Heart Healthy Nutrition

Heart Healthy Nutrition

Coronary artery disease (CAD) is a leading cause of death in the United States. In CAD, deposits of fat, cholesterol and calcium (atherosclerosis) build up inside the artery. These deposits are called plaque. Like the inside of a rusty water pipe, the wall of the artery becomes rough, hard and narrow. The flow of blood and oxygen is slowed or blocked. This may cause chest pain or a heart attack. Atherosclerosis is also a major cause of stroke and vascular disease.

Reduce your risk for heart and vascular disease by making healthy food choices. An important first step is to be aware of your blood cholesterol levels. Blood cholesterol numbers include:

  • Total blood cholesterol: The liver makes all the cholesterol the body needs, but we also eat cholesterol in food. As cholesterol levels rise above 200 mg/dL the risk for heart attack and stroke increases. Total blood cholesterol levels should be less than 200 mg/dL.
  • Low-density lipoprotein (LDL): Also known as "bad" cholesterol, LDL causes the buildup of cholesterol in the arteries. High levels may increase the risk of heart attack and stroke. Desirable levels:
    • Low-risk individuals (0–1 risk factor), <130 mg/dL
    • Moderate-risk individuals (2 or more risk factors), <100 mg/dL
    • High-risk individuals (diabetic or known CAD), <70 mg/dL
  • High-density lipoprotein (HDL): Also known as the "good" cholesterol, HDL carries the cholesterol away from the body cells and tissues to the liver for excretion. Higher levels of HDL are linked with lower risk of heart attack. Desirable levels are greater than 40 mg/dL for men and 50 mg/dL for women.
  • Triglycerides: A type of fat in your body, triglycerides are carried in the blood and are broken down for energy. Sugar, alcohol and saturated fat may increase triglyceride levels. High triglyceride levels may add to your risk of heart attack. Desirable levels are less than 150 mg/dL.

Healthy eating

Healthy eating plans are useful when making improvements to both diet and lifestyle for heart health. TLC and DASH are designed to help you improve your heart health. These plans include:

  • Therapeutic Lifestyle Changes (TLC): The TLC plan can help you lower high blood cholesterol and protect your health. TLC is a plan that is low in saturated fat, trans fat and cholesterol. The TLC eating plan also promotes the addition of plant stanols and sterols as well as soluble fiber to your diet. Incorporate the TLC program into your lifestyle and you'll lower your chances of developing heart disease, future heart attacks and other heart disease complications.
  • Dietary Approaches to Stopping Hypertension (DASH): If you have high blood pressure or pre-hypertension, you may want to incorporate the DASH eating plan. This plan emphasizes fruits, vegetables, fat-free or low-fat milk and milk products, whole grain products, fish, poultry, beans, seeds and nuts.

The DASH eating plan also emphasizes less salt/sodium, sweets, added sugars, sugar-containing beverages, fats and red meats than the typical American diet. This heart healthy way of eating is also lower in saturated fat and cholesterol and is rich in nutrients that are associated with lower blood pressure, which include potassium, magnesium, calcium, protein and fiber.

Healthy eating guidelines

The following guidelines include steps from both the TLC and DASH eating plans. For further specific guidance and/or help in implementing these guidelines, see a registered dietitian.

Foods to increase

Whole-grain, high-fiber foods

  • 50 to 60 percent of your total calories should come from carbohydrates. Most carbohydrates should come from high fiber/whole grains, vegetables, fruits, and fat-free and low-fat dairy products.
  • Aim for carbohydrates that are high in fiber.
  • Adding soluble fiber to your diet may help decrease LDL cholesterol levels.
  • All fiber-containing foods are a combination of both soluble and insoluble fiber. The American Heart Association suggests that you eat foods high in both types of fiber.
  • Eat a variety of whole grain, vegetables and fruits to increase fiber intake.
  • Consider adding a fiber supplement (Metamucil®) if your diet is not adequate.


