From childhood to adulthood, the AHA’s latest guidance shows how consistent, real-world food choices, not fad diets or quick fixes, can meaningfully reduce heart disease risk over a lifetime.
Study: 2026 Dietary Guidance to Improve Cardiovascular Health: A Scientific Statement From the American Heart Association. Image credit: Chinnapong/Shutterstock.com
A recent American Heart Association scientific statement summarized the current evidence on food-based dietary patterns and provided practical, context-specific guidance to reduce cardiovascular disease risk and improve overall cardiovascular health outcomes.
Heart-Healthy Diets: Why Starting Early Matters
American Heart Association (AHA) dietary guidance centers on overall dietary patterns rather than isolated foods or nutrients. Heart-healthy patterns include a diet rich in vegetables, fruits, whole grains, lean proteins, and nontropical plant oils, and low in added sugars, saturated fat, and sodium. Overall, diets high in plant-based foods and low in animal products are associated with reduced coronary heart disease risk and more favorable coronary heart disease risk factors and metabolic profiles.
Dietary habits are shaped and shared within households and learned early in life, though they can shift during key transitions, such as adolescence and young adulthood. Since cardiovascular disease (CVD) risk begins to accumulate early in life, dietary quality is relevant from the prenatal period onward. Poor dietary patterns in childhood contribute to obesity, metabolic syndrome, hypertension, dyslipidemia, and type 2 diabetes (T2D), and these conditions may progress to adulthood.
Heart-Healthy Eating Applies in Every Food Setting
Consistent mindfulness about dietary choices across all settings is essential for achieving and sustaining a heart-healthy pattern and supports broader policy efforts to improve food environments. Therefore, AHA guidance applies universally, including eating at home, in restaurants, at workplaces, schools, and other institutions.
The current statement highlights key features of a heart-healthy dietary pattern.
Feature 1: Balance Energy Intake and Physical Activity to Maintain a Healthy Weight
Maintaining a healthy body weight is central to cardiovascular health. Obesity affects approximately 21 % of U.S. children and adolescents and 40 % of adults, which increases CVD risks. Energy intake should be calibrated to individual needs, taking into account age, sex, body composition, and activity level.
Physical activity targets include daily movement for young children, at least 60 minutes of moderate-to-vigorous activity for older children and adolescents, and at least 150 min/week for adults, alongside regular muscle-strengthening activity.
Dietary patterns, including Mediterranean-style, pescetarian, and ovo-lacto vegetarian, support cardiovascular health and healthy weight. However, some popular weight-loss diets may offer short-term benefits but have uncertain long-term cardiovascular effects and may worsen cardiovascular risk factors. Individualized guidance that accounts for cultural, socioeconomic, and personal factors is key to promoting lasting adherence.
Feature 2: Daily Intake of a Wide Variety of Vegetables and Fruits
Whole and minimally processed vegetables and fruits are foundational to heart-healthy eating. These foods are consistently associated with improved blood lipids, blood pressure, and glycemic control. Whole forms are preferred over juice for their fiber content. Fresh, frozen, and canned varieties are all beneficial, ideally without added sugars or sodium.
Feature 3: Whole Grains Over Refined Grains
Whole grains, such as whole wheat, oats, brown rice, quinoa, barley, and rye, retain all three kernel components (endosperm, germ, and bran), providing fiber, vitamins, minerals, and bioactive compounds. Regular whole-grain consumption is associated with lower risks of CVD, stroke, T2D, and metabolic syndrome, as well as improved blood pressure, lipid levels, and glycemic control. Replacing refined grains with whole grains also supports gut microbiota health and reduces inflammatory markers.
Feature 4: Heart-Healthy Sources of Protein
Protein quality matters more than quantity for cardiovascular health. Recommendations focus on protein sources with favorable fatty acid profiles and fiber content, organized into the following subgroups.
- Plant sources: Legumes and nuts are protein-rich, high in unsaturated fat and fiber, and linked to lower CVD and all-cause mortality risk. Plant-based meat alternatives can diversify intake but are often ultraprocessed and may contain added sugars, sodium, and preservatives, which require cautious use.
