Top Things to Know: 2021 Dietary Guidance to Improve Cardiovascular Health

Published: November 02, 2021

  1. This statement summarizes available evidence, provides contextual guidance for key components of dietary patterns to reduce cardiovascular morbidity and mortality, and discusses population-wide adoption of the dietary guidance.
  2. Dietary patterns cover the balance, variety, and combination of foods and beverages habitually consumed; food-based dietary pattern guidance is designed to achieve nutrient adequacy, support cardiovascular health and general wellbeing, while being flexible to accommodate personal preferences, ethnic and religious practices, and life stages.
  3. Efforts to achieve and sustain healthy dietary and lifestyle behaviors from birth throughout the life course remain a high priority. These efforts aim to reduce adverse cardiometabolic conditions, such as excess body weight, dyslipidemia, elevated blood pressure, and metabolic syndrome.
  4. The statement summarizes the rationale and evidence for ten key features of dietary patterns to promote cardiometabolic health.
  5. The ten features are:
    1. Adjust energy expenditure and maintain body weight;
    2. Choose wide variety of fruits and vegetables;
    3. Chose whole grains and products made up mostly of whole grains;
    4. Include healthy sources of protein (regular fish/seafood intake; low fat or non-fat dairy; lean cuts of meat if needed and avoid processed foods);
    5. Use liquid plant oils;
    6. Choose minimally processed foods;
    7. Minimize intake of added sugars;
    8. Choose or prepare foods with little or no salt;
    9. Limit (avoid preferably) alcohol intake;
    10. Apply this guidance irrespective of where food is prepared or consumed.
  6. The statement discusses additional benefits of heart-healthy dietary patterns which includes a favorable nutrient profile, fulfilling essential nutrient requirements from foods rather than supplements, being inherently rich in fiber and unsaturated fats, and low in saturated fat, trans fat, cholesterol, added sugar, and salt, a reduced risk of other chronic conditions, and a lower environmental impact.
  7. Factors including, targeted food marketing, neighborhood segregation, unhealthy built environments, food insecurity, and structural racism create challenges to adopting a heart healthy dietary pattern.
  8. Additionally, varied access, availability, price, promotion, and placement of products in different environments often make it easier to choose unhealthy vs. healthy foods.
  9. Precision nutrition has future potential to provide personalized diets for cardiovascular disease prevention; though as the field is still developing, it is important to continue focusing on public health nutrition strategies to improve the food environment.
  10. Creating an environment that facilitates, rather than impedes, adherence to heart-healthy dietary patterns among all individuals in an environmentally sustainably way is a public health imperative.


Lichtenstein AH, Appel LJ, Vadiveloo M, Hu FB, Kris-Etherton PM, Rebholz CM, Sacks FM, Thorndike AN, Van Horn L, Wylie-Rosett J; on behalf of the American Heart Association Council on Lifestyle and Cardiometabolic Health; Council on Arteriosclerosis, Thrombosis and Vascular Biology; Council on Cardiovascular Radiology and Intervention; Council on Clinical Cardiology; and Stroke Council. 2021 Dietary guidance to improve cardiovascular health: a scientific statement from the American Heart Association [published online ahead of print November 2, 2021]. Circulation. doi: 10.1161/CIR.0000000000001031