This review aims at summarizing updated evidence on cardiovascular disease (CVD) risk associated with consumption of specific food items to substantiate dietary strategies for atherosclerosis prevention. A systematic search on PubMed was performed to identify meta-analyses of cohort studies and RCTs with CVD outcomes. The evidence is highly concordant in showing that, for the healthy adult population, low consumption of salt and foods of animal origin, and increased intake of plant-based foods—whole grains, fruits, vegetables, legumes, and nuts—are linked with reduced atherosclerosis risk. The same applies for the replacement of butter and other animal/tropical fats with olive oil and other unsaturated-fat-rich oil. Although the literature reviewed overall endorses scientific society dietary recommendations, some relevant novelties emerge. With regard to meat, new evidence differentiates processed and red meat—both associated with increased CVD risk—from poultry, showing a neutral relationship with CVD for moderate intakes. Moreover, the preferential use of low-fat dairies in the healthy population is not supported by recent data, since both full-fat and low-fat dairies, in moderate amounts and in the context of a balanced diet, are not associated with increased CVD risk; furthermore, small quantities of cheese and regular yogurt consumption are even linked with a protective effect. Among other animal protein sources, moderate fish consumption is also supported by the latest evidence, although there might be sustainability concerns. New data endorse the replacement of most high glycemic index (GI) foods with both whole grain and low GI cereal foods. As for beverages, low consumption not only of alcohol, but also of coffee and tea is associated with a reduced atherosclerosis risk while soft drinks show a direct relationship with CVD risk. This review provides evidence-based support for promoting appropriate food choices for atherosclerosis prevention in the general population.

This study evaluates the relation of a Mediterranean dietary pattern and its individual components with the cardiovascular risk factors profile, plasma glucose and body mass index (BMI) in people with type 2 diabetes. We studied 2568 participants at 57 diabetes clinics. Diet was assessed with the EPIC (European Prospective Investigation into Cancer and Nutrition) questionnaire, adherence to the Mediterranean diet was evaluated with the relative Mediterranean diet score (rMED). A high compared to a low score was associated with a better quality of diet and a greater adherence to the nutritional recommendations for diabetes. However, even in the group achieving a high score, only a small proportion of participants met the recommendations for fiber and saturated fat (respectively 17% and 30%). Nonetheless, a high score was associated with lower values of plasma lipids, blood pressure, glycated hemoglobin, and BMI. The relationship of the single food items components of the rMED score with the achievement of treatment targets for plasma lipids, blood pressure, glucose, and BMI were also explored. The study findings support the Mediterranean dietary model as a suitable model for type 2 diabetes and the concept that the beneficial health effects of the Mediterranean diet lie primarily in its synergy among various nutrients and foods rather than on any individual component.

Diabetes mellitus is widely recognized as a strong independent risk factor for coronary heart disease (CHD). Several epidemiologic studies have confirmed that men with diabetes are 2 to 3 times more likely to die from CHD than those without diabetes and that the risk is even higher in women.^1-5 Prior myocardial infarction (MI) is also a strong risk factor for coronary and cardiovascular disease (CVD) mortality.⁶ Expert groups have recommended that CHD-CVD prevention in all patients with diabetes include measures as vigorous as those for people with a prior MI,^7-9 implying that the 2 conditions have a similar impact on risk. However, whether the excess cardiovascular risk conferred by diabetes rivals that of a previous MI has been explored only to a limited extent^10-14 and with apparently inconsistent results. One investigation reported that diabetes and previous CHD were equally strong predictors of both CHD and all-cause mortality,¹⁰ but this conclusion has been challenged by results of later studies.^12-14 The modulating roles of age, major cardiovascular risk factors, and duration of follow-up have been incompletely explored and may partly explain discrepancies. Furthermore, there is evidence that risk of noncardiovascular mortality is also increased in people with diabetes,^15-17 but limited information exists on the comparative associations of MI and diabetes with noncardiovascular mortality. Clarifying these issues might provide evidence for enhanced risk stratification and preventive strategies.