Cardiovascular disease (CVD) is the leading cause of mortality worldwide. A recent review by Tyrovola et al. revealed a startling increase in cardiovascular disease cases, which doubled between 1990 and 2019. (1) Projections indicate that cardiovascular disease will continue to be the primary cause of mortality, contributing to an estimated twenty-three million deaths by 2030. (1)
Cardiovascular disease covers a broad spectrum of conditions that affect the heart and blood vessels, such as heart failure, hypertension, coronary artery disease, and myocardial infarction (heart attack), among others. Key risk factors contributing to cardiovascular disease include High Blood Pressure (HBP), high cholesterol, obesity, Diabetes, smoking, and a sedentary lifestyle. Nutrition is pivotal in managing many of these risk factors. In this blog post, we will explore the two leading causes/contributors of cardiovascular disease—hypertension and high cholesterol—while highlighting the nutritional strategies for managing each. We will also provide a comprehensive guide on the key micronutrients that support cardiovascular health.
CHOLESTEROL
Cholesterol is a waxy, fat-like substance that is essential for many bodily functions, including the production of hormones and the formation of cell membranes. While cholesterol is crucial for our health, having too much of it in our blood can increase the risk of cardiovascular disease.
Cholesterol is often categorised into two types: low-density lipoprotein (LDL) cholesterol and high-density lipoprotein (HDL) cholesterol. LDL cholesterol is known as the “bad” cholesterol, because high levels of LDL cholesterol can lead to plaque buildup in the arteries, causing a condition known as atherosclerosis. This build-up of plaque can cause the arteries to become narrow and could eventually result in a blockage, increasing the risk of a heart attack or stroke. HDL cholesterol is considered the “good” cholesterol because it helps to remove the LDL cholesterol from the arteries, transporting it to the liver to be broken down and eliminated from the body. Higher HDL cholesterol levels are often associated with a lower risk of heart disease.
Managing high cholesterol through nutrition involves making lifestyle changes that are aimed at decreasing LDL cholesterol and increasing HDL cholesterol:
1. Limit Saturated and Trans Fats
Saturated fats, commonly found in foods like red meat, full-cream dairy products, and fried or processed items, can contribute to cardiovascular disease by raising both total and LDL cholesterol levels. Similarly, trans fats, prevalent in many baked goods such as cakes and biscuits, can significantly increase LDL cholesterol and decrease HDL cholesterol. To combat these effects and promote heart health, it is crucial to focus on incorporating heart-healthy fats into your diet. These beneficial fats are found in plant sources such as olive oil, avocados, nuts, and seeds.
2. Increase Omega-3 Fatty Acid Intake
Omega-3 fatty acids are essential fats that are critical for numerous bodily functions and are especially renowned for their profound benefits to heart health. Omega-3 fatty acids help to reduce inflammation in the body which is a key factor in preventing the onset of atherosclerosis. Additionally, omega 3’s effectively lowers triglyceride levels while boosting HDL cholesterol, contributing further to cardiovascular well-being. The most common sources of Omega-3 fatty acids are fatty fish (salmon, tuna, mackerel, sardines, and trout), flaxseeds, chia seeds, and walnuts.
3. Increase Fibre Intake
Research consistently highlights the pivotal role of a high-fibre diet in lowering the risk of cardiovascular disease. Fibre plays a crucial role in enhancing lipid profiles by lowering LDL cholesterol and combating inflammation, which helps protect against atherosclerosis and promotes cardiovascular health. Soluble fibre is especially effective in managing high cholesterol, as it reduces the absorption of cholesterol into the bloodstream. Excellent sources of soluble fibre include oats, barley, beans, lentils, fruits, and vegetables. In addition to the vascular benefits, fibre is also instrumental in weight management, which in turn can further decrease the risk of cardiovascular disease.
