal fats, coconut oil, and processed foods).
  • Always go for whole grain foods to increase your fiber intake. The fiber in whole grain bread and pasta, quinoa, oatmeal, and brown and wild rice lowers your cholesterol and blood pressure.
  • Fight chronic inflammation – a very important puzzle piece in the development of CHD – with powerful antioxidants in berries, cruciferous vegetables (like broccoli), dark green leafy vegetables, and beans.
  • Regularly include some of the following foods as they are proven to be especially effective against hypertension, a main risk factor for CHD: beetroots (beetroot juice), leafy green vegetables (broccoli, kale, brussels sprouts, bok choy, etc.), garlic, oats, green tea, hibiscus tea, and dark chocolate.

For more details on how to implement a whole food, plant-based diet, have a look at our brochure.

References   [ + ]

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