Relationship of the healthy diet characteristics recommended by the 2021 ESC guidelines with vascular events in patients with established CVD

Category	Detail
Condition	Established cardiovascular disease (CVD)
Key Mechanisms	Dietary adherence to Healthy Diet Characteristics reduces risk of non-fatal vascular events (stroke and myocardial infarction)
Target Population	Patients with established cardiovascular disease
Care Setting	Cardiology, cardiothoracic or vascular surgery, neurology, internal medicine outpatient and clinical care

Patients with established CVD reported adherence to a median of 4 out of 11 Healthy Diet Characteristics recommended by 2021 ESC guidelines.
Higher compliance with Healthy Diet Characteristics was associated with a lower risk of non-fatal stroke and myocardial infarction (HR 0.89 per additional characteristic).
Only 10–20% of patients met recommendations for vegetable intake, plant-based diet, and saturated fat intake.

Assess dietary intake using food frequency questionnaires focusing on 12 Healthy Diet Characteristics.

Encourage adherence to Healthy Diet Characteristics including increased intake of fiber-rich, plant-based foods (vegetables, fruits, nuts).
Limit saturated fat intake to less than 10 energy percent.
Consume fish once to twice a week (≥100 g/week).
Limit alcohol intake to a maximum of 100 g/week.
Limit red meat intake to 350–500 g/week.
Minimize trans-fat intake as far as possible.
Limit salt intake to less than 5 grams per day.
Discourage sugar-sweetened beverage intake.

Regularly evaluate dietary adherence and cardiovascular risk factors in patients with established CVD.

Low adherence to Healthy Diet Characteristics is associated with increased risk of non-fatal vascular events.
High intake of saturated fats and low intake of vegetables and plant-based foods increase cardiovascular risk.

2553 patients with established cardiovascular disease from the UCC-SMART cohort

Median adherence to 4 out of 11 Healthy Diet Characteristics; higher adherence correlates with reduced risk of stroke and myocardial infarction.

Promote dietary counseling focusing on increasing fiber-rich, plant-based foods such as vegetables and nuts.
Advise patients to reduce saturated fat intake below 10% of energy intake.
Encourage regular fish consumption (at least 100 g/week).
Monitor and support gradual improvement in dietary adherence to reduce recurrent cardiovascular events.

Clinical Scorecard: Association of Recommended Healthy Dietary Traits from the 2021 ESC Guidelines with Cardiovascular Events in Individuals with Established CVD