Healthy Diet Traits per 2021 ESC Guidelines Linked to Lower Cardiovascular Events in CVD Patients

Overview

In patients with established cardiovascular disease (CVD), adherence to the 2021 ESC Healthy Diet Characteristics was generally low, with a median compliance of 4 out of 11 recommended traits. Higher compliance was associated with a significantly reduced risk of non-fatal vascular events, including stroke and myocardial infarction.

Background

The 2021 European Society of Cardiology (ESC) guidelines emphasize a healthy diet as a key component of cardiovascular disease prevention. These guidelines specify 12 dietary characteristics focused on plant-based foods, fiber, nuts, fish, and limits on saturated fat, red meat, salt, alcohol, and sugar-sweetened beverages. While prior studies have linked healthy diets to lower CVD risk in the general population, data on patients with established CVD remain limited. This study evaluates dietary adherence and its association with cardiovascular outcomes in this high-risk group.

Data Highlights

Key Findings

• Patients with established CVD reported adherence to a median of 4 out of 11 Healthy Diet Characteristics recommended by the 2021 ESC guidelines.
• Only 10–20% of patients met key recommendations for vegetable intake, plant-based diet, and saturated fat limits.
• 58% of patients consumed at least 100 grams of fish per week, aligning with guideline recommendations.
• Higher compliance with Healthy Diet Characteristics was associated with an 11% lower risk of non-fatal vascular events per additional characteristic met.
• The study supports the relevance of the 2021 ESC dietary recommendations specifically in patients with established CVD.

Clinical Implications

Clinicians should emphasize improving dietary adherence in patients with established CVD, focusing on increasing intake of fiber-rich, plant-based foods such as vegetables and nuts, while reducing saturated fat consumption. Even incremental improvements in compliance with the ESC Healthy Diet Characteristics can significantly reduce the risk of recurrent cardiovascular events. Dietary counseling should be integrated into secondary prevention strategies.

Conclusion

Adherence to the 2021 ESC Healthy Diet Characteristics among patients with established CVD is suboptimal but associated with meaningful reductions in cardiovascular event risk. Targeted efforts to improve diet quality in this population are warranted to enhance secondary prevention outcomes.

References

1. ESC Guidelines 2021 -- Cardiovascular Disease Prevention in Clinical Practice
2. UCC-SMART Cohort Study -- Dietary Assessment and Cardiovascular Outcomes