  • Total fiber goal = 25–30 grams
  • Soluble fiber goal = 5–10 grams (on average accompanied by a 5 percent reduction in LDL cholesterol)

Monounsaturated sources of fat (nuts, olive oil and avocado)

  • Unsaturated fats include both monounsaturated and polyunsaturated fats.
  • Unsaturated fats are usually liquid at room temperature and are only from vegetable sources.
  • Monounsaturated fats and polyunsaturated fats may help to lower your cholesterol when used in place of saturated fats in your diet.
  • Focus on reducing foods high in saturated fats, trans fat and select unsaturated fats instead.
  • Sauté with olive oil instead of butter.
  • Use olive oil instead of vegetable oil in salad dressings and marinades.
  • Use canola oil when baking.
  • Sprinkle slivered nuts or sunflower seeds on salads instead of bacon bits.
  • Snack on a small handful of nuts rather than potato chips or processed crackers.
  • Try peanut butter or other nut-butter spreads (nonhydrogenated) on celery, bananas or rice cakes.
  • Add slices of avocado, rather than cheese, to your sandwich.
  • Prepare fish such as salmon and mackerel, which contain monounsaturated and omega-3 fats, instead of meat one or two times a week.


  • Limit polyunsaturated fat intake up to 10 percent of total calories.
  • Limit monounsaturated fat intake up to 20 percent of total calories.


  • Fish is a great source of protein that is low in saturated fats.
  • Fish intake has been associated with decreased risk of cardiovascular disease.
  • Fish is a primary source of omega-3 fatty acids, which lower triglyceride levels.
  • The highest levels of omega-3 fatty acids are found in cold water fish.


  • Individuals without heart disease: 2 servings (~8 ounces) of oily fish per week
  • Individuals with heart disease: 1 gram of omega-3 fatty acids (EPA DHA) per day from oily fish or supplements (under consultation with physician)
  • Pregnant women or women of childbearing age should avoid fish high in mercury, such as swordfish and albacore tuna.

Foods to limit

Foods high in cholesterol

  • Cholesterol is a waxy substance only found in food from animals.
  • Eating foods high in cholesterol may increase the cholesterol level in the body.
  • Food sources include meat, eggs, yolks, dairy products, organ meats, fish and poultry.


  • Keep cholesterol intake to less than 200 mg per day.


  • Fat is an important source of energy for the body.
  • All dietary fats contain a mixture of saturated fat, monounsaturated fat and polyunsaturated fat and, if eaten in excess, will raise blood cholesterol.

Healthy fats

  • Monounsaturated fat is an unsaturated fat. It lowers total cholesterol and LDL cholesterol levels when substituted for saturated fat without decreasing HDL cholesterol levels and can lower triglycerides if substituted for carbohydrates.
  • Polyunsaturated fat is an unsaturated fat that may lower total cholesterol levels and LDL cholesterol levels when substituted for saturated fat.
  • Omega-3 fats are polyunsaturated fats found in fish oil and certain plant and nut oils.
  • Omega-6 fats are polyunsaturated fats found in seed oils, soft margarines and oils.

Harmful fats

  • Saturated fat raises both total and LDL cholesterol levels and is commonly found in animal products. This type of fat is generally solid or waxy at room temperature and can be found in bacon, butter, cheese and chocolate.
  • Trans fat raises LDL cholesterol and can lower HDL cholesterol. This fat is commonly found in commercial baked goods, fried foods, donuts, shortenings and some margarine.


  • Minimize intake of beverages and foods with added sugars to lower total calorie intake and to promote a nutrient-dense diet.
  • Individuals who consume large amounts of beverages with added sugars tend to consume more calories and gain weight.
  • Evidence suggests that calories consumed as liquid are not as satiating as calories consumed as solid food.


  • Read food ingredient lists to find sugar and hidden sugars such as fructose, high fructose corn syrup, cane juice, honey and molasses. Ingredients are always listed in order of abundance.


  • Moderate alcohol intake has been associated with reduced cardiovascular events.
  • The consumption of alcohol cannot be recommended solely for cardiovascular disease risk reduction.
  • Alcohol can be addictive and high intake can contribute to hypertriglyceridemia, hypertension, liver damage, physical abuse, vehicular and work accidents and increased risk of breast cancer.


  • If alcoholic beverages are consumed, they should be limited to no more than two drinks per day for men and one drink per day for women, and ideally should be consumed with meals.


  • Season foods with spices rather than salt at the table and in cooking.
  • Limit the amount of processed or canned foods eaten.


  • 2300 mg sodium per day for a healthy person
  • 1500 mg sodium per day for people with high blood pressure
  • Note: 1 teaspoon salt = 2300 mg sodium

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