Introduction

Coronary Heart Disease (CHD) is one of the leading causes of death worldwide. Globally, 110 million men and 80 million women live with the disease, with around 9 million of those dying each year.¹ In the UK, this translates to around 101 deaths per 100,000 people ² (as of 2021), as 68,000 annual deaths are recorded among patients. That equates to one death every eight minutes.³ These shocking statistics highlight the prevalence and severity of CHD and essentialise the need to tame the impact and manage the symptoms within populations around the globe. The proceeding information provides dietary guidelines tailored for CHD patients, offering actionable tips and advice on what to eat, what to avoid and how to make heart-healthy food choices conducive to well-being. Whether you’re managing CHD yourself, caring for someone who is, or looking to prevent its development in the future, these recommendations will unlock the knowledge required to take control of your diet and protect your heart.

Coronary heart disease and diet: the ins and outs

Diet is a modifiable risk factor in preventing, reducing, and managing CHD. The condition occurs when the coronary arteries, which deliver blood to the heart, become constricted or blocked due to plaque build-up.⁴ This plaque is a combination of fatty deposits, cholesterol and other substances that narrow the arteries and prevent the vital supply of blood to the heart muscle. Blockages in blood flow cause the associated symptoms of chest pain (angina), heart attacks, shortness of breath, feeling faint or nauseous and pain in the neck, shoulders, jaws or arms.⁵ Risk factors include elevated blood pressure, high cholesterol levels, smoking, obesity and, of course, an unhealthy diet.

The foods we eat play a pivotal role in the development and management of CHD. Unfavourable dietary habits include excessive saturated fats, trans fats, sodium and added refined sugars. You can expect these in highly processed foods; hence, the overarching advice is to stick to whole foods. Opting for the ultra-processed limbo that so many of us find ourselves invested in is a sure way to exacerbate the risk of morbidity and mortality from CHD. These foods (e.g., sweets, fried foods, crisps, etc.) contribute to plaque buildup in our arteries, whilst heart-healthy alternatives provide the opposite effect. A diet rich in fruits, vegetables, legumes, lean proteins and healthy whole grains will reduce inflammation in the body and subsequently lower blood pressure, cholesterol and all the other symptoms of CHD.⁶

An appreciation for the dietary implications of CHD empowers individuals to make smarter decisions. By making more informed food choices and adopting healthier eating habits, the risk of CHD development can be seriously mitigated, thus improving heart function and quality of life.

The dietary recommendations

With the definition, causes, and symptoms of CHD verified and the importance of nutrition in mitigating its onset and development established, the natural next step is to reveal the dietary recommendations. The following section intends to do precisely this, as heart-healthy guidelines are presented to help reduce the risk of the disease and its progression.

Heart-healthy fats

Differentiating between the various sources of dietary fat is important when attempting to garner an appreciation for its impact on CHD and our health. It has already been revealed that saturated and trans fats are potentially damaging to heart health and can cause symptoms of CHD. These fats are commonly found in full-fat dairy products, red meat, and ultra-processed foods. Their cardiac-deteriorating effect is largely due to their high Low-Density Lipoprotein (LDL) cholesterol levels.⁷ Despite some conflicting evidence ⁸ and a lot of friction and nuance around the efficacy of this long-standing postulation, there is sufficient evidence to suggest that LDL cholesterol contributes to plaque build-up in the arteries.⁹ Lowering LDL cholesterol and saturated and trans fats is a major mover in reducing atherosclerosis (fat build-up in artery walls) and CHD.

The alternative is unsaturated fats, which, in contrast, are beneficial for heart health – particularly monounsaturated (e.g., nuts, seeds, avocado) and polyunsaturated (e.g., walnuts and fatty fish). The recommendation is to optimise the consumption of these healthier fats and minimise the consumption of the alternatives. The British Heart Foundation recommends less than 30g of saturated fat per day for males and 20g for females, whilst all should consume no more than 5g of trans fats.¹⁰ Other guidelines suggest that saturated fats should make up no more than 7% of total calorie consumption.¹¹

Good Ol’ fruit and veg

As the saying goes, there is no smoke without fire. The noise circulated about the health benefits of fruit and vegetable consumption in the past few decades is fully justified. I am here to amplify that noise and tell you that their incorporation into a dietary plan for CHD is essential! Fruit and vegetables (e.g., dark leafy greens, berries, citrus fruits, cruciferous vegetables, etc.) are packed with key nutrients. Their critical combinations of vitamins, minerals, fibre, and antioxidants provide an anti-inflammatory effect on the body, which simultaneously contributes to the health of our heart. Adequate fibre consumption can also reduce LDL cholesterol levels.¹²

Research has shown that consuming 7 portions of fruit and vegetables per day can reduce the risk of CHD by ~20%.¹³ These findings have been further supported by proceeding research evidence, indicating that consuming over 5 servings of fruit and vegetables can reduce the risk of CHD by 17%, compared with less than 3 servings.¹⁴ Yet another study has indicated that for every portion of fruit and vegetables per day, the risk of CHD is slashed by between 4 and 7%.¹⁵  The evidence is clear. Eating fresh, frozen, dried, canned fruits and vegetables (without added sugar or salt) is essential for a coronary heart patient.

