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Dietary patterns

Find the most important recent research around the types of dietary patterns that support cardiovascular health

Portfolio Diet

Andrea J. Glenn, Marta Guasch-Ferré, Vasanti S. Malik, Cyril W.C. Kendall, JoAnn E. Manson,Eric B. Rimm, Walter C. Willett, Qi Sun, David J.A. Jenkins, Frank B. Hu and John L. Sievenpiper (2023) Portfolio Diet Score and Risk of Cardiovascular Disease: Findings From 3 Prospective Cohort Studies. Circulation. Ahead of print 

Closely following the Portfolio dietary pattern, including foods that have been shown to actively lower cholesterol (eg, plant proteins, nuts, viscous fibre, phytosterols/stanols and plant monounsaturated fats) has been associated with a 14% lower risk for total CVD, CHD and stroke according to results from three large observational studies.


Mazidi, M, Webb, RJ, George, ES, Shekoohi, N, Lovegrove, JA and Davies, IG (2021) Nutrient Patterns are Associated with Discordant Apolipoprotein B and Low-Density Lipoproteins: A Population-Based Analysis. British Journal of Nutrition. ISSN 0007-1145

Individuals with discordantly high apoB to LDL-cholesterol levels carry a higher risk of atherosclerotic CVD compared with those with average or discordantly low apoB to LDL-cholesterol. This study aimed to determine associations between apoB and LDL-cholesterol discordance in relation to nutrient patterns (NP) using National Health and Nutrition Examination Survey data. Three NP explained 63·2 % of variance in nutrient consumption. These consisted of NP1 rich in saturated fat, carbohydrate and vitamins, NP2 high in fibre, minerals, vitamins and PUFA and NP3 rich in dietary cholesterol, protein and sodium. The discordantly high apoB to LDL-cholesterol group had the highest consumption of the NP1 and the lowest consumption of the NP2. 

Mediterranean diet

Miguel A Martínez-González, Cesar I Fernandez-Lazaro, Estefanía Toledo, et al (2020), Carbohydrate quality changes and concurrent changes in cardiovascular risk factors: a longitudinal analysis in the PREDIMED-Plus randomized trial, The American Journal of Clinical Nutrition, nqz298,

This study examined 6 and 12 month changes in carbohydrate quality index (CQI) and concurrent changes in several CVD risk factors in a multicenter, randomized, primary-prevention trial (PREDIMED-Plus) based on an intensive weight-loss lifestyle intervention program. During the 12 month follow-up, the majority of participants improved their CQI by increasing their consumption of fruits, vegetables, legumes, fish, and nuts and decreasing their consumption of refined cereals, added sugars, and sugar-sweetened beverages. After 6 months, body weight, waist circumference (WC), systolic and diastolic blood pressure (BP), fasting blood glucose, glycated hemoglobin (HbA1c), triglyceride levels, triglycerides and glucose (TyG) index, and TyG-WC decreased across successive quintiles of improvement in the CQI. After 12 months, improvements were additionally observed for HDL cholesterol and for the ratio of total to HDL cholesterol. 

Estruch, R., Ros, E et al (2013) Primary prevention of cardiovascular disease with a Mediterranean diet. (PREDIMED)  The New England Journal of Medicine.  368. 14. Pp. 1279-90

This randomised controlled trial found that among people at high cardiovascular risk, a Mediterranean diet supplemented with extra-virgin olive oil or nuts reduced the incidence of major cardiovascular events.

Vegetarian diets

Abderrahim Oussalah, et al (2020) Health outcomes associated with vegetarian diets: An umbrella review of systematic reviews and meta-analyses Clinical Nutrition,

This meta-analyses of 20 observational or interventional studies assessed at least one health outcome in association with vegetarian diets. In comparison to omnivorous diets, vegetarian diets are associated with clinically relevant positive outcomes on both total and LDL cholesterol and body weight. Subjects adhering to vegetarian diets had a significantly lower risk of diabetes, ischaemic heart disease, and cancer, in comparison to omnivores

Kim H, Caulfield LE, et al (2019) Plant‐Based Diets Are Associated With a Lower Risk of Incident Cardiovascular Disease, Cardiovascular Disease Mortality, and All‐Cause Mortality in a General Population of Middle‐Aged Adults. Journal of the American Heart Association.

Diets higher in plant foods and lower in animal foods were associated with a lower risk of cardiovascular morbidity and mortality in a general population.

Satija, A., & Hu, F. B. (2018). Plant-based diets and cardiovascular health. Trends in cardiovascular medicine, 28(7), 437–441. 

This review summarises the current evidence base examining the associations of plant-based diets with cardiovascular endpoints, and discusses the potential biological mechanisms underlying their health effects, practical recommendations and applications of this research, and directions for future research. The authors conclude that healthy plant-based diets should be recommended as an environmentally sustainable dietary option for improved cardiovascular health.

Chiavaroliab L, Nishi S, et al (2018) Portfolio Dietary Pattern and Cardiovascular Disease: A Systematic Review and Meta-analysis of Controlled Trials. Progress in Cardiovascular Disease

Current evidence demonstrates that the Portfolio dietary pattern leads to clinically meaningful improvements in LDL-C as well as other established cardiometabolic risk factors and estimated 10-year CHD risk.

Dietary Approaches to Stop Hypertension (DASH)

Catherine M.Phillips, Janas M.Harrington, Ivan J.Perry (2019) Relationship between dietary quality, determined by DASH score, and cardiometabolic health biomarkers: A cross-sectional analysis in adults. Clinical Nutrition; 38 (4): 1620-1628

Findings from this study suggest that higher quality diet is associated with improved adiposity measures and a less insulin resistant, pro-inflammatory, pro-thrombotic and pro-atherogenic cardiometabolic profile which may impact on central obesity and metabolic syndrome risk.