Food and Health: Nutrition for Cardiovascular Disease Prevention and Management — The 2026 ACC Scientific Statement

Dietary patterns rich in vegetables, fruits, whole grains, legumes, nuts and unsaturated fats are consistently associated with lower cardiovascular risk.

The Mediterranean diet and DASH dietary pattern have particularly strong supporting evidence.

Randomized trials, including PREDIMED and CORDIOPREV, provide important evidence for Mediterranean-style eating in primary and secondary cardiovascular prevention.

These dietary patterns can lower blood pressure, reduce LDL cholesterol and support healthier blood glucose levels, although the magnitude of each effect varies across interventions and populations.

They also emphasize foods that provide fibre, essential nutrients and beneficial plant compounds.

A predominantly plant-based diet can include fish and selected dairy products.

The strongest evidence supports a consistent, high-quality dietary pattern, with particular emphasis on plant foods and unsaturated fat sources.

The cardiovascular effects of dietary fat depend on its composition and the foods used as replacements.

Replacing saturated fats with unsaturated fats lowers LDL cholesterol and supports cardiovascular risk reduction.

Olive oil, rapeseed oil, other liquid vegetable oils, nuts and seeds are recommended sources.

Butter, animal fats and tropical oils rich in saturated fat are less favourable choices.

Importantly, replacing saturated fats with refined carbohydrates or added sugars does not provide comparable cardiovascular benefits.

The statement also examines differences between dairy products. Butter, cheese, milk and fermented dairy foods have distinct nutritional characteristics and should be evaluated separately.

Evidence concerning full-fat dairy remains heterogeneous. These uncertainties do not establish a cardiovascular advantage for butter or other saturated-fat-rich foods.

Replacing saturated fats with unsaturated plant oils is among the best-supported dietary strategies for lowering LDL cholesterol and cardiovascular risk.

Protein is essential for maintaining muscle mass, physical function and metabolic health.

However, cardiovascular outcomes are influenced by protein sources.

Legumes, nuts and other plant proteins are associated with lower cardiovascular risk, particularly when they replace red or processed meat.

Fish also contributes to a healthy dietary pattern.

A notable aspect of the ACC statement is its critical assessment of the higher protein targets proposed in the 2025–2030 US Dietary Guidelines.

The suggested intake of 1.2–1.6 grams per kilogram of body weight daily has not been shown to provide additional cardiovascular benefits for all adults.

Much of the supporting evidence comes from studies involving weight management, with limited information on long-term cardiovascular events.

Higher protein intake may still be appropriate for older adults at risk of muscle loss, physically active individuals and selected patients undergoing weight reduction.

Protein recommendations should be individualized, with attention to food sources, muscle health, nutritional status and kidney function.

Whole grains, legumes, vegetables and fruits provide fibre and nutrients that support cardiovascular and metabolic health.

Higher fibre intake is associated with lower LDL cholesterol, better blood glucose control and reduced cardiovascular risk.

A daily intake of approximately 25 grams or more is a useful general target for many adults.

Refined grains and sugar-sweetened beverages offer fewer nutritional benefits and are associated with higher cardiometabolic risk.

Reducing excessive sodium intake remains an established intervention for lowering blood pressure.

Potassium-rich foods can provide additional benefits. Potassium-containing salt substitutes may also lower blood pressure and reduce cardiovascular events in selected populations.

However, these substitutes require caution in people with impaired kidney function or those taking medications that increase potassium levels.

Fibre-rich carbohydrates and lower sodium intake remain fundamental elements of cardiovascular prevention.

Higher consumption of ultra-processed foods is associated with increased cardiovascular and metabolic risk.

The strongest concerns involve sugar-sweetened beverages, processed meats and products rich in refined starches, added sugars, sodium or saturated fats.

However, ultra-processed foods represent a diverse category.

Some commercially prepared whole-grain breads, yoghurts and breakfast cereals retain favourable nutritional characteristics despite their classification.

The statement recognizes that the relationship between food processing and health is complex. Nutritional composition, food structure and processing methods may all contribute.

The cardiovascular implications of ultra-processed foods differ substantially between products. Nutritional quality remains essential to their assessment.

Low-carbohydrate diets can lower blood glucose levels and support weight loss in selected individuals, particularly those with type 2 diabetes.

Their cardiovascular effects depend on the foods replacing carbohydrates.

Diets emphasizing plant proteins and unsaturated fats are generally associated with lower cardiovascular risk than those dominated by saturated animal fats.

Ketogenic diets high in saturated fat may substantially increase LDL cholesterol in some individuals.

Intermittent fasting can support weight loss and lower selected metabolic risk markers over the short term.

However, available trials have not demonstrated consistent superiority over conventional calorie restriction for long-term cardiovascular outcomes.

Evidence of reduced cardiovascular events or extended human lifespan remains insufficient.

The ACC supports sustainable, nutritionally adequate dietary strategies, with careful consideration of individual metabolic and cardiovascular risk.

Regular fish consumption is supported within a balanced dietary pattern.

Routine omega-3 supplementation is not recommended for primary cardiovascular prevention in otherwise healthy adults.

Specific prescription formulations may reduce cardiovascular events in selected high-risk patients, although these treatments have different indications and evidence from standard supplements.

The statement also discusses the increased atrial fibrillation risk observed in some trials of high-dose omega-3 preparations.

Alcohol consumption should not be initiated for cardiovascular protection. Any potential cardiovascular associations must be considered alongside established health risks, including cancer.

Moderate filtered coffee and tea consumption is generally compatible with cardiovascular health for most adults.

Much of the evidence for their long-term benefits remains observational. Unfiltered coffee can increase LDL cholesterol because of naturally occurring coffee compounds.

Water and unsweetened beverages remain appropriate choices for everyday hydration.

Medications acting on the GLP-1 pathway can produce substantial weight loss and reduce cardiovascular events in selected patient populations.

However, reduced appetite and lower energy intake may compromise nutritional adequacy.

Insufficient protein, fibre and micronutrient intake are important concerns. Significant weight loss may also involve loss of lean body mass.

Adequate nutrition, resistance exercise and individualized dietary support can help preserve muscle mass and physical function.

These measures are particularly important for older adults and individuals at risk of malnutrition or sarcopenia.

Successful obesity treatment requires attention to nutritional quality, muscle preservation and long-term metabolic health.

Advances in genetics, microbiome research, metabolomics and artificial intelligence are creating new opportunities for individualized dietary assessment.

These approaches may eventually provide more accurate identification of nutritional needs and metabolic responses.

However, evidence that they reduce long-term cardiovascular events remains limited.

The statement also highlights the importance of access to healthy food and structured nutritional support.

Programmes commonly described as Food Is Medicine may increase consumption of nutritious foods and reduce barriers to healthy eating. Further research is needed to establish their effects on major clinical outcomes.

Personalized nutrition is an evolving field. Established dietary principles remain the foundation of cardiovascular prevention.