Heart health and nutrition: What does a heart healthy diet look like?

February is National Heart Month in the UK, a campaign from the British Heart Foundation to raise awareness of heart conditions and promote healthy living. We all know how important a sensible diet and exercise is in supporting our heart health, so in this week’s blog, our Nutritional Therapist Annie will be taking a closer look at certain vitamins, minerals, and nutrients that may play an important role in supporting your overall cardiovascular health.

---

A healthy diet and exercise routine is key in supporting our heart and overall health. Cardiovascular disease is a major global health challenge with many people facing hypertension, stroke, and coronary artery disease. The underlying pathologies of these conditions are thought to be routed in inflammation, oxidative stress, dyslipidaemia, and endothelial dysfunction, all of which can be impacted to some extent by diet and lifestyle

What does a heart healthy diet look like?

A diet rich in an abundance of colourful and whole plant foods boasts an array of antioxidant and anti-inflammatory nutrients that can have a beneficial impact on metabolic and cardiovascular health. Research has consistently found an association between good quality healthful diets, with higher intakes of fruits and vegetables, and a lower risk of cardiovascular diseases (CVD), including stroke and coronary heart disease.¹

This way of eating also usually means higher levels of soluble fibre. Soluble fibre is a complex carbohydrate found in plants that have been found to help support blood sugar levels, improve bowel regularity, and, through its ability to create a gel-like substance, bind to cholesterol in the small intestine and support its excretion out of the body.

Nutrients such as selenium, zinc, vitamins C and E, and beta carotene have specifically been found throughout the research to be associated with lower incidences of CVD mortality, even in those who were identified as having a greater risk of chronic diseases.²

Next up we will take a look at some specific well-known nutrients that have been identified in the research to support heart health.

Vitamins, minerals and nutrients that support heart health

Omega-3 fatty acids

Omega-3 is widely studied for its protective role in cardiovascular health. There are two major essential fatty acids, omega-3 and omega-6, which cannot be made in the body and therefore must be obtained from food. The modern Western diet has been consistently found to consist of inadequate levels of omega-3, due to low intakes of oily fish (sardines, mackerel), and other plant omega-3 sources, such as flax, hemp, and chia seeds.

This, paired with higher levels of omega-6-rich foods, which include processed foods can lead to an imbalanced omega-3:omega-6 ratio. It is worth noting that healthy foods such as nuts and seeds also contain omega-6, as previously mentioned, we do need omega-6, we just need to be getting it from these healthy sources, rather than refined and processed foods! Studies point out that until the 1850s a 1:1 ratio between the two types of fatty acid was normal in the human diet, however, this has shifted to around 1:20 (omega-3: omega-6 ratio) in Western society today.

There are two long-chain omega-3 polyunsaturated fats: ‘EPA’ (eicosapentaenoic acid) and ‘DHA’ (docosahexaenoic acid), which are linked to numerous health benefits, including improving cardiovascular health, supporting healthy cholesterol levels, and reducing inflammation.³

Research has found that omega-3 may help reduce triglyceride levels and improve overall cholesterol levels, support healthy blood pressure, and improve endothelial function.⁴

Much of the research has found an inverse correlation between higher omega-3 intakes and the reduction of inflammatory markers and cardiovascular disease risk. One meta-analysis exploring the positive effects of omega-3 supplementation found an overall clinical trend toward significant improvements in several key cardiovascular markers. The findings revealed an overall reduction in triglycerides, total cholesterol, and blood pressure alongside improvements in HDL cholesterol. Levels of inflammation, measured by C-reactive protein and IL-1, were also improved.⁴

The DO-HEALTH trial, consisting of 2,157 healthy and active adults aged 70 years and older revealed that omega-3 supplementation positively contributed to a reduction in triglyceride levels alongside an increase in HDL levels. They also identified small but significant decreases in LDL, non-HDL levels, and total cholesterol over three years.⁵

The NHS currently recommends eating at least two portions of fish a week, including 1 of oily fish, but is this enough in the current Western diet?

