Moving towards a healthy dietary pattern: particular foods that should be included more often in the diet

Dietary management of CVD risk is a key element in CVD prevention. Hence, considering foods, rather than nutrients in isolation, is advantageous.

Vegetable oils and margarines

When aiming to reduce SFA intake by replacing them with unsaturated fats for CVD prevention, plant-based sources, such as vegetable oils and vegetable oil-based spreads and margarines can be healthy substitutes to animal-derived SFA.

Vegetable oils deliver essential fatty acids such as Omega-3 ALA and the Omega-6 LA as well as fat soluble vitamins, e.g. Vit. E. They provide different combinations of SFA, MUFA and PUFA depending on their origin. Among vegetable oils, olive oil, particularly extra-virgin olive oil, is especially emphasized in the Mediterranean dietary pattern as it is particularly rich in MUFA and antioxidants compounds. In fact, the PREDIMED trial has shown that supplementing a Mediterranean diet with extra-virgin olive oil can reduce the incidence of major cardiovascular events among persons at high CVD risk15.

veg Margarines are made from various vegetable oils that are rich in PUFA and MUFA. Some margarines contain added plant sterols and stanols or Omega-3 which confer a particular cardiovascular health benefit and help to lower LDL-cholesterol and TG levels14, 16.


Nuts are another plant-based alternative to SFA rich foods. Most common nuts in the diet are almonds, walnuts, peanuts, hazelnuts, pistachios and chestnuts. Including nuts as a part of a daily healthy diet should be emphasized as, if compared to foods of animal origin (like meat, cheese, whole milk and egg yolks), they have a very high unsaturated to saturated fats ratio16. In fact, they are also high in Omega-3 (e.g. ALA) and low in SFA. Next to their optimal lipid profile, other not-fat components,Nuts such as plant sterols, dietary fibres, along with particular amino acids, are likely to play an important role in their LDL-cholesterol lowering effect17,18.

Nut consumption has been also associated with reduced risk of CHD and hypertension19.

The beneficial effects on multiple CVD and metabolic risk factors of supplementing a diet with a portion (approximately 30g) of nuts was shown in the PREDIMED trial15.

Increase nuts consumption (preferably unsalted) for a healthy hearth: a little amount17, can have a big impact for CVD prevention.
Fish and fish oil

Fish and seafood deserve particular attention within dietary changes towards a heart healthy diet. They are an important source of many nutrients including unsaturated fats and protein, several vitamins (e.g. Vit. D and B) and minerals (e.g. selenium, iodine, and potassium)10.

A characteristic of fish and, especially, oily fish, is its high content of very long chain Omega-3 EPA and DHA.

In addition to the cardiovascular health benefits (see above), EPA and DHA have anti-inflammatory effects, and, for this reason, they might not only prevent plaque development but also contribute to the atherosclerotic plaque stabilization20.

Fish Next to fish, fish oil or marine omega-3 are beneficial for heart health. Although fish oil does not have an effect on blood TC and LDL-cholesterol levels, at high doses (>3g/day) EPA+DHA are effective in plasma TG lowering14,20. Such high intakes can only be reached through supplements.

ADVICE: Eat fish at least twice a week, one of which should be an oily fish7. In addition to providing very long chain Omega-3 fatty acids fish provides proteins, vitamins and minerals. Opt for a moderate consumption of mollusks and shellfish, as they are also a significant source of cholesterol.