Whole grains over refined grains

Swapping whole grains for refined grains has a hugely positive potential return on investment for CHD patients. Brown rice, oats, quinoa, whole wheat, or sourdough bread (with minimal ingredients and additives) are far better than their refined counterparts. Their fibre content and low glycaemic effect contribute to more stable blood sugar levels to help reduce polarising energy levels whilst lowering cholesterol and aiding digestive processes. Making these simple switches in grain selection has been shown to reduce the relative risk of CHD by 19%.¹⁶

Lean and mean protein

As previously alluded, highly processed meats like bacon, sausage and deli meats are loaded with saturated and trans fats and should be avoided by coronary heart patients. Leaner protein sources are far more beneficial to heart health and should be prioritised. Fatty fish (rich in omega-3 fatty acids) like salmon and mackerel, pasture-raised poultry, beans, legumes (e.g., lentils and chickpeas), tofu and tempeh are all excellent choices. Unprocessed and quality red meat should be consumed in moderation.¹⁷

Reduce salt and sodium intake

High blood pressure poses a major cause and symptom of CHD, and salt (sodium) intake is directly linked to levels of blood pressure. It is generally recommended that salt consumption be minimised for coronary heart patients. Excess sodium in the body leads to better water retention, increasing blood volume and, thus, pressure. Chronically, this can place serious strain on the heart and cause arterial damage and degradation. It is also the reason that a heart-healthy diet should contain less than 5 grams of salt (~2 grams of sodium) per day, as per the World Health Organisation’s recommendations.¹⁸ Limiting consumption of processed and packaged foods and cooking from home allows for more autonomy and control over total daily sodium consumption. Reading food labels to help identify excessively high sodium products (over 140mg per serving) is also advisable.

Shun the sugar

As with excessive consumption of salt and sodium, added sugars should be reduced as much as possible. Overeating refined sugars is a fast track to obesity, insulin resistance, inflammation, high cholesterol and high blood pressure – all major risk factors for CHD. The supporting evidence is plentiful. Arguably, the most poignant comes from a 15-year study demonstrating that individuals consuming over 25% of their daily energy from sugar were twice as likely to suffer heart disease mortality than those who were consuming less than 10%.¹⁹ Sugary products like sugar-sweetened beverages, chocolates, cakes, sweets and pastries should be avoided. Instead, opt for herbal teas, and to satisfy a sweet tooth, try natural fruits or honey and get creative in the kitchen. I should re-emphasise the importance of reading food labels to understand any hidden sugars added to seemingly harmless processed foods.

The action plan

Unfortunately, knowing what is needed to reduce the risk and severity of CHD is simply not enough. Establishing effective implementation strategies is equally, if not more, important. This section gives a quick insight into the heart-healthy behaviours conducive to the above recommendations, providing the toolkit needed for a holistic dietary approach to CHD.

Control those Portions

Overeating food unnecessarily is an antagonist for CHD. A conscious approach to caloric intake can benefit a coronary heart patient, and the active management of portion sizes offers a vehicle to achieve this feat. Smaller plates, smaller utensils, mindful eating, chewing slowly, and leaving at least twenty minutes between one portion and the next (to allow satiation hormones and cues to trigger) are some palpable strategies to implement.

Meal planning

The principle of forward-thinking and backward-planning can prove transformative for anyone and their diet. After reading this article, a coronary heart patient who has learned the guidelines needed to manage their condition will benefit. Planning meals and crafting a dietary map specific to one’s lifestyle and commitments is a terrific approach. Prepping and batch-cooking the heart-healthy ingredients discussed in the previous section can help us steer clear of temptation and stay on track.

Eating out

Nobody should be denied the opportunity to enjoy a meal with friends or family. Special occasions should be embraced and should become anxiety-free situations that provoke nothing but smiles and calm. Planning and reading a restaurant’s menu to identify heart-healthy choices with the recommendations above is a great approach. Opting for grilled, baked, and steamed options over fried options and having the presence of mind to ask for clarity over the makeup of a recipe will help too! Most restaurants are prepared to modify their recipes or plating methods, so do not hesitate to ask.

The round-up

The purpose of this article was to provide a clear set of guidelines for a heart-healthy diet. The aim was to empower coronary heart patients and unlock the understanding required to navigate their condition from a dietary perspective. By focusing on nutrient density and whole foods, avoiding processed and refined alternatives and taking a proactive approach, it is possible to relieve symptoms of CHD. Coronary heart patients can make significant strides in a positive direction by consistently implementing these recommendations. Combined with a holistic health approach, regular exercise and tailored lifestyle modification, it is possible to generate significant improvements in the health of your heart over time.

Summary of dietary recommendations for coronary heart disease

Coronary Heart Disease (CHD) is a leading cause of mortality worldwide, necessitating effective dietary strategies for prevention and management. A heart-healthy diet is crucial, focusing on whole foods while avoiding saturated and trans fats, excessive sodium, and added sugars. Key recommendations include:

1. Heart-Healthy Fats: Prioritize unsaturated fats (e.g., nuts, seeds, fatty fish) and limit saturated (less than 30g/day for men, 20g/day for women) and trans fats (less than 5g/day).
2. Fruits and Vegetables: Aim for at least 7 servings daily to reduce CHD risk significantly, providing essential nutrients and fibre.
3. Whole Grains: Choose whole grains (e.g., brown rice, oats) over refined grains to improve blood sugar stability and lower cholesterol.
4. Lean Proteins: Opt for lean sources like fatty fish, poultry, and legumes, and limit processed meats.
5. Reduce Sodium: Limit salt intake to less than 5g/day to manage blood pressure and minimize heart strain.
6. Limit Added Sugars: Avoid sugary foods and beverages to reduce obesity and associated risks.

Implementing portion control, meal planning, and mindful eating can further enhance adherence to these guidelines. By focusing on nutrient-dense, whole foods and maintaining a proactive approach, individuals can significantly improve their heart health and overall well-being.