What about the concern many have about the contamination of fish with heavy metals, PCBs, and other ocean pollutants?

How to add oily fish into your diet whilst avoiding heavy metal and ocean pollutants

It is best to choose smaller fish such as wild salmon and sardines and avoid larger fish such as fresh tuna and swordfish, alongside incorporating plant forms of omega-3 including walnuts, hempseeds, chia seeds, and flaxseeds, which offer omega-3 in the form of a-linolenic acid (ALA).

These forms of omega-3 have also been found in the research to reduce the risk of cardiovascular disease and coronary heart disease alongside showing marked improvements in total cholesterol, LDL, triglycerides, and blood pressure. ⁶ However, conversion of ALA to EPA and DHA may be lower in some people, so supplementation with an algae oil source is often preferred.

Co-enzyme Q10 and heart health

Mitochondrial dysfunction, oxidative stress, and inflammation have all been highlighted as major contributors to the pathogenesis and progression of cardiovascular disease.

Co-enzyme Q10 (CoQ10) is a fat-soluble cofactor required by every cell in the body. It is essential for the production of adenosine triphosphate (ATP) in the mitochondria, which supply energy to all the muscles in the body, including the heart. It is also a potent antioxidant, helps to combat free radical damage, and can reduce the total synthesis and oxidation of LDL cholesterol. Oxidised cholesterol can build up in the artery walls and potentially lead to atherosclerosis increasing heart attack and stroke risk. Alongside this, CoQ10 has vasodilating properties via its effect on the endothelium and vascular smooth muscle and therefore may support healthy blood pressure.⁷

Both clinical studies and meta-analyses have demonstrated CoQ10’s therapeutic efficacy in reducing adverse cardiovascular events. One study of patients with myocardial infarction, who had low levels of COQ10 at baseline, found improved recovery after supplementation compared to controls.⁸ They summarised that:

“Coenzyme Q10 treatment can effectively promote the recovery of cardiac function after myocardial infarction and prevent its progression to heart failure, partially through inhibiting NLRP3/IL1β pathway-mediated inflammation in macrophages.” ⁸

The 2-year Q-SYMBIO randomised control trial study demonstrated that CoQ10, alongside conventional treatment, contributed to improved patient symptoms, with a reduction in subsequent major adverse cardiovascular events and mortality, both by 42%.⁹ Other supporting research found the clinical benefit of CoQ10 in the recovery of cardiac function after myocardial infarction.⁹

The production of COQ10 is largely endogenous and declines with age. Levels can be further impacted by medications that reduce its production, such as cholesterol-reducing statin medications and so may be an important consideration in practice.⁸

Vitamins and minerals to support heart health

The B vitamins and their link with homocysteine levels

It is known that elevated homocysteine is linked to poorer cardiovascular outcomes. One potential cause of elevated homocysteine in the body is a lack of sufficient nutrients including B12, B6, and folate which support the methylation cycle to keep homocysteine levels in check.

Research has found that B vitamins can support homocysteine metabolism which subsequently reduces the risk of adverse cardiovascular events, as well as supporting the management of conditions such as hypertension.^{10, 11}

Antioxidant vitamins, such as vitamins C and E

Antioxidant vitamins contribute to cardiovascular health by protecting the body from oxidative stress. It has been discussed that deficiencies in antioxidant nutrients such as vitamin C can increase cardiovascular disease risk by increasing the oxidation of low-density lipoproteins.

Vitamin C, overall, has been proposed to support endothelial function and lipid profiles and protect against oxidative stress.

Other research has found an association between vitamin E supplementation and a reduction in blood pressure and endothelial dysfunction, most likely due to its powerful antioxidant and anti-inflammatory effects and reported ability to inhibit platelet aggregation and the adhesion of molecules to the artery walls.¹¹

Vitamin D

Deficiency in vitamin D is a key nutritional problem that has serious consequences for overall health due to its multiple anti-inflammatory and immune-modulating properties.