- Fish and seafood: Non-fried fish and seafood are associated with lower CVD event and myocardial infarction risk, largely due to their omega-3 fatty acid content and displacement of saturated fat-heavy protein sources. Fish oil supplementation alone has not been shown to reduce CVD risk in healthy adults and may increase atrial fibrillation risk in some individuals.
- Dairy: Low-fat and nondairy unsaturated fat sources are preferred over full-fat dairy for cardiovascular health, although the evidence comparing low-fat and full-fat dairy remains debated and context-dependent. Fermented dairy may offer added benefits through gut microbiota modulation, though evidence remains limited.
- Red and processed meat: Replacing red or processed meat with plant proteins, poultry, dairy, or eggs lowers coronary heart disease risk, with effects depending on the replacement food and with stronger adverse associations observed for processed meats than unprocessed red meat. When red meat is consumed, lean unprocessed cuts in limited portions are preferred, and processed meats should be minimized.
Feature 5: Replace Saturated Fats With Unsaturated Fat Sources
Replacing saturated fat with polyunsaturated fat reduces LDL cholesterol and lowers the risk of coronary heart disease. Nontropical plant oils (e.g., soybean, canola, olive) are preferred over animal fats and tropical oils (e.g., coconut, palm) in food preparation.
Feature 6: Minimize Ultraprocessed Food Consumption
While food processing can improve safety, shelf life, and nutrient fortification, ultraprocessed foods are often high in sodium, added sugars, and additives while lacking fiber and key nutrients. Global intake is high and rising, with strong evidence linking ultraprocessed diets to obesity, CVD, T2D, and all-cause mortality. However, definitions and classification systems for ultraprocessed foods vary, and not all products are nutritionally equivalent. Minimally processed alternatives should be prioritized across all food environments.
Feature 7: Limit Added Sugars
Added sugars, often found in processed foods, sugar-sweetened beverages, syrups, and concentrates, are strongly linked to obesity, T2D, coronary heart disease, and cardiovascular mortality. Adults consuming more than 25 % of energy from added sugars face a nearly 3-fold higher CVD mortality risk compared to those consuming less than 10 %, independent of adiposity. Minimizing added sugar intake is recommended across all life stages.
Feature 8: Reduce Sodium Intake
Sodium and potassium have opposing effects on blood pressure. These are the leading modifiable risk factors for preventable mortality. Sodium reduction lowers blood pressure in both hypertensive and normotensive individuals, with the greatest effect in Black individuals, older adults, and those with hypertension or diabetes. Increasing potassium intake through vegetables and fruits also lowers blood pressure and is associated with reduced CVD risk.
A combined approach of reducing sodium and increasing potassium is recommended; however, potassium-enriched salt substitutes should be used cautiously in those at risk for hyperkalemia and may be less impactful where most sodium intake comes from commercially prepared foods.
Feature 9: Avoid Alcohol or Strictly Limit Intake
Although earlier observational data suggested a protective effect of low-to-moderate alcohol intake on coronary heart disease, Mendelian randomization studies have not confirmed this association.
Alcohol’s relationship with blood pressure is linear from the lowest intake levels, with no safe threshold for hypertension risk. The 2025 AHA/ACC guideline recommends avoiding alcohol to prevent or treat hypertension, and both the World Health Organization (WHO) and the U.S. Department of Health and Human Services (HHS) recommend avoiding alcohol to reduce the risk of certain cancers rather than suggesting a protective benefit.
Binge and heavy drinking should be strongly discouraged, and if alcohol is not consumed, it should not be initiated for cardiovascular benefit; if it is consumed, intake should be limited.
Conclusions
The updated AHA guideline identifies nine features of a heart-healthy dietary pattern: balancing energy intake and activity; eating varied vegetables and fruits daily; favoring whole over refined grains; choosing heart-healthy protein sources; replacing saturated with unsaturated fats; minimizing ultraprocessed foods; limiting added sugars; reducing sodium; and avoiding or strictly limiting alcohol.
These patterns are nutrient-dense, support fiber intake, generally limit foods high in cholesterol while recognizing that dietary cholesterol is not a primary target for most individuals, keep saturated fat below 10 % of total energy, and align with dietary guidance for T2D, certain cancers, kidney disease, and cognitive health.
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