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 sources such as butter.

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.

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


Nuts are another plant-based food option with low SFA and healthy unsaturated fat levels17. Most common nuts in the diet are almonds, walnuts, peanuts, hazelnuts, pistachios and chestnuts. Nuts should be included as part of a daily healthy diet17. In fact, they are also high in Omega-3 (e.g. ALA). Next to their optimal lipid profile, nuts also contain non-fat components like plant sterols, dietary fibres, along with particular amino acids, that 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 30 g) of nuts was shown in the PREDIMED trial15.

Increase nut consumption (preferably unsalted) for a healthy heart: a small 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, 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 properties, and, for this reason, they play a role in preventing plaque development and also contribute to the atherosclerotic plaque stabilization20.

Fish oil and marine omega-3 are also beneficial for heart health. Although fish oil does not have an effect on blood TC and LDL-cholesterol levels, at high doses (>3 g/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 molluscs and shellfish, as they also provide a significant source of cholesterol.

Test your knowledge
When moving towards a healthy dietary pattern which foods should be included more often in the daily diet? (More than one answer may be correct)
  1. Nuts
  2. Vegetable oils and vegetable oil-based margarines
  3. Fish, esp. oily fish
  4. Full fat dairy foods
Check your answer