It is well known that vitamin D receptors are present in the endothelial cells, cardiomyocytes, and vascular smooth muscle. Research has found that vitamin D supplementation can help reduce coronary disease progression as well as inhibit the renin-angiotensin system and parathyroid hormone secretion, it therefore may play a role in blood pressure regulation.¹¹

Deficiency of vitamin D has been speculated to play a role in the pathogenesis of CVD. Low levels have been correlated with inflammation, autoimmunity, diabetes, dyslipidaemia, metabolic syndrome, the proliferation of smooth muscle cells, and endothelial dysfunction, all of which interact with cardiovascular health in some way.¹¹

Vitamin K2

Vitamin K2 is a fat-soluble vitamin most commonly associated with blood clotting and bone health. However, its role in cardiovascular health is highlighted in the research for its benefits in reducing age-related atrial stiffness and improving vascular elasticity.¹²

A protein called Matrix Gla (MGP) plays a key role in inhibiting soft tissue calcification, by binding calcium to reduce its crystallizing in the artery cell walls. MGLA needs to be activated by carboxylation with vitamin K, therefore adequate levels of this nutrient are required to reduce vascular calcification, which is a hallmark of atherosclerosis.^12,13

One study of 53,000 Danish adults found that those with higher intakes of vitamin K1 and K2 from foods were 21% less likely to experience adverse cardiovascular events.

Authors noted that the potential mechanisms behind the beneficial effects of vitamin K may be due to reduced levels of inflammation, regulation of insulin, and the prevention of arterial stiffness due to calcification.¹⁴

Magnesium

Magnesium is an essential mineral that serves as a cofactor for a huge variety of enzymatic reactions in the body. Low levels have been found to have been associated with cardiovascular disease, metabolic syndrome, and type 2 diabetes.

Studies have suggested that a higher magnesium intake can exert beneficial effects on cardiovascular risk factors by having antihypertensive actions and supporting vasodilation, glucose and lipid metabolism, and overall lipid profiles.

Magnesium plays a specific role in endothelial function and supports the modulation of smooth muscle tone, as well as positively affecting lipid parameters. Studies found a reduction in LDL cholesterol and triglyceride levels alongside an increase in HDL cholesterol.^15,16

Summary

Overall, as you can see, nutrition plays a huge role in keeping your heart and entire cardiovascular system healthy. Our diets can have a profound effect on inflammation, blood pressure, triglyceride, and cholesterol levels to name a few, and so incorporating a variety of nutrients including omega-3, B vitamins, vitamin D, and magnesium among others, can help you take proactive steps towards a healthy cardiovascular system!

---

References

1. Zurbau A, Au‐Yeung F, Blanco Mejia S, et al. Relation of Different Fruit and Vegetable Sources With Incident Cardiovascular Outcomes: A Systematic Review and Meta‐Analysis of Prospective Cohort Studies. Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease. 2020;9(19):e017728. doi:https://doi.org/10.1161/JAHA.120.017728

2. Jenkins DJA, Kitts D, Giovannucci EL, et al. Selenium, antioxidants, cardiovascular disease, and all-cause mortality: a systematic review and meta-analysis of randomized controlled trials. The American Journal of Clinical Nutrition. 2020;112(6):1642-1652. doi:https://doi.org/10.1093/ajcn/nqaa245

3. Wang T, Zhang X, Zhou N, et al. Association Between Omega‐3 Fatty Acid Intake and Dyslipidemia: A Continuous Dose–Response Meta‐Analysis of Randomized Controlled Trials. Journal of the American Heart Association. 2023;12(11). doi:https://doi.org/10.1161/jaha.123.029512

4. Wang Y, Wang Y, Shehzad Q, et al. Does omega-3 PUFAs supplementation improve metabolic syndrome and related cardiovascular diseases? A systematic review and meta-analysis of randomized controlled trials. Crit Rev Food Sci Nutr. 2024;64(26):9455-9482. doi:10.1080/10408398.2023.2212817

