Dietary Recommendations for Cardiovascular Health

Introduction to Healthy Fats

• Reducing saturated fatty acids to 7% of total energy intake is recommended by the American Diabetes Association and the American College of Cardiology to improve cardiovascular health 1, 2, 3, 4, 5, 6, 7
• Limiting trans-unsaturated fatty acids is advised by the American Diabetes Association to reduce cardiovascular risk 1
• Replacing saturated fats with monounsaturated fats (e.g., olive oil, canola oil) and polyunsaturated fats (e.g., corn oil, peanuts) is suggested by the American Academy of Family Physicians to improve lipid profiles 8
• Replacing saturated fat with carbohydrates may improve LDL cholesterol but could raise triglycerides and lower HDL, according to the American Academy of Family Physicians 8

Dietary Components for LDL Lowering

• Adding plant stanols/sterols (2g/day) can help lower LDL cholesterol, as recommended by the American Academy of Family Physicians and the American College of Cardiology 8, 2, 3, 6, 7
• Consuming viscous (soluble) fiber (10-25g/day) can help lower LDL levels, as suggested by the American Diabetes Association and the American Heart Association 9, 1, 10
• Increasing soluble fiber can further reduce LDL levels, according to the American Diabetes Association 1

Physical Activity and Weight Management

• Regular physical activity (at least 30 minutes of moderate-intensity exercise on most days) improves insulin sensitivity, reduces plasma triglycerides, and raises HDL levels, as reported by the American Diabetes Association and the American College of Cardiology 1, 4, 7, 11, 12
• Weight loss and physical activity improve lipid profiles and insulin sensitivity, as suggested by the American Diabetes Association 1
• Targeting a BMI between 18.5-24.9 kg/m² and waist circumference <35 inches for women is recommended by the American College of Cardiology 5, 2, 6, 7

Pharmacological Therapy and Monitoring

• If LDL remains elevated (≥160 mg/dL) despite 12 weeks of lifestyle modifications, pharmacological therapy may be considered, according to the American Academy of Family Physicians and the American College of Cardiology 8, 3, 13
• High-intensity statin therapy is indicated for patients with high cholesterol levels, regardless of the presence or absence of other risk factors, according to the American College of Cardiology 3, 13
• The following LDL-C targets are recommended based on risk category:

14, 4, 2, 6, 15, 16

• If the cholesterol goal is not achieved with maximum tolerated statin, consider adding another medication (e.g., ezetimibe, PCSK9 inhibitor) to provide additional cholesterol reduction 13, 17, 10, 14

Additional Recommendations

• Smoking cessation is important, as stopping smoking can increase HDL levels by up to 30%, according to the American Academy of Family Physicians 8
• Increasing consumption of fruits, vegetables, whole grains, and foods rich in omega-3 fatty acids is recommended for patients with high cardiovascular risk 2, 3, 2, 6, 7
• The American Diabetes Association recommends a Mediterranean or DASH eating pattern with reduced saturated and trans fats to help manage lipid levels and reduce cardiovascular risk 10
• Regular monitoring of lipid panels, liver function tests, blood pressure, and fasting glucose/HbA1c is recommended for patients with cardiovascular risk factors, according to the American Heart Association 18
• Lipid panels should be monitored 4-12 weeks after statin initiation, then annually if stable, to assess treatment efficacy and adjust the treatment plan as needed 10, 19
• HbA1c levels should be monitored every 3-6 months to assess glycemic control and adjust the treatment plan as needed
• Patients should be monitored more closely for changes in glucose levels after initiating statin therapy, and adjustments to the treatment plan can be made as needed 10