4. Consume Antioxidant-Rich Foods
Antioxidants are compounds that protect the body from oxidative stress and inflammation by neutralising harmful free radicals, which are unstable molecules that can damage cells and contribute to disease. Free radicals oxidise LDL cholesterol which can exacerbate plaque formation in the arteries, further contributing to atherosclerosis. Increasing your intake of antioxidants can markedly decrease your risk of cardiovascular disease by neutralizing the harmful effects of free radicals. Sources of antioxidants include berries (blueberries, strawberries, blackberries), dark chocolate, nuts (almonds, walnuts), vegetables (peppers, tomatoes, spinach, kale), green tea and spices (turmeric, cinnamon and ginger).
5. Maintain a Healthy Weight
Losing even a small amount of weight can significantly lower cholesterol levels and improve heart health. Achieving this involves maintaining a balanced diet and engaging in regular physical activity. Exercise can help to raise HDL cholesterol and lower LDL cholesterol and triglycerides. The World Health Organization suggests aiming for at least 150 minutes of moderate aerobic exercise or 75 minutes of vigorous exercise each week to reap these benefits. (2)
HYPERTENSION
Hypertension, commonly known as high blood pressure, is a condition where the force of the blood against the walls of the arteries is consistently too high. It is a prevalent health issue that significantly increases the risk of developing cardiovascular disease, stroke, and other serious health problems. Hypertension is caused by a variety of factors, including genetics, diet, lifestyle, underlying health conditions, and stress. Effectively managing these factors can significantly lower blood pressure, decreasing the risk of hypertension and cardiovascular disease.
Nutritional management of hypertension focuses on dietary interventions that help to lower blood pressure and reduce the risk of cardiovascular complications:
1. Dietary Approaches to Stop Hypertension (DASH) Diet
The Dietary Approaches to Stop Hypertension (DASH) diet is specifically designed to combat high blood pressure. It offers a flexible set of guidelines that do not require special foods, focusing instead on daily and weekly nutritional goals. Proven to lower blood pressure and LDL cholesterol, the DASH diet emphasizes consuming a variety of fruits, vegetables, and whole grains. It also includes low-fat or fat-free dairy products, fish, poultry, and legumes, while limiting foods high in saturated fats like red meats and full-fat dairy products, as well as sugar-sweetened beverages and sweets. To learn more about the DASH diet, visit the NHLBI DASH Eating Plan.
2. Reduce sodium intake
Excessive sodium intake increases blood pressure. Sodium contributes to fluid retention. The excess fluid in the bloodstream places added stress on the heart and blood vessels, leading to higher blood pressure. Moreover, elevated sodium levels in the bloodstream can impair the function of blood vessel cells, reducing their ability to regulate blood flow and pressure effectively. To manage sodium intake, it is recommended to aim for less than 2,300 milligrams (mg) per day. However, restricting intake to less than 1,500 mg per day has been shown to yield even greater reductions in blood pressure. Here are some practical tips to reduce sodium consumption:
Limit Processed Foods: Processed foods such as canned goods, processed meats, and snacks often contain high levels of sodium
Cook at Home: Cooking meals at home allows you to control the amount of salt added during food preparation. Use herbs, spices, and other flavourings when you cook to reduce the amount of salt used
Read Food Labels: Checking nutrition labels helps identify products with lower sodium content. Opt for low-sodium or sodium-free alternatives
3. Limit alcohol consumption
Excessive alcohol consumption can elevate blood pressure through various mechanisms. Chronic heavy drinking can lead to sustained high blood pressure. Additionally, alcohol can interfere with medications prescribed to manage hypertension and can contribute to weight gain due to its high-calorie content, which is in itself a risk factor for cardiovascular disease. For individuals at risk of cardiovascular issues, including hypertension, it is generally recommended to limit alcohol intake to no more than 4 drinks per week. This guideline helps mitigate the potential adverse effects of alcohol on blood pressure and overall heart health.
4. Maintain a Healthy Weight
Similarly with cholesterol, maintaining a healthy weight can help lower your risk of hypertension. Having excessive body weight places additional strain on your heart, as your heart needs to pump more blood around your body to supply the extra tissues with oxygen and nutrients. Additionally, having excessive adipose tissue can also result in hormonal imbalances that can affect blood pressure regulation. Effective weight management is essential for both preventing and managing hypertension. By achieving and maintaining a healthy weight through balanced nutrition, regular exercise, and healthy lifestyle choices, individuals can reduce the strain on their hearts and improve overall cardiovascular health.