5. Gaengler S, Sadlon A, De Godoi Rezende Costa Molino C, et al. Effects of vitamin D, omega-3 and a simple strength exercise programme in cardiovascular disease prevention: The DO-HEALTH randomized controlled trial. The Journal of nutrition, health and aging. 2024;28(2):100037. doi:https://doi.org/10.1016/j.jnha.2024.100037
6. ‌Sala-Vila A, Fleming J, Kris-Etherton P, Ros E. Impact of α-Linolenic Acid, the Vegetable ω-3 Fatty Acid, on Cardiovascular Disease and Cognition. Adv Nutr. 2022;13(5):1584-1602. doi:10.1093/advances/nmac016

7. Coenzyme Q10 and cardiovascular disease: an overview – The British Journal of Cardiology. bjcardio.co.uk. https://bjcardio.co.uk/2015/10/coenzyme-q10-and-cardiovascular-disease-an-overview/
8. Pan W, Zhou G, Hu M, et al. Coenzyme Q10 mitigates macrophage mediated inflammation in heart following myocardial infarction via the NLRP3/IL1β pathway [published correction appears in BMC Cardiovasc Disord. 2024 Oct 5;24(1):537. doi: 10.1186/s12872-024-04195-1]. BMC Cardiovasc Disord. 2024;24(1):76. Published 2024 Jan 28. doi:10.1186/s12872-024-03729-x

10. Mortensen AL, Rosenfeldt F, Filipiak KJ. Effect of coenzyme Q10 in Europeans with chronic heart failure: A sub-group analysis of the Q-SYMBIO randomized double-blind trial. Cardiol J. 2019;26(2):147-156. doi:10.5603/CJ.a2019.0022
11. Yuan S, Mason AM, Carter P, Burgess S, Larsson SC. Homocysteine, B vitamins, and cardiovascular disease: a Mendelian randomization study. BMC Medicine. 2021;19(1). doi:https://doi.org/10.1186/s12916-021-01977-8
12. ‌Shah AK, Dhalla NS. Effectiveness of Some Vitamins in the Prevention of Cardiovascular Disease: A Narrative Review. Front Physiol. 2021;12:729255. Published 2021 Oct 8. doi:10.3389/fphys.2021.729255
13. Maresz K. Growing Evidence of a Proven Mechanism Shows Vitamin K2 Can Impact Health Conditions Beyond Bone and Cardiovascular. Integr Med (Encinitas). 2021;20(4):34-38.
14. Shioi A, Morioka T, Shoji T, Emoto M. The Inhibitory Roles of Vitamin K in Progression of Vascular Calcification. Nutrients. 2020;12(2):583. Published 2020 Feb 23. doi:10.3390/nu12020583
15. Bellinge JW, Dalgaard F, Murray K, et al. Vitamin K Intake and Atherosclerotic Cardiovascular Disease in the Danish Diet Cancer and Health Study. Journal of the American Heart Association. 2021;10(16). doi:https://doi.org/10.1161/jaha.120.020551
16. Rosique-Esteban N, Guasch-Ferré M, Hernández-Alonso P, Salas-Salvadó J. Dietary Magnesium and Cardiovascular Disease: A Review with Emphasis in Epidemiological Studies. Nutrients. 2018;10(2):168. Published 2018 Feb 1. doi:10.3390/nu10020168
17. DiNicolantonio JJ, Liu J, O’Keefe JH. Magnesium for the prevention and treatment of cardiovascular disease. Open Heart. 2018;5(2):e000775. Published 2018 Jul 1. doi:10.1136/openhrt-2018-000775

---

RELEVANT LINKS:
The British Heart Foundation

---

All of our blogs are written by our team of expert Nutritional Therapists. If you have questions regarding the topics that have been raised, or any other health matters, please do contact them using the details below:

nutrition@cytoplan.co.uk
01684 310099

Find out what makes Cytoplan different

Last updated on 5th February 2025 by cytoffice