Choosing Foods for a Post-Heart Attack Diet

Research has shown that eating a nutritious diet can help reduce your risk of getting coronary artery disease (CAD).

If you already have CAD, you may wonder what type of diet would support your heart health. Which foods should you choose (or avoid) if you've had a myocardial infarction (heart attack), stroke, acute coronary syndrome, or angina?

Until recently, research on diet and CAD wasn't that strong. Therefore, the dietary recommendations for people with CAD have not always been clear.

There is one popular eating pattern that addresses all of these recommendations: the Mediterranean diet.

This article will cover what research has shown about how the Mediterranean diet could be beneficial if you have CAD.

What Is the Mediterranean Diet?

There is no official definition of the Mediterranean diet. The name was chosen because the eating plan features many habits of people living in the Mediterranean regions of the world.

The Mediterranean diet is mostly a plant-based diet. When you follow this eating plan:

• You'll eat a lot of fruits, vegetables, legumes, nuts, and whole grains
• You'll have moderate servings of cheese, eggs, and yogurt
• You can include a few portions of fish, other seafood, and poultry, in your meals each week
• You can enjoy olive oil and red wine in moderation

Possible Heart-Health Benefits

The Mediterranean diet has several key elements that might be especially beneficial for the cardiovascular system.

For example:

• The diet includes many foods that are lower in saturated fats, trans fats, cholesterol, sodium, and added sugars. In excess, these nutrients can have a negative effect on heart health factors like weight, blood pressure, and blood sugar levels.
• Some of the most emphasized foods in the diet, like olive oil, are major sources of heart-healthy monounsaturated fatty acids.
• Some nutrients in the diet, like omega-3 fatty acids, may help lower cholesterol and triglycerides.

Mediterranean Diet Research

Recent studies have provided evidence that the Mediterranean diet can help prevent CAD as well as improve outcomes for people who already have the condition.

One example is the 2018 PREDIMED trial. The study compared two versions of the Mediterranean diet with a simple low-fat diet (the type of diet that's been recommended for people with CAD over the last 25 years).

PREDIMED Part One

The first part of the study included more than 7,000 people who were at high risk for CAD. The researchers followed up with the group after about 5 years.

The incidences of heart attack, stroke, or heart-related death were lower in the two groups that had randomly been assigned to the Mediterranean diets.

PREDIMED Part Two

The second part included 30,000 people who were 55 years of age or older. Each person either had CAD or diabetes with cardiovascular complications. The participants were grouped by their dietary habits. The researchers followed each group for an average of 56 months.

The people who followed a Mediterranean-style diet had a significantly lower incidence of heart attack, heart failure, stroke, or cardiovascular death than the people who followed other eating patterns.

Cochrane Review

In 2019, a group of experts provided some insight into the state of research on the Mediterranean diet and cardiovascular disease risk. They looked at just under 50 papers on the subject for their review.

The researchers tried to provide an overview and summary of the findings from all the studies, as well as highlight what we don't yet know.

Here are a few key points from their review:

• Even though there have been a lot of studies looking at the Mediterranean diet and heart disease, the evidence has been mixed.
• Some studies have found evidence that following a Mediterranean-style diet can help prevent cardiovascular disease, but the quality of that evidence was not always very strong.
• There were also plenty of studies that did not find evidence that the Mediterranean diet helped to prevent cardiovascular disease.

The researchers concluded that we don't yet have enough high-quality evidence to show there is a clear preventative benefit of a Mediterranean diet for lowering the risk of cardiovascular disease.

How to Try the Diet

Whether you're concerned about your risk for CAD, you have CAD already, or you just want to try a new eating pattern, there are some key steps you can take to follow the Mediterranean diet:

• Avoid processed foods
• Make plant-based foods the base of your diet (fruits, vegetables, legumes, and whole grains)
• Use olive oil or canola oil instead of butter and margarine
• Limit red meat to once or twice a month
• Eat fish and poultry at least twice a week
• If you already consume alcohol, consider enjoying a glass of red wine with dinner

Summary

Some research suggests that the Mediterranean diet can be helpful for people with CAD, but we still don't have enough evidence to know for sure.

The types of research studies that would provide the strongest evidence to support these findings haven't been done yet.