KEY MICRONUTRIENTS IN CARDIOVASCULAR HEALTH
Effective management of cardiovascular disease, hypertension, and high cholesterol goes beyond lifestyle and dietary changes. It also involves ensuring you get the right minerals essential for maintaining a healthy heart and vascular system. Some of the key micronutrients that play a role in preventing cardiovascular disease and can have significant effects on cholesterol and hypertension are Potassium, Magnesium, and Calcium.
1. Potassium
Potassium is an important mineral and electrolyte that plays a critical role in maintaining cardiovascular health. It actively maintains fluid balance by counteracting sodium’s effects and facilitates nerve signals and muscle contractions, ensuring optimal heart and muscle performance. It is shown that a higher Potassium intake is associated with a reduced risk of cardiovascular disease. For adults, the recommended daily Potassium intake ranges from 2500 to 3000mg per day, however, can be as high as 4700 mg per day for some individuals. (3)
2. Magnesium
Magnesium is an essential mineral that is involved in a multitude of bodily functions, ranging from muscle and nerve function to blood glucose control and blood pressure regulation. This vital nutrient helps to maintain a steady heartbeat, supports immune function to protect against inflammation and aids in electrolyte balance and vasodilation, which is crucial for lowering blood pressure. In addition to this, Magnesium is also involved in lipid metabolism, thus influencing cholesterol levels by enhancing HDL cholesterol and reducing LDL cholesterol. The recommended daily intake of Magnesium varies across age groups and genders, typically averaging around 400 mg per day for men and 310 mg per day for women. (3)
3. Calcium
Calcium is a vital mineral known primarily for its role in bone health, yet its importance extends far beyond the skeletal system. Calcium plays a significant role in cardiovascular health, muscle function and nerve signalling. Calcium is crucial for the contraction and relaxation of blood vessels, which is essential for maintaining normal blood pressure. Calcium is also important for the contraction of the heart muscle, directly contributing to heart health. Beyond cardiovascular benefits, Calcium is necessary for proper muscle function and nerve transmission, underscoring its overall health benefits. The recommended daily intake of Calcium is around 1000 mg for both men and women aged 19-50, increasing to 1200 mg per day for adults over 51. (3)
FOOD SOURCE COMPARISON TABLE
Below is a table highlighting the most common foods that are excellent sources of Potassium, Magnesium, and Calcium. (3,4,5) Incorporating a variety of these nutrient-rich foods into your diet can help ensure adequate intake of these essential minerals and contribute to maintaining optimal heart health.
Nutritional management is a cornerstone in the prevention and treatment of cardiovascular disease. By reducing sodium intake and consuming a heart-healthy diet, low in saturated and trans fats, increasing fibre intake and ensuring adequate intake of essential minerals like Potassium, Magnesium and Calcium, individuals can significantly improve their heart health.
References:
Ludwig, H., Brown, P., and Clark, J. (2023) 'Impact of Nutritional Interventions on Cardiovascular Health', Nutrients, 15(10), p. 1064. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10005442/pdf/nutrients-15-01064.pdf (Accessed: 14 June 2024).
World Health Organization (2021). WHO Guidelines on Physical Activity and Sedentary Behaviour. [online] Available at: https://iris.who.int/bitstream/handle/10665/337001/9789240014886-eng.pdf?sequence=1 [Accessed 27 June 2024].
Whitney, E. and Rolfes, S.R., 2019. Understanding Nutrition. 15th ed. Stamford, CT: Cengage Learning.
United States Department of Agriculture (USDA), n.d. FoodData Central. [online] Available at: https://fdc.nal.usda.gov/ [Accessed 27 June 2024].
National Institutes of Health (NIH), n.d. Office of Dietary Supplements - Nutrient Information. [online] Available at: https://ods.od.nih.gov/ [Accessed 27 